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Tuesday, January 20, 2015

TMA Honors Hidalgo County Humanitarians

Texas Medical Association President Austin I. King, MD, honored three Hidalgo County leaders and one organization for their dedication to improving the health of their community, and who came to the rescue of thousands of Central American immigrants who entered Texas last year and continue to do so today. 

The honorees are: Martin Garza, MD, Edinburg pediatrician; Hidalgo-Starr County Medical Society; Sister Norma Pimentel, executive director, Catholic Charities of the Rio Grande Valley; and Eduardo Olivarez, chief administrative officer, Hidalgo County Health Department.

For many weeks, these honorees worked together to meet the various health and personal needs of children and families who entered the United States. Supported by Catholic Charities, the Hidalgo County Medical Society, and the Hidalgo County Health Department, physicians offered health screenings, medical care, and comfort to each person in need.  



Tuesday, January 13, 2015

Recognizing the Stages of Grief

By Sid Roberts, MD
Lufkin Radiation Oncologist

Editor’s Note: This blog post was originally published Jan. 6 at the Lufkin Daily News and on Dr. Roberts’ blog

My father recently passed away from pancreatic cancer at age 81. What a devastating disease! He lasted a mere two months. Thanks to attentive physicians and great hospice care, he was comfortable and at peace when he died.

For my mom, who was married to my father for nearly 60 years, grieving will be a process. In the medical field, we are taught to think about grief in five stages first described by Elisabeth K├╝bler-Ross in 1969: denial, anger, bargaining, depression, and acceptance. Watching my mom walk through my father’s diagnosis and death, I caught glimpses of many of these stages in her emotions and responses. It is important to note that these stages were never meant to be all-inclusive or rigidly ordered. Depending on circumstances, certain stages may be more prominent than others, or not experienced at all.

Denial is indeed often the initial response to hearing that you have (or a loved one has) a terminal disease. We just can’t believe it is happening, especially when the one with the diagnosis looks so well on the outside or doesn’t feel that bad. Unfortunately, denial can result in poor judgment. Luckily for my parents, any flashes of denial were tempered by solid medical advice and faith in their doctors.

Anger is one of those ugly emotions that can pop up at any time. But, it is one that is not difficult to understand. I typically see anger as a reaction because of dreams that will go unfulfilled. My mom was humorously a little miffed that my father didn’t make it to their 60th anniversary in April. But anyone familiar with my mother knows she is too strong a Christian to be truly angry. Significant, unresolved anger can signal deeper emotional or spiritual needs that can affect everything from pain management to dying a peaceful death.

Bargaining is the most interesting stage to me. There is a deep desire in us to bargain as Faust did with the devil for something unattainable… in this case, a cure. Sometimes we bargain with God: “If only you would spare him, I promise I would do anything!” In the terminal cancer arena, this bargaining often takes the guise of a search for alternative, unproven “snake oil” treatments. (Mexico, anyone?) To my parents’ credit, they did not pursue futile, expensive elixirs or elusive cures.

Depression and acceptance tend to wrestle with one another, with melancholy eventually fading and acceptance gaining the upper hand. At least that is what we expect with typical grief.

My mother is a strong, confident woman. She held her head high at my father’s funeral and presided over the reception and luncheon with poise and grace. She so appreciated having her sons and relatives with her! I feared she might not do well by herself after everyone left, but she firmly informed me that she needed some time alone to grieve. For her, that was the right decision. She will cry; she will remember. But she will go on, I have no doubt.

Grief shouldn’t be buried. Tears are OK, even desired. However, debilitating, ongoing depression is not healthy. A minority of people experience a complicated grief that requires significant emotional, psychosocial, even medical support. Hospices are obligated to offer bereavement services for families of patients. What most don’t know is that you don’t have to have lost someone on hospice to join a hospice bereavement group! If you are grieving a recent loss and want to talk to someone or participate in a support group, contact your local hospice for help. You don’t have to grieve alone.

Dr. Roberts is a radiation oncologist at the Arthur Temple, Sr. Regional Cancer Center in Lufkin. He is a contributing writer for the Lufkin Daily News and blogs at SRob61.blogspot.com

Thursday, January 8, 2015

Cartoon: Vaccinate Yourself Against Vaccine Misinformation

If you’ve ever searched the word “vaccines” on the Internet, chances are you’ve come across some really scary ― but patently false ― information. If you’re looking for a smart, concise history on vaccines and the science behind these life-saving medical miracles, check out this fun comic strip by Popular Science cartoonist and blogger Maki Naro. First published on The Nib, Mr. Naro’s cartoon, “Vaccines Work: Here Are the Facts,” explains why we should fear vaccine-preventable diseases like measles, whooping cough, and influenza, and not the vaccines themselves.

“Like diseases, fear and misinformation spread easily to those who aren’t vaccinated against them,” Mr. Naro writes. “Help contribute to herd immunity by educating your community today!”


Wednesday, January 7, 2015

FDA Reevaluates Gay Blood Donor Eligibility

By Meredith A. Reyes, MD
Houston pathologist

The Food and Drug Administration (FDA) has announced it will revise the current lifetime ban on blood donation from men who have had sex with other men (MSM), even once, since 1977. Many patients may wish to understand the reasoning behind the longstanding deferral of these potential blood donors, or the scientific and medical evidence that supports the change in this policy.

The policy of deferring MSM donors has been in place since the early 1980s, early in the AIDS epidemic and before the HIV virus had been discovered. It has remained in place because MSM are, as a group, at increased risk for HIV, hepatitis B, and other infections that may be transmitted to those who receive blood transfusions. MSM represent about 4 percent of the men in the United States4. In 2010, however, they accounted for 78 percent of new HIV infections among males and 63 percent of all new infections2. MSM accounted for 54 percent of all people living with HIV infection in 2011. The estimated number of new HIV infections was greatest among MSM aged 13-24 years.

Improvements in blood donation screening have been made since the ban was put in place. Today blood is screened for multiple infectious agents, including two different tests for HIV. Despite those improvements, the risk of acquiring HIV from transfusion is approximately 1 per 2 million units transfused. This very small risk remains because of a “window period” between the time an individual is infected and the time laboratory tests will detect infection – approximately 9 days for HIV. The lifetime deferral has remained in place because of this “window period” and because MSM remain at high risk for HIV .

The strict, lifetime deferral policy means many healthy blood donors are turned away. The new FDA policy would change the deferral period for men who have had sex with men to a temporary, 12 month period. This is consistent with policies for other populations considered at high risk for HIV infection (accidental needlestick/blood exposure, sexual contact with an individual with HIV, or viral hepatitis). This 12- month deferral far exceeds any known “window period” for detectability of infection. It has also been discussed that certain members of the MSM population (those with low numbers of partners or in long-term relationships with only one partner) might be at a lower risk of HIV infection. However, no donor screening standards or questions have been devised that can reliably identify a potentially lower risk group of donors. The UK, Australia, Sweden, Hungary, and Japan all have instituted 12- month deferral periods; Canada and New Zealand have 5-year deferrals; and South Africa has a 6 month deferral. Italy and Spain assess the risk of all donors with a questionnaire, regardless of their sexual orientation.

It has been documented, both within and outside of the US, that MSM who otherwise would not be allowed to donate blood, have violated the current lifetime deferral. A recent study found that this practice may be increasing. That study interviewed those who had not complied with the lifetime ban. Many of those interviewed said they would, however, comply with a 12-month deferral period. It is estimated the change to a 12-month deferral would allow about 180,000 new U.S. men to be eligible for donation.

Doctors and patients want confirmation that the blood supply is safe. The FDA has concluded that there is no scientific or medical evidence supporting an indefinite deferral of MSM donors. Changing the deferral to 12 months after last sexual contact with another male is similar to the standards used for others at increased risk of transfusion-transmitted infections. The FDA is expected to issue national guidelines in the future, and will require increased surveillance of all transfusion-transmitted diseases to evaluate this new policy.

Meredith A. Reyes, MD, is chair of the TMA Committee on Blood and Tissue Usage. She is also Associate Director of Transfusion Services at Houston Methodist Hospital.

Tuesday, January 6, 2015

Vaccinate Yourself and Your Children Against the Flu

By Jason V. Terk, MD
President, Texas Pediatric Society
Be Wise — Immunize physician advisory panel member

It happens every year, and it always seems the same. Influenza appears, millions of people get sick, many thousands get hospitalized, and many of those hospitalized die. And yet, influenza vaccination remains one of the most undeservedly controversial interventions in our public health toolbox. There are many reasons why this is the case. It is (like all vaccines) an imperfect preventive measure that one can never be sure did what it was supposed to do. You never get a memorandum from your body letting you know that you were exposed to influenza and did not get sick because of immunity from the vaccine you decided to get. On the other hand, many people get sick in the wintertime with the many viruses that are not influenza and erroneously believe that that the flu vaccine failed to protect them. And, of course, there are the many people who get the flu vaccine too late and get sick from natural infection and believe the vaccine caused their illness. The common thread through all of this is belief.

Belief-based decisions are by their very nature resistant to revision. So, it is very hard to convince people who decide not get a flu vaccine for themselves or their children that their conclusions about this very important public health tool are wrong if their decision is based on belief rather than evidence. In fact, presenting factual information that conflicts with their belief-based decision actually causes a hardening of that belief-based decision.

That is why for me influenza season can be such a heartbreaker. Every year it happens, and every year it is the same. Children (the patients I take of) get sick, and too many children unnecessarily die. The Centers for Disease Control and Prevention already has raised an alarm about the high number of pediatric deaths seen this winter. It is too soon to have 15 children die, with a relatively small part of the country seeing widespread influenza in the early part of the season. Flu is now affecting greater parts of the country, and those pediatric deaths are sure to climb.

This year is worse than others for one major reason. The predominant strain of influenza A is H3N2 rather than the H1N1 strain that usually circulates. And, historically, when H3N2 is the predominant strain, we have more people getting sick with more severe disease. Yes, the vaccine is not well-matched to what is circulating, but it does protect to some degree. It certainly protects better than no vaccine. Anecdotally, it has been my observation this year that kids who have come in with flu who were vaccinated have been less sick than those who did not get the vaccine.

It is the nature of omission bias that we feel less responsible for acts of omission versus acts of commission. In this case, omitting getting a flu vaccine for yourself and your child can be serious and deadly. Once again, please get vaccinated!


Wednesday, December 31, 2014

Me&My Doc’s Top 10 Posts of 2014

From the rollout of the Affordable Care Act (ACA) health insurance marketplace and the veteran health care debacle to the Central American immigrant crisis and Ebola and pertussis outbreaks, 2014 was a year for health stories. Here are Me&My Doctor’s top 10 posts of 2014:

  1. The Truth About Ebola. Myths and fear dominated the social media conversation when a Liberian man died from Ebola at a Dallas hospital. After two nurses who cared for him became infected, all eyes were on the Texas medical community. TMA stepped up, and Ed Dominguez, MD, addressed the public’s concerns with a fact-based article on the science behind the disease.

  2. Speak Your Mind Texas to Help Youth Suffering From Mental Illness. The Texas Department of State Health Services is starting up a conversation about mental health with “Speak Your Mind Texas.” The campaign focuses on teens and young adults who may be struggling with mental illness or substance abuse, and teaches them and their loved ones how to notice the signs and where to seek help.

  3. Immunization Registries Protect Texans. TMA physician Donald Murphey, MD, testified in support of a more complete immunization registry for children and adults so physicians and public health officials can use the information to support vaccination outreach and manage infectious disease outbreaks proactively in Texas communities.

  4. Video: Medicare Can’t Work Without Doctors. Another year, another Medicare payment cut loomed for physicians who care for seniors. TMA’s animated video illustrates how this yearly uncertainty causes many doctors to retire, close their practice, or stop taking new Medicare patients, making it harder for seniors to find a doctor.

  5. A Calling to Help. For medical student Jason Wu, becoming a doctor is about more than caring for patients in a clinical setting. Mr. Wu learned firsthand that his “calling to help” included stepping up in emergency situations to use his knowledge and expertise after fellow travelers fell ill.

  6. What the Medicare Numbers Reveal ― and What They Don’t. In April, the Centers for Medicare & Medicaid Services released information detailing how the $77 billion Medicare spent to pay physicians was distributed among the country’s 880,000 providers. This caused a small uproar in the media about how much certain physicians were paid in that year. However, it quickly became clear there were a lot of misconceptions about what the numbers really mean.

  7. Texas Baby Dies of Pertussis. The first Texas victim of pertussis in 2014 was a 27-day old baby too young to be vaccinated against the deadly disease. TMA physicians urge everyone who is in contact with infants to prevent another tragedy like this one and get a pertussis vaccine.

  8. ACA Now Covers Breast Cancer Prevention. To help the fight against cancer, the U.S. Department of Health and Human Services clarified that under the ACA, most health insurance companies and employer plans must cover certain cancer-preventing medicines without copays or other out-of-pocket expenses for women at increased risk for breast cancer.

  9. You’ve Got ACA Marketplace Questions ― “Hey, Doc” Has Answers. If you’ve signed up for the ACA’s marketplace, it’s likely you may have questions about your shiny new health insurance. TMA’s “Hey, Doc” education campaign answers these questions and more in a weekly segment.

  10. Dying Peace. TMA’s Johnson Wu, DO, writes about the difficult decisions patients face when diagnosed with a terminal cancer: “My hope is to see every person treated with respect, dignity, and without suffering at the end of life. We can do this only if we as a society are open and willing to accept comfort care and quality of life over aggressive treatment. Death is inevitable, but patients should be able to die in peace.”


Tuesday, December 30, 2014

Flu, not Ebola, is the epidemic we should be concerned about

By Carol J. Baker, MD
Pediatric Disease Specialist

This article originally appeared in the Houston Chronicle. Republished with permission from the author.

Recently, the news has been dominated by the dangers and deaths from Ebola virus, with thousands of Americans being deployed to West Africa to fight Ebola. Yet we need to also be concerned about another epidemic, one that hits us every year: influenza virus or the flu, which killed more Americans last year than the current total deaths from Ebola in Liberia. While the severity of the flu epidemic is unpredictable, it always hospitalizes thousands of Americans and last year killed 107 children, almost half of whom were previously healthy; so far this year, five children have died. This month ushered in this year's epidemic in Texas. We also learned from the U.S. Centers for Disease Control and Prevention that the most frequent strain of the four influenza viruses, H3N2, is dominant so far. H3N2 flu is linked to severe influenza seasons, with high rates of hospitalization and death. Also, a little more than half of the patients with H3N2 flu disease so far have virus that has mutated slightly, making this part of the vaccine less effective.

You may think this change in one of the four flu viruses is a reason not to get vaccinated. This is simply not the case. The influenza vaccine remains the best way to protect yourself and your family from the flu, and it is better than other important strategies, like hand and cough hygiene and staying away from people with flu symptoms. Even with the mutated H3N2 flu circulating, this year's flu vaccine protects against other strains causing flu. While this year's vaccine could be somewhat less effective, opting for no vaccination assures no protection.

Getting the flu vaccine is especially important to protect the most vulnerable: pregnant women, children under two years of age, the elderly and those people with diseases or receiving medications that impair the immune system (e.g., cancer). Last year, only 52 percent of pregnant women and 70 percent of children under two were vaccinated. Pregnant women are five times more likely to have a complication from influenza that results in hospitalization than nonpregnant women of the same age. Vaccination not only protects the woman, but the antibodies created by the mother in response to flu vaccine pass through the umbilical cord and breast milk to the baby, protecting the baby before age 6 months when the flu vaccine can be given. Also, flu-vaccinated pregnant women have fewer premature and low-birth weight babies, and millions of flu vaccine doses given in the past have proven how safe this vaccine is for mother and baby.

While you may think that flu is no worse than other respiratory viruses common this time of year, flu is distinct. It causes high fever, severe muscle aches, fatigue, sore throat and in children sometimes vomiting and diarrhea, symptoms that last a week or more. Getting the vaccine not only protects, but if you do get the flu, the symptoms are less severe and don't last as long.

Every year, my colleagues and I care for far too many vulnerable infants and children who suffer needlessly from an infection that can be prevented. It's not too late to be immunized: The flu epidemic typically peaks in February and continues into the spring. Vaccine is still available; if your physician has no more supply, go to a pharmacy or the health department. It takes 14 days to be protected after vaccination, so readers who haven't already done so should take this opportunity to seek the flu vaccine as soon as possible.

We still anticipate seeing an increase in cases at our hospitals, so there is still time to protect yourself and your loved ones. Flu vaccine is truly the best personal protective equipment you can wear during flu season.

Carol J. Baker, a physician, is a pediatric infectious disease specialist and executive director of the Center for Vaccine Awareness and Research at Texas Children's Hospital. Baker, also a professor of pediatrics, molecular virology and microbiology at Baylor College of Medicine, is a past chair of the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices.

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