Friday, February 5, 2016

Save a Life: The Texas Two Step Offers Free, Hands-Only CPR Training

This Saturday, more than 20,000 Texans will gather in locations across the state to learn how to save lives.

The Texas Two Step, a free, 20-minute training session in hands-only CPR, will teach participants how to act quickly to save a life by taking two steps:

  1. Call 911.
  2. Begin hands-only CPR by pushing hard and fast on the center of the chest.

Heart disease is the #1 killer of Texans with four out of five cardiac arrests occurring at home. CPR saves lives, but most people are unprepared to help when a loved one, friend or colleague needs CPR. Texas Two Step CPR Training will provide free life-saving training for Texans.

Hosts for this family event are Texas College of Emergency Physicians, Texas Medical Association, American College of Emergency Physicians, HealthCorps, and MaveRx.

For a full list of the locations and more on this event, check out the TCEP's Texas Two Step event website.

Wednesday, February 3, 2016

What Texans Need to Know About Zika

By Rakhi Dimino, MD
Medical Director of Operations, OB Hospitalist Group
Member, TMA Council on Science and Public Health

Are you pregnant and going on a “babymoon” soon (taking a vacation before your baby is born)? If so, a new warning might interest you.
The Aedes aegypti mosquito responsible for transmitting Zika.
Image by Day Donaldson via Flickr

Recently, the Centers for Disease Control and Prevention (CDC) issued travel warnings for pregnant women visiting Mexico, certain countries in the Caribbean including the U.S. Virgin Islands and the Dominican Republic, and South American countries — because of the Zika virus.

The Zika virus is most commonly spread to humans when an infected mosquito bites. There have recently been reports of the virus spreading through sexual contact. In an adult pregnant woman, the virus generally flies under the radar because about 80 percent of those infected don’t have noticeable symptoms. Those who do have symptoms might have fatigue, rash, joint pain, red eyes, and fever. This virus, however, has been linked to a severe birth defect called microcephaly. Microcephaly literally means “small head” and can be related to developmental delays, hearing and vision problems, and seizures. We don’t know if newborns who were infected with the Zika virus while in the womb definitely will have developmental delays and other problems related to their microcephaly.

CDC recommends that women who have traveled to the affected countries and who develop possible symptoms of the virus within two weeks of their visit should see their physician and be screened for Zika. Their newborn should then be screened after birth if the mother’s test was positive or inconclusive.

While there is no known treatment for the virus, newborns who test positive can be carefully followed by their physicians for potential complications related to the virus, such as developmental delays. Unfortunately, many experts believe this virus will spread quickly to parts of North America and South America where mosquitoes are present, including Texas. The good news is that only one particular type of mosquito can spread the virus, and it is the same mosquito thought to transmit the dengue virus, which has had only small isolated outbreaks in the United States.

What can you do to prevent contracting the virus, especially while you are pregnant? First, you may want to avoid travel to countries where Zika is already prevalent. Second, wear long sleeves and pants to minimize possible exposure to mosquito bites. Wearing mosquito repellent, particularly with DEET, when you are in an area with mosquitos can be helpful. You can also spray your clothing with permethrin (an insect repellant medication) to repel mosquitos. Lastly, consider working with your community to remove areas with standing water, such as in trash cans, littered bottles, and elsewhere. Thankfully the temperatures are a little cooler here in Texas, and the mosquito population is low for now.

Dr. Dimino is a Houston OB Hospitalist and Medical Director of Operations for OB Hospitalist Group.

Monday, February 1, 2016

TMA Looks at Raising Physician Awareness of Human Trafficking

Some victims of human trafficking are walking into physicians’ offices, and many doctors believe these visits put the doctor in a unique position to help them escape sexual labor and slavery, reports Texas Medicine magazine, the monthly publication of the Texas Medical Association (TMA).

Some physicians are studying a proposed TMA resolution to help.

While it happens in many states, Texas is one prominent epicenter of the U.S. human trafficking trade, accounting for nearly one-tenth of the National Human Trafficking Resource Center’s tip calls in 2014. A 2008 Texas Attorney General report said nearly 20 percent of human trafficking victims found nationwide had been in Texas. And Texas Gov. Greg Abbott recently proclaimed January 2016 Human Trafficking Prevention Month.

Reports show many of these victims visit physicians, most commonly in emergency departments and urgent care centers. One such report compiled responses from a series of focus groups of female sexual trafficking survivors. Of those survivors who answered questions about their health care, nearly 88 percent told the winter 2014 Annals of Health Law they had contact with a health care practitioner while being trafficked.

Some physicians see those visits as opportune for helping the victims escape their situation.

“Medical providers are some of the only professionals that victims of human trafficking come in contact with during their period of slavery,” said obstetrician-gynecologist Melinda Lopez, MD, who founded and ran a clinic for sexual trafficking victims in Austin in 2013-14. “So we are really a window of opportunity for these people who are seeking access to services and to escape their situation. When we’re not able to pick up on some of those [signs] ourselves or even know what the risk factors are, or what to do with those after we do identify them, we’re missing that opportunity.”

Arlo Weltge, MD, vice speaker of TMA’s House of Delegates, said a TMA resolution to raise physicians’ awareness of trafficking would be a step in the right direction, because once physicians know what to look for, they’ll begin to recognize when a potential victim shows up in their exam room. TMA’s Council on Science and Public Health is studying a proposed resolution to raise physician awareness on this issue and will report on it for TMA’s Winter Conference later this month. TMA’s Medical Student Section introduced the proposed resolution.

David Gruber, assistant commissioner for regional and local health services at the Texas Department of State Health Services, told Texas Medicine more physician involvement in identifying trafficking victims and taking subsequent action represents “an opportunity to intervene, to break the chain of events.”

“I can compare it to being primed for Ebola or a highly contagious infectious disease or the doctor in Florida who identified the anthrax case way back in 2001,” he said. “If you’re attuned to something, you have a better chance of being able to recognize it. So if we can educate those in the medical community on signs and symptoms, much like we do for signs and symptoms of disease, then there’s a chance to do some good.”

Tuesday, January 19, 2016

Infographic: An Ounce of Prevention Is Worth More Than a Pound of Cure

As the familiar Benjamin Franklin saying goes, “An ounce of prevention is worth a pound of cure.”

The following infographic reveals the truth behind this adage. Created by the Adventist University of Health Sciences, the graphic illustrates how the top five causes of death in the United States (heart disease, cancer, chronic lower respiratory ailments, accidents, and stroke) could be dramatically reduced if America invests more in community-based prevention programs.

Some of the preventive initiatives suggested by the graphic include expanding tobacco-free environments, increasing healthy food options in schools and communities, and establishing safe walking routes and outdoor spaces for physical activity.

Tuesday, January 12, 2016

Vaccine Can Prevent Cervical Cancer - Infographic

A vaccination during adolescence can prevent cancer later in life. During Cervical Cancer Awareness Month in January, Texas physicians want to encourage parents to get their adolescents vaccinated against human papillomavirus (HPV), the cause of almost all cervical cancers. Even unvaccinated older teens and young adults can benefit.

In 2016, more than 1,000 Texas women will be diagnosed with cervical cancer, and nearly 400 will die from the deadly disease, according to the Texas Cancer Registry. Sadly, Texas’ HPV vaccination rates are low: In 2014, only half (50.7 percent) of the state’s 13- to 17-year-old girls and a third of boys the same age (36.6 percent) had received one or more of the three recommended doses of HPV vaccine.

“When I have to tell one of my patients she has cervical cancer, I wish I could turn back the clock to encourage her to get vaccinated against HPV,” said obstetrician/ gynecologist Kimberly Carter, MD, of Austin. “That simple step of getting vaccinated can reduce the risk of a potentially life-threatening illness and a lot of medical testing, treatment, and emotional distress,” said Dr. Carter, who is a member of the Texas Medical Association’s (TMA’s) Be Wise — ImmunizeSM Physician Advisory Panel.

Besides causing cervical cancer, which affects women, HPV also can cause other increasingly common cancers that affect both women and men, including oropharyngeal cancer (affecting the throat and tonsils), anal cancer, and more. And HPV can cause genital warts.

HPV is the most common infection spread through intimate or sexual contact in the United States. The American Cancer Society says HPV can be passed from person to person during sex, as well as through skin-to-skin contact with an infected area of the body, such as hand-to-genital contact.

Almost all (80 percent) of sexually active people will have the virus sometime in their life. Most people with HPV won’t notice any problems, but some may develop symptoms years later. When HPV infections persist, they can lead to genital warts or cancer.

Like any shot, the HPV vaccine is most effective before the person is exposed to the virus. That is one reason doctors want young people to get the HPV vaccination — before exposure. Young girls and boys under age 14 benefit most from the shots because their bodies fight HPV best at that age. However, the vaccine can help even after the person becomes sexually active.

The HPV vaccination (three shots given over six months) is primarily recommended for 11- and 12-year-old girls, though girls as young as 9 years old and females up through age 26 can be vaccinated. Boys should get the shots, too: Doctors recommend 11- and 12-year-old boys get the vaccine, though males 9 through 21 years of age, even as old as age 26, might benefit.

Three HPV vaccinations are available, and all are safe and effective, said Dr. Carter. Two of the vaccines protect against genital warts. The newest HPV vaccine, HPV9, gives the most protection — against nine strains of HPV. Dr. Carter suggests patients talk with their doctor about which vaccination is best.

“If more people got the HPV vaccine, we could reduce the number of infections and ultimately reduce the risk of cervical cancer by two-thirds,” said Dr. Carter, who also is president of the Texas Association of Obstetricians and Gynecologists.

TMA published an infographic (above) and a fact sheet about the importance of HPV vaccination, in English and Spanish.

Friday, January 8, 2016

100 Reasons Why Walking Does a Body Good

The start of a New Year has everyone thinking about New Year resolutions, one of the most common of which is to start living a healthier lifestyle. What better way to begin than by going outside for a walk?

The Walk With a Doc (WWAD) program encourages healthy physical activity in people of all ages by organizing physician-led walks with patients. The walks are an opportunity for physicians to encourage an active lifestyle and answer patients’ health-related questions in an environment less intimidating than the exam room. Mostly, it’s a way to get patients moving, because — as WWAD points out — there are 100 benefits to walking:

100 Benefits of Walking 
  1. Reduces blood pressure
  2. Lowers cholesterol
  3. Increases the concentration of high-density lipoprotein (HDL or “good” cholesterol in the blood)
  4. Reduces chances for coronary heart disease
  5. Increases efficiency of heart and lowers resting heart rate
  6. Makes heart muscle stronger
  7. Improves contractile function of the heart
  8. Strengthens lungs
  9. Improves respiratory function
  10. Improves cardiovascular endurance and performance
  11. Provides more oxygen to the body, including organs and muscles
  12. Provides more nutrient supply to the body
  13. Reduces chance of stroke (by up to 50 percent)
  14. Helps alleviate varicose veins
  15. Increases metabolic rate
  16. Stimulates digestion
  17. Makes digestion more efficient
  18. Stimulates intestinal movements, resulting in better elimination of wastes
  19. Reduces chances for colon cancer
  20. Strengthens and develops muscles
  21. Increases efficiency of muscles
  22. Benefits joints due to stronger muscles
  23. Helps maintain cartilage health in the joints
  24. Eases muscular tension
  25. Alleviates back problems
  26. Increases muscle flexible and agility
  27. Improves speed of muscle contraction and reaction time
  28. Enhances skin health by opening skin pores while walking, resulting in more efficient removal of dirt and impurities
  29. Burns up and removes toxins from the body
  30. Increases blood flow to the brain
  31. Stimulates growth of nerve cells in the memory center of the brain
  32. Improves various indexes of psychological functioning
  33. Enhances brain functioning by increasing the amount of oxygen available to it
  34. Increases sense of well-being
  35. Increases resistance to pain because endorphin levels are elevated
  36. Increases sense of excitement because hormone epinephrine is elevated
  37. Alleviates boredom
  38. Lessens worry and tension
  39. Reduces stress by removing lactic acid from the blood
  40. Alleviates anxiety and/or pain because the tranquilizing effect of exercise lasts for several hours
  41. Enhances mood
  42. Provides an excellent opportunity to enhance one’s social network
  43. Boosts energy
  44. Improves self-esteem and self-confidence as body and mind are improved and strengthened
  45. Increases one’s sense of self-control
  46. Provides a source of pleasure and fun
  47. Releases anger and negative emotions
  48. Reduces depression more effectively than short- or long-term psychotherapy
  49. Enhances coordination, power, timing, and balance
  50. Boosts immune system functioning
  51. Reduces severity of asthma
  52. Improves functioning of organs
  53. Can relieve tension headaches
  54. Can reduce the urge to smoke because the adrenaline rush and stress relief from a brief workout can replace similar feelings smokers get from tobacco
  55. Burns calories
  56. Causes the body to use calories more efficiently
  57. Causes weight loss
  58. Allows one to keep lost weight from returning
  59. Can act as an appetite suppressant
  60. Decreases fat tissue
  61. Improves physical appearance
  62. Enhances one’s image and opinion of his or her body
  63. Improves bone density and prevents osteoporosis
  64. Reduces joint discomfort
  65. Helps manage arthritis
  66. Allows one to feel better about his or her body and enjoy sex more as a result
  67. Provides an enhanced ability to achieve orgasm
  68. Allows for greater sexual satisfaction
  69. Can reduce or eliminate impotence due to increased blood flow
  70. Prevents or manages type 2 diabetes
  71. Helps insulin work better, lowering blood sugar
  72. Has a significant salutary effect on fibrinogen levels
  73. Alleviates menstrual cramps
  74. Improves athletic performance
  75. Can add years to one’s life
  76. Enhances quality of life
  77. Reduces pain and disability
  78. Improves glycogen storage
  79. Reduces risk of developing certain types of cancers of the colon, prostate, uterine lining, and breast, and other chronic diseases
  80. Regulates hormones
  81. Allows one to overcome illness or injury more quickly
  82. Can lessen medical bills
  83. Reduces anxiety by causing fewer worries about health
  84. Can allow for better performance at work
  85. Allows one to stay independent as he or she gets older
  86. Can keep health care insurance premiums lower
  87. Makes one more attractive to potential mates
  88. Allows for a healthy pregnancy
  89. Increases energy and ability to do things one likes
  90. Allows one to be more productive and less stymied by stress and depression
  91. Can help make possible increased income due to increased energy
  92. Allows one to become more familiar with his or her body and its functioning
  93. Can stimulate one mentally
  94. Lets one eat more without gaining weight
  95. Provides a healthy break from work
  96. Adds variety and spice to life
  97. Gives one increased ability to defend oneself and loved ones if needed
  98. Provides a natural high afterwards, such as runners’ high
  99. Provides heightened alertness
  100. Reduces inflammation 

The Texas Medical Association brings the Walk With a Doc Texas program to TMA member physicians for free. If you would like more information about the WWAD Texas program, contact Debra Heater at (512) 370-1390 or debra.heater@texmed.org.

This list originally appeared in a Walk With a Doc newsletter. The Walk With a Doc program is a nonprofit program that encourages anyone interested in taking steps for his or her health to walk with community physicians, specialists, and health care professionals, who provide support and answer questions. In Texas, where there are 24 walk sites, Walk with a Doc is made possible through a grant from TMA Foundation that includes generous gifts from TMA Insurance Trust and Prudential.

Cited sources:
Mayo Clinic 
Georgia State University
Centers for Disease Control and Prevention

Tuesday, January 5, 2016

Doctors Must Reinstill Sense of Duty

By Sid Roberts, MD
Lufkin Radiation Oncologist

This article was originally published at Houston Chronicle and is reprinted here with permission from the author.

I am a physician. Being a doctor defines me. Whether I am seeing patients in my Cancer Center or dining at a restaurant, I am Dr. Roberts. I have expectations of myself in my role of physician, certainly. But the broader community has expectations of me, as well - expectations of competence, compassion and especially availability. Surveys and patient satisfaction scores, however, show that physicians are not meeting those expectations.

I see two broad reasons for this disconnect. One is related to how we practice medicine in the 21st century (in front of a computer rather than in front of our patients). The other has to do with what we see our role to be as physicians.

As a member of my hospital's Performance Improvement Committee, patient safety is our primary concern. Too often, though, we get bogged down in an ever-increasing slough of statistics. Some data we need to track (mortality rates, infection rates, etc.) but other data (such as whether patients think the bathroom is clean enough) are, to put it mildly, distracting.

Chasing data has become the focus of American medicine, and the individual patient has been lost in the process. On top of this is the stress and frustration of working with a bloated and perversely incentivized health-care bureaucracy that views every failure to dot an "i" or cross a "t" as fraud and abuse. Not surprisingly, not only has patient satisfaction declined, but physician satisfaction with the practice of medicine has tanked as well.

It isn't simply about computers and bureaucracy. Since I started practice in 1991, the percentage of physicians in private practice has dropped dramatically. The "New England Journal of Medicine's" CareerCenter website posted that physicians coming out of residency are increasingly gravitating toward contracted rather than private practice positions. Anecdotal reports put the desire to be employed as high as 80 percent. Various reasons are given, including the uncertain direction of health-care reform, declining reimbursement and rising overhead costs. Increasingly, physicians just want to show up at work, practice medicine (without having to deal with administrative and insurance issues), and then go home. They believe that employed positions offer a more predictable work schedule than private practice.

This growing employment model, not just among millennials, coincides with a major shift in attitude among physicians about their role - dare I say duty? - when it comes to patient care. "Becker's Hospital Review," an industry magazine, noted that physicians increasingly expect their affiliated hospitals to provide compensation for on-call coverage, which used to be an expectation of all physicians who had hospital privileges. By 2001, nearly two-thirds of health care organizations provided call pay to at least some physicians.

In our hospital committee meetings, we - the self-selected 10-percenters who are involved in medical staff leadership - bemoan the loss of a sense of citizenship among physicians. We opine on the privilege of being on a medical staff, and that there are responsibilities that come with those staff privileges. Ultimately, we just want our fellow physicians to "do what is right." That simple ethical imperative is the heart and soul of the practice of medicine. Not just doing what is expedient. Certainly not just doing what you hope (or demand) to get paid for.

I fear this is where we are in medicine today. Being a physician is no longer a profession - a calling, a responsibility - it is simply a job. The art and practice of medicine has been reduced to a series of individual transactions, each separately identified in an ever-complex system of billing codes, rather than an ongoing relationship not just between doctor and patient, but between doctor and community.

How can we recover the profession? How do we reinstill a sense of duty? Of moral obligation?

Medical schools have the initial obligation to provide a strong ethical foundation for the practice of medicine. But organizations that provide ongoing training and continuing medical education are responsible as well. The Texas Medical Board requires two ethics and/or professional responsibility CME credits every 24 months as part of a total of 48 credits required.

The Texas Medical Association, which has more than 48,000 physician and medical student members, offers 62 ethics-related CME courses ranging from communication skills and dealing with difficult patients to stress and burnout and HIPAA compliance. However, there is not a single course on basic ethical principles, which have guided the practice of medicine in Western civilization for centuries. Maybe that is because an ethical imperative to "do what is right" presupposes we know (and are willing to agree on) what "right" is.

The United States Conference of Catholic Bishops produced a document - Ethical and Religious Directives for Catholic Health Care Services - which guides all Catholic healthcare institutions, including CHI St. Luke's Health hospitals. Physicians of all faiths would be well served to read and abide by these directives, which first and foremost stem from a sacred view of human dignity. If nothing else, physicians should re-read the Hippocratic Oath, which for centuries has united physicians in a common, patient-centered cause.

Finally, we should look to physician role models around us. The Lufkin/Angelina County Chamber of Commerce hosts an annual Salute to Healthcare banquet where they honor a Healthcare Professional of the Year, Nurse of the Year, Individual of Merit, and a Lifetime Achievement Award winner. In November, I had the honor again of emceeing the event. As I announced the Lifetime Achievement award recipient, I emphasized the award is not just about showing up at work for 40 years and then retiring. That's just doing your job. What we honor each year is the extra - the above and beyond - that exemplifies a career marked by service not just to patients but to society. I hope that by honoring those who set a great example of leadership, compassion, and generosity over and above medical skill, younger physicians will be inspired to follow these examples of care beyond the dollar.

I challenge my physician colleagues, young and old alike, to "do what is right" by all patients. This is your profession, if you will still claim it.

Roberts (@srob61) is a private-practice radiation oncologist at CHI St. Luke's Health Memorial in Lufkin.
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