A QUARTERLY PUBLICATION OF THE POTTER-RANDALL COUNTY MEDICAL SOCIETY FALL 2013 | VOL 23 | NO. 4
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4 PANHANDLE HEALTH FALL 2013 FALL 2013 | VOL 23 | NO. 4
CONTENTS This Volume Features Pioneer Doctors of the Panhandle
6 Editor’s Message 26 “Dr. Jack” Fox and “Dr. Mike” Henderson: by E.F. Luckstead, M.D. Spanning 50 Years of Medicine in Childress by Amy Kindle and John Henderson 7 Executive Director’s Message by Cindy Barnard 29 John Prendergast, DO: Panhandle’s “Dr. Jack” by Steve Urban, M.D. 8 Guest Editorial: Early Medical History of the Texas Panhandle 32 Forty Years of Family Practice in Canyon: by Steve Urban, M.D. Dr. George Dudley Moore by Gary R. Moore 11 Pampa’s Dr. Raymond Hampton by Moss Hampton, M.D. 35 Case Corner by Roger Smalligan, M.D., 14 Borger’s Dr. Joe Knowles Mohammed Al-Janabi, M.D., and Steve Urban, M.D. by Steve Urban, M.D. 37 Pharmacy Corner: Panhandle Drug Store: 18 Dr. Snyder and Dr. Rush: Canadian Pioneers Over 60 years of Continuity by Nona Dale Snyder Fulton, M.D. (Retired) by Mark Land, PharmD and Callie Land, BSN
38 Health News 20 “Doctor Roy”: Perryton’s Roy Sanford by Scott Sanford, M.D., Steve Sanford, M.D., by Tarek Naguib, M.D., M.B.A., F.A.C.P. Sally Sanford and Steve Urban, M.D. 39 Patient Education: The Flu by Tarek Naguib, M.D., M.B.A., F.A.C.P.
POTTER-RANDALL COUNTY PANHANDLE HEALTH MEDICAL SOCIETY EDITORIAL BOARD Executive Committee Sam Cunningham, M.D., President Jay Reid, M.D., President-Elect Gene Luckstead, M.D., Editor Tarek Naguib, M.D., MBA, FACP, Secretary/Treasurer Jaime Zusman, M.D., Assistant Editor TMA Delegates: Robert Gerald, M.D. Walter Bridges, M.D. Rouzbeh Kordestani, M.D. Brian Eades, M.D. Paul Tullar, M.D. Brian Schneider, M.D. Ryan Rush, M.D. Rakhshanda Rahman, M.D. Tarek Naguib, M.D. Rodney Young, M.D. Gene Luckstead, M.D. Rouzbeh Kordestani, M.D. Copy Editor: Steve Urban, M.D.
On The Cover: “Prize of the Hunt” by R. Kim Poarch
PANHANDLE HEALTH is published quarterly by the Potter-Randall County Medical Society, (806) 355-6854. Subscription price is $12.00 per year. POSTMAN: Send address changes to PANHANDLE HEALTH, 1721 Hagy, Amarillo, Texas 79106. ISSN 2162-7142 Views expressed in this publication are those of the author and do not necessarily reflect opinions of the Potter-Randall County Medical Society. Reproduction of any contents without prior written approval of the publisher is strictly prohibited. Publication of advertisement in PANHANDLE HEALTH does not constitute endorsement or approval by the Potter-Randall County Medical Society or its members. PANHANDLE HEALTH reserves the right to reject any advertisement. PHOTOCOMPOSITION AND PRINTING BY CENVEO. FALL 2013 PANHANDLE HEALTH 5 Editor’s Message
by E.F. Luckstead, M.D.
am pleased to invite you to read shares his own family members’ and nities and towns. The article about Ithe fall edition of Panhandle Health relatives’ recall and historical reflec- young Childress physician(s) pro- with Dr. Steve Urban serving as tion of their family medical care. vides an excellent example of how the guest editor. The lead article by Young, older and retired physicians one medical legacy from the physi- Dr. Urban provides a colorful collec- generously shared past medical and cian community influenced their tion of western lore and collective personal histories with Dr. Urban. eventual return home to practice. I thought from the early towns and Family members, old friends and hope that all our Panhandle Health regional culture of physicians and associates also have provided their readers will enjoy their opportunity the people in the Texas Panhandle. information for this history of the to relive these Texas Panhandle Historical anecdotes, in our guest Texas Panhandle. medical legacies! editor’s witty prose, provide us a medical legacy of iconic physicians The communities of Borger, and individual communities in the Canadian, Canyon, Childress, Our Next Issue Of early Texas Panhandle! Pampa, Panhandle and Perryton are highlighted regarding their earlier The history of early medical care, years of medical care. Dr. Urban has Panhandle Health with its crisis and challenges, is pro- demonstrated excellent stewardship Features: vided by family members, associates as the guest editor with his historic and colleagues from communities collection of physician icons, empha- surrounding Amarillo in the Texas sizing their role in the medical care Surgery Panhandle. Dr. Urban’s lead article in these Texas Panhandle commu-
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Be a part of the circle. In 2006, Potter Randall County Medical Society introduced the Circle of Friends, a program designed with the business of medicine in mind. Members of the Circle of Friends are companies that pay an annual fee to participate in Medical Society events. Their financial commitment allows PRCMS to provide quality programs throughout the year, such as the Annual Meeting, Doctors Day, Resident Reception, Family Fall Festival, Retired Physicians Lunch and Women in Medicine. In return, these companies are invited to
A s attend these events and discuss with the physicians the benefits that their companies offer a physicians practice. m a x We are grateful for the support of these organizations and anticipate another great year of serving the needs of our members. The ar e illo s T purpose for Circle of Friends is to provide a valuable base of resources to assist the physician in the business of medicine so their practice of medicine can improve. This program has proven to be a valuable resource of services such as liability insurance, accounting, banking and much more. This year, we hope to expand the Circle to include services the physician may use in his or her personal life. Through this program, we can invite businesses serving physicians to support the Society and increase their visibility among its members. Corporate support contributes to the Society’s ability to advocate and care for physicians and patients in Potter and Randall Counties. The Medical Society thanks all of its supporters as it offers new opportunities to its membership.If your business is interested in being a part of our Circle of Friends, please contact Cindy Barnard at 355-6854 or e-mail [email protected]
6 PANHANDLE HEALTH FALL 2013 Executive Director’s Message
by Cindy Barnard
n 2012, we published an on the time-honored “Four A’s of attend can earn CME hours. Watch Iextremely popular edition of Medical Practice”: available, afford- your mail for the invitation. Panhandle Health entitled “Pioneer able, affable, and able! Today, 21 of Doctors of the Panhandle”. That Texas’ 254 counties have no doctor The cover of our magazine is issue focused on Amarillo special- at all, so rural doctors are still tre- by R. Kim Poarch, entitled “Prize ists. In our current issue, our Guest mendously important. People living of the Hunt”. Kim entered the Editor, Dr. Steve Urban, has chosen in remote areas of West Texas can picture framing business in 1975 to honor the pioneer practitioners still be over 100 miles from a doc- and began painting full time in of the Panhandle’s outlying commu- tor. When asked what he would do 1996. He prefers to paint on loca- nities of the 50’s through the 80’s— if one of his workers broke an arm, tion and has painted in Alaska, Pampa, Canadian, Borger, Perryton, a Panhandle rancher replied, “Call a Canada, Colorado, New Mexico, etc. These doctors were an integral vet.” Even though we are now in the and Wyoming. His favorite place to part of their communities, serving 21st century, not much has changed paint is the Palo Duro Canyon, near not only their myriad patients in for the true country doctor. his home. His work can be found in every imaginable medical capacity collections throughout Texas, New but also holding positions on vari- We are planning a “Legislative Mexico, Colorado, and New Jersey. ous civic, community, church, and Update” in October given by TMA Kim currently owns “Gallery at the philanthropic boards. Most of these President, Dr. Stephen Brotherton Palace” in Canyon, Texas. physicians were family practitioners from Ft. Worth. Physicians who which necessitated keeping up with developments in diagnosis and treat- ments of virtually every human dis- PHYSICIANS BUSINESS SERVICE ease, presenting a special challenge Professional Medical Billing & Management to stay current. These physicians “We tailor our service to meet the needs of your practice.” saw their patients in the full context of the small communities in which * Billing they both lived. For example, the * Accounts Receivable Management patient was the patient as well as the * Financial Management/Consulting teacher of the doctor’s children, and * Electronic Claims Submission the doctor was the doctor as well as the coach of her children’s base- 3144 W. 28th, Suite C (806) 355-6593 ball team. Of course, the approach Amarillo, TX 79109 (800) 769-8151 to rural medicine ultimately rested
FALL 2013 PANHANDLE HEALTH 7 Guest Editorial: Early Medical History of the Texas Panhandle
by Steve Urban, M.D.
Texas panhandle in the late 1800’s few creeks and rivers and ruled by the William Tecumseh Sherman, had used In 1874, the transcontinental horse warriors. Within 10 years, every- to “pacify” Georgia. Whereas previ- railroad spanned America, Andrew thing would change. ous generals had captured Comanche Carnegie and J.D. Rockefeller were ponies, only to have them liberated accumulating their first millions, and The settlement of the Texas (usually that same night) by their P.T. Barnum presented the “Greatest Panhandle depended on three fac- “Indian” owners, MacKenzie had them Show on Earth” for its second record- tors: the “pacification” of the native all shot. He pursued the camps (i.e. setting year. The world was reading Americans, the westward expansion women and children) mercilessly. In War and Peace, and the impressionists of the railroads, and the development May of 1875 even the proud Quanah shocked Paris with a new view of form of the barbed wire fence (patented by Parker surrendered and retired to the and light. At this time the settled pop- Joseph Glidden in 1874). The rate-lim- reservation at Ft. Sill, Oklahoma. ulation of the panhandle of Texas was iting step (then, as now) was finding effectively zero. enough water to make it all work. Soon after the victory of the 4th cavalry, cattlemen moved into our If you look at maps of this era, our area—initially “free-range” owners like In 1873, the Comanches still region is designated as “Comanche Charles Goodnight (1876), later set- and Kiowa hunting grounds.” ruled this region (for a compelling tled landowners whose cattle were con- Occasionally, a wagon train to Santa account, read S.C. Gwynne’s Empire of strained by the new barbed wire. Right Fe, a band of Hispanic Comancheros, the Summer Moon) (1). Then Colonel behind them snaked the railroads— or a misguided trading party would Ranald MacKenzie wreaked final the high plains first supplied by the pass through, but generally this area defeat on the Comanches, using the Santa Fe (originally, the Atchison, was a trackless prairie interrupted by a same approach that his boss, Gen Topeka, and Santa Fe) through south- ern Kansas. Its terminus at Dodge City in 1872 created the archetypical cow- town; subsequent extension to Pueblo in 1876, Albuquerque in 1880, and final linkage with the Southern Pacific at Deming, NM in 1881 connected wheat, cattle and buffalo lands in the central plains to markets on the east and west coast. Then came the Ft. Worth and Denver, whose progress across the panhandle in 1887 gave rise to Clarendon, Texline and (most importantly) Amarillo.
Finally: the water First the few rivers and creeks, marked by rudimentary forts—e.g. Bent’s Fort (also styled Fort Adobe, later Adobe Walls) and Fort Elliott on the Canadian. In their wake, villages such as Old Tascosa (1876) and Old Mobeetie (1878) struggled into being. Then came hand-dug wells on the flat- land; finally machine dug wells with the necessary windmills. At last, settled civilization—mostly rural and scat- tered, to be sure-- had arrived.
Early panhandle medicine Of course, medical care in the late 1800s was rudimentary at best. Most doctors had no formal train- ing and no scientific background at 8 PANHANDLE HEALTH FALL 2013 all. They learned via the apprentice- $100/week for Dr. Wright to stay until “One evening, Walter was playing ship method, much as did an artisan HIS baby had been safely delivered. a game called dare base, and ran into or tradesman. Many of the so-called the barbed wire guy line of a windmill; “doctors” in the west were half-trained Ochiltree County: case in point his face was ripped open from mouth rapscallions or alcoholics on the run. Much of the history that follows to ear and he was in a bad way for a In newspapers of the time you will comes from Ochiltree County (county while. Soon a fine pioneer woman find “announcements” (advertising seat: Perryton), where my Urban- who knew how to meet the occasion was prohibited by the AMA!) boast- side forebears settled in 1888 and my came on the scene. Her name was ing of local doctors’ graduation from maternal Hummer-side forebears set- Mrs. Beagle; she asked that the boy be respected universities and medical tled in 1905. Every county has its own held by force while she took an ordi- schools, to distinguish them from story—undoubtedly of more ancient nary needle and silk thread and sewed practitioners with only “trade-school” provenance than ours—but I know a pretty stitch. Today the scar appears diplomas. Ochiltree County’s story best and, to be the work of a competent surgeon after all, I AM the guest editor! (2). The dearth of qualified doctors was a significant drawback to settlement My great-grandfather Wiliam L. Early practitioners in Ochiltree of the Panhandle in the early days. Coppock homesteaded in Ochiltree County included Dr. Alfred Ahlman, Dr. Tom Hale has shared with me an County in 1888 but returned to who in 1906 opened a sanitorium; the account by his great-grandmother Tennessee with his family several doctor and his family lived downstairs Mrs. W.B. Wright, who settled near years later. Having to dig a water well and the patients occupied the second “Fort” Bugbee on the Canadian River 250 feet deep with pick, shovel and floor. Dr. William Pearson graduated in 1877. Ms. Wright was the first Anglo windlass was only part of the prob- from Vanderbilt in 1883 but came to woman to homestead in Hutchinson lem. The family considered the lack the dry panhandle of Texas “for his County. When she became preg- of ready medical care an important health” (this usually meant that he nant with her first child, the near- factor. The nearest physician at this had tuberculosis) and never practiced. est doctor was in Dodge City; so the time was in Liberal, Kansas, 50 miles Dr J.T. Guthrie was a well-loved prac- Wrights hired her brother, a physician away by horseback across a wagon- titioner but died in the 1918 influ- from Missouri, to stay at their home trail through the prairie. An excerpt enza pandemic while tending to his through the lying-in. Later, the owner from the memoirs of Walter Stollings patients. of a large cattle operation nearby (related by marriage to the Hummer offered the astounding retainer of clan) elucidates the problem: | continued on page 10
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FALL 2013 PANHANDLE HEALTH 9 Perhaps the most colorful early “[Ochiltree] was thrown onto and CBCs) and of course the radioim- practitioner in Ochiltree County was a state of intense excitement last munoassay had not been developed. Dr W.J. Brewer, who was Dr. Guthrie’s Saturday just as dusk was gathering, The hospital was proud of its “Jones brother-in-law. He came to Old by the sound of several shots fired metabolic apparatus” for measuring Ochiltree in 1908 (11 years before in quick succession in the region of basal metabolic rate for the diagnosis Perryton was founded) and practiced the drug store, and a pall of sadness of hypothyroidism! in Ochiltree County for 30 years. His surrounded the scene where two of obituary proudly mentions his train- our prominent business men had A lot has changed since those ing at Barnes Medical College and just engaged in a duel with automatic early days. The Flexner report his “post-graduate work” at Tulane pistols, each one receiving a severe (1910) transformed medical educa- and Chicago Polyclinic. A newspa- wound, but neither being fatally tion. By the 1940s and 50s, doctors per announcement from May 1916 shot.” were trained at Baylor and UTMB bragged that Dr. Brewer, “one of our (rather than in proprietary schools). leading physicians and surgeons” No detail was omitted in the Residencies were more likely accom- was attending a refresher course in account; modern HPIPA compliance plished in a hospital than in a saloon. Chicago. The Ochiltree Herald com- officials must shudder to read these Quantitative chemistries, then the mended him “for his progressiveness facts: radioimmunoassay, then CT and MRI and desire to be at all times at the top scans moved us toward diagnostic of his profession.”(3) “Dr. Brewer was leaning up against certainty. Were doctors better diag- his car, writing a prescription for nosticians in those days? Probably That Dr. Brewer may have had Bogus Wilbanks…when Judge Correll not. Were they more revered and other desires came out in October of walked up on the sidewalk…and respected? Probably. They carried 1916, when Dr. Brewer and County opened fire on Brewer, who imme- the torch of healing to the bedside, Judge Cap Correll shot it out in a diately drew a gun and began shoot- even if their therapeutic armamen- duel in the “usually quiet little city ing at Correll. About nine shots were tarium was weak. They brought care of Ochiltree” over “difficulties of a exchanged, only two taking effect, and empathy with them. Nowadays delicate nature which have existed one from each gun.” we’re too busy to sit and ponder— between the two men for some we’ve got to pay off those scanners time.”(4) Early 20th century jour- Certain details might seem exces- and get the patient out of the hos- nalistic diction must be quoted to be sive in today’s Globe News. We learn pital before the discharge planner fully enjoyed: that the Judge was struck “in the comes around! When we read the old abdomen, the ball severing the intes- accounts, though, we sometimes won- tines in two places and lodging in the der: how much has been gained and hip” and that he was taken to Liberal how much lost, in the advance toward Kansas “in Ed Forbes’ Oldsmobile.” our modern technological medicine? INTRODUCING Somewhat cryptically (but perhaps germane to the delicate matter), were References DocBookMD are told that Dr. Brewer has “a wife (1) Gwynne SC. Empire of the Summer and two daughters” and that “Judge Moon. Scribner, New York 2011. DocBookMD is a Correll is 35 years old and was mar- (2) Whippo SP, ed. Wheatheart of smartphone platform ried to Miss Carrie Whippo only last the Plains: An Early History of designed by physicians June.” Eat your heart out, Lance Ochiltree County. Ochiltree County for physicians that Lahnert! Historical Survey Committee, 1969. provides an exclusive Shooting a judge must not have (3) Ochiltree News. May 26, 1916. HIPAA-compliant been severely frowned upon in those The Ochiltree News succeeded professional network. days—or else they really needed a the earlier Eagle-Investigator. doctor!—since Dr. Brewer moved Perhaps the querulous tone of A revolution at your fingertips with the rest of the town in 1919. The the Eagle led to its demise. On town of Ochiltree hoisted up its skirts May 18, 1910 it scolded: “The and moved 7 miles north to the side friends of the Investigator will DocBookMD.com of the new Santa Fe spur. There Dr. please hand us in news items Available at no charge to TMA members Brewer continued to practice through while they are fresh. We prefer thanks to the generous support of the the 1930’s; he experienced a surpris- not to publish a birth after a child Texas Medical Liability Trust ingly peaceful demise in 1953. is weaned, a marriage after the honeymoon, or the death of a Modern medicine man after his widow has married Sponsored by In 1930, a new hospital was built again!” by Drs. Budd and May in the grow- (4) Ochiltree News. October 6, 1916. ing town of Perryton. The proud announcement mentions $10,000 of Thanks to Odie Dear, Rena Gay equipment, 12 private rooms, one Richardson, and Stacy Brown at the large public ward, and a fluoroscope! Museum of the Plains in Perryton TX for In those days serum chemistries were assisting my research of early Ochiltree not widely available (just urinalyses County medicine. 10 PANHANDLE HEALTH FALL 2013 Pampa’s Dr. Raymond Hampton
by Moss Hampton, M.D.
Raymond Hampton, M.D. re you related to THE Dr. was initially a 90 bed facility. In 1957 it year rotating internship in Oklahoma AHampton?” I can’t tell you was expanded to 126 beds to serve the City and had hoped to do a surgi- “ how many times I’ve been growing population. It was in service cal residency in San Antonio. After asked that question. Sometimes it until 1981 when the current hospital a partial year doing another rotating would be from patients or one of their facility was built. internship in San Antonio, he decided family members. Sometimes it would to enter private practice. One of his be from relative strangers when they My father, Ray Hampton, was born medical school classmates, Dr. Julian found out that I grew up in Pampa. in Vernon, Texas. His father owned a Key, was practicing in Pampa at the But, it was always followed by a story or plumbing shop and his mother was a time and encouraged him to come to a comment about how my father had school teacher. He had one younger Pampa. At that time there were about taken care of his/her mother or deliv- brother. His early days in Vernon were 10 physicians in town. He came to ered his/her sister or operated on colored by the events of the Great Pampa in the fall of 1949 and asked his/her grandfather and what a won- Depression, and while he and his fam- Dr. Frank Kelly for a job with the Kelly derful doctor they thought my dad ily fared better than most, it left a last- Clinic. He was hired immediately and was. He seemed to have taken care of ing impression on him. He graduated began his career as a general practitio- everyone in Pampa! Where do I begin from high school at age 16 and gradu- ner that lasted for 51 years. to tell his story? ated from the University of Texas at age 18. He completed medical school In late 1950 he was recalled into the The community of Pampa started at the University of Texas Medical Navy as part of the Korean Conflict and as a railroad station house for the Branch in Galveston in three years, spent almost two years in the service. Southern Kansas Railroad in 1887 on and received his MD degree when he land owned by the Francklyn Land was 21 years old. He completed a one | continued on page 12 and Cattle Company (later the White Deer Land Co.). In April 1902, a plat for the town site was approved by peo- ple living there. It was incorporated in 1912 and by the 1920’s was noted for its wheat fields, cattle ranches, and oil An Accredited wells. The medical community in Pampa began in 1902 with the arrival of Dr. V.E. von Brunow. He first practiced Comprehensive out of his home and later out of the back of a drug store. Dr. von Brunow is also reported to be the first person to own an automobile in Pampa. He worked there for 38 years. Another Sleep Center early Pampa physician, Dr. Walter Purviance, had a significant impact on the local medical community. He began practicing in Pampa in 1920 TIM MOORING, M.D. & GARY POLK, M.D. after serving in World War I and prac- ticed there for over 35 years. He was a real estate developer, was mayor for two terms, and was involved in Amarillo Diagnostic Clinic, P.A. many civic projects. More physicians came to town in the 1930’s and early 1940’s as Pampa continued to grow and prosper. The first hospital, the Pampa Jarrett Hospital, opened in SLEEP DISORDERS CENTER 1926. It was an 18 bed hospital and operated until 1950. In 1930, the Worley Hospital opened with 48 beds and operated until 1975. Highland 8/*/5) "."3*--0 59t General Hospital was built in 1950 and FALL 2013 PANHANDLE HEALTH 11 During that time, he met and mar- board certified anesthesiologist, no anything I wanted to do, and he always ried Harriet McPhail. They returned pulmonologist or intensivist, no ICU, expected me to do my best. While to Pampa on Thanksgiving Day, 1952 no telemetry or ventilator, just “regu- he never forced medicine on me, he and have lived there ever since. On his lar” doctors and nurses doing the best would often ask if I wanted to go with return in 1952, he started the Medical they could to care for their patients. him. I can remember going on house and Surgical Clinic with Dr. Charles calls with him when I was young. As a Ashby, Dr. Phil Gates, and Dr. Dick Other aspects of medicine were medical student, I was often included Bonner. The clinic was in operation also different in those days. There in deliveries and surgeries when I was until January, 2000 when he retired. were fewer medications, especially home on break from medical school. antibiotics. There was much less When I returned to practice in Pampa When you talk with my father about technology and they often had to in 1986, he was there again whenever the practice of medicine in those days improvise. There were no disposable I needed his advice about a problem (1950’s and 1960’s), he will tell you instruments, no cell phones, no com- or whenever I needed an assistant in that they were just doing the best they puters. Of course, malpractice cases a difficult case. He would give me his could with the few tools that they had were uncommon and Medicare and opinion when asked and make “sugges- available to them. During those years Medicaid had not yet been instituted. tions” about how I might think about in Pampa, all the physicians in town As he often says, everything was much a problem. That being said, it didn’t were general practitioners. But, these simpler then. take me long to figure out who the physicians “did it all”! My father deliv- “real” Dr. Hampton was. His patients ered babies for about 30 years. He When asked why he went into med- were extremely loyal. If I were seeing performed a variety of surgical pro- icine, my father will tell you that his one of his long-time patients, they cedures including cholecystectomies, mother wanted one of her sons to be a always wanted his opinion because appendectomies, tonsillectomies and doctor and the other to be a preacher. he was “their doctor”. Of course, his hysterectomies until shortly before he He knew he wasn’t cut out to be a patients would also tell me stories retired. He introduced several ortho- preacher! Medicine was his life, and about bringing him pies, cakes, or pedic procedures to the hospital when he liked Pampa because he felt he fresh vegetables with the implication he first came to town. In fact, my could practice the full spectrum of that if I ever became as good as he was, youngest brother who is an orthopedic his profession there. He worked long I might reap those benefits as well! surgeon in Pampa was “amazed” at the hours and the telephone rang fre- procedures he was routinely doing. At quently at our house! I listened to In addition to his professional times they had to do “heroic” things. enough conversations to know that, responsibilities, he was involved with The story my father tells of perform- when I heard “she’s 8 centimeters”, it his community and with organized ing a partial pneumonectomy with Dr. meant he needed to hurry up and get medicine. He served on the Pampa Ashby on a man who otherwise would to the hospital. That was long before School Board for 12 years and later on have died was thrilling and unbeliev- I knew the obstetrical significance of the Pampa Library Board for 18 years. able in today’s world. There was no the comment. He always seemed to be He was active in the Texas Medical “on call”. He often said that the best Association, the Panhandle District thing that happened in Pampa was Medical Society, and the Top of Texas when the hospital hired a full time Medical Society. He served on the In Memory emergency room physician. TMA Board of Counselors for 15 years. He was an avid golfer and loved snow He also worked hard to stay cur- skiing as well as traveling. He retired rent. I can still see him sitting in his in January, 2000 and has enjoyed his favorite chair reading the New England retirement. His interest in medicine is Journal of Medicine every night after still there, but he admits he couldn’t dinner. In 1969, he closed his practice have kept up with all of the new tech- for 6 weeks and went to Harvard for a nology we use in medicine today. review course so that he could become one of the first board certified physi- I am very proud of my father, Ray cians in Pampa. He always carried him- Hampton M.D., and the things that he self in a professional manner, wearing accomplished while practicing medi- a coat and tie to the office and the cine for 51 years in Pampa. In my mind hospital Monday through Friday until he is the epitome of a “real doctor”. the day he retired. In the operating I enjoy listening to the stories people room he was “all business”. There was tell me about how my father did some- Dr. Thomas C. Neese no casual conversation as he expected thing special for them or their family. Cardiologist, everyone to be paying attention to the I was very touched when a high school died on July 11, 2013 operation. For those who worked with classmate recently told me that my him regularly in the OR, he was always father saved his father’s life when he at the age of 75. a teacher. He would be teaching you had been severely injured. My father He was a member something about the operation, teach- has been my mentor, role model of the Potter-Randall ing you to tie knots, or teaching you and the person I have most admired how to be a good assistant. (along with my mother!) for my entire County Medical Society life. He taught me much about the art for 41 years. At home, he was always there when and practice of medicine, and for that you needed him. He was supportive of I am forever grateful. 12 PANHANDLE HEALTH FALL 2013 FALL 2013 PANHANDLE HEALTH 13 Borger’s Dr. Joe Knowles
by Steve Urban, M.D.
Joe Knowles, M.D. hen I decided to write about the famous exploring/surveying Borger developed into a national hub Wone of Borger’s iconic prac- party of Randolph Marcy braved the for oil and natural gas processing and titioners, I wasn’t sure where Comanches. A small trading post was transport. to turn. Borger’s history is replete established in 1843 to trade with the with colorful characters, both doc- Indian population. Known as Bent’s Stories of the tempestuous and tors and lay people, but who should Fort or Ft Adobe, it was soon aban- colorful early days of Borger are too be singled out? I sought the advice of doned when the Comanches found many to tell, but apparently crime was respected Amarillo practitioners Dr. out what it was really like to trade with rampant. A 1928 news story recounts Tom Johnson and Dr. Taylor Carlisle the white man. The site (Adobe Walls) 40 arrests a day; the jail was said to (both Borger products), and each hosted its first battle (Kit Carson vs the be swarming with “bootleggers, gam- directed me to Joe Knowles as the con- Indians) in 1864 and then the more blers, highjackers, prostitutes, pimps summate small-town practitioner. Joe important 2nd battle of Adobe Walls and other undesirables.” Newspaper now lives with his wife Sue just off the (Billy Dixon vs Quanah Parker, medi- reports chronicle characters such as golf course at LaPaloma. Despite his cine man Isa-tai and their warriors) in “Toughey” Williams, Bill “Tangle Eyes” 84 years, Joe possesses a great memory 1874. Moss, and the “notorious bootlegger, and a sharp wit. He can look back on bank robber and murderer” Shine the changes that have befallen medi- As was the common pattern, buf- Popejoy, who was shot and killed while cine in the last 60 years with a sense of falo hunters and open range ranches trying to escape from the county jail. accomplishment in the care he deliv- followed the “pacification” of the In 1929, after the district attorney and ered but also with a sense of nostalgia Comanches, but railroads did not another citizen were murdered, the about what has been lost in the trans- penetrate the dry prairie. In 1890, governor declared martial law; it took formation to technological, subspe- there were only 58 residents (includ- the National Guard to restore any cialty-centered medicine. An interview ing Mr. and Mrs. Billy Dixon) in the semblance of peace! with Joe and wife Sue on an eminently whole county. Everything changed golf-worthy day provides the basis for in the 1920s, when oil gushed forth, In 1929 Dr. L. M. Draper, a Duke this article. with natural gas spewing soon University and University of Maryland behind. Stinnett, Phillips (originally medical school graduate, entered this Early history of Hutchinson County Whittenburg) and Borger were all pandemonium. He set up his practice The early history of Borger and incorporated in 1926; Borger bur- and brought the first X-ray machine Hutchinson County diverges from geoned most dramatically and became to Hutchinson County. Joe Knowles most other areas of the Panhandle. the classic oil “boom town”. It was said directed me to Dr. Draper’s memoirs. First of all, the Canadian River served that 30-40,000 inhabitants swarmed Like most practitioners of this era, he as a conduit for many explorers and the unpaved streets of Borger by 1928, did everything on the spot; transfer- wagon trains through Comanche although most lived in tents, shan- ring patients to Amarillo across poor country; so Hutchinson County’s his- ties, or in the backs of trucks. The roads in those days was not much of tory starts early. A major wagon cara- Phillips Petroleum company bought an option. Dr. Draper delivered babies van bound for Santa Fe, NM came its first refinery there. The J.M. Huber in tents and in the backs of pickup through in 1840; a few years later Company came along thereafter, and trucks; he sewed up wounds as best he
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14 PANHANDLE HEALTH FALL 2013 could. Dr. Draper treated Pretty Boy 8000 in Borger, without an obstetrical nately, Dr. Knowles’ UTMB classmate Floyd on one occasion; fortunately for death. Dr. Jim Wheeler moved from Dumas him (but perhaps not for some oth- to join the practice. Soon Dr. Bob ers) the famous gangster recovered. Joe completed his internship at Holmes joined them in Borger. Fees Brooke Army Hospital, where he per- were miniscule in those days. An office Joe Knowles: the early years formed his first CPR—done via emer- visit cost the patient $4, an appendec- Joe grew up on a small farm near gency intercostal incision and open tomy $150, a C-section $250. Total Burnet, Texas in the height of the cardiac massage. The young soldier obstetric care from (soon after) con- depression. As with most children of survived! Pioneer cardiac surgeon ception through post natal discharge this era (Joe was born in 1929), he Dr. Arthur Blalock visited Brooke was $150 for a primipara, $125 for a was greatly affected by the privations and demonstrated in the operat- multip. In 1956, Dr. Knowles’ malprac- of the time. Although his father had ing amphitheater his newly devel- tice insurance cost $25/year! a UT education, commodity prices oped mitral commissurotomy, done were terrible and city jobs were through a purse-string opening in the Small town hospitals were going scarce. Joe recalls that the family had left atrium, with finger-fracture of the concerns in those days. Joe recalls the no automobile and sometimes only mitral valve. To operate on the beat- 125 bed North Plains Hospital with “food till the middle of next week.” ing heart seemed like a miracle to its staff of 16 general practitioners, a Fortunately, Joe’s father secured a job observers young and old. pathologist, a radiologist, and even an with the agricultural extension service, ophthalmologist. A few years later, an and the family moved to the Bryan/ After internship, Dr. Knowles anesthesiologist joined the staff. There College Station area. Joe worked his “owed Uncle Sam” two more years of were no general surgeons or ob/gyn way through Texas A&M and in 1949 service and in 1954 moved to the hos- matriculated at the largest medi- pital at the Amarillo Air Force base. | continued on page 16 cal school in Texas at the time, UT It’s easy to forget what a huge opera- Medical Branch in Galveston. tion the AAFB was before Lyndon Johnson shut the whole thing down. Medical school and further training As many as 32,000 soldiers, instruc- 100,000 Joe Knowles had to work his way tors, and employees swarmed the east through medical school as well. A sum- Amarillo facility. Although most of the mer job provided the $300 needed to doctors resided “in town”, Joe lived in Bike Helmets purchase a microscope for his fresh- a duplex on site. All specialties might man year. Joe remembers many hours rotate as “medical officer of the day” & Counting working as an orderly at St. Mary’s in the emergency room, but Captain Hospital; he had to sell blood for $15 Knowles was on first call for obstetric a pint for spending money. A vivid or general surgical cases. In a sense, memory was of classmate Herman Joe’s 2 years at the base were like a res- Barnett, the first African-American idency in surgery and ob. Dr. Knowles’ medical student in the state. Although colleagues and mentors at the 140- Jim Crow laws were still in effect, the bed AAFB Hospital were skilled prac- UTMB students supported their class- titioners from across the country. Joe mate. Joe recalls one instance (after honed his surgical skills with a Tulane- graduation) at a TMA meeting, where trained surgeon, and pediatrics with a restaurant owner refused to serve a Philadelphia-trained academician Herman in the main dining room. (also paying off his medical educa- The TMA members arose to a man tion.) Joe’s ob/gyn colleague was an Thanks for helping and left with their colleague. excellent senior attending named Dr. Cliff Matthews; together they deliv- TMA’s Hard Hats for Dr. Knowles did his junior ob/gyn ered 140 babies a month. Town con- Little Heads reach a clerkship at Bexar County Hospital sultants included Dr. Earley B. Lokey in San Antonio. He remembers the and Dr. George Wyatt. If his C-section major milestone — wise advice of a faculty member: “Pay rate exceeded 5%, Joe had to explain attention to the L&D nurses—they each case to the formidable Dr. Lokey! and for helping us keep know more than you do” and “the best Captain Knowles’ astounding salary of Texas children safe. obstetrician is often the one who can $400/month, however, provided some sit on his hands the longest.” Joe says consolation. that the most important admonition was “Remember, none of you walk on Thirty years in Borger, Texas water”—i.e. practice humility. In those In 1956, Joe Knowles moved to early days of fetal monitoring, the opti- Borger and began his 30 year love mum primary C-section rate was felt to affair with the city and its citizens. His Hard Hats for Little Heads is funded by the TMA Foundation thanks to top donors — Blue Cross and Blue Shield of Texas, be 5%! Joe delivered over 1400 babies senior partner, Dr. Clarence Brinley, Prudential, and an anonymous foundation — in his training, and between 7000 and died unexpectedly after 2 years; fortu- and gifts from physicians and their families. FALL 2013 PANHANDLE HEALTH 15 practitioners, however, because the Powell “never did anything just to at the Top of Texas Medical Society generalists performed these tasks. make money” (things must have been (Borger, Pampa, Perryton, Spearman, Dr. Knowles estimates that “99% of different in those days!). Dr. Prewitt Canadian and Shamrock) would often the work was done locally.” Closed was serious and committed. Everybody number 50 or 60. One hundred to a fractures, C sections, and open cho- took indigent call on a rotating basis hundred and fifty would gather for lecystectomies presented no prob- and nobody complained. “It was our the annual Panhandle District Medical lems. Prostatectomies, mastectomies, duty,” says Dr. Knowles. Society meetings. thyroid surgery, neurosurgical proce- dures, open orthopedics, and (later) Looking back Joe Knowles made a huge impact CABGs were referred to Amarillo. Medical practice was different on the lives of tens of thousands of Pediatric cardiac surgery went to in the 50s and 60s, but not always in Borger patients over the years. He was Oklahoma City or Houston. In those ways you would expect. You couldn’t well-trained, skilled, and thoughtful. days, however, acute MIs were man- get a CABG in Amarillo until Henry Joe Knowles cared for his patients. If aged locally; emergency intervention Martinez came along, but a woman highly-trained practitioners like Tom was unknown until the late 1980s. could sneak off to Dalhart for an Johnson and Taylor Carlisle attest to abortion. Sulfa drugs, penicillin, and Dr. Knowles’ expertise and compas- Dr. Knowles crossed paths with streptomycin were the only antibiot- sion—well, that is enough for me. many pioneer Borger practitioners. ics, and corticosteroids had just come Joe shepherded generations of chil- Drs Larry and Arthur Hansen started on the scene. Only 6 of Joe’s 162 dren through the Hutchinson County a clinic and continued in practice classmates at UTMB were women; school system. He could make a diag- until the 1960’s. Brothers W.G. and now women make up more than nosis from the history and physical M.M. Stevens were quality doctors. Dr. half of most medical school classes. exam; he could distinguish organic Hugh Pennal, one of Amarillo’s pio- Dr. Knowles lists these as the biggest from functional disease, and could neer psychiatrists, practiced in Borger changes that he saw in his nearly 30 treat both. Generations of patients for a few years before going back to years of practice in Borger: subspe- in Borger have benefitted from his complete his psychiatry training. In cialization, government interference advice, and I personally have prof- addition to his partners, Dr. Knowles in the practice of medicine, and com- ited from his insights. Let us hope admired colleagues Paul Powell and plex documentation and billing proce- that future physicians of Hutchinson Rex Prewitt. Dr. Powell was a gifted dures. Organized medicine was more County will combine Dr. Joe Knowles’ technician in the OR and a thought- important to the Panhandle medical diligence, skill, and compassion. ful diagnostician. Joe says that Dr. community in those days; attendance
16 PANHANDLE HEALTH FALL 2013 FALL 2013 PANHANDLE HEALTH 17 Dr. Snyder and Dr. Rush: Canadian Pioneers
by Nona Dale Snyder Fulton, M.D. (Retired)
ut, it’s so tiny!” These words dent. And, little babies had no com- Although complicated injuries Bepitomize the reaction of for- punction about making their arrival in were referred to specialists in Amarillo “ mer patients of our grandfa- the midst of a busy afternoon! (100 miles away), simple fractures ther, Dr. E. H. Snyder (Dr. Snyder), were treated on the spot. A small 8’ and our father, Dr. Rush A. Snyder Obstetrics played a very impor- x 8’ lead lined room at the back of (Dr. Rush), upon entering the wait- tant role in the life of both Dr. the office housed an old Picker X-ray ing room of the Snyder Clinic at the Snyder and Dr. Rush, and together machine, and the X-rays were devel- top of Main Street, across from the they delivered generations of babies oped by hand with the wet method Hemphill County Courthouse in in Canadian and the surround- (Quite a contrast to the digital imag- Canadian, Texas. Despite the fact that ing communities. General practice ery of today!) Casts were applied and the entire office building could fit included not only care of patients of later removed in the adjacent treat- inside the waiting area of most current all ages, but also complete obstetri- ment room. Unlike the brown paneled Amarillo physicians’ offices, 50 to 60 cal care. When our family returned to walls of the remainder of the office, patients were seen each day from the Canadian from a stint with the U. S. the treatment room was painted white early 1900s until the doors closed on Army in Herzogenaurach, Germany and housed a barber-type chair and April 30, 1985. (near Nürnberg) in 1948, the com- scales similar to those immortalized plete package of pre-natal care, deliv- on the Saturday Evening Post cover In contrast to the row of secretaries ery, and post-natal care was $50.00 by Norman Rockwell. Indeed, after seated in front of impersonal comput- (At that time office visits were $2.00, having had that shot in the rear, each ers in present day waiting areas, a sin- though later increasing incrementally child could anticipate the reward of gle receptionist greeted each patient, to $3.00, $5.00. and $10.00). Indeed, choosing a cloth-handled sucker from usually by name. Records were kept on Dad’s little black book of anticipated the big jar (sugar allowed, but no stick 5” x 7” cards housed in two fireproof, dates of deliveries structured our handles to injure a child running out two-drawer filing cabinets by her desk, personal family life. Ultrasound and of the office!). with short pertinent notations made other technological advances were by the physician at time of each visit. unknown, but the nurses at the hospi- Blood samples for more compli- tal were very adept in knowing when it cated analysis were mailed to outlying Appointments were not made. was time to call Dr. Rush! Of course, laboratories, but the physician per- Patients were generally seen on a there were no smart phones or answer- formed routine CBCs and urinalyses in first come, first served basis, unless ing services, but we always let the tele- the small workspace by the back door. an emergency pre-empted the order phone operator and the hospital know Disposable needles and plastic syringes of arrival. Patients were understand- where we could be located. Yes, a live had not made their appearance during ing of these delays, as they knew that person manned the switchboard at the early years of practice, and one of someday a member of their own fam- the telephone office, and she always the responsibilities of the reception- ily might be that person injured on remembered where Dr. Rush had just ist was to clean and sterilize the glass an oil rig, on the ranch, at the rodeo made a house call! syringes and metal needles. Any burrs grounds, or in an automobile acci- detected at the tip of a needle (by using a cotton ball!) were carefully filed down on a flint bar before the needles were placed in the small sterilizer.
Collection agencies were not a factor. Having made house calls to the majority of his patients, Dr. Rush knew their economic circumstances. Certain checks needed to be taken to the bank two blocks down Main Street as soon as the doors opened! By the same token, he also knew that the reg- ular $5.00 monthly payment made by struggling families was the most they could afford. Civic responsibilities were 18 PANHANDLE HEALTH FALL 2013 embraced despite the heavy practice an opportunity to socialize with fellow load. Our father came home at noon physicians. for our main family meal—except on Tuesdays, when he faithfully attended Although vacations were few and the weekly meeting of the Canadian far between, our parents enjoyed play- Rotary Club across the street in the ing bridge and visiting with friends. basement of the W.C.T.U. (Women’s Our father was one of the original Christian Temperance Union) build- “catalog junkies,” and we never knew *ÀÌiÊi>Ì Ê ing. Dr. Rush also served as President what the mailman might bring! Prior of the Board of the Canadian to attending medical school, Dad had >`Ê7iiÃð Independent School District and was a received his degree as a mechanical Õâi° dedicated member of the board of the engineer, and he never lost his yen 'ET INVOLVED WITH THE 4EXAS -EDICAL First National Bank. Every August he for gadgets or cars. Indeed, patients !SSOCIATIONS "E 7ISE )MMUNIZE 3- spent an afternoon giving physicals for always knew where Dr. Rush was when PROGRAM AND HOST AN IMMUNIZATION aspiring athletes, for which he received they spotted his car. Privacy was not an OUTREACH EVENT a reserved seat at the football games. option in a small town! 6ACCINATIONS ARE IMPORTANT EFFECTIVE Until the early 1950’s Canadian Though my two brothers, Rush AND SAFE was a big railroad town, and both our A. Snyder, Jr., M.D. and Edward H. ÀÊÀiÊvÀ>Ì]ÊÛÃÌÊÕÀÊ7iLÊÃÌi grandfather and our father served as Snyder, M.D., and I moved away and >ÌÊÜÜÜ°ÌiÝi`°À}ÉLiÜÃi]ÊÀÊVÌ>VÌÊ Ì iÊ/ Ê iÊ7ÃiÊVÀ`>ÌÀÊ>ÌÊx£Ó®ÊÎÇä£{Çä doctors for the Santa Fe employees. became medical specialists, the lives of ÀÊLiÜÃiVÀ`>ÌÀJÌiÝi`°À}° Many evenings, our family would drive our grandfather and father made an down to the train station at the foot indelible impression on us as we cared iÊ7ÃiÊpÊÕâiÊÃÊ>ÊÌ of Main Street so we could wave to for patients. Yes, the office was “tiny”, Ì>ÌÛiÊi`ÊLÞÊ/ Ê« ÞÃV>ÃÊ>`ÊÌ i / Ê>Vi]Ê>`ÊvÕ`i`ÊLÞÊ the engineers, conductors, brakemen, but the impact of these two general Ì iÊ/ ÊÕ`>Ì° and porters as passengers boarded practitioners was immense. the San Francisco Chief. Our father was a member of the Top of Texas Note: Items from the Snyder Clinic Medical Society and, often accompa- can be seen at the Canadian River nied by our mother Rachel, drove to Valley Pioneer Museum in Canadian, "E 7ISE )MMUNIZE IS A REGISTERED SERVICE MARK OF THE 4EXAS -EDICAL !SSOCIATION the monthly meetings, where he had Texas.
SAVE THE DATE ATTENTION: POTTER RANDALL COUNTY MEDICAL SOCIETY MEMBERS AND THEIR FAMILIES FAMILY FALL FESTIVAL SUNDAY, OCTOBER 13TH 5:00 TIL 8:00 RIVER BREAKS RANCH INVITATION TO FOLLOW
FALL 2013 PANHANDLE HEALTH 19 “Doctor Roy”: Perryton’s Roy Sanford
by Scott Sanford M.D., Steve Sanford M.D., Sally Sanford and Steve Urban M.D.
Roy Sanford, M.D. oy Sanford was Perryton’s “native hood and an outstanding academic Roy Sanford’s medical career was cut Rson” and carried the advantages career, he returned home to practice short by health problems, leading to as well as the burdens of this des- medicine at the surprisingly young his retirement in 1974. Those he left ignation through almost thirty years of age of 24. He brought modern post- behind remember his intellect, his medical care. After a traumatic child- war medical standards to Perryton. commitment to his patients, and his community service. He helped estab- lish in Perryton the tradition of a longstanding stable medical commu- nity; four doctors in Perryton today have practiced there for over 25 years. Finally, he inspired his two sons, Dr. Scott Sanford and Dr. Steve Sanford, to follow his lead as primary care physicians.
Medical practice in Perryton during the interwar years. For the earliest medical history of Perryton, see the introductory article to this issue. The colorful Dr. Brewer survived his 1916 shootout and prac- ticed in the new town of Perryton until the 1930s. Others besides county judge Cap Correll may have had conflicts with Dr. Brewer, as he had a series of partners and associates through the years. Famous Ochiltree County prac- titioners in the 1930s and 40s were Drs. May and Budd, who were later joined by Dr. G. L. Kengle. During the “dust bowl” the prosperity that had made Ochiltree County one of the largest wheat-producing counties in the nation suddenly withered. The 1930s were long, dry, dusty, and poor. Finally in 1938 the rains returned. After World War II, America was the world’s bread basket; prices and pro- ductivity returned, and Perryton again became a prosperous community.
Roy Sanford: the younger days. Roy Sanford was born in Topeka Kansas in 1918. His childhood before moving to Perryton was a troubled one. His mother suffered from psychi- atric problems (Steve suspects bipo- lar disorder), and his parents were divorced when Roy was only two years old. Not only was divorce a stigma in those days, but Roy and his older brother Herbert were “passed around” from relative to relative. Eventually, 20 PANHANDLE HEALTH FALL 2013 Roy’s father H.C. remarried (happily this time to Virginia) and reunited his family in Perryton. H.C. was a certified pharmacist and busy small-town entre- preneur who purchased the Corner Drug Store on Perryton’s main street and brought his talented son back to Perryton, partly to further his business interests.
As a student in Perryton, Roy Sanford’s personality and intellectual gifts began to carry him forward. He graduated from Perryton High School in 1934. Although undersized, he went out for the football team; in later years, Roy felt that football trauma may have contributed to the arthritis and back troubles that so plagued his middle and later years. He entered college at age 16! One spring break he came home for a visit and met future wife Queenie, who was working for H.C. at the Corner Drug store; they remained married for over 50 years. Roy rocketed through the University of Oklahoma, receiving an undergraduate degree in medicine and a medical school diploma by 1941. In those days, because of the height- ened need for physicians occasioned by World War II, you could get a medical degree in only 3 years. Roy completed a rotating internship at the highly- regarded Colorado General Hospital, intending to pursue an internal medi- cine residency.
Why Roy did not go on for further training is unclear. Instead of apply- ing for residency in medicine, Roy returned to his home town of Perryton to take up general practice. It may have been because of the dire short- age of small town doctors (many had joined the armed forces). Roy’s older brother Herbert had started a prac- tice in Perryton and may have needed backup. Or it may have been due to pressure from Roy’s father H.C., who had big plans for his son. By 1945 H.C. and Roy had partnered to build Sanford Hospital (today’s Ragsdale Building). H.C. moved his pharmacy into the new building. In the 1960’s they designed and built the Senior Village nursing home.
The Sanford Hospital served the needs of the Perryton community until a new hospital (which Roy was
| continued on page 22 FALL 2013 PANHANDLE HEALTH 21 also instrumental in designing) was bowel resections in the new hospital. nursing home patients before and after built in 1967. The surgery suite and a Steve recalls that Bluford developed a office hours. Vacations were infrequent few inpatient rooms occupied the 3rd mild resting tremor, which gave pause in the early days. Roy also worked hard floor of the Sanford Hospital; most of to some patients. However, when Dr. to keep up with medical advances. the inpatient rooms were on the sec- Johnson had a scalpel in his hand, the Both sons recall their father going to ond floor. The ground floor housed tremor abated, and his incisions were Continuing Medical Education courses H.C.’s pharmacy, the doctors’ offices, straight and true. in Boston; in the evenings he would waiting room and medical labora- “relax” with the New England Journal of tory; a cafeteria was in the basement. “Dr. Roy” later recruited Drs. Ansel Medicine. Sometimes the boys would Brother Herbert had inherited his McDowell, Gene Waide, and Claude accompany him on hospital rounds, mother’s emotional problems and Betty to join his clinic. Forty-five but he rarely discussed medical issues suffered from alcoholism; he soon years later, Dr. Betty still practices in at the dinner table. The family enjoyed moved away and eventually commit- Perryton and remembers Dr. Roy’s Sunday lunch at the Sanford Hospital ted suicide. Roy stayed and flourished, “brilliant mind” and his community cafeteria after church every week. becoming Perryton’s iconic practitio- service. Dr. Betty, Dr. Rick Siewert, Somehow Doctor Roy managed to make ner for nearly three decades. Dr. Tripps Childers, and Dr. Rex time for being a father. Scott remem- Mann have each served the patients in bers later family vacations to Colorado 30 years of medicine in Perryton Perryton for over 25 years. Dr. Jenny or Disneyland, and Sally recalls trips to An important characteristic of McGaughy has joined them after com- the Ford plant in Detroit or concert- medicine in Perryton has been a sta- pleting a family medicine residency going in Chicago. Steve remembers ble group of practitioners who have and an extra year of obstetric training. that Roy took time to teach him golf committed their careers to small town Few small towns in the Panhandle can (no football!). Although encouraged to practice. Roy Sanford and Dr. G.L. boast of such continuity of care. value education, neither son felt pres- Kengle helped carry on the tradition sured to enter the medical profession. of Drs. Brewer, May and Budd. Roy “Doctor Roy”: more than a doctor had begun practice with Dr. Kengle, Scott and Steve, as retired internists, Sally’s memories of her father but they had split up by 1945. Roy have particular insight into the life of a shed light on his remarkable range of recruited residency-trained surgeon small-town doctor. The main thing they interests and his astounding energy Dr. Bluford Johnson in the early recall is how hard Roy had to work. He in getting it all done. She remem- 1950s. Dr. Johnson performed hyster- had a full office practice, and tended bers him as a “renaissance man” who ectomies, cholecystectomies, and even to emergencies as well as hospital and was curious about a whole range of
SAVE THE DATE ATTENTION: POTTER RANDALL COUNTY MEDICAL SOCIETY MEMBERS AND ALLIANCE CHRISTMAS PARTY THURSDAY, DECEMBER 5TH
INVITATION TO FOLLOW
22 PANHANDLE HEALTH FALL 2013 topics—from religion (although a in a radiation oncology residency at alternative concepts. She now lives and staunch Methodist, he was curious Baylor in Houston. Roy hoped that a works in California. Younger son Steve about Eastern religion and loved more sedentary life would decrease his attended SMU, then Baylor College William James’ The Varieties of Religious chronic pain, but the pain continued; of Medicine. Steve did a residency in Experience) to art and music. He was a he returned briefly but unsuccessfully medicine at Baylor in Houston and vivid storyteller. As a game, he would to Perryton. The operations didn’t joined the faculty in the department ask Sally for a random image (i.e. a work, and “Dr. Roy” had to call it quits of community medicine until 1985, cigarette butt lying on the ground) in 1974 at age 56. when he and his family moved to and then entertain her with an entire Cleveland, OH. For many years, Steve “short story” based on that small ker- The specter of chronic pain contin- ran the 6000-member employee health nel. He was an assiduous reader. Steve ued to torment Roy Sanford in early service at the University Hospitals of recalls that his father read the entire retirement. He and Queenie retired Cleveland. He continued full time 11 volume Story of Civilization by Will to Colorado Springs, where Sally and occupational medicine practice in the and Ariel Durant. Like many small- her family, as well as several medical Cleveland area until his retirement in town bibliophiles (Ralph Randel of school buddies, lived. Further surger- 2010. After careers of service, all three Panhandle comes to mind), Roy par- ies were to no avail, but eventually children look to Roy Sanford as a role ticipated in a Great Books club, work- his doctors found a successful pain model and mentor. But Steve also saw ing his way through Mortimer Adler’s regimen, and Roy became comfort- the toll that full-time small town medi- Great Books of the Western World. Sally able enough to travel. Finally, Roy cine took on his “workaholic” father remembers him as always kind and and Queenie moved to Sun Lakes, and sought a practice that allowed him empathetic, never angry or resentful. Arizona. His health was frail (as often evenings and weekends to spend with She says that he “answered hardship happened after multiple surgeries in his family. with kindness” and that he “champi- those days, he had developed “post- oned the person he was with” regard- transfusion hepatitis”—i.e. hepatitis In short, Roy Sanford enjoyed less of their social or financial status. C) but at least his back was more com- the perquisites but bore the respon- He never complained about his super- fortable. Queenie spent her life caring sibilities of being Perryton’s favored human work schedule; Sally says that for Roy until his death in 1993. son. He returned to his home town he “willingly served.” at age 24 and established a standard- Roy Sanford served as an inspiration of-care practice there for 30 years, Despite a heavy burden on medi- for two sons, Scott and Steve, as well until the rigors of his work schedule cal practice, “Dr. Roy” found time for as daughter Sally. Both sons became and the erosion of time wrecked his community as well as family involve- internists. Scott attended Davidson health. He helped bring the scien- ment, serving both on the school College, then Baylor College of tific advances of post-WWII medicine board and the board at the United Medicine, and completed his medicine to small town Perryton and helped Methodist Church. He made time for residency at the prestigious University populate the town with a series of hunting, fishing and golf; he sang and of Colorado (where Roy had done his dedicated practitioners that extends played string bass in an award-winning internship). Scott served on the senior to this day. Claude Betty and (the now men’s quartet (led by funeral direc- staff at the Scott and White Clinic for 3 deceased) Gene Waide learned medi- tor Alton Boxwell, they were “The years before moving to Odessa, where cine at his feet, then passed the torch Four Hearsemen”). Queenie enjoyed he practiced for the next 32 years. He to committed physicians Rick Siewert, reading nearly as much as did Dr. has recently retired to Kerrville. Sally Tripps Childers, and Rex Mann. They Roy, but she had to cut her education graduated from Colorado College have provided the example for Jenny short after 2 years at the University and worked for many years as a non- McGaughy and future primary care of Oklahoma. She devoted her life to traditional healer; she always felt that physicians to follow. Who among us family and church work and in later her father gave her his full support, can claim a greater legacy? years to taking care of Roy as his even though her practice was based on health declined.
Later years and retirement Roy Sanford’s medical practice was cut short by health issues. Despite his still-remembered stature in Perryton, he practiced there only 30 years. He was beset by osteoarthritis of the knees and degenerative back prob- lems. Steve estimates that Roy had 8-10 spine operations in a vain attempt to relieve the pain; Sally says that he had 25 surgeries in all, including a coronary artery bypass. In the early 1970’s he turned his practice over to his younger associates and enrolled FALL 2013 PANHANDLE HEALTH 23
“Dr. Jack” Fox and “Dr. Mike” Henderson: Spanning 50 Years of Medicine in Childress
by Amy Kindle and John Henderson
DR. JACK FOX he found a colleague who could But doctors were scarce. Dr. Fox, Jack Fox had some big shoes to help. That’s the way things work Dr. Robert Butler and Dr. Jacobus fill. His father, Dr. Grover Fox, was in rural communities. And it wasn’t Westenburg, the only other doctors a beloved family doctor in Childress uncommon for his bill to be paid in town, couldn’t continue to take County for 50 years. with something other than money – care of everyone. And none of them chickens, livestock, vegetables and could be considered young. During When Jack graduated from home-baked desserts often became the next few years, other doctors Childress High School in 1934, currency. came to town but didn’t stay. he enrolled in premed at Texas Tech, then medical school at Dr. Jack eventually replaced his So the man everyone called “Dr. UTMB Galveston. In 1942 he was father as the beloved family doctor Jack” got busy. Working with the licensed by the Texas Board of of the community. He also emerged hospital district board of trustees, Medical Examiners and entered a as a community leader, particularly he went to New York City to meet surgical residency at the Cleveland as a visionary for the medical needs a young surgeon looking for an Clinic. World War II interrupted his of Childress. He mentored numerous opportunity. In 1974, Dr. Honorato residency, so he joined the Navy and students to become nurses, laboratory Olay moved to Childress and joined was sent to the European Theater technicians, radiology technicians the staff at Fox Clinic and Childress and later to Japan. After the war he and other healthcare professionals. General Hospital. Things were better, completed his residency as Chief The young people he encouraged but not good enough. And Dr. Butler Resident and became board certified helped staff Fox Clinic and the local had retired! in Pathology and General Surgery; he hospital for many years. was named a Fellow of the American Enter the self-appointed College of Surgeons in 1953. After THE CRISIS: Medical Action Crisis Committee, teaching anatomy & physiology at By 1970 Childress had a newly a group that recognized the need UT Medical School for a few years, constructed hospital sitting on a hill for additional, younger doctors. Dr. Fox moved his family home and at the western edge of town. The The committee included several joined his father’s practice where he building was beautiful, modern and graduates of Childress High School soon became known as “Dr. Jack.” held everything needed to provide who had moved away, completed medical care for this community of their education and returned to Even though he was a board 9,000 residents. Childress County Childress because they wanted to live certified general surgeon, he commissioners had won a hard and raise their families in the small- treated everyone in town anytime fought battle to create a hospital town, nurturing environment of their they were sick. It didn’t matter what district, pass a bond election and youth. Funds were raised to purchase the problem was, Dr. Jack knew build a facility to meet community the vacated Butler Clinic and to the answer. And if he wasn’t sure needs for years to come. furnish it with new equipment. Then the clinic was given to the hospital district for use as a recruiting tool. HEALTHY NOW HEALTHY FUTURE The crisis committee and the hospital I district teamed up to find a solution. Texas Medical Association Foundation* harnesses the DR. MIKE HENDERSON volunteer and philanthropic spirit of TMA and TMA During the same period, >ViÊiLiÀð another Childress native, Dr. Mike / ÊÃÕ««ÀÌÃÊiÞÊ i>Ì Ê«ÀÛiiÌÊÌ>ÌÛiÃÊvÊ Henderson, was completing his / Ê>`ÊÌ iÊv>ÞÊvÊi`ViÊÌ >ÌÊVÀi>ÌiÊ>Êi>Ì ÞÊ family practice residency at John ÜÊ>`Ê>Êi>Ì ÞÊÕÌÕÀiÊvÀÊ>Ê/iÝ>Ã°Ê Peter Smith Hospital in Fort Worth. Learn more at ÜÜÜ°Ì>v°À} or After high school graduation Mike V>Ênää®Ênnä£Îää]ÊiÝÌ°Ê£ÈÈ{° had entered Southwestern Oklahoma State University and earned a BS I/ ÊÃÊ>Êxä£ÊV®ÊήÊÀ}>â>ÌÊ>`ÊÞÕÀÊ}vÌÊÃÊÌ>Ý`i`ÕVÌLiÊÌÊÌ iÊvÕÊiÝÌiÌÊvÊÌ iÊ>Ü° in Pharmacy. But, inspired by his 26 PANHANDLE HEALTH FALL 2013 early mentors, Dr. H. R. Stevenson the philosophy that cooperation, not of Memphis, Dr. Walter Brooks of competition, gets the job done. TMA Practice E-Tips Quanah and Dr. Jack Fox, he entered medical school at the University of In April 2004 all Childress Texas Houston. After completing physicians moved into the current post graduate work in Ft. Worth, Dr. Fox Rural Health Clinic, named in Henderson chose to return to his home honor of the beloved family doctors town and become a country doctor. of years past. Other doctors have He moved his young family home to moved in, then out of Childress. Childress to open a rural practice. But for the doctors who remain, it is their common desire to provide Assisted by the hospital district, high quality care for neighbors and Family Clinic was opened in 1978, friends that keeps the local medical in the building purchased by the community strong. They exhibit Medical Action Crisis Committee. enduring commitment to the community and to their profession. Dr. Henderson has watched families created, protégés launch PAYING IT FORWARD a career, dried millions of tears, Drs. Olay, Henderson and Green Helps Your Practice provided hope when there wasn’t are now the mentors, guiding Run Right. any and given advice to thousands of and teaching younger physicians. people of all ages during the past 35 Through the years, Childress And It’s Free. years. He has delivered more than physicians have mentored numerous Twice a month, TMA Practice 2300 babies—that’s comparable to medical students during clinical E-Tips offers four brief, the population of many small Texas rotations at Fox Rural Health Clinic. practical tips for managing a towns—and now delivers second and Four of those students -- Dr. Craig medical practice in Texas. third generation babies. Darter, Dr. David Caldwell, Dr. Dondi Ridens and Dr. Dustin Pratt – Each issue gives you hands- Family members, colleagues, now practice alongside them at Fox on, use-it-now advice on friends, co-workers and his patients-- Clinic. And Dr. Steve Carter practices coding, billing, payment, especially his patients--all agree that it Emergency Medicine in the CRMC HIPAA compliance, office takes more than a medical degree to emergency room. policies and procedures, and be a successful physician. Those same practice marketing, along with people will tell you that what it really And finally, in December of 2007, useful links. takes is true dedication, faith in God more than thirty years after “Dr. Jack” and a compassionate, loving heart. took over the reins, the Childress How Do You Get E-Tips? Those are the attributes of Childress’ hospital retired the original bonded “Dr. Mike.” indebtedness. Today it remains debt- Have TMA Practice E-Tips free! delivered to your inbox by CHILDRESS’ MEDICAL logging in to www.texmed. COMMUNITY Rural communities across the org, and click on Subscriptions Like “Dr. Jack” before him, “Dr. panhandle, the state and the nation on the left. (It’s easy.) Mike” helped bridge the gap in struggle to provide access to health medical care in Childress. In 1979 care. The trend toward medical And while you’re there, you Dr. W. D. Green, a medical school specialization has compounded rural can sign up your office staff to colleague, joined Family Clinic. And challenges. It’s never just a single receive E-Tips, too. in 1980 they were joined by Dr. Jeff reason that enables one medical If you need help logging in, Jones, another colleague. Thanks to community to thrive while another contact TMA Knowledge the hospital district and the Medical falters, but the sustaining value Center at (800) 880-7955 or Action Crisis Committee, space was of family practice physicians who available and ready to be used. work hard to meet the need can’t [email protected]. be overstated in the Childress story. For 32 years physicians at both The hospital, the physicians and the clinics have worked together to community will continue working ensure the citizens of Childress had to provide quality health care in an access to quality healthcare. They isolated region of Texas – and all laid the foundation for the current parties believe the best days are still medical community, always guided by ahead. FALL 2013 PANHANDLE HEALTH 27
John Prendergast, DO: Panhandle’s “Dr. Jack”
by Steve Urban, M.D.
John Prendergast, D.O. ost communities in our area ing into what everybody called the Amarillo. An important early stal- Mremember an iconic doctor, “Old Folks’ Home.” It deteriorated wart of the medical community was almost always a general practitio- until it was evacuated and torn down; Dr. Orphus York, who practiced in ner or family physician, who lives in the Panhandle patients requiring hos- collective memory long after retirement. pitalization were sent out, usually to | continued on page 30 For Panhandle, TX that trailblazing physician was John Prendergast, D.O. (known to everybody young and old as “Dr. Jack”), who delivered care to the town from 1952 to 1985. When I came to Amarillo in 1981, my partners told me to expect referrals from Dr. Jack and to anticipate that the patients would always be thoughtfully evaluated. He would know their personal history by mem- ory: “When Dr. Jack says they’re sick, they’re SICK; it’s your job to find out why!” When Panhandle Health decided to honor practitioners from the surround- ing area, I knew that I wanted to write about Jack Prendergast. Fortunately, his widow Phyllis still lives in Panhandle, has an excellent memory and an excellent /,95(5409(5+(4+/,95 (ZZVJPH[L4LKPJHS+PYLJ[VY(ZZVJ scrapbook, and agreed to be interviewed for this article. Dr. Jack’s life was full and 4(9*09>054+4(9 eventful; he had the health and well- 469.(53,(24+24+ (ZZVJPH[L4LKPJHS+PYLJ[VY(ZZVJPH VY being of the citizens of Panhandle in his 4LKPJHS+PYLJ[VY[VY hands for 33 years. The purpose of this article is to recount that history for the readers of our journal. )90(5>,0:7O+4+)90(5>,0:7O 4+ Early medicine in Panhandle Texas (ZZVJPH[L4LKPJHS+PYLJ[VY(ZZVJPH[L4LKPJH J[VY Panhandle was founded in 1887 as +(55@40A,+( the county seat of newly-formed Carson 4(49,4 County. It soon became the terminus )LYLH]LTLU[:WPYP[\HS*HYL)LYLH]LT of the Southern Kansas Panhandle Railway (an offshoot of the Atchison, Topeka, and Santa Fe) but because the larger mainline Ft. Worth & Denver 96550,(;205: 96:,(55:40;/ 954:557* Railroad bypassed it, Panhandle lost 4:5*5:*/7595 out to Amarillo as a cattle shipping (KTPUPZ[YH[VY center. Ranching and harvesting buf- falo bones left from the 1870’s for fer- love tilizer were early “industries.” By 1900 /,3,54033,9 comfort the population was about 300, and two */7595 doctors were listed on the census rolls. +PYVM7YVMLZZPVUHS:LY]PJLZ respect By 1930, on the basis of dryland wheat farming and early interest in oil and gas, the population had risen to 2,035, which is about where it is today. (806) 356.0026 | 1.866.654.2941 | hospicesouthwest.com
A sanatorium (hospital) was con- structed early on, eventually evolv- FALL 2013 PANHANDLE HEALTH 29 Panhandle from 1908 until 1956 (1). Fortress” lasted from 7 to 10 hours, and Dr York started when calls were made on occasion they would fly 3 days in a by horseback in any sort of weather. He row! After the European missions had purchased his first automobile in 1916 been completed, Jack returned state- but had often to resort to his horse side until his honorable discharge after Tom over subsequent years because of V.J. Day. Phyllis remembers her depen- the poor condition of the county roads. dent’s stipend of $50/month while Smallpox was common in the early Jack was enlisted! days, and victims were quarantined in a “pest house” as long as they were still After the war, the GI Bill provided TMA’s new Internet- contagious. Until his retirement at age $90/month for Jack to attend osteo- 81, Dr York served as the Santa Fe doc- pathic school in Kansas City; despite based tool can help tor, treating everyone from migrant Phyllis’ additional salary, they couldn’t you be ready for the workers to moguls in his little office. afford an automobile and Jack had to walk to school. She recalls Jack’s 36 staggering number of Dr. Paul Roberts was another pio- hour shifts during his internship at the commercial insurance neer practitioner. Phyllis Prendergast now-defunct Lamb Hospital in Denver, recalls that Dr. Roberts, approach- Colo. and federal and state ing retirement in the early 1950’s, regulations that affect had engaged a young physician (Dr. Early years in Panhandle Hessey) as an associate. Soon there- Phyllis’ uncle was a physician in you and your patients. after, Dr. Hessey was killed in an auto Hedley and encouraged Jack to look accident after transporting a patient to for practice opportunities in this TMA’s Deadlines for Doctors Amarillo. Dr. Roberts continued in solo area. Jack and Phyllis, with two young gives you and your staff the big- picture view of upcoming state practice a few years before retiring; by sons, decided to move to Panhandle. and federal compliance timelines then, Dr. Jack had come to town. From the beginning, they loved the and key health policy issues that town (larger at least than Hedley!). impact Texas physicians. John Leo Prendergast Following World War II, many young The future Dr. Jack was born near Panhandle families had returned to When you log on to Ainsworth NE in 1920. Jack’s upbring- civilian life there and were engaged www.texmed.org/deadline, you ing was hard, as his family was aban- in businesses, farming, and ranching. can see at a glance: doned by his father and everybody Phyllis relates: “we were all starting a UÊ / iÊÀi}Õ>̽ÃÊ`iÌ>ÃÊ>`Ê had to work to keep food on the table. new phase of our lives and had much background information; Despite this, Jack was able to excel in in common; so we settled in Panhandle UÊ / iÊVÃiµÕiViÃÊvÊÌÊ school, where he met and courted for the next 33 years of Jack’s practice.” complying, penalties, and Phyllis. They were married in 1942 and The fact that Jack was trained in osteo- incentives; remained married for 57 years until pathic medicine caused some problems Jack’s death. They had 2 sons: Jim (now in the early days. Although now many UÊ / iÊiÝÌÊÃÌi«ÃÊÞÕÊii`ÊÌÊ an equine veterinarian) and George of our valued colleagues are DOs, in take to meet the compliance (who is in the oil and gas business). those days there was a sharp divide. date; and Osteopathic physicians could not admit UÊ ÜÊ/ ÊV>Ê i«ÊÞÕÊiiÌÊ Like many young men of his era, patients to many hospitals (this was the deadline. Jack served in World War II. He still the case when I came to Amarillo had taken private flying lessons and in 1981; we had separate DO and MD HIPAA … ICD-10 … wanted to be a pilot, but when he was hospitals). Dr. Witt operated an osteo- drafted in 1942 his depth perception pathic hospital in Groom (notice how Taxes … Coding … was wanting, and he was assigned as many small towns had their own phy- Meaningful Use … E-Rx … a radio operator to a B-17 squadron. sicians in those days!). Jack admit- Medicare … PQRS Phyllis remembers moving around the ted a few patients there, but the drive United States as Jack was trained for to Groom every day interfered with all jobs performed by the crew (e.g. his office practice, and so he referred gunnery), not just his primary job at most of his sicker patients to Amarillo. www.texmed.org/deadline the radio. Reading through his flight Phyllis remembers Drs. William (800) 880-7955 log with Phyllis was a fascinating expe- Klingensmith, Clay Dine, Earley Lokey, rience. Jack flew with his crew from Ralph Citron, and Jan Werner as linch- Rapid City SD to Newfoundland and pin consultants. A few patients refused then joined the 8th Air Force squadron to see an osteopathic physician, but in Glatton, England. From September community leaders such as Jim and 1944 to January 1945, Jack and his 9 Mogie McCray and Chock and JoBeth fellow crew members flew 35 missions Smith welcomed Jack with open arms; over Germany (and one over Metz, soon even the skeptics had been won France). The flights in the “Flying over by his care and expertise. Although obstetrics was an impor- in the early days, influenza always). tant part of the practice of many gen- Phyllis remembers that Jack had to eral practitioners in those days, Dr. withstand pressure from the formida- Why aren’t Jack only delivered 4 babies during ble Jo Randel when forced to cancel his 33 years. One woman (the wife of museum day because of a flu outbreak! an airman at Amarillo Air Force Base) He was chosen Panhandle’s outstand- you using insisted that Jack deliver her child. ing citizen in 1978, an honor he always When he told her that she needed to valued. Texas’ best find an obstetrician at the base hos- pital, she just waited until she was Retirement in labor and showed up at the office. Jack up and retired in 1985 and referral Jack rummaged up his OB pack, per- never looked back. He put a notice formed the delivery, and then rode in in the Panhandle newspaper, and the tool? the ambulance with mother and child townspeople respected his privacy. He to the AAFB Hospital. They continued loved the Panhandle Panthers and was to come to him for private care until able to attend the football games with- the family was transferred. out fearing that he’d have to set a bro- ken bone. Finally he could hunt and Small town practice play golf when he wanted to. Once, Being the sole practitioner in a on the golf course, he asked a former small town carries its own challenges. patient for a cigarette. “You told me to In the early days of his practice, quit, and I did!” the patient exclaimed. patients were few, but eventually Jack Unfortunately, Jack himself couldn’t would see 30-40 patients a day, 5 days break the cigarette habit from his Air a week (no appointments!). The office Force days. Emphysema took his life in was open until noon Saturday morn- 1999 at the age of 79. ings, and Jack often saw a few patients on Sunday mornings. Phyllis estimates Dr. Jack was an essential member that he would have to go back to the of the community of Panhandle from office 2 evenings a week. Phyllis was 1952 until his death in 1999. Phyllis office manager in the daytime and sub- recalls that Jack loved his work and stitute nurse after office hours or when his patients, and that he “seldom com- his nurse was on vacation. Patients in plained.” Noncompliance or relapse need of stitches would often ring the into alcoholism might occasion a shake front door bell. “They would just bleed of the head or a reprimand. Jack knew on my front porch,” sighs Phyllis. the limits of his expertise and was never afraid to refer or to get a second opin- A trip to the post office or the gro- ion. He gave a very few adjustments, cery store would bring numerous medi- performed no surgery, and only deliv- cal queries. Jack often said to his wife, ered babies in an emergency--but he “Phyl, I practice more medicine at the could listen, could hear the unstated as TMA Mobile post office than at my own office!” He well as the overt complaint, and could seldom took an official day off, saying give advice as authoritatively as he that the patients would just find him could write a prescription. When deliv- App anyway. In those days of switchboards, ering medical care, he provided care the telephone operators usually knew as well as medicine. Even now when a Now available for his whereabouts and would pass the citizen of Panhandle tells me about an iPhone/iPad, BlackBerry, information on. Like many practitio- important turning point for the better- and Android phones. ners, after being awakened by a phone ment of their health, they often remark call at night, he would sleep fitfully, “And then Dr. Jack said…” worrying about his patient; sometimes he would open the office after mid- References: night and see the patient, just so he (1) Randel JE, and the Carson County could get back to sleep. Historical Survey Committee, eds. Sponsored by: Free Benefit Texas Medical TMA Members On A Time to Purpose: A Chronicle of Association s ly Dr. Jack was the house physician Carson County. Pioneer Publishers Insurance Trust 24/ $IRECTORY !CCESS s ,IVE 5PDATES at St Anne’s Nursing Home for many (1966). (I appreciate the guidance and Texas Medical s %VENTS s .EWS !LERTS years, and I recall the excellent level of Ms. Louise Mulkey, Dr. York’s Liability Trust of care that these patients received. granddaughter, for helping me dis- Public health problems included bites cover this very interesting histori- from stray dogs and epidemics (polio cal document). Forty Years of Family Practice in Canyon: Dr. George Dudley Moore by Gary R. Moore
Dudley Moore, M.D. y father, Dr. George Dudley the coast of North Africa. His journey Great Depression. The Depression was MMoore, practiced family medi- to his medical profession, his career, awful and had a terrible effect on his cine in Canyon for 40 years and his life in retirement are filled father. Though they were never hun- before retiring in 1991. Dad really with stories of hard work, creative- gry, his father lost all his self respect. enjoyed his practice and witnessed ness, devotion to family, and service, He was a very academic man and many changes in medicine during and this article strives to share some once he didn’t have a job he didn’t this time. He helped deliver countless of that with you. have any money to do anything. It just new babies to life in the Panhandle. In wiped him out. Canyon you had to do just about every- My father was born on November thing, which he did. He also raised a 9th, 1919 in Gorgas, Alabama, which Dad soon moved to Crawfordsville, large family and taught us how to be isn’t too far from Birmingham. It was Indiana to live with his uncle who was respectful and good citizens of our a coal mining town, and they used a doctor. His parents sent him there community. the coal to run the generators at the to be cared for by his uncle until Alabama Power and Light Company. they could get their feet back on the Dad never did anything halfway. His family moved around quite a bit ground. In Crawfordsville, my dad was It was “full steam ahead” or noth- after he was born. His father was an introduced to music, which changed ing at all. Part of “The Greatest engineer and his mother was a home- his life. He had volunteered to be an Generation,” he served in the Army maker, and he had one younger usher for a band concert as there was but did not go to combat. He lost his brother. While living in Louisville his a band from Hobart, Indiana, directed brother, a bomber pilot, in WWII off father lost his job at the start of the by William Reveille. Dad said the con-
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32 PANHANDLE HEALTH FALL 2013 cert had such an impact on his life After finishing his surgical training His practice was all about doctor/ that he did not want to butt heads in a in Louisville in 1950, he started look- patient relationships, so he did home football uniform anymore. From that ing around for a place to practice. The calls until his very last day. moment on he became involved in Presbyterian minister that married my music, and for the next 70 years it was parents had accepted a call from the Dad recalled several close calls. a major part of his life. church in Canyon, Texas, to be their One was with a pregnant woman at minister. Dad asked him if there was the hospital; Dr. Bob Gross called and His uncle was also major influence a college and if there were Hereford asked Dad to help one night. He also on Dad’s life. Uncle George was a sur- cattle. He said ‘yes’ to both so Dad was called the anesthetist and the inhala- geon and also very active in the com- on his way to Canyon per his uncle’s tion therapist thinking there could munity. Uncle George gave Dad some guidelines. be a problem. The patient “was as advice: “When you are ready to start a white as a sheet,” Dad recalled, and practice, make sure your community In 1951 he started his practice in did not have a blood pressure. To has a college -a school of higher learn- Canyon and initially went into fam- take her from the bed and get her ing- because it is a good place to live ily practice with Dr. Robert Jarrett. into the operating room would have and you have nice people. And make Despite having satisfied all the require- taken a lot of time that they couldn’t sure you see Hereford cattle.” The sec- ments to become board certified in afford so Dad just reached up and ond thing he said was, “Remember you surgery, there was a restriction in place grabbed a sterile knife. He didn’t don’t own anybody.” A doctor never at that time that one could not be cer- have any gloves, he hadn’t washed “owns” a patient. It’s a big lesson. tified if you did more than five per- his hands, and didn’t have scrubs on. cent general practice, which is what he He made an incision right down the Dad attended Baylor University. wanted to do. So, he did orthopedic middle of her belly. The baby had After his second year he owed the and general surgery, as well as family ruptured the uterus, which was up school some money so he dropped practice. He did it all and enjoyed it under the liver. It took them 2.5 min- out for a year and worked on an iron and had enough training to allow him utes to get the baby out from the time ore ship on the Great Lakes where to do it well. Bob had hollered, “Knife!” The baby another uncle was a captain. Once was in terrible shape, but the inhala- day his cousin, Marty Andrews, and Dad felt he had a pleasant prac- tion therapist, Sappington, was great, Dad were working on a freighter tice. He liked his patients and his and went to work on her. He was “as together at the Soo Locks. They had patients liked him. He enjoyed folks. good as any big-shot anywhere,” said put ashore to handle the cables. As He didn’t just have patients. He had Dad. Meanwhile, Eddie Garner, the they were doing their work they had a friends who were his patients. The anesthetist, and Dad went to work on detailed discussion about the merits of people who worked for him were his the mother. Both Mother and Baby Mozart’s music compared to Chopin’s. friends, too. His nurses, lab techs and lived that night, and my Dad saw the As was common when the freighter receptionist had the best rapport with mother over the years and she even put ashore, several people gathered their patients. There were six people sent him a picture of the daughter on around to watch the activities and working together at one time: a book- her graduation. some of the people overheard their keeper, receptionist, two nurses, a lab discussion. He recalled that one man technician and my dad. One of the strangest patients for said, “you guys are ‘just sailors,’ aren’t my Dad was a prisoner from Dimmitt you?” They said, “We are sailors.” The The favorite part of his practice was who was brought into his office after fellow said, “It is so surprising to hear family practice because he got to know he had swallowed eight spoons. When you two talking with such knowledge people. He got to know his patients they took an x-ray he could clearly see about fine music.” They delighted in very well and they got to know him. He the eight spoons in his belly. Dad told telling them, (perhaps changing their enjoyed doing surgery, and he enjoyed the sheriff’s deputy to feed him a lot perceptions about ‘sailors,’) that Dad OB. When he delivered a baby, he of bread and bring him back tomor- was a pre-med student and Marty was a would take care of the mother and row for another x-ray. They followed law student! take care of the baby, and he did this that procedure until he had passed all for many families across the region. the spoons. The guards would bring When Dad was going to med school Before he knew it Dad could go out a spoon in with them and hold it up in the 1940’s he worked at Louisville and see babies by the hundreds that saying, “He passed another one.” They General Hospital, and polio had he had delivered. accounted for seven spoons. The pris- reared its ugly head. The hospital had oner came in one last day for his x-ray entire rooms filled with iron lungs. Dad made a lot of home calls while and the deputy made a mistake. He He never forgot the sound of the air practicing in Canyon. From the stand- failed to stay between the prisoner and compressing in those machines going point of a doctor/patient relationship, the door. “When we weren’t looking, “shhh…pssss…shhh…psss…..” It was it was very valuable, but from the doc- tough. tor’s standpoint, it was a waste of time. | continued on page 34 FALL 2013 PANHANDLE HEALTH 33 the prisoner bolted.” Dad heard the lifetime were antibiotics, cortisone, In retirement Dad enrolled at back door crash open. Dad, 60 years and the polio vaccine. In 1940-1941 WTAMU (then WTSU) and played the young, heard what was going on from you had sulfa drugs, and then later tuba in the concert band under the another room and took out after him came penicillin, which was significant direction of friend Dr. Gary Garner. He and caught him on the street. The because you could do operations and played in the band for many years. He sheriff’s deputy was right behind him have something to fight infection with. also formed a small group called the and, seeing what Dad was about to do Before penicillin, people might die Fabulous Five; they would play at area said, “Please don’t hurt him!” Dad had because they had peritonitis and there events, and all donations to the group the prisoner by the hair, but turned was nothing to treat it with. But sulfa went to the band scholarship fund at him over to the Deputy. and penicillin made a big difference. WT. Over time, the ‘Fab Five’ raised in Dad said he was fortunate that he had excess of $100,000. My father truly loved In the 40 years the he practiced antibiotics during his professional music and stayed active and involved medicine, he saw huge changes. His career in Canyon. Polio vaccines and until his death in January of 2007. practice got bigger. Doing family prac- other immunizations made a huge dif- tice he saw 60-80 patients per day, and ference. Dad used to see polio cases all His guiding principles were as fol- delivered about two babies a week or the time where the patient died. But, lows: If you have a job, do it: Patient a little over a hundred a year. He did with polio vaccines it was a different care is the first priority: Cleanliness surgery between three and five times story. Hence, there has not been an is important: Respect for the Flag is a week. He worked hard and, accord- iron lung in Canyon since 1955. important: Friends are important: ing to Dad, “had the best staff in the And, work is a pleasure. work.” Certainly, in surgery, there After he had been practicing medi- were lots of changes over the years. cine for 40 years, he decided that I want to acknowledge Jeanne They started doing laparoscopic sur- it was time to retire. He had seen so Archer as a major helper in this gery for things like tubal ligations and many changes and lived through all article. She wrote a book about my gall bladders. of them, including malpractice insur- father’s life and for a $20 donation to ance going from $2000 per year ini- the WTAMU Band scholarship fund I But, the three things that made tially to $5000 per month by the time will mail a copy to you. Please feel free the most difference in medicine in his he retired in 1991. to contact me at [email protected].
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34 PANHANDLE HEALTH FALL 2013 CASE CORNER by Roger Smalligan, M.D., Mohammed Al-Janabi, M.D., and Steve Urban, M.D.
alignancy is the second most supraclavicular area; the nodes were clavicular, axillary, retroperitoneal, and Mcommon cause of hypercalcemia, firm, non-tender, mobile but matted mesenteric regions, with splenomegaly. after primary hyperparathyroid- together, the largest being 1 cm in size. ism. Malignant hypercalcemia is due to Trachea was midline, thyroid normal, The patient was admitted and bone destruction from metastatic dis- no carotid bruits, normal JVP. Lungs: treated for hypercalcemia with IV nor- ease 20% of the time; in 80% of cases, clear bilaterally. Heart: no murmur, gal- mal saline. He received a blood transfu- however, it is humorally mediated. lop or rub. Abdomen: soft, nontender, sion for symptomatic anemia. General Humoral hypercalcemia of malignancy nondistended, no palpable liver or surgery was consulted and performed (HHM) is usually associated with exten- spleen. Digital rectal examination: no excisional biopsy of a left supraclavicu- sive, clinically-apparent disease and car- hemorrhoids, normal sphincter tone, lar lymph node. Pathological analysis ries a poor prognosis, but occasionally no masses, smooth prostate. Upper and revealed Hodgkin disease, nodular scle- hypercalcemia can be the presenting lower extremities: loss of muscle mass, rosis subtype. manifestation of malignancy, and its but normal joint mobility and periph- investigation can lead to a readily treat- eral pulses; mild ankle edema was pres- Discussion able diagnosis. We report a patient pre- ent bilaterally. On neuro exam, the Most lesions causing humoral hyper- senting with HHM who was found to patient was alert and oriented, without calcemia of malignancy are solid tumors have Hodgkin’s disease (HD). focal weakness. and are associated with the produc- tion of parathormone-related peptide A 54 year-old white male was referred Initial laboratory studies: CBC: WBC (PTHrP) by the tumor. (1) This sub- for admission from the primary care 5.3, Hgb 7.1, platelet count 270,000. stance, although produced by a gene on clinic because of progressive fatigue and MCV 83, MCH 26, RDW 26, differential: a different chromosome than parathor- abnormal laboratory results. The fatigue N 64%, L 25%, M 9%. PT 14.5, INR 1.4, mone, has N-terminal homology with had started 3 months before, but had PTT 36.6. Glucose 74, Na 144, K 3.5, Cl PTH and can activate the PTH receptor worsened 2 weeks prior to admission. 99, bicarbonate 34, BUN 18, creatinine in bone and kidney, leading to hypercal- The patient reported weight loss of 0.8, Ca 13.8 (8.5-10.2), Mg 2.0, phos- cemia. Since PTHrP is involved in fetal about 30 lbs over this 3 month period; phorus 4.2, total protein 6.2, albumin squamous differentiation (and is there- family and co-workers had noticed that 2.3, AST 23, ALT 12, ALP 103, total bili- fore one of the “oncofetal” peptides), he looked ill and pale. On review of sys- rubin 0.6. FOBT: negative. squamous cell carcinomas are common tems he mentioned night sweats with- causes of HHM. Any cancer can give out fever and more recent development On admission, further studies were rise to this syndrome, but squamous cell obtained: transferrin 185 (215-365), carcinomas of the lung, head and neck, of lower limb edema. Constipation ferritin 1090 (30-300), iron 102 (48- cervix and skin are the most common. had developed, but the patient denied 182), TIBC 276 (261-478), folate 10 anorexia, dyspnea, chest pain, itching or (3.4-19.4), Vitamin B12 944 (180-914), Hematological malignancies are skin rash. Past medical history revealed PTH 1 (12-89), 1,25, dihydroxyvita- relatively rare causes of HHM. The chronic back pain, without recent min D 68 (15-75), 25-OH Vitamin D 13 commonest hematological cause of change, and was otherwise negative. He (ideal >30), ESR 46. CT scan of chest/ hypercalcemia is multiple myeloma was taking no medications. Family his- abdomen/pelvis revealed extensive (MM), which causes elevated calcium tory was negative for cancer and other- lymphadenopathy involving the supra- wise unremarkable. He lived in Amarillo | continued on page 36 with his wife, had finished high school, and was employed as a construction (ELP A MINORITY STUDENT FULFILL THE DREAM TO JOIN THE FIELD OF MEDICINE #ONTRIBUTE worker. He had smoked tobacco since TO SCHOLARSHIPS FOR QUALIFIED UNDER he was a teenager, recently cutting REPRESENTED MINORITIES ACCEPTED TO 4EXAS down to less than half a pack/day. He MEDICAL SCHOOLS $ONATIONS TO 4-! &OUNDATION ARE TAX DEDUCTIBLE TO THE FULL denied recent alcohol or illicit drug use. 3HARE EXTENT PERMITTED BY LAW &OR MORE INFORMATION ABOUT DONATING Physical examination revealed vital CALL EXT OR OR SEND AN E MAIL signs: BP 110/70, HR 80 and regular, TO LISAWALSH TEXMEDORG RR 18, oxygen saturation 92% on room THE H air, T 98.5F. The patient was thinly built, and looked pale, but was in no acute distress. Neck: palpable lymph $REAAM nodes in the left anterior cervical tri- 'IVE TO THE 4-! -INORITY 3CHOLARSHIP 0ROGRAM TODAY angle, left submandibular area and left FALL 2013 PANHANDLE HEALTH 35 levels approximately 30% of the time. patients with acute ATLL present with to expression by the tumor cells of the Usually, however, the hypercalcemia hypercalcemia. Derepression of the 1-hydoxylase enzyme that activates the of MM is associated with focal osteo- PTHrP gene has been found to be the circulating form of Vitamin D (25-OH lytic lesions rather than HHM. Another cause in some cases. cholecalciferol). Hence B cell lympho- hematological cause of hypercalcemia mas cause hypercalcemia by a Vitamin-D is Adult T-cell Leukemia-Lymphoma Most lymphomas causing hyper- dependent mechanism, rather than by (ATLL). Although relatively rare in calcemia are B-cell neoplasms. Most a parathormone or PTHrP-mediated the United States, it is a common cause of the reported cases involve large- mechanism. This is similar to the hyper- worldwide because of its association cell variants, including some cases of calcemia seen with sarcoidosis or other with the “original” retrovirus, HTLV-1, splenic lymphomas, mantle cell lym- granulomatous diseases, where increased which is seen in the Caribbean, West phomas, and Burkitt’s lymphomas. In 1–hydroxylase activity is also the cause. Africa and parts of Asia. Over 50% of these cases the hypercalcemia is due Hodgkins disease has rarely been reported as a cause of humoral hyper- calcemia of malignancy, and studies of the pathogenesis of the hypercalcemia in these few cases are rarer still. (2,3) The suppressed PTH level and the high 1,25 OH Vitamin D levels in our case suggest that aberrant activation of 1 hydroxylase is a cause in our patient, as it is in patients with other B-cell lymphomas.
This case demonstrates that, 3501 Soncy, #118 although it is a rare manifestation, hypercalcemia can be seen in highly treatable cancers like Hodgkin’s lym- (806) 359-7999 phoma. Studies of parathormone lev- els, Vitamin D metabolites, and PTHrP serum levels help focus the work-up. Excisional biopsy (rather than fine-nee- Now Accepting: dle aspiration) is usually necessary to make a definitive diagnosis. After initial City of Amarillo Healthplan medical management of the hypercalce- mia, prompt institution of combination United Healthcare chemotherapy and/or radiation therapy after staging in these patients can be Firstcare HMO & PPO lifesaving.
HealthSmart References: 1. Clines GA. Mechanisms and treat- Alliance Regional Network ment of hypercalcemia of malig- Aetna nancy. Curr Opin Endo Diab Obes. 2011; 18: 339-346. CIGNA 2. Chevalier N, Udi J, Sigler M et al. Interplay of parathormone-related Medicare peptide (PTHrP), renal insufficiency and bulky disease in the pathogen- Medicaid esis of hypercalcemia in Hodgkin’s lymphoma (HL). Eur J Haemat. :RUNHU·V&RPS 2010; 85: 368-369. 3. Mercier RJ, Thompson JM, Harman …and many other insurances GS, Messerschmidt GL. Recurrent hypercalcemia and elevated 1,25-dihydroxyvitamin D levels in Hodgkin’s disease. Am J Med. 1988; 84: 165-168. 36 PANHANDLE HEALTH FALL 2013 PHARMACY CORNER Panhandle Drug Store: Over 60 years of continuity by Mark Land, PharmD and Callie Land, BSN
nly a handful of faces have in 1994, and from Texas Tech School Automated telephone services found Oappeared behind the counter at of Pharmacy in 2001. He worked at the at larger pharmacies and mail order the Pharmacy in Panhandle, Texas VA Hospital pharmacy for 7 years—but companies can discourage patients who over the past century, but one thing when the opportunity arose to return are seeking information or counsel- has remained the same—great unique to Panhandle with his family, he looked ing. Many of these patients do call or hometown service. Whichever pharma- forward to providing pharmacy services come in the Drug Store to ask questions cist owned and worked at the store, you in the hometown he grew up in. because they can talk to a person face to could expect them to know your name, face regarding questions or concerns. your family and lots of other details and The service that you receive at this history that one would only know in a small, rural, independent pharmacy is One negative aspect for small rural, small town. a unique experience that differs from independent pharmacies is pricing. Due any large chain. Many customers have to the volume, big chain pharmacies Prior to 1950, Doc Ferrell ran Ferrell voiced that the experience they have can buy their drugs at a bigger discount, Pharmacy at 218 Main. The phar- at the Panhandle Drug Store is faster giving them pricing advantages. Most macy was a full service drug store that than a larger chain pharmacy. You can independent pharmacists are aware of included a soda fountain. Doc and his walk in for refills or new prescriptions the pricing incentives at larger pharma- wife ran the pharmacy and fountain, and leave within 5 to 10 minutes. The cies, but small independent pharmacies serving the people of Panhandle for service is kinder and more personal. do price competitively also. It is impor- years. The actual year of the pharmacy’s Mark’s business cards have his cell tant to talk with your pharmacist regard- inception is lost in history. phone number so patients can contact ing pricing if you currently are using a him after hours or on weekends. When bigger chain or mail order pharmacy In November 1975, Harry Vance, a patient gets discharged from a hos- and are considering switching phar- pharmacist, and wife bought the busi- pital or visits an urgent care center in macy providers. Mark is very conscien- ness and renamed it H & J Vance the evening or on the weekend, it is not tious of brand versus generic pricing for Pharmacy. Harry continued business unusual for them to call because they his customers and preferred products as usual until November 1994 when fear having to wait 1-2 hours to get their that local employer’s pharmacy ben- he sold the pharmacy to Dick Conrad. new medications filled at a larger phar- efits cover at a better rate. Many times, Dick Conrad ran the business at 218 macy in Amarillo before driving home. Mark will have already called a provider Main until 1998 when he moved the and discussed changing a prescription pharmacy to 201 Main Street, where Mark and his pharmacy staff have with them before a customer picks up it is currently located on the corner of been known to make deliveries or house the prescription. Having a prescrip- Main Street and Highway 207. Dick had calls under certain circumstances. tion changed to a preferred medication outgrown the small pharmacy area and They provide consultations—teaching and/or generic can have huge financial needed more room for his expanding someone how to use their inhalers or impacts for patients. business. When the pharmacy moved, blood sugar meters, going over medi- Dick also moved the marble bar and cations with family members or deliv- It is important to note that many soda fountain where it still stands today ering to someone who is homebound. larger towns such as Amarillo have sev- providing sodas, cherry limes and milk Panhandle Drug Store delivers to cus- eral, smaller independent pharmacies shakes for the town of Panhandle. It tomers in Groom every Wednesday. that offer the same (sometimes more) has been a favorite to everyone over the That was started by the previous owner unique services. “Mom and Pop” phar- years! After school the kids in town can Dick Conrad, who was a Groom native, macies still exist today!! In Panhandle, be found walking to the pharmacy for and continues today. The Drug Store however, no matter what the phar- a snack; it is always a nostalgic stop for also delivers to a handful of hospice macy is named, the personal service people returning to Panhandle. patients in the areas around Panhandle. you receive will be outstanding. Like any small business owner—you own it, Since May 2008, Mark Land has One other benefit to using a rural, you work it, you love it and you are very been the current owner and pharmacist independent pharmacy is that you can proud of the service that you offer. That for the Panhandle Drug Store. Mark’s always talk to a person when calling on is what patients have been able to find family moved to Panhandle in 1978; he the phone and can walk in for prompt for over 60 years at the Panhandle Drug graduated from Panhandle High School counseling when you have a question. Store. FALL 2013 PANHANDLE HEALTH 37 HEALTH NEWS by Tarek Naguib, M.D., M.B.A., F.A.C.P.
USPSTF Recommends HIV preventing the state from expanding screening. Infectious Disease New Avian Influenza A (H7N9). Medicaid under the Affordable Care News (May) reported that the US Infectious Disease News (May) Act, taking away authority from the Preventive Services Task Force now reported new cases of (H7N9) that head of the state’s Health and Human recommends population-wide HIV involves mostly adults in contrast with Services Commission to negotiate screening due to substantial benefit the old avian influenza (H5N1) that expanding Medicaid coverage with derived from early treatment. affected mainly children. The first the federal government, for up to cases were recorded in China. Thirty 1.5 million low-income uninsured Every Other Year Mammography one died out of 130 cases, so far. Texans. Reduces Cancer. JAMA’s Daily News Site (5/15) reported that women Novel Coronavirus. Infectious Five States Opt out Despite Popular aged 50-74 years at high risk for breast Disease News (May) reported another Sentiment. ACP Daily Digest (5/22) cancer who had mammography every coronavirus causing severe acute reported that a new poll, out of other year did as well as comparable respiratory illness (SARI) similar to the Joint Center for Political and women who had it annually. This the previously reported (SARS) in Economic Studies, found that 62 does not apply to women under age 2002. First cases were reported in percent of people in Alabama, 50. Saudi Arabia. Georgia, Louisiana, Mississippi, and South Carolina support expansion of Radioactive Microbes Nuke Tumor North Korean TB. Science (4/26) Medicaid under the Affordable Care Cells. Science (4/26) reported that reported that North Korea has one Act. Yet, all five of these states have injecting weakened radioactive- of the highest TB rates outside sub- opted out of expansion. tagged bacteria (Listeria monocytogenes) Saharan Africa, and a burgeoning into blood of advanced pancreatic drug-resistance problem. A rare Charge Master Staying. ACPE cancer patients has resulted in the cooperation between the US and Daily Digest (5/14), quoting The bacteria invading the cells of the North Korea is in progress hoping to Huffington Post, reported that, tumor and shrinking it by 64%. control this global infectious threat. despite disclosure of ”wildly varying” hospital price disparities by the Unhealthy Lifetyle Doubles Coronary Dengue Highly Prevalent. JAMA Centers for Medicare and Medicaid Disease. ASN Kidney Daily (5/15) (5/15) reported that 390 million Services, the system seems “unlikely” reported that the ten-year incidence people worldwide each year become to change any time soon. The price of coronary artery disease for those infected by dengue virus, 3 times list is called the “charge master” and with an unhealthy lifestyle, versus as much as was thought earlier. Of is applied to patients without health those with a healthy lifestyle, was 30.6 note, south Texas has seen sporadic insurance. versus 12.0 per 1000. The study of dengue hemorrhagic fever outbreaks 102,128 adults was published in the in the past due to the presence of Amarillo Helium. Science (5/3) Canadian Medical Association Journal. the mosquito that transmits the reports that US reserves of helium, potentially fatal virus. stored near Amarillo, Texas, supply Hypertension Increasing among US 42% of US and 35% of global Adults. JAMA (5/15) reflected the New Mosquito Control Strategy. demand. A House bill was passed to CDC report of statistically significant JAMA (5/15) reported that traps regulate the sale of helium until it increase in self-reported hypertension designed to capture Aedes mosquitos, drops to a certain level, after which it and intake of antihypertensive which transmit dengue fever, were will be reserved only for federal use. medications. The increase was noted placed at 300-m intervals in 21 cities Helium is used to run MRI machines, in almost all states. over 2 years in Brazil. Over 27,000 manufacture optical fibers and cool cases of dengue fever were prevented samples to near absolute zero. High Lead Levels in US Children. in Brazil during this period. The JAMA (5/15) reported that over method was reported to be more Amarillo Infections. The City of 500,000 US children, or 2.6%, effective than the conventional Amarillo Health Department (May) between ages of 1 and 5 years, have methods that include targeting larvae reported a significant decline of higher than acceptable blood lead and spraying. salmonella and shigella enteric levels. Black children were highest infections in 2012 compared to affected, then whites, then Hispanics. Texas House Rejects Medicaid the year before. The news was well Of note, Texas soil has increased lead Expansion. ACP Daily Digest (5/22) received after Amarillo’s prolonged levels in areas near old smelters. reported the passage of a House bill flu season.
38 PANHANDLE HEALTH FALL 2013 PATIENT EDUCATION
Influenza Infection (The Flu) What is influenza infection? Severe cases of influenza infection Take the flu vaccine Influenza is a disease that is charac- Severe debilitating pneumonia may The flu vaccine is mandatory for terized by fever, headache, congestion, develop because the virus has weak- everyone beginning in October of cough, and muscle pains. It affects ened the lung defenses, causing an every year. Public health authorities humans and other animals like birds added bacterial superinfection. Rarely, work on a continuous basis to predict and pigs. Many cases are mild while severe weakness and paralysis, called the best vaccine combination for the others are severe. Rarely, the severity Guillain-Barre syndrome (GBS), may season. Anyone older than 6 months may be enough to cause death. develop causing respiratory failure. should get vaccinated, especially older patients, pregnant women, and per- How do I suspect influenza infection? How do doctors treat influenza sons with chronic disease. The vaccine Influenza infection is suspected infection? shot is made of killed viruses. It cannot whenever there is fever, headache, con- There is specific treatment for the cause the flu. However, it may cause gestion, cough, and muscle pains in influenza virus. Oseltamivir is an oral an allergic reaction, especially to per- the setting where other cases are docu- agent that is effective against influenza. sons who are allergic to eggs or had a mented and in the appropriate season Amantadine is an older agent that previous reaction to the shot. Another (late fall through the winter). The flu has less utility. In addition, supportive form of the influenza vaccine is given season is generally preceded by that of treatment is important to provide flu- as a nasal spray. This has live attenu- the west Nile virus and followed by that ids and nutrients. Mechanical ventila- ated viruses that do not cause the flu. of the RSV virus with some overlap. tion is used for respiratory failure in It is reserved for healthy persons age 2 severe cases and plasma exchange is through 49 years. How to diagnose influenza infection? done in cases of GBS. A diagnosis of a suspected case in Prepared by Tarek Naguib, M.D., the appropriate setting, as outlined How can I avoid influenza infection? M.B.A., F.A.C.P. above, could be confirmed by the rapid Respiratory droplets carrying the flu test that is performed on nasopha- virus should be avoided. Avoid expo- This page is dedicated solely for ryngeal secretions. sure to persons with respiratory infec- the purpose of patient education. tion, especially in closed places like Physician offices may reproduce this What is the cause of influenza urgent care waiting rooms. page and distribute it for this purpose infection? without permission. The cause of influenza infection is What is the difference between com- a virus that spreads from humans or mon cold and the flu? As this page is provided for educa- infected animals to humans via drop- Common cold usually causes milder tional purposes only it shall not be con- let transmission. The droplets are dis- upper respiratory symptoms like con- strued by any means to replace actual charged in the air when coughing or gestion, sneezing, headache, and physician’s management. sneezing takes place. Droplets travel in cough. When fever and severe muscle the air for a distance of few to several aches develop, the likelihood becomes Sources reviewed: The United feet. When the exposed person inhales high that we are actually dealing with States Centers for Disease Control & the contaminated air, he becomes the flu. Prevention website infected.
Have a Heart for Physicians As physicians, you know the greatest calling in life is to help those in need. The PHR Assistance Fund of Texas Medical Association does just that. The fund provides loans for medical and/or rehabilitative services for impaired physicians. Please help physicians who are in recovery and need financial assistance. We rely on donations to help us continue this important work. Send your heartfelt donations to the PHR Assistance Fund at 401 West 15th A statewide fund-raising campaign for the Street, Austin, TX 78701-1680. Or call Linda Kuhn at TMA at Physician Health and Rehabilitation Assistance Fund (800) 880-1300, ext. 1342, or (512) 370-1342 for information.
FALL 2013 PANHANDLE HEALTH 39 Yes, I Would Like To Contribute To The Potter-Randall County Medical Society Education Fund The education fund was established in 1981 to promote the advancement of general education in medical science in Potter and Randall counties through discussion groups, forums, panel lectures, and similar programs. It is the hope of the society that, through the education fund, the work of our physicians will be continued by increased public awareness and understanding of the advances in medical science. We are happy to accept memorials and/or honorariums. Notification of gift is sent immediately. Amount remains confidential. Your contribution is tax deductible. Please make checks payable to Potter-Randall County Medical Society, and send to PRCMS, 1721 Hagy, Amarillo, Texas 79106. Enclosed is my contribution of $ ______Print Name ______Address ______City ______State ______Zip ______My gift is in memory of ______My gift is in honor of ______Please send acknowledgement of this gift to: Name ______Address ______City ______State ______Zip ______
Are you accepting new patients? Looking to enlarge your practice? ENROLL IN THE PRCMS REFERRAL SERVICE! PRCMS receives calls each day from patients looking for a physician who: 1. Accepts new patients 4. Accepts their insurance 2. Is near their home or office 5. Speaks a second language 3. Performs a certain procedure 6. Accepts medicare or medicaid Call the Potter-Randall County Medical Society at 355-6854 for more information and the referral service. Remember the referral service is voluntary, and is free of charge to the physician and the patient.
40 PANHANDLE HEALTH FALL 2013 PROFESSIONAL CARDS
Cardiology Hospice/Palliative Internal Medicine Medicine AMARILLO DIAGNOSTIC (cont.) AMARILLO HEART GROUP Neurology Joaquin Martinez-Arraras, M.D. ODYSSEY HOSPICE Dr. Mark Drew Douglas Lewis, D.O. Marc Moreau, M.D. Board Certified in Sean Milligan, M.D. Prakash K. Desai, M.D. Hospice & Palliative Care Nuclear Medicine Jon Luigi Haddad, M.D. 6900 I-40 West, Suite 150 Bill F. Byrd, M.D. Robert E. Jackson, III, M.D. Amarillo, TX 79106 Pulmonary Diseases D. Gary Soya, M.D. 806-372-7696 (ofc) Bruce Baker, M.D. Agustin Cabrera-Santamaria, M.D. 800-572-6365 (toll free) 806-372-2825 (Fax) Timothy S. Mooring, M.D., D, ABIM Ismaile S.H. Abdalla, M.D. www.odsyhealth.com Gary R. Polk, M.D., D, ABSM Ernesto Rivera, M.D. ______Rheumatology Arunava D. Ray, M.D. Ming Chen, M.D., Ph.D A. Alan Chu, M.D. HOSPICE CARE OF THE Janet M. Schwartzenberg, M.D. SOUTHWEST Rajesh Nambiar, M.D. Sleep Disorders 6600 Killgore Drive, Suite 110 1901 Port Lane Amarillo, TX 79106 Timothy S. Mooring, M.D., D, ABIM Amarillo, TX 79106-2430 Morgan Leak, M.D. Gary R. Polk, M.D., D, ABSM (806) 358-4596 • 1-800-355-5858 Medical Director Physician Extenders www.amarilloheartgroup.com Brian Weis, Ph.D., M.D. Tommie Buchanan, FNP-C Associate Medical Director William A. Ledford, RN, FNP-C Cardiovascular & Marc Irwin, M.D. Albert Lusby, FNP-C Associate Medical Director Teresa Pattison-Thomas, P.A.-C Thoracic Surgery Hernan Miranda, M.D. Freida Toler, FNP-C Associate Medical Director Masoud A. AlZeerah, M.D., F.R.C.S.C. (806) 356-0026 (Office) (866) 654-2941 (Toll Free) Neurosurgery Radiofrequency ablation for (806) 358-3114 (Fax) varicose veins & spider veins www.hospicesouthwest.com Jeffrey D. Cone, M.D., F.A.C.S. 1301 S. Coulter, Suite 103 Neurological & Spinal Surgery Amarillo, TX 79106 Internal Medicine Board Certified - American Board of Specialization (806) 463-1712 • Fax (806) 463-1715 Ruth Pilco-Jaber, M.D. 6822 Plum Creek Drive www.amarilloveins.com Board Certified in Internal Medicine Amarillo, TX 79124 3501 Soncy Road, Suite 131 (806) 373-3177 • Fax: (806) 373-0423 Amarillo, TX 79119 ______Dermatology (806) 467-9111 • Fax (806) 467-9333 ______Bret D. Errington, M.D. HIGH PLAINS DERMATOLOGY Board Certified by the American Board CENTER, P.A. Mouin M. Jaber, M.D. of Neurological Surgery - Cranial and Randal E. Posey, M.D. Board Certified in Internal Medicine Spinal Neurosurgery Turner Caldwell III, M.D. 3504 N.E. 24th 7120 W. 9th Larry C. Roberts, M.D. Amarillo, TX 79107 Amarillo, TX 79106 Scott D. Miller, M.D. (806) 381-1732 • Fax (806) 381-0748 (806) 463-2251 • Fax: (806) 463-2252 4302 Wolflin Ave. ______Near I-40 & Western J. Brett Gentry, M.D. 355-9866 AMARILLO DIAGNOSTIC CLINIC ______6700 W. Ninth Neurological & Spinal Surgery Amarillo, TX 79106 Board Certified - American Board William R. East, M.D. (806) 358-0200 of Neurological Surgery 5211 W. 9th • Amarillo, TX 79106 Endocrinology Wayne S. Paullus, M.D. (806) 355-7421 Susan T. Wingo, M.D. Neurological & Spinal Surgery Gastroenterology Hearing Daniel A. Beggs, M.D. Board Certified - American Board R. Todd Ellington, M.D of Neurological Surgery Jake C. Lennard, JR., M.D. PHYSICIANS HEARING CENTER James E. Lusby, M.D. Wayne “CP” Paullus III, M.D. Royce A. Armstrong, Au.D., CCC-A Thomas L. Johnson, M.D. Neurological & Spinal Surgery Taylor W. King, Au.D., CCC-A Infectious Disease #11 Medical Drive 3501 S. Soncy Road #140 J. Taylor Carlisle, M.D. Amarillo, TX 79106 Amarillo, TX Internal Medicine (806) 353-6400 • (800) 358-2662 Holly Mitchell, M.D. (806) 352-6901 • Fax (806) 352-2245 Joanna Wilson, D.O. www.swneuro.com PROFESSIONAL CARDS
Obstetrics & Obstetrics & Ophthalmology Gynecology Gynecology PANHANDLE EYE GROUP (cont.) TTUHSC (cont.) PANHANDLE OBSTETRICS C. Alan McCarty, M.D. & GYNECOLOGY Chad Winchester, MSN, WHNP Comprehensive Ophthalmology, Dudley E. Freeman, M.D. Diana R. Parker, RNC, WHNP Cataract Surgery Gregory A. May, M.D. GYNECOLOGIC SURGERY 7411 Wallace Blvd. Cullen Hopkins, M.D. Hena Tewari, M.D. Amarillo, TX 79106 George Barnett, M.D. Teresa E. Baker, M.D. (806) 351-1177 • (800) 6393 Sarah Bergeron, RNC, WHNP Paul E. Tullar, M.D. W. John W. Murrell, M.D. Brenna Payne, RNC, WHNP Robert P. Kauffman, M.D. Comprehensive Ophthalmology, 7620 Wallace Blvd. Beverly E. Gerard, M.D. Cataract & Oculoplastic MENOPAUSAL MANAGEMENT Amarillo, TX 79124 Reconstructive Eyelid Surgery (806) 359-5468 • Fax (806) 358-1162 Robert P. Kauffman, M.D. 7411 Wallace Blvd. ______Beverly E. Gerard, M.D. Amarillo, TX 79106 REPRODUCTIVE MEDICINE & INFERTILITY (806) 351-1177 • (800) 782-6393 PEDIATRIC GYNECOLOGY WOMEN’S HEALTHCARE J. Avery Rush, M.D. GYNECOLOGIC ULTRASOUND ASSOCIATES, P.L.L.C. Cataract & Refractive Surgery Robert P. Kauffman, M.D. Carin C. Appel, M.D. Sloan W. Rush, M.D. URODYNAMIC TESTING & Rhodesia A. Castillo, M.D. Cornea, Cataract & Refractive Surgery INCONTINENCE MANAGEMENT Pamela A. Chandler, M.D. 7308 Fleming Ave. Paul E. Tullar, M.D. David L. Chastain, M.D. Amarillo, TX 79106 MATERNAL FETAL MEDICINE Brian J. Eades, M.D. (806) 353-0125 • (800) 225-3937 OBSTETRIC ULTRASOUND Ann E. Harral, M.D. Bruce L. Weinberger, M.D. Heather J. Holmes, M.D. Clyde A. Meeks, M.D. www.ttuhsc.edu/amarillo/ Comprehensive Ophthalmology, Amanda Murdock, M.D. patient/obgyn/ultrasound Cataract & Refractive Surgery Stephanie Crockett, MSN, RN, FNP, BC GENETICS 700 Quail Creek Dr. Kati Howard, MSN, CFNP Golder N. Wilson, M.D. Amarillo, TX 79124 1301 Coulter, Suite 300 (806) 353-6691 • (800) 637-2287 GENETIC COUNSELING Amarillo, TX 79106 J. Edward Ysasaga, M.D. Shirley Karr, MSN (806) 355-6330 • Fax (806) 351-0950 Antonio V. Aragon, II, M.D. PSYCHOLOGY whaonline.net Ryan Rush, M.D. Dayna Schertler, LCSW ______Diseases & Surgery of the Retina, Vitreous, & Macula J.M. Anderson, Jr., M.D. Ophthalmology 7411 Wallace Blvd. Dana Peterson, APRN, WHNP Amarillo, TX 79106 1500 S. Coulter, Ste. 2 PANHANDLE EYE GROUP, L.L.P. (806) 351-1870 • (888) 404-1870 Amarillo, TX 79106 Specializing in the Diseases (806) 463-5635 • Fax (806) 463-2202 & Surgery of the Eye ______www.paneye.com Oncology Amber Dobler-Dixon, M.D. HARRINGTON PHYSICIANS, INC. TEXAS TECH UNIVERSITY Glaucoma Laser & Surgery Power of ONE HEALTH SCIENCES CENTER AMARILLO: 7411 Wallace Blvd. MEDICAL ONCOLOGY DEPARTMENT OF (806) 350-1100 • (866) 567-0948 Robert E. Gerald, M.D. Brian Pruitt, M.D. OBSTETRICS AND GYNECOLOGY Comprehensive Ophthalmology, Sachin Agarwal, M.D. Amarillo Campus Cataract & Refractive Surgery MEDICAL ONCOLOGY/HEMATOLOGY 1400 Coulter • 354-5650 7308 Fleming Ave. Stewart Sharp, M.D. www.ttuhsc.edu/amarillo/som/ob Amarillo, TX 79106 Suhasini Nadesan, M.D. OBSTETRICS & GYNECOLOGY (806) 359-7603 • (800) 283-8018 Anita Ravipati, M.D. John W. Klein, M.D. Hena Tewari, M.D. Harrington Cancer Center Teresa E. Baker, M.D. Comprehensive Ophthalmology, Cataract Surgery 1500 Wallace Blvd., Paul E.Tullar, M.D. 13 Care Circle Amarillo, TX 79106 Usha Sethi, M.D. Amarillo, TX 79124 (806) 359-4673 • Fax (806) 354-5888 Beverly E. Gerard, M.D. (806) 353-2323 • Fax (806) 351-2323 www.harringtoncc.org Haylee DeVries, PA-C (888) 393-7488 PROFESSIONAL CARDS
Orthopaedic Orthopaedic Pediatrics Surgery Surgery TEXAS TECH PHYSICIANS OF AMARILLO Howard Berg, M.D. Aubrey L. Smith, M.D. PEDIATRICS/PEDIATRIC SUBSPECIALTIES Joint Replacement Surgery Orthopaedic Surgery, Arthroscopic & 1400 S. Coulter • (806) 354-5437 Board Certified Reconstructive Surgery / Shoulder Surgery CHILDREN WITH SPECIAL NEEDS/ 13 Medical Drive Board Certified - Fellow of the Academy PEDIATRIC SURGERY Amarillo, TX 79106 of Orthopaedic Surgeons 1901 S. Medi-Park Drive (806) 358-4531 • Fax (806) 359-1723 1600 Coulter, Bldg. B (806) 468-4300 ______Amarillo, TX 79106 NEONATAL INTENSIVE CARE SERVICE - (NWTH) (806) 359-0718 • Fax (806) 359-9613 (806) 354-1390 Dustin C. Frazier, M.D. PEDIATRIC INTENSIVE CARE SERVICE - (NWTH) General Orthopaedic Surgery (806) 354-1585 Board Certified Otolaryngology ADOLESCENT MEDICINE 8 Medical Drive (ent) Marita Sheehan, M.D. Amarillo, TX 79106 PEDIATRIC BEHAVIOR/DEVELOPMENT (806) 463-7224 • Fax (806) 463-2171 PANHANDLE EAR, NOSE & THROAT Angela Huang, M.D. www.dustinfraziermd.com 3501 South Soncy Road, Ste. 140 PEDIATRIC CARDIOLOGY ______Amarillo, TX 79119-6405 Eugene F. Luckstead, M.D. (806) 355-5625 Fax (806) 352-2245 Srilatha Alapati, M.D. Douglass Y. Hyde, M.D. Michael Guttenplan, M.D. PEDIATRIC GASTROENTEROLOGY Adult Reconstructive and Stacie Morgan, M.D. Abiodun Johnson, M.D. Pelvic/Acetabulum Trauma Surgery Amber Price, M.D. PEDIATRIC GENETICS 1901 Medi Park, Ste 10 Martin Schneider, M.D. Golder Wilson, M.D. Amarillo, TX 79106 Geoffrey Wright, M.D. PEDIATRIC HEMATOLOGY/ONCOLOGY (806) 356-2310 • Fax (806) 356-2312 Osvaldo Regueira, M.D. ______Curtis Turner, M.D. Pain Management/ PEDIATRIC NEPHROLOGY Michael O. LaGrone, M.D. Treatment Tetyana Vasylyeva, M.D. Reconstructive Spine Surgery, Scoliosis, Emily Howard, PA Pediatric Orthopaedics Board Certified ADVANCED PAIN CENTER PEDIATRIC PULMONARY (CYSTIC FIBROSIS) 1600 Coulter, Bldg. B Robert Paige, M.D. Adaobi Kanu, M.D. Amarillo, TX 79106 6819 Plum Creek PEDIATRIC – GENERAL (806) 354-2529 • Fax (806) 354 2956 (806) 463-1789 • Fax (806) 355-2469 Oluyemisi Fatunde, M.D. ______Amanda Griffin, M.D. Shannon Herrick, M.D. Victor M. Taylor, M.D. Vinod Sethi, M.D. Michael S. Manderson, M.D. 7100 West 9th Marita Sheehan, M.D. Adult Reconstructive Spinal Surgery (806) 352-7431 • Fax (806) 352-2374 Muhammad Uddin, M.D. Board Certified Huang Petersen, NP 13 Medical Drive Brittany Thomas, PA Amarillo, TX 79106 Pediatrics PEDIATRIC SURGERY (806) 322-1333 • Fax (806) 322-1334 Bonna Benjamin, M.D. ______Meganne Walsh, M.D. Janet Meller, M.D. 716 North Polk Jason Nirgiotis, M.D. James R. Parker, M.D. Amarillo, TX 79107 CHILDREN WITH SPECIAL NEEDS Board Certified (806) 374-5900 • Fax (806) 374-5914 Walter Bridges, M.D. Specializing in Sports Medicine ______Rolf Habersang, M.D. & Total Joint Replacement Angie Chadwick, R.N., M.S.N., F.N.P. 7000 W. 9th Ave. Michael Doyal, R.N., F.N.P., B.C. Amarillo, TX 79106 Pia Habersang, M.S.N., C.N.S., Ed.D. (806) 350-2663 • Fax (806) 350-2664 Sue Rankin, R.N., M.S.N., F.N.P.
FALL 2013 PANHANDLE HEALTH 43 PROFESSIONAL CARDS Plastic & Radiology Surgery Reconstructive Surgery HIGH PLAINS RADIOLOGICAL (cont.) Victor V. Hands, M.D., F.A.C.S. Rahul Mehta, M.D. Peripheral Vascular Surgery, Mary Ann Piskun, M.D. Howard Nunn, M.D. General and Laparoscopic Surgery Board Certified by the Paul Pan, M.D. BOARD CERTIFIED American Board of Plastic Surgery Robert Pinkston, M.D. 2418 S.W. 8th Ave. 1801 Halstead, Ste. B Richard Rosebrock, M.D. Amarillo, TX 79106 Amarillo, TX 79106 Matthew Scalapino, M.D. (806) 376-4385 (806) 358-8731 • Fax (806) 358-8837 Rakesh R. Shah, M.D. ______Martin Uszynski, M.D. Kimberly Waugh, M.D. Rouzbeh Kordestani, M.D., M.P.H. Lawrence Zarian, M.D. Plastic, Aesthetic, Reconstructive & Hand Surgery 3501 Soncy, #137 Amarillo, TX 79119 (806) 322-5438 • Fax (806) 322-5505 www.drkordestani.com MOVING? Plastic & Reconstructive Please Note Change of Address Surgery Patrick Proffer, M.D., F.A.C.S. Cosmetic, Reconstructive & Hand Surgery Board Certified by NAME______The American Board of Plastic Surgery Member of the American Society of Plastic Surgery 1611 Wallace
(806) 352-1185 • Fax (806) 352-4987 NEW ADDRESS______www.drproffer.com Radiology HIGH PLAINS RADIOLOGICAL CITY______STATE______ASSOCIATION 1901 Medi Park, Suite 2050 Amarillo, TX 79106 (806) 355-3352 • Fax (806) 355-5367 John Andrew, M.D. ZIP______PHONE______Gary Aragon, M.D. Branch Archer, M.D. Richard Archer, M.D. Gail Bentley, M.D. Gayle Bickers, M.D. MAIL THIS FORM TO: Charles Brooks, M.D. Crandon Clark, M.D. Stanley Cook, M.D. PANHANDLE HEALTH Tully J. Currie, M.D. Michael Daniel, M.D. 1721 Hagy Aaron Elliott, M.D. Stephan Haas, M.D. Arouj Hashmi, M.D. Amarillo, Texas 79106 Richard Khu, M.D. FIVE-STARLIVINGFIVE-STARLIVING
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(806) 376-6301 [email protected] 15 Medical Drive Amarillo, TX 79106-6160 www.neely.com ,_WLYPLUJL[OL6WLU(PY490+PMMLYLUJL ^P[OV\Y(KKP[PVUHS:LY]PJLZ0UJS\KPUN*; ?9H`Z 6WLU(PY490PZHJJYLKP[LKI`[OL (TLYPJHU*VSSLNLVM9HKPVSVN` :\WLYPVY0THNLX\HSP[`^P[O:PLTLUZ /0./-0,3+:;9,5.;/ ;LZSH 67,5+,:0.54(.5,; -LLSH[LHZLPUV\YJHSTHUK JVTMVY[HISLLU]PYVUTLU[ :HTLKH`5L_[KH` HWWVPU[TLU[ZH]HPSHISL 7YVMLZZPVUHSZ[HMM^P[O`LHYZ VMKLKPJH[LKZLY]PJL[V(THYPSSV 0THNLZH]HPSHISL]PH^LI :DOODFH%OYG$PDULOOR7; 3K )D[ ZZZRSHQDLUPULDPDULOORFRP Non-Profit Organization U.S. Postage PAID Permit No. 247 A QUARTERLY PUBLICATION OF THE POTTER-RANDALL COUNTY MEDICAL SOCIETY Amarillo, Texas 1721 HAGY AMARILLO, TEXAS 79106