Sidelined from a promising football career because of a broken hip, 18-year-old Jorge Alvarez faced a daunting decision: whether to leave and pursue his collegiate education or stay in his hometown of San Antonio. With the decision weighing on him, Alvarez was unsure of what the best choice might be, should he stay or should he go?

As fate would have it, the future interventional and general cardiologist opted to stay and found a fiscal blessing through his then-employer, now friend, John Nikolaou. Then, the future doctor was working at San Antonio’s Car Wash Express. “I’d been working there already for six months, from vacuuming and drying down cars to selling car washes,” Alvarez recounts with a chuckle. “He [John Nikolaou] said ?Hey, I’ll pay your books and tuition if you stick around and not go off anywhere.?” There were a handful of high school peers that worked with Alvarez at Nikoloau’s car wash, and Nikoloau believed that it would be better for the business if the same reliable young men were around.

“It wasn’t as expensive as it is now, but it was still a couple thousand dollars which for me I thought ?Great! I can put in the 40 hours, and that’s what I did,?” Alvarez shares.

“Cardiology gave me a mixture of normalcy and an extreme adrenaline rush”

With the financing for his college education secured, Alvarez faced a new decision. What should he study? Naturally, there is an array of fields medical students can seek to study and specialize in, and no one field is better than another. It comes down to a question of desire, the field and specialty that truly speak to you. For Jorge Alvarez, that was cardiology. “I was always interested in the heart, I always thought cardiology as a field was interesting,” Alvarez explains. “Cardiology gave me a mixture of normalcy and an extreme adrenaline rush. It’s a two-faced animal in the best of ways, one minute I can be sitting in my office talking with a patient I’ve seen for nine years, and suddenly, I get a call that someone’s coming in in cardiogenic shock and it’s time for me to go and help—it’s my job and time to keep them from dying—then I come back maybe an hour later like nothing happened,” Alvarez shares excitedly about his field.

MDMonthly_MethodistHospitalThis diversity in the field and with patient interactions is something that speaks to Alvarez. “It [cardiology] allows you to have that long-lasting relationship with patients and their families, but then it also gives you those quick action moments,” Alvarez says. The nature of the field of cardiology necessitates a cool head and a level leadership that is needed in treating some of the sickest patients. “As a cardiologist, you’re kind of like the quarterback working with other specialists around you to help direct what’s going to happen in helping patients do well, and it depends on how you orchestrate their care,” Alvarez explains.

An alumnus of the University of Texas at San Antonio and the University of Texas Health Science Center at San Antonio, where he successfully completed his internship, residency and fellowship, Dr. Jorge Alvarez serves as a clinical instructor to the future medical professionals of tomorrow. While he doesn’t lecture as much as he previously did because of his packed schedule, Alvarez typically instructs medical students and physicians’ assistant students, occasionally interacting and instructing the university’s fellows as well.

Being around the minds and future medical professionals while also passing on his acquired knowledge was a motivating factor for Dr. Alvarez to begin instructing students. “When you do this [practice medicine], it’s a lifelong process. You never stop learning, and the great part about being around students is that they’re so full of questions. Sometimes you get to see things in a different light, and it forces you to stay up-to- date and see things from a different perspective,” Alvarez shares.

“My hope is that someday soon people will say if you need to have any cardiovascular procedure go to San Antonio, that’s where the team of doctors at Methodist Hospital are premier.”

Coupled with this, Dr. Alvarez feels that working alongside the students helps in the communication process. Explaining medicine and maladies to be digestible information can be a difficult task, but working as a clinical instructor reinforces the necessity of being able to explain complex issues and treatments in relatable, understandable terms. “It really helps you in being able to bring complicated issues down to a level that patients with no knowledge of disease can understand and feel comfortable with,” Alvarez says. This mutually beneficial arrangement betwixt instructor and student plays a larger societal role as well. Like most physicians, Dr. Alvarez entered the field to help his community, and one of his methods to help the San Antonio community is by educating the next generation of medical professionals.

“As a cardiologist, you’re kind of like the quarterback working with other specialists around you to help direct what’s going to happen in helping patients do well, and it depends on how you orchestrate their care”

Insofar as Dr. Alvarez’s commitment to the community’s overall health, he emphasizes exercise and strives to lead by example. Admittedly, he and his wife Becky are exercise enthusiasts, and Alvarez shares that his wife Becky is a successful, consistent marathon runner and that the couple are currently training for a triathlon together. “We have to young boys, Alex and Zach, and I think that families that encourage exercising and foster a healthy lifestyle is a big deal because it sets an example. It’s a big deal for me because I’m able to set an example for my patients,” Alvarez explains.

MDMonthly_CardioIndeed, Dr. Alvarez sports his Fitbit and shares his results with patients who explain that they don’t have the time to exercise. “I practice what I preach,” Alvarez shares. “It’s only 4 p.m., I have 10,000 steps and I still have to exercise today. It’s a way to motivate me and my patients, to show that we all can make time to live healthy lifestyle. You have to invest in yourself.” The most important thing, the doctor shares, is finding an exercise that you truly enjoy.

Professionally, Dr. Alvarez is able to proudly share that he was among the first surgeons in the region to perform a transcatheter aortic valve replacement (TAVR). This new method of replacing heart valves, without surgically opening the chest, is amazing in its ability to reinvigorate a patient’s life without having to perform an invasive surgery. Methodist Hospital was the first non-academic institution to perform the procedure at that time, and today, they’re the number one institution in South Texas to perform these procedures volume wise—often performing three to four per week, about 120-150 per year.

The first procedure, Dr. Alvarez remembers, was like the first day of school. He was eager and couldn’t sleep the night before as he waited for his chance to perform this landmark procedure. “It was high-stress and intense, but the procedure went fabulously,” Dr. Alvarez recounts. The patient, a woman about 89-years-old at the time, is still doing well and is one of Dr. Alvarez’s clinic patients.

“When you do this [practice medicine], it’s a lifelong process. You never stop learning, and the great part about being around students is that they’re so full of questions”

Coupled with TAVR procedures, Dr. Alvarez utilizes the Watchman Device LAA Closure Technology, for patients who are unable to take warfarin, an anticoagulant or blood thinner. “As of right now, we [Methodist Hospital] are one of two institutions, definitely the biggest institution, that employs the Watchman device,” Alvarez shares. Warfarin is one of the chief medication complications that results in hospital admissions. Due to a number of factors, there are patients who are unable to take the medication, the Watchman solves this problem by providing patients who require some form of anticoagulation with an alternative that is as good as taking preventative stroke medication.

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Staying updated on cutting-edge technology in the medical field isn’t as simple as ordering a brochure. Indeed, medical professionals like Dr. Alvarez are sought out because of their stellar reputation, recognized esteem and admired skill sets in their field. “You have to have a certain skill set and amount of experience in certain procedures that is mandated by the FDA to be asked to participate and evaluate these new technologies,” Dr. Alvarez explains.

Because of Dr. Alvarez and his colleagues’ notable reputation of excellence they receive a number of referrals from across South Texas, out-of- state and word of mouth by former patients who were exceedingly pleased with their treatment. While Dr. Alvarez and his colleagues treat a large number of patients and employ an array of new, state-of- the-art technologies, he still finds the TAVR procedure to be one that captivates his own heart because of its ability to restore a patient’s life—TAVR patients are typically older, particularly sick, and have been told that they have few options.

Dr. Alvarez shares that one of his favorite TAVR memories was of an 88-year-old patient who was in a wheelchair and unable to walk without being short of breath. “We did a TAVR procedure and about two months later I saw her family members. I asked, ?What are you doing here?? and they explained that their grandmother had broken her hip. I thought, ?Oh no, that’s horrible,? and they shouted ?No no, it’s great! She was playing soccer in the yard with her grandkids and great-grandkids,?” Dr. Alvarez shared happily.

Looking toward the future, Dr. Jorge Alvarez envisions and strives for Methodist Hospital to become a destination center for cardiovascular care, continuing an already solid reputation of exceptional care. “One of the things I remember growing up was being bothered that people had to travel to Minnesota, Cleveland, Houston or Dallas. I thought people should be coming here, there’s no reason to leave San Antonio,” Dr. Alvarez recounts. “My hope is that someday soon people will say if you need to have any cardiovascular procedure go to San Antonio, that’s where the team of doctors at Methodist Hospital are premier.”

With the skilled hands and experience of Dr. Jorge Alvarez and his colleagues, coupled with the latest state-of- the-art technology, Methodist Hospital and the city of San Antonio are primed to become a national destination for extraordinary cardiovascular care.


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