SALUD (142)
HOUSTON
Q: Is heart disease the leading cause of death in the United States? A: Yes. According to the Centers for Disease Control, an American will have a coronary event about every 25 seconds. According to the American Heart Association, every 39 seconds one person will die from heart disease.
Q: What are some of the risk factors for heart disease? A: The conventional risk factors include high cholesterol, high blood pressure, obesity, diabetes, and tobacco use or second hand smoke.
Q: Will over-the-counter supplements alone improve my heart health? A: No, there are no cardiovascular benefits to OTC nutriceuticals or vitamins alone.
Q: Do all heart attacks have the same symptoms? A: Most heart attacks start slowly and build up gradually over few minutes time. Heart attacks can be perceived as mild pain or discomfort, including pressure, squeezing, tightness, fullness or pain. The chest discomfort may radiate to the neck, jaw, or arm, and is usually associated with shortness of breath, nausea, diaphoresis and pallor. Diabetics and women may not have the typical symptoms of chest discomfort, and may have only few of the associated features (shortness of breath or nausea, etc)
Q: Do women have different heart attack symptoms than men? A: Yes. While chest discomfort is still a primary symptom, women will also suffer from these symptoms with or without chest discomfort: shortness of breath, nausea or vomiting, abdominal pain or heartburn, and unusual or unexplained fatigue.
Q: Is heart disease preventable? A: There are some illnesses that cause heart disease and other heart conditions. However, adopting a healthy lifestyle can dramatically reduce your risk for heart disease. For example, lowering fat intake (avoiding read meat, if possible) and adding more activity to your day can help lower cholesterol. At least 30-60 minutes of cardiovascular exercise is recommended daily (or at least 5 days a week). Even if your workout is broken into shorter sessions through out the day, it can still reduce your risk of developing heart disease.
Q: Can exercise and diet help me no longer need my cholesterol and blood pressure medications? A: Exercise is essential to lower cholesterol and blood pressure, but do not stop taking medications if you make these lifestyle changes. The magnitude of benefits might not be enough to completely stop treatments. The American Heart Association recommends daily aerobic exercise, or at least 5 days a week, of moderate intensity for at least 30 minutes. The AHA also recommends a Mediterranean-like diet rich in legumes, vegetables and fruits, as well as non-fat dairy products and grains and low in saturated fats. Adding more fish to your diet is also recommended. Low sodium is also suggested to prevent high blood pressure.
Q: If I am on medication to treat heart disease, does that mean I am no longer at risk of a heart attack? A: No, this means you are working to lower your risk of future heart attacks. However, some of the causes resulting in heart attacks may be genetic or hereditary. Heart attacks in these instances can still happen. It is best to talk with your doctor to do what you can to minimize the risk as much as possible.
Q: I don’t think I’m at risk, should I still talk to my doctor? A: Yes. A yearly exam should include a blood pressure check, lipid and cholesterol test and a discussion with your doctor about other risk factors. Your physician is likely to compute risk score to calculate your risk for coronary heart disease and inquire about family history of coronary heart disease. From there, you and your doctor can decide how often to follow up and what else you can do to improve your overall health.
Stop Medical Emergency for Medicare/Medicaid Patients
Dozens of physicians from across Texas took time away from their medical practices to ask state leaders to reinstate cuts that harm access to care for thousands of Texas’ dual-eligible patients. Dual-eligible patients are old enough to qualify for Medicare and able to qualify for Medicaid assistance because of their income. Texas Medicaid slashed program funds over a year ago at the direction of the 2011 Texas Legislature, creating a medical emergency for hundreds of thousands dual-eligible patients and the doctors who care for them. “The increased regulation and low Medicaid payments are forcing doctors to leave the Valley or retire early,” said Victor Gonzalez, MD, Hidalgo-Starr County Medical Society president, and member of the Texas Medical Association (TMA) and Border Health Caucus (BHC). “It’s impossible to recruit young physicians.” The ophthalmologist lost six young physicians he trained and who received retina fellowships under his program. Dr. Gonzalez explains, “When the health care infrastructure collapses, it hurts all patients in the community and in neighboring cities. If patients can’t get care in a Harlingen emergency department (ED), they will end up in a San Antonio, Houston, or Dallas ED at a much greater expense.” For nearly a year, TMA and BHC physicians organized rallies, met with state leaders, and lobbied to get the cuts reversed. BHC is a confederation of county medical societies that work together to improve patient care and public health throughout South Texas. Many of the BHC doctors take care of large percentages of elderly, low-income patients. “Texas must fully reinstate the Medicaid cuts to ensure dual-eligible patients receive the health care they need to survive,” said Stephen L. Brotherton, MD, TMA’s president-elect. “We must take another step to stop Texas’ medical emergency that’s harming access to care for thousands of patients and their doctors.”
Background
Medicare and Medicaid pay dual-eligible patients’ medical bills, with Medicare paying a majority of the tab. In January 2012, Texas Medicaid stopped paying the patients’ Medicare deductible, which was $140 — this year its $147. Medicaid also stopped paying the patient’s coinsurance (due if Medicare’s payment to the physician exceeded what Medicaid pays for the same service, which is usually the case). The coinsurance had been an 80/20 split, with Medicare paying 80 percent of the patient’s doctor bill and in most cases, Medicaid paying the remaining 20 percent. These cuts affected approximately 320,000 dual-eligible patients in Texas, who are the oldest, sickest and most frail, and who rely on regular physician care and prescription medications. Doctors kept seeing these patients even though Texas Medicaid was not paying the patients’ deductibles nor fully paying all of the 20-percent coinsurance. Many doctors were forced to tap savings, obtain loans, cut staff, retire early, or move away. Some patients lost their doctor altogether. Other patients were more fortunate, like the 5,000 dual-eligible patients of Javier A. Saenz, MD, a family doctor in La Joya, Texas. “For months early last year he worked 12 hours every day, caring for his patients’ needs the best he could, while the State of Texas paid him basically nothing for providing all of that care,” said Dr. Gonzalez. “He exhausted his personal savings account of $50,000 and took out bank loans so he could keep his doors open and continue to care for the people of his community.”
Part of the Cut Restored
Finally last week, under the direction of the Texas Legislative Budget Board, the Texas Health and Human Services Commission restored coverage of the Medicare deductible for dual-eligible patients in 2013. “That’s a start,” said Dr. Brotherton, pleased that some relief has arrived. But the 20-percent coinsurance cut remains. “We’re asking state leaders and lawmakers to fully restore the funding for our Medicaid-Medicare dual-eligible patients,” said Luis M. Benavides, MD, the Border Health Caucus vice chair. “Our patients need us.” TMA is the largest state medical society in the nation, representing more than 47,000 physician and medical student members. It is located in Austin and has 120 component county medical societies around the state. TMA’s key objective since 1853 is to improve the health of all Texans.
Flu season is picking up steam across Texas. Widespread influenza has reached epidemic levels in the state, killing six children so far this flu season, according to the Centers for Disease Control and Prevention (CDC). Texas physicians urge people six months and older to get the flu vaccine if they haven’t already, and to take precautions to stop the spread of this deadly disease. “This year is much worse than last year,” said Jason Terk, MD, a Keller pediatrician and chair of the Texas Medical Association (TMA) Council on Science and Public Health. “This year the flu arrived early and sickened more people than past years,” he added. “The predominant flu type this year is called H3N2, and people seem not to have as good immunity from this type as from other flu strains.” “Years when this strain predominates are usually bad flu seasons,” said Dr. Terk, a TMA Be Wise — ImmunizeSM advocate. Be Wise — Immunize aims to vaccinate Texans and educate people about the importance of protecting against disease through immunization. However, it’s not too late to get vaccinated and protect yourself and your loved ones from this potentially deadly disease, he said. “The flu vaccine is the best way to reduce your chances of getting sick from any one of the flu viruses that circulate every year. It also helps the people who live and work around you because getting vaccinated boosts community immunity.” (When more people are vaccinated, fewer people get sick and spread the bug to those who are not vaccinated.) Physicians say the flu shot is just as effective whether you got it in October or you get it now in January, though it takes about two weeks for vaccine to help someone develop resistance to the flu. One shot protects an individual for the entire flu season, which runs from October through May. “Everyone who is 6 months of age or older should get a vaccination against the flu every year,” said Dr. Terk. “Children, especially those under the age of 2 years, as well as the elderly, pregnant women, and those with underlying health conditions are at increased risk for complications from flu — so much so, they could die.” That additional vulnerability to the flu is why physicians characterize these as high-risk groups. For those who develop mild flu-like symptoms, physicians say stay home to prevent spreading the illness to others, and drink plenty of fluids. Contact your doctor if you have severe symptoms or if you are sick and are in one of the high-risk groups. There are medications to treat the flu, and the CDC recommends the use of antiviral medications to treat influenza, starting as early as possible after becoming sick. But doctors urge Texans to take precautions to avoid getting sick in the first place: Cover your mouth with a tissue or your elbow when you sneeze; wash your hands often; stay away from people who are sick; and avoid touching your eyes, nose, and mouth. But the flu shot might be the best defense. “Protect your family, yourself, and those around you. Get a flu vaccination. It is safe and effective,” said Dr. Terk. TMA is the largest state medical society in the nation, representing more than 47,000 physician and medical student members. It is located in Austin and has 120 component county medical societies around the state. TMA’s key objective since 1853 is to improve the health of all Texans.
HOUSTON
Women with a family history of breast and ovarian cancer should make education about the disease and their risk for it a priority, said a breast oncologist and genetic counselor from the Lester and Sue Smith Breast Center at Baylor College of Medicine. “Breast cancer genetic research is advancing rapidly,” said Dr. Julie Nangia, an assistant professor in the Smith Breast Center. “Providing more education on breast and ovarian cancer prevention in high-risk women is a top priority in the breast cancer community.” “Identifying high-risk women is key to early detection/prevention and saves lives,” said Nangia. “Women who have a strong family history may be at a high risk to develop cancer.” Additionally, there are known genetic mutations that may significantly increase the risk for breast and ovarian cancer, said Zentack. “Testing is available to identify mutations for the BRCA1 and BRCA2 genes.” Genetic experts such as Zentack help assess the need for testing. “We consider multiple factors when deciding which family members of breast cancer patients should be tested, including the type of cancer, age and how close the relation is,” said Zentack. Carriers of the BRCA mutation should be aggressively screened and consider preventative surgeries, Nangia said. They should also be offered preventative medications such as chemoprevention with tamoxifen or raloxifene, which can reduce breast cancer risk by 50 percent. Lifestyle changes such as reducing alcohol intake and maintaining a healthy weight and exercise schedule are also important behaviors to reduce risk for all women.
AUSTIN, Texas
Researchers at The University of Texas at Austin have developed a menu of 61 new strains of genetically engineered bacteria that may improve the efficacy of vaccines for diseases such as flu, pertussis, cholera and HPV. The strains of E. coli, which were described in a paper published this month in the journal PNAS, are part of a new class of biological “adjuvants” that is poised to transform vaccine design. Adjuvants are substances added to vaccines to boost the human immune response. “For 70 years the only adjuvants being used were aluminum salts,” said Stephen Trent, associate professor of biology in the College of Natural Sciences. “They worked, but we didn’t fully understand why, and there were limitations. Then four years ago the first biological adjuvant was approved by the Food and Drug Administration. I think what we’re doing is a step forward from that. It’s going to allow us to design vaccines in a much more intentional way.” Adjuvants were discovered in the early years of commercial vaccine production, when it was noticed that batches of vaccine that were accidentally contaminated often seemed to be more effective than those that were pure. “They’re called the ‘dirty little secret’ of immunology,” said Trent. “If the vials were dirty, they elicited a better immune response.” What researchers eventually realized was that they could produce a one-two punch by intentionally adding their own dirt (adjuvant) to the mix. The main ingredient of the vaccine, which was a killed or inactivated version of the bacteria or virus that the vaccine was meant to protect against, did what it was supposed to do. It “taught” the body’s immune system to recognize it and produce antibodies in response to it. The adjuvant amplifies that response by triggering a more general alarm, which puts more agents of the immune system in circulation in the bloodstream, where they can then learn to recognize the key antigen. The result is an immune system more heavily armed to fight the virus or bacteria when it encounters it in the future. For about 70 years the adjuvant of choice, in nearly every vaccine worldwide, was an aluminum salt. Then in 2009, the FDA approved a new vaccine for human papillomavirus (HPV). It included a new kind of adjuvant that’s a modified version of an endotoxin molecule. These molecules, which can be dangerous, appear on the cell surface of a wide range of bacteria. As a result, humans have evolved over millions of years to detect and respond to them quickly. They trigger an immediate red alert. “In some of its forms an endotoxin can kill you,” said Trent. “But the adjuvant, which is called MPL, is a very small, carefully modified piece of it, so it’s able to trigger the immune response without overdoing it.” What Trent and his colleagues have done is expand on that basic premise. Rather than just work with an inert piece of endotoxin, they’ve engineered E. coli bacteria to express the endotoxin in many configurations on the cell surface. “These 61 E. coli strains each have a different profile on their surface,” said Brittany Needham, a doctoral student in Trent’s lab and the first author on the paper. “In every case the surface structure of the endotoxin is safe, but it will interact with the immune system in a range of ways. Suddenly we have a huge potential menu of adjuvants to test out with different kinds of vaccines.” One form might work better with cholera vaccine, another with pertussis (whooping cough) and another with a future HIV vaccine. Trent, Needham and their colleagues should be able to fine-tune the adjuvants with increasing precision as more E. coli strains are engineered and tested, and as their understanding of how they interact with the immune system deepens. “I think we’re at the dawn of a new age of vaccine design,” said Trent. “For a long time vaccinology was really a trial-and-error field. It was a black box. We knew certain things worked. We knew certain vaccines had certain side effects. But we didn’t entirely know why. Now that’s changing.” Trent said that an additional advantage of their system is that the E. coli can be engineered to express key viral and bacterial antigens along with the endotoxin. A single cell could deliver both parts of the one-two punch, or even a one-two-three punch, if antigens from multiple diseases were expressed in a single E. coli. “It makes possible a vaccine that provides protection from multiple pathogens at the same time,” said Trent. Trent and his colleagues are working on a second round of designer E. coli. They have also filed a provisional patent on their system and are working with the university to find a corporate partner to pay for clinical trials. “This is ready to go,” said Trent. “I can’t predict whether it will actually make it to the market. But it’s very similar to the adjuvant that has already been approved, and my instinct is that if a company will undertake to do the trials, it will get approved. A company could call us tomorrow, we could send them a strain, and they could start working.”
HOUSTON
A vast majority of children with the flu have illness that can be managed at home, said a pediatric emergency medicine physician from Baylor College of Medicine (www.bcm.edu). Dr. Andrea Cruz, an assistant professor of pediatrics – emergency medicine and infectious diseases at BCM and an emergency medicine physician at Texas Children’s Hospital (www.texaschildrens.org), suggested parents do not panic and rush their child to the emergency room if they suspect the flu. “If an older, healthy child is suspected by the family of having the flu and that child is not having difficulty breathing, and is continuing to eat and drink well, then the family should start by seeking care at their pediatrician's office,” said Cruz. “This will entail waiting for a much shorter period of time than if they were to come straight to the emergency room with mild illness.” Any child with underlying medical conditions such as cancer, immunodeficiency or a child that has central lines (long tubes inserted in the neck, chest, arm or leg are used to give fluids or drugs, take blood samples, or monitor pressure inside arteries of the heart) should seek care emergently whenever they have fever, Cruz said. “We also recommend that children younger than 2 months seek care if they have fever greater than 100.4 or for children 2-24 months, fever greater than or equal to 102.2,” said Cruz. “However, this care does not need to be sought in the emergency room if children are breathing and feeding well. “ Cruz said flu feels different than the average cold, with muscle aches, sore throat, and generally feeling very run down being some of the most common symptoms aside from fever. She reminded that flu is preventable and while no vaccine is 100 percent effective, the flu vaccine this year is a good match for the viral strains circulating in the community. “It is not too late for families to get immunized. The flu vaccine cannot cause influenza disease, and vaccinating is the best way to prevent spread of influenza in the community and in the home.”
HOUSTON
A vast majority of children with the flu have illness that can be managed at home, said a pediatric emergency medicine physician from Baylor College of Medicine (www.bcm.edu). Dr. Andrea Cruz, an assistant professor of pediatrics – emergency medicine and infectious diseases at BCM and an emergency medicine physician at Texas Children’s Hospital (www.texaschildrens.org), suggested parents do not panic and rush their child to the emergency room if they suspect the flu. “If an older, healthy child is suspected by the family of having the flu and that child is not having difficulty breathing, and is continuing to eat and drink well, then the family should start by seeking care at their pediatrician's office,” said Cruz. “This will entail waiting for a much shorter period of time than if they were to come straight to the emergency room with mild illness.” Any child with underlying medical conditions such as cancer, immunodeficiency or a child that has central lines (long tubes inserted in the neck, chest, arm or leg are used to give fluids or drugs, take blood samples, or monitor pressure inside arteries of the heart) should seek care emergently whenever they have fever, Cruz said. “We also recommend that children younger than 2 months seek care if they have fever greater than 100.4 or for children 2-24 months, fever greater than or equal to 102.2,” said Cruz. “However, this care does not need to be sought in the emergency room if children are breathing and feeding well. “ Cruz said flu feels different than the average cold, with muscle aches, sore throat, and generally feeling very run down being some of the most common symptoms aside from fever. She reminded that flu is preventable and while no vaccine is 100 percent effective, the flu vaccine this year is a good match for the viral strains circulating in the community. “It is not too late for families to get immunized. The flu vaccine cannot cause influenza disease, and vaccinating is the best way to prevent spread of influenza in the community and in the home.”
Michael J. Astrue, Commissioner of Social Security, announced the agency is expanding the services available with a my Social Security account, a personalized online account that people can use beginning in their working years and continuing throughout the time they receive Social Security benefits. More than 60 million Social Security beneficiaries and Supplemental Security Income (SSI) recipients can now access their benefit verification letter, payment history, and earnings record instantly using their online account. Social Security beneficiaries also can change their address and start or change direct deposit information online. “We are making it even easier for people to do their business with us from the comfort of their home, office, or library,” Commissioner Astrue said. “I encourage people of all ages to take advantage of our award-winning online services and check out the new features available through an online my Social Security account.” Social Security beneficiaries and SSI recipients with a my Social Security account can go online and get an official benefit verification letter instantly. The benefit verification letter serves as proof of income to secure loans, mortgages and other housing, and state or local benefits. Additionally, people use the letter to prove current Medicare health insurance coverage, retirement or disability status, and age. People can print or save a customized letter. Social Security processed nearly nine million requests for benefit verification letters in the past year. This new online service allows people to conduct business with Social Security without having to visit an office or make a phone call, and very often wait for a letter to arrive in the mail. It also will reduce the time spent by employees completing these requests and free them to focus on other workloads. People age 18 and older can sign up for an account at www.socialsecurity.gov/myaccount. Once there, they must be able to provide information about themselves and answers to questions that only they are likely to know. After completing the secure verification process, people can create a my Social Security account with a unique user name and password to access their information. People age 18 and older who are not receiving benefits can sign up for a my Social Security account to get a personalized online Social Security Statement. The online Statement provides eligible workers with secure and convenient access to their Social Security earnings and benefit information, and estimates of future benefits they can use to plan for their retirement. In addition, the portal also includes links to information about other online services, such as applications for retirement, disability and Medicare. “Given our significantly reduced funding, we have to find innovative ways to continue to meet the needs of the American people without compromising service,” said Commissioner Astrue. “These new enhancements will allow us to provide faster service to more people in more places.” For more information, please go to www.socialsecurity.gov/myaccount.
Parallels Between Mental Institutions & ‘Normal Life’ Keep Adding Up, Says Former State Hospital Doctor
"Insane” has a clear meaning when we can look at it next to “sane” in the real world. Unfortunately, that has become more and more difficult to do, says Mike Bartos, former chief of staff at a state psychiatric hospital for the criminally insane. “It’s not just because the media rely so much now on bizarre behavior to entertain their audiences,” says Bartos, author of “BASH” – Bay Area State Hospital – (www.mikebartos.com), a fast-paced tongue-in-cheek novel that stems from his decades of experience as a mental health-care professional. “Take a look at what have become the ‘normal’ problems in modern America – some of them could be textbook examples of psychological dysfunction.” Case – or rather, cases – in point:
• Obesity epidemic: Denial, compulsion, addiction and sublimation are just a few mechanisms at work in the psychology of a largely obese population. Sublimation is the mature defense activity perpetrated when socially unacceptable impulses, such as sexuality, are redirected, in this case to the consumption of salty, fatty and sugary food. With more than two thirds of the U.S. population either overweight or obese, there is nothing sane about this health crisis.
• Banking: The financial crisis that changed the world in 2008 can be largely owed to a cluster of “too big to fail” U.S. banks and their employees who thought they could continuously repackage terrible debt loans. Meanwhile, unqualified customers snatched up properties they couldn’t afford. This was an undiagnosed mega-scale gambling addiction. Many in the financial world knew it simply could not be sustained but the players continued to ante up.
• Climate change: Denial, denial, denial. The raw data from objective scientists overwhelmingly tells us man is largely responsible for warming global temperatures, yet we continue to use fossil fuels and to fill landfills with methane-producing waste. It’s a classic case; we completely ignore symptoms and evidence to maintain the status quo.
• A drugged nation: Marijuana, a natural relaxant, is outlawed in most states while tobacco and alcohol – responsible for incalculable violence and sickness, as well as tens of thousands of accidents and deaths each year – are lucrative and legal vice industries. Meanwhile, some pharmaceutical companies and physicians encourage substance abuse and chemical dependency by promoting pills to ease the inevitable emotional and physical pains that come with life. “Many of my psychiatric patients suffered from addiction to both legal and illegal drugs. Sometimes it was hard to tell which came first, the addiction or the other mental health issues,” Bartos says. “The legal or illegal status of certain drugs seems to be completely arbitrary -- much like the behavior of a patient suffering psychosis,” he says. • Spoiled-brat adults: Narcissistic Personality Disorder isn’t only now accepted in society, it’s widely encouraged and celebrated, Bartos says. Reckless driving and road-rage are just two examples in which individuals are so self-absorbed, they believe their time and sense of entitlement are more important than the lives and safety of others. Throw on top of that our obsession with plastic surgery, need for constant attention on social media, and pre-occupation with consumer brands and we have pandemic megalomania.
• War: America has been at war for 10 years now, and leaders cannot say with any precision what we are doing with our current campaign in Afghanistan, nor what we accomplished with our last one in Iraq. It’s as if government leaders have a masochistic, sociopathic relationship with one percent of the U.S. population – the military, and their families. Young men are shipped off in the prime of their health, and often return physically or mentally damaged, if they come back at all. “Is this sane?” Bartos asks.
With reports of flu widespread across Texas, state health officials urge people to get a flu shot now and take other steps to protect themselves from the flu and its possible complications. “Texas, like much of the country, saw an early start to the flu season and continues to experience a high level of flu and flu-like illness,” said DSHS Commissioner Dr. David Lakey. “The best thing people can do to protect themselves is to get a dose of flu vaccine now. There is plenty of vaccine available.” Each season’s vaccine provides protection against three strains of flu. Researchers with the U.S. Centers for Disease Control and Prevention say this year’s vaccine is well matched with the strains now circulating. While the number of flu cases in Texas is high, DSHS has no indication that cases have been more severe than usual this season. DSHS recommends vaccination for everyone six months old and older. It’s especially important for those in high-risk groups like children, people 65 and older, pregnant women and people with chronic health conditions. People in those groups are more likely to experience serious or life-threatening complications from flu such as bacterial pneumonia, ear and sinus infections, dehydration and worsening of chronic conditions like congestive heart failure, asthma or diabetes. Flu symptoms usually start abruptly and include fever, body aches, chills, a dry cough, sore throat, runny nose and extreme fatigue and can last a week or longer. There is an adequate supply of antiviral medications that can help lessen the severity and duration of the flu when started within 48 hours after symptoms appear. “I encourage people who have a sudden onset of fever along with a cough or sore throat to talk to their doctor as soon as they can about possible treatment,” Lakey said. In addition to getting vaccinated, people should remember to protect themselves and others from flu and other respiratory illnesses by washing their hands frequently, covering all coughs and sneezes and staying home if they’re sick. There is more information on the flu, including a vaccine finder, at TexasFlu.org. People can also contact their health care provider, local health department or dial 2-1-1 to find out where to get a flu shot.
