Healthcare Awareness – Tarrant County Physician Online

The Zebra Is Losing Its Stripes: My Journey to Discover the Disease That Was Killing Me . . .

Feature Article

By David M. Lavine, MD

This article was originally published in the July/August 2026 issue of Tarrant County Physician.

This article is about a personal medical journey which involves a four-year-long search to solve a problem which I hope will be an inspiration to those who read it.

The title comes from a grand rounds lecture given by Dr. Justin Grodin, a faculty member in advanced heart failure and cardiac amyloidosis at UT Southwestern.¹ As the old saying goes, “When you hear hoofbeats you think of horses, but occasionally there is a zebra in the herd.” Well, my zebra is cardiac amyloidosis. When I was in medical school, this disease was hardly mentioned. Most doctors knew little to nothing about it.

My Reason
My reason for this article is personal and apparent. I could give you the detailed particulars of this disease, but suffice it to say, amyloidosis is caused by a protein misfolding/malformation which, in transthyretin amyloid cardiomyopathy (ATTR-CM), originates in the liver. The resulting amyloid infiltrates the myocardium, resulting in a thickening and stiffening of the heart muscle. The big problem is that the amyloid fibrils do their damage by concentrically thickening the muscle. The chest X-ray will not show cardiac hypertrophy, but the heart capacity is reduced, resulting in decreasing cardiac efficiency.

The most affected chamber is the left ventricle. Amyloid deposits make the walls stiff, preventing the chamber from relaxing and filling properly between beats. The next chamber most affected by the amyloid is the right ventricle impairing the right side’s ability to pump blood effectively. Because the ventricles become too stiff to accommodate blood entering the heart, pressure increases, causing the atria (the upper collecting chambers) to stretch and enlarge. This chamber enlargement leads to electrical disruption and arrhythmias such as atrial fibrillation. The more advanced the disease, the worse the outlook. The quicker the diagnosis, the more favorable the outcome.

The Journey to a Heart Biopsy
In 2021, I was beginning to have a general sense of malaise manifested by persistent fatigue and an ever-increasing intolerance to inclines. Needless to say, these symptoms were problematic. I had just retired and was looking forward to some active years. Yes, I was getting some answers for my symptoms piecemeal, but I felt a great urgency to complete this puzzle. With my medical background as an asset, I started a battery of tests. My PCP ordered an NT-proBNP biomarker. This measures the stress on your heart, which secretes a specific protein (NT-proBNP), especially during ischemic events. Normal is less than 450—mine was 1,402. What little information I could glean from the literature was sparse and, to say the least, gloomy. Survival rates were dismal. It made NO sense. I was a physically active person day in and day out.

My Quest
My pilgrimage to find the holy grail had begun. All my available sources of information created more questions than answers. As my quest for information grew, so did my sources. I even spoke with a past president of the American College of Cardiology, via a link with a medical classmate referral. A plethora of tests revealed nothing outstanding except ever-rising biomarker numbers. A follow-up Troponin level was 253, when normal is less than 47. Troponin also measures the stress of the heart following a sentinel event, but, I had never had an MI or outright cardiac failure; I was just feeling puny with an ever-decreasing activity level.

Corralling the Zebra
With no definitive answers and a situation that was getting worse, I pursued every medical connection I had. Nothing struck home, nothing was obvious, but persistence is my mantra. In Fort Worth and Charlottesville, Virginia, brilliant minds saw the discrepancies, but in over four years, found no good explanation. Even “Dr. Google” was stumped.

I Hear the Hoofbeats Coming
But the elusive mystery remained. I heard the hoofbeats and knew there was a zebra, but where was it? I had navigated a lot of “ifs and maybes” but found nothing definitive. No one could seem to explain the obvious incongruence of a 75-year-old active male and unexplained elevated biomarkers.

I Found the Zebra!
A new thought came from an old friend and internist. He had started on this journey with me in 2021. We had perused every pertinent fact and lab. After three years of continual dialogue, he queried about the possibility of my having cardiac amyloidosis. Because it was such a rare disease, 1:100,000, it seemed highly unlikely. But I wasn’t giving up . . . I was in the battle of my life. So on my next visit to my Fort Worth cardiologist, I asked if I could get a comparison echocardiogram. My last one in April 2025 was like the five previous ones. No zebras. I did ask him about the “rare” possibility of cardiac amyloidosis. His answer was definitive: “You don’t have cardiac amyloidosis.”

Despite this, in August of 2025, I got my echo report: “amyloid myocardiopathy highly suspected.”

Pulling oﬀ the Stripes One by One
Now I consider myself to be a self-educated doctor of a disease that was once considered very rare. ATTR-CM is now becoming “the disease of the month.” Jack Nicklaus, the G.O.A.T. of golf, was recently diagnosed with the same disease. He has become a spokesperson for the drug Vyndamax, the same one I am on. I’m sure many people remain to be included in this group. Thus the goal of this article . . . to educate my peers.

Epilogue
As for me, I have accumulated a fine team of super specialists from Fort Worth to Charlottesville, Virginia and UTSW, Dallas. There is NO Way I am ever letting this transitioning zebra out of my sight—it took too long to find.

I am presently enrolled in Dr. Grodin’s clinic at UTSW and have agreed to participate in an intramural study that he is directing. Hopefully my numbers will help others. Also, I will continue to take super drug Vyndamax, which is a thyretein stabilizer. I also hope to enter a depleter study (Cleopattra), utilizing new technology, later this year. Research is abounding for this disease.

Last Thoughts—The Immortal Zebra May Not Be a Zebra After All
I shudder to think what might have been, had I not been so proactive, i.e., pushy. Everything I have researched is so “real time” that it is truly hard to separate the disease as part of the landscape of aging or a distortion/malformation of that landscape. If it is the latter, then hopefully growing old will be more unfettered with a diagnosis and an effective way to treat this disease.²

The Whole is Greater Than the Sum of its Parts
Once I had the results and diagnosis, I knew what was making me sick. I had caught the zebra, but as the name of this article implies, this cardiac amyloidosis may not be a zebra after all. As it turns out, I was the “poster child” for ATTR-CM wild type. This includes a plethora of musculoskeletal problems inherent in amyloid migration and infiltration. This can start with carpal tunnel syndrome (I had four procedures for this syndrome. The first release, which was endoscopic, was 20 years ago. I had a repeated open procedure, due to the same carpal tunnel symptoms, 10 years ago, obviously from continued amyloid infiltration.), ruptured bicep tendons, (I had two) and atrial fibrillation, which is resistant to cardioversion and ablation. This ultimately ended up with a pacemaker placement a year ago.

Finally, a heart biopsy in October of 2025 confirmed it. I would encourage you to look at the varied and sundry well-known end-organ systems of this not-so-rare disease. It may start with a simple carpal tunnel syndrome and work its way through the musculoskeletal complex and end with a definitive myocardial biopsy.

Early diagnoses, to confirm or negate, is as simple as getting a Congo red stain after a carpal tunnel, trigger finger, or residual cartilage disc diagnosis, as they are a few of the related conditions. A blood serum electrophoresis (SPEP) study is also important, or a 24-hour urine collection if you are considering a differential diagnosis.

My medical background (plastic surgery) afforded me contacts in the medical community. There is no doubt that I am here today and writing this article because of my medical connections. I hope and pray my education has been an enlightenment to you.

Please remember our Hippocratic Oath: “I will use my power to help the sick, to the best of my ability.” The life you save will be one grateful patient. It may even be your own.

References:

Justin Grodin, Cardiac Amyloidosis: The Zebra Is Losing Its Spots, presentation, February 1, 2019.
I gathered this information from a number of personal communications, including those with the Amyloid Cardiology Specialist Department of Cardiology, The University of Virginia Medical Center; Amyloid Cardiology Specialist, Health Resources, Heart & Vascular Specialists; Amyloid Cardiology Specialist, Department of Cardiology, UT Southwestern Medical Center; Amyloid Webinars ARC (Amyloid Research Consortium); the Amyloidosis Foundation Facebook page; and Mackinzie’s Mission.

Women’s Mental Health: The Barriers to Access

The President’s Paragraph

By Cheryl Hurd, MD, TCMS President

This article was originally published in the July/August 2026 issue of Tarrant County Physician.

This May, I had the privilege of presenting at a workshop with psychiatric colleagues regarding women’s mental health at the annual meeting of the American Psychiatric Association. We had strong attendance and a robust discussion. But given all the questions from our audience members, it became evident to me that this is a topic deserving of additional outreach, and not just to fellow psychiatrists. However, I had a dilemma . . . a draft deadline and multiple PowerPoint slides with all the information. After a couple of hours of trying to gather everything into a cohesive article to present to you all here, I decided to seek the assistance of AI. I dumped everything I had into Copilot, gave it about four dozen or more prompts, and it coalesced all my work. I still had to edit extensively; who knew that Copilot was so fond of run-on sentences?! The following has been further edited by the people who help maintain the decorum of our Tarrant County Physician journal.

Women’s mental health is as much an access issue as a diagnostic one. Across clinical settings, it is common to see:

Depression

Anxiety

Trauma-related conditions

Perinatal Mental Health Challenges

Emotional strain associated with:
• Caregiving responsibilities
• Financial hardship
• Discrimination
• Chronic disease

Whether these concerns are recognized, disclosed, and treated is often shaped by social context, such as current physical environment and cultural and/or historical aspects of different communities. Insurance, transportation, childcare, translation services, stigma, community trust, and local behavioral health capacity all affect timely care. Women in underserved communities are at particular risk for late diagnosis and interrupted treatment because social determinants of health and health system barriers often converge. And national mental health workforce shortage areas remain widespread.¹

Underserved care is not found in a single setting but is a condition of limited access that can exist anywhere. A woman may live in a rural county with the closest psychiatrist being a long drive away. Another woman may live in an urban neighborhood with multiple hospitals yet still face long waits, unaffordable copays, language barriers, and fragmented referral pathways. In both settings, available services may not be truly usable. Women may present late, rely on urgent care, or disengage when treatment plans fail to account for barriers such as housing instability, caregiving demands, or work schedules. For physicians, treatment planning must address not only diagnosis and severity but also whether follow-up is realistic.

Rural and urban settings pose different challenges. In rural practice, barriers often include distance, limited specialist supply, service closures, privacy concerns, and broadband gaps that weaken telehealth. In urban settings, the problem is often system complexity: long wait times, fragmented care, uneven service distribution, insurance limitations, and cultural or linguistic mismatch between a patient and their physician. These differences require different responses. Rural physicians may depend more on collaborative care, telepsychiatry, and cross-system referral relationships, whereas urban physicians may focus on reducing handoff failures, improving navigation, and integrating behavioral health into primary care or women’s health clinics. Rural counties fare worse than non-rural counties on measures of clinical care and social determinants of health,² and shortage designations affect both rural and urban areas.¹

Perinatal mental health is critically important, but risks change across the lifespan. Anxiety, depression, trauma exposure, eating disorders, self-harm risk, intimate partner violence, caregiving stress, chronic illness, loneliness, grief, and cognitive concerns may present differently at each stage of life. In underserved communities, unstable housing, food insecurity, discrimination, limited preventive care, and delayed treatment can intensify symptoms and complicate care. A useful clinical framework goes beyond symptom checklists to assess safety, functioning, social stressors, and barriers to follow-up.
Routine screening is one of the strongest opportunities to improve women’s mental health care, but only when paired with a workflow that supports action. In women’s health, primary care, and perinatal settings, screening can identify depression, anxiety, trauma-related symptoms, and safety concerns before they escalate. A positive screen should trigger a risk assessment, a discussion of treatment options, a referral or warm handoff when indicated, and a plan for monitoring response and adherence. Routine screening for depression and anxiety is recommended in well-woman, pre-pregnancy, prenatal, and postpartum care. Standardized instruments and systems for timely assessment, treatment, and follow-up are also recommended.³

Care models should reflect practice realities rather than assume one solution fits all. In rural settings, telehealth can reduce travel burdens and extend specialty access, especially when supported by audio-only options and coordination with local primary care. In urban settings, access may improve more through shorter referral loops, stronger safety-net capacity, co-located behavioral health services, and language-concordant care. Telehealth is most effective when patients have the privacy, reliable connectivity, digital skills, and device access needed to use it. Underserved communities may also benefit from multiple telehealth formats, including phone-based care.⁴ At the same time, rural telehealth continues to face setting-specific implementation barriers.⁵

As you can see, addressing women’s mental health requires a layered, setting-specific approach. Trauma-informed, culturally responsive care is essential. In rural settings, physicians may need to offset workforce shortages and distance through collaborative care and telehealth-enabled consultation. In urban settings, the priority is often reducing fragmentation and improving access within systems that may appear resource-rich but remain difficult to navigate.
Ultimately, the central question is not simply whether a patient lives in a rural or urban area, but whether she can obtain timely, acceptable, and practical care. That requires early identification, realistic care planning, and systems that coordinate between screening, referral, and treatment. For physicians, the implication is straightforward: overcoming social barriers is part of the care plan, not peripheral to it.

“Healing takes time, and asking for help is a courageous step.” —Mariska Hargitay

References:

Health Resources and Services Administration, “Health Workforce Shortage Areas,” accessed June 30, 2026, https://data.hrsa.gov/topics/health-workforce/shortage-areas/dashboard.
W. B. Weeks et al., “Rural-Urban Disparities in Health Outcomes, Clinical Care, Health Behaviors, and Social Determinants of Health and an Action-Oriented, Dynamic Tool for Visualizing Them,” PLOS Global Public Health 3, no. 10 (2023): e0002420, https://doi.org/10.1371/journal.pgph.0002420.
American College of Obstetricians and Gynecologists, “Screening and Diagnosis of Mental Health Conditions During Pregnancy and Postpartum,” Clinical Practice Guideline, June 2023, https://www.acog.org/clinical/clinical-guidance/clinical-practice-guideline/articles/2023/06/screening-and-diagnosis-of-mental-health-conditions-during-pregnancy-and-postpartum.
U.S. Department of Health and Human Services, “Telehealth for Underserved Communities,” August 20, 2024, https://telehealth.hhs.gov/documents/Telehealth_for_Underserved_Communities_08-20-24.pdf.
Rural Health Information Hub, “Rural Telehealth Toolkit,” last modified June 8, 2023, https://www.ruralhealthinfo.org/toolkits/telehealth.
Centers for Disease Control and Prevention, “Social Determinants of Health,” last modified May 16, 2024, https://www.cdc.gov/public-health-gateway/php/about/social-determinants-of-health.html.

Beyond the Desk: Where This Work Really Happens

Project Access Tarrant County

By Kathryn Keaton

This article was originally published in the May/June 2026 issue of Tarrant County Physician.

Over the past month, much of our Project Access work did not take place at a desk.

It began at a conference hosted by Texas A&M Fort Worth where we presented alongside other professionals on the role of Medical-Legal Partnerships in addressing barriers to care. The conversation focused on collaboration and how healthcare, legal, and community-based organizations can work together more effectively to support patients navigating complex systems. PATC had the honor of presenting what we are doing to combat barriers in our session, “When Noncompliance Isn’t the Problem: Addressing SDOH in Indigent Populations.”

Presenting at the Medical-Legal Partnerships Conference

Later in the month, the setting looked very different.

At a church gym in Arlington, a group of participants gathered for “Financial Confidence Starts Here,” a new endeavor within our Salud en tus Manos initiative. Led by a certified financial coach, the session focused on practical, real-life strategies: managing expenses, prioritizing financial obligations, and navigating the challenges that arise when a health issue disrupts income or stability.

These two settings—a professional conference and a community-based classroom—may appear unrelated. In practice, they are closely connected.
It is easy to assume that nonprofit healthcare coordination happens primarily behind the scenes through referrals, scheduling, and documentation. Those components are essential, but they represent only part of the work required to ensure that patients not only access care but are prepared to successfully complete it.

Teaching the “Financial Confidence Starts Here” class

Increasingly, we are seeing that what happens outside of traditional clinical settings has a measurable impact on what happens within them.

At the conference, conversations were centered on systems and how partnerships can reduce barriers and improve access at a structural level. In the classroom, those same barriers were discussed from a different perspective: how they are experienced in daily life. Participants asked practical questions about managing bills, handling unexpected expenses, and making decisions when financial and health challenges intersect.

Together, these experiences reinforce a consistent reality: access alone is not enough.

Patients benefit from care when they are prepared to engage with it—when they understand how to communicate with their providers, how to manage the logistical and financial aspects of treatment, and how to navigate the systems surrounding their care. Building that level of readiness often happens outside the exam room.

For our volunteer physicians, this work matters.

Patients who arrive with greater confidence, clearer understanding, and fewer external barriers are better positioned for efficient, effective visits. Time can be spent on clinical decision-making rather than navigating preventable obstacles. The work happening in community and professional settings ultimately supports the care delivered in clinical ones.

With PATC patients at Salud en tus Manos

For our funders, this work is equally important.

Initiatives like Salud en tus Manos continue to evolve in response to what we are seeing in the community. Expanding into teaching financial literacy through “Financial Confidence Starts Here” reflects a growing recognition that financial stability is closely tied to health outcomes. When patients are equipped with practical tools and knowledge, the impact of donated care is strengthened—appointments are kept, treatment plans are completed, and outcomes are more sustainable.

At Project Access Tarrant County, we remain committed to both.
The coordination of specialty and surgical care is and will always be central to our mission. At the same time, our work increasingly includes engagement in spaces that extend beyond traditional healthcare settings, whether through professional collaboration or direct community education.
Much of our work does happen behind the scenes.

But some of the most important work happens far beyond in conference rooms where ideas are shared, in classrooms where confidence is built, and in conversations that ensure when a patient finally sits in front of a physician, they are ready to fully engage in their care.

And that is where this work truly happens.

Beating the Stigma: The Challenges in Treating Substance Use Disorders

President’s Paragraph

By Cheryl Hurd, MD, TCMS President

This article was originally published in the May/June 2026 issue of Tarrant County Physician.

By the time you all read this article, I hope you will have had a chance to listen to some of Tarrant County Medical Minute’s many interesting podcast episodes. I recently had the privilege of being invited as a guest on the podcast (you can find my episode here), which TCMS launched in 2025. It was fun, and I also found it to be an opportunity to continue to highlight mental health and advocacy. As I’ve mentioned before, mental health is marginalized and stigmatized but so essential to overall health. I appreciated the opportunity to talk about this on the podcast, fulfilling one of my promises to speak openly about mental health issues.

So, today we are going to talk about an even more stigmatized mental health issue—substance use disorders. They are far more common than many of us realize. According to the Substance Abuse and Mental Health Services Administration in their National Survey on Drug Use and Health in 2023–24, nearly 48 million Americans age 12 and older, or about one in six people, meet criteria for a substance use disorder in any given year.¹

Texas mirrors this national statistic. Alcohol use disorder accounts for the largest proportion, followed by drug use disorders involving marijuana, stimulants, opioids and more. State‑level estimates from the National Survey on Drug Use and Health indicate that roughly one out of seven Texans meets criteria for a substance use disorder each year.² While this is slightly lower than the national average, it still represents millions of people across our state whose health, relationships, and economic stability are affected. In a state as large and diverse as Texas, the collective impact of these conditions is substantial: it affects healthcare utilization, workforce participation, public safety, and even community well-being.

For physicians, this data shows what is already evident in clinical practice. Substance use disorders frequently coexist with chronic medical conditions, complicating diagnoses and treatments while increasing the risk of poor health outcomes. For legislators and policymakers, the numbers highlight the scope of the issue and the importance of continuous investment in prevention, early identification, evidence‑based treatment, and long‑term recovery support. And for the general public, the message is both sobering and illuminating: substance use disorders are common, treatable medical conditions, not moral failures or character flaws.

Substance use disorders do not exist in isolation. National data consistently demonstrates high rates of co‑occurring mental illness as well.¹ This overlap reinforces the need for integrated approaches to care that address the whole person rather than fragmented systems that separate “mental health” from “substance use.” The stigma surrounding substance use disorders mirrors the stigma that has historically marginalized mental health conditions—just as depression and anxiety were once dismissed as weaknesses rather than illnesses, substance use disorders continue to be judged rather than treated.

Stigma remains one of the most powerful barriers to care. It delays seeking help, discourages honest conversations between patients and physicians, and shapes policies that emphasize punishment over treatment. When individuals fear judgment, they are less likely to disclose substance use concerns, less likely to engage in treatment, and less likely to experience recovery. This is true no matter what walk of life you stem from, no matter what profession you are in. Reducing stigma is thus a clinical, ethical, and public health imperative.

Texas‑specific health data further illustrates the downstream effects of untreated substance use disorders, including alcohol‑related hospitalizations, drug‑related overdoses, and preventable deaths.² Even when prevalence rates are slightly lower than national averages, the absolute number of affected individuals places significant strain on healthcare systems and communities. These outcomes are not inevitable; evidence‑based prevention strategies, timely access to treatment, and sustained recovery supports have been shown to reduce morbidity, mortality, and costs.³ The key is that these initiatives have to be adequately funded and broadly accessible.

It is essential to treat substance use disorders as seriously and compassionately as other chronic illnesses. This includes speaking openly about prevalence, acknowledging the role of stigma, and advocating for systems of care that are based on scientific evidence rather than outdated assumptions. If one in six Americans—and one in seven Texans—are affected, then nearly every family, workplace, and community has a stake in how we respond. As physicians, policy advocates, and community leaders, we have both the opportunity and the responsibility to lead with data, compassion, and transparency. By reframing substance use disorders as the common, treatable health conditions they are, we can achieve these goals of reducing stigma, improving access to care, and improving the health and well-being of the populations we serve.

For physicians, the message should be clear: substance use disorders are common and addressing them as part of routine medical care should be best practice. Screening and brief, non-judgmental conversations about substance use should be normalized in our clinical settings. How we ask and how we respond do matter. Framing substance use disorders as treatable medical conditions like the evidence shows will increase patient disclosures, increase their engagement in treatment, and ultimately lead to their trust in us. We must lead the shift from judgment to treatment by insisting that substance use disorders are met with evidenced based care, equitable insurance coverage, and our compassion—not silence or shame.

“We, as a culture, have not fully acknowledged how much help is needed. The only real shame is on us for not being willing to speak openly. For continuing to deny that mental health is related to our overall health. We need to start talking, and we need to start now.”
– OPRAH WINFREY

References:

Blaire Bryant, Naomi Freel, and Emily Steckler, “SAMHSA Releases New 2024 Data on Rates of Mental Illness and Substance Use Disorder in the US,” National Association of Counties, July 28, 2025, https://www.naco.org/news/samhsa-releases-new-2024-data-rates-mental-illness-and-substance-use-disorder-us.
“Substance Use Disorder Statistics,” Drug Policy Facts, accessed May 4, 2026, https://www.drugpolicyfacts.org/node/4476.
Johanna Bellon et al., “Association of Outpatient Behavioral Health Treatment With Medical and Pharmacy Costs in the First 27 Months Following a New Behavioral Health Diagnosis in the US,” JAMA Network Open 5, no. 12 (2022): e2244644, https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2799220.
Substance Abuse and Mental Health Services Administration, “National Survey on Drug Use and Health (NSDUH): 2023 National Releases,” SAMHSA, accessed April 1, 2026, https://www.samhsa.gov/data/data-we-collect/nsduh-national-survey-drug-use-and-health/national-releases/2023.
Substance Abuse and Mental Health Services Administration, “State Estimates of Mental Health and Substance Use,” accessed April 1, 2026, https://nsduhweb.rti.org/respweb/estimates.html.
Li-Tzy Wu, He Zhu, and Udi E. Ghitza, “Multicomorbidity of Chronic Diseases and Substance Use Disorders and Their Association with Hospitalization: Results from Electronic Health Records Data,” Drug and Alcohol Dependence 192 (2018): 316–23, https://doi.org/10.1016/j.drugalcdep.2018.08.013.
Lauren R. Ray et al., “Combined Pharmacotherapy and Cognitive Behavioral Therapy for Adults With Alcohol or Substance Use Disorders: A Systematic Review and Meta-analysis,” JAMA Network Open 3, no. 6 (2020): e208279, https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2767358.

Mental Health in Medicine: A Call to Lead

President’s Paragraph

By Cheryl Hurd, MD, TCMS President

This article was originally published in the January/February 2026 issue of Tarrant County Physician.

Hello everyone, my name is Cheryl Hurd, and it is my honor and privilege to serve as the 2026 TCMS president. I am a psychiatrist who has been in active practice for nearly twenty-five years, but I have also been a medical educator for the majority of that time. (I am also an English Lit major, so the “President’s Paragraph” is likely to become much longer than a paragraph. . . .) I want to thank the many presidents before me who have written articles and stories that have amused, enlightened, and inspired me. I admire the passion (and compassion) as well as the courage of my predecessors. I can only hope to aspire to the same level of dedication to my theme as they did to theirs.

My mission has always been to provide the highest quality and evidenced-based care to patients while training the next generation of physicians in best practices. Easy buzzwords to write, but they’re sincere nonetheless. As a psychiatrist, mental health is at the forefront of my mind. Mental health has long been marginalized, treated as secondary to physical illness, and burdened by stigma. Yet the evidence is clear: Mental health is inseparable from overall health, and its neglect undermines our patients, our communities, and ourselves.

I have chosen to make mental health advocacy the defining theme of my tenure. This is not just a matter of professional responsibility; it is a moral imperative. TCMS should be among those leading the way in ensuring that mental health is recognized as a cornerstone of care in this county and throughout the great state of Texas.

Millions of people struggle with depression, anxiety, trauma, and substance misuse; this includes us as physicians. Suicide remains a leading cause of death among young people, and burnout continues to erode the well-being of healthcare professionals. We still lose as many as 400 attending physicians to suicide a year.¹ Residents and medical students are facing the same challenges. These realities are not just statistics—they are the lived experiences of our patients, colleagues, families, and ourselves.

The pandemic further exposed the fragility of our mental health infrastructure. The sequelae of the pandemic included an explosion in mental health disorders across our country. Demand for services surged, yet access remained uneven despite the adoption of telepsychiatry. Rural communities, marginalized populations, and children bore disproportionate burdens. I was president of the medical staff at JPS from the beginning through the height of the pandemic, and I saw firsthand the devastation that was wrought on the physical and mental well-being of the healthcare workforce. My most important service as medical staff president during that time was to bolster our physicians and other providers, provide resources, give updates, and instill hope when despair seemed to overwhelm us. The infrastructure could not meet the demands, and it often still doesn’t.

So, I would like to focus on expanding equitable access to care for all; integrating mental health into primary care, schools, and workplaces; and leading a conversational shift that normalizes open discussions about mental health across our practices and communities. Through advocacy we can advance reforms that treat mental health with the same seriousness as physical illness, expand the workforce with training and support for all physicians (not just mandate PHQ-9 and GAD-7 questionnaires at every visit), strengthen school partnerships to provide early intervention, invest in community clinics, expand telehealth to close gaps in underserved areas, and promote research and innovation that drive evidence‑based solutions.

As physicians, we still carry unique credibility in shaping public discourse. When we speak openly about mental health—whether in clinical settings, community forums, policy debates, or even podcasts—we dismantle stigma and inspire change.

We must also look inward. Physician burnout and moral distress remain pressing concerns that negatively impact physician well-being. By prioritizing mental health within our own profession, we model resilience and compassion for the broader healthcare system. TMA, our state medical association, has developed many resources in service of our members for these very issues. Many county societies have done the same, as have we at TCMS. I encourage everyone to visit the Physician Wellness website and learn more about our efforts: https://www.tcam.org/physician-wellness.

I know that I am asking a lot of all of you, and it won’t be easy. There are many financial constraints and competing interests that limit the expansion of services. We have a workforce shortage that hinders access, and the stigma of mental illness persists (particularly when it is related to substance use disorders). Differences in healthcare policies and funding priorities can complicate efforts to expand mental health services, but collaboration can help bridge these divides. These challenges are not insurmountable. With advocacy, innovation, and determination, we can overcome them.

Mental health is about people. It is about the child struggling with anxiety, the veteran coping with trauma, the parent balancing stress, and the physician facing burnout. By focusing on mental health, we confirm that every individual’s well-being matters.

As president of our medical society, I call upon each of you—physicians, educators, researchers, and advocates—to join me in this work. Together, we can elevate mental health, ensuring that it is recognized as a fundamental component of healthiness and a shared responsibility of the medical community.

“What mental health needs is more sunlight, more candor, and more unashamed conversation.” —Glenn Close

References:

John Matheson, “Physician Suicide,” American College of Emergency Physicians https://www.acep.org/life-as-a-physician/wellness/wellness/wellness-week-articles/physician-suicide#:~:text=Each%20year%20in%20the%20U.S.,and%20alcohol%20and%20substance%20abuse;.

The Power of Palliative Care: A Physician’s Perspective

By Dr. Mo Rezaie

A Misunderstood Mission

One of the most significant misconceptions about palliative care is that it’s solely focused on end-of-life care. This couldn’t be further from the truth. Palliative medicine is a specialized area of medicine that focuses on improving the quality of life for people living with serious illnesses. By addressing physical, emotional, and spiritual needs, palliative care helps patients and their families navigate difficult times with grace and dignity.

Beyond Physical Symptoms

While palliative care can certainly help manage physical symptoms like pain and fatigue, it goes far beyond that. It’s about addressing the whole person, including their emotional, social, and spiritual well-being. This might involve counseling, support groups, or spiritual guidance.

The Importance of Early Palliative Care

Many people believe that palliative care is only for those in the final stages of life. However, palliative care can be beneficial at any stage of an illness. Early palliative care can help patients and their families make informed decisions about treatment options, manage symptoms effectively, and improve quality of life.

A Growing Need

Despite its many benefits, palliative care remains underutilized. There is a significant shortage of palliative care physicians, and many healthcare providers are not adequately trained to provide palliative care. This can lead to suboptimal care for patients with serious illnesses.

A Call to Action

To address this growing need, we must increase awareness of palliative care and encourage more healthcare providers to specialize in this field. By working together, we can ensure that all patients have access to the compassionate and effective care they deserve.

A Personal Perspective

As a palliative care physician, I have the privilege of witnessing firsthand the transformative power of this specialty. By focusing on the patient’s overall well-being, we can help them live their best lives, even in the face of serious illness.

Morvarid “Mo” Rezaie, DO, HMDC, FACOI is a Palliative Medicine physician at The Center for Cancer and Blood Disorders.