Monday, December 9, 2019

Science: Vaccines Do Not Cause Autism, But Physicians Fight to Reassure, Immunize

Editor's Note: This video is part of a monthly Texas Medical Association series highlighting infectious diseases that childhood and adult vaccinations can prevent. posts a video about a different disease/public health issue each month. Some of the topics featured include: FluMeaslesPneumococcal diseaseHuman papillomavirus (HPV)Chickenpox and shinglesPertussis (whooping cough), Hepatitis ARubella (also known as German measles), RotavirusPolioMumpsTetanusHepatitis B, and Meningococcal BDiphtheria, pregnancy and vaccines, and more. 

TMA designed the series to inform people of the facts about these diseases and to help them understand the benefits of vaccinations to prevent illness. Visit the TMA website to see news releases and more information about these diseases, as well as physicians' efforts to raise immunization awareness.

In this video, Jennifer Shuford, MD, a consultant to TMA's Committee on Infectious Diseases and infectious disease medical officer for the Texas Department of State Health Services, says there is no connection between vaccines like the measles-mumps-rubella (MMR) vaccine and autism. She emphasizes the surplus of well-documented scientific research dismissing the claims popularized by antivaccine advocates.

The MMR vaccine protects against measles, mumps, and rubella - contagious diseases caused by a virus. Patients who contract any of these diseases can suffer from symptoms like fever, cough, runny nose, fatigue, and swelling. The U.S Centers for Disease Control and Prevention (CDC) recommends children get two doses of the MMR vaccine: one dose at age 12 to 15 months and another dose at 4 to 6 years old. Teenagers and adults are also urged to be caught up with their MMR vaccination.

Opposition against vaccinations grew when a former British doctor, wrote a now-debunked study claiming a link between MMR and autism spectrum disorder (ASD), a developmental and neurological disability that affects a person's behavior, communication, and learning skills. The publication later retracted the paper after finding the physician skewed his research, abused the children he studied, and hid financial incentives for the report. (He eventually was barred from practicing medicine.) More than 25 scientific studies since that time have found no casual link between the MMR vaccine and ASD.

While more parents are resisting vaccinating their children with shots like the MMR vaccine, a national measles outbreak has occurred in 2019. Texas health officials reported 21 confirmed measles cases as of September.
According to the CDC, the majority of people who got measles were unvaccinated.

Meanwhile, vaccination rates across the U.S. and Europe have dropped. There are currently more than 64,000  school vaccination exemptions recorded in Texas – however the state's overall exemption rate is 1.2%, meaning more than 98% of students are vaccinated.

Vaccines like the MMR vaccine are not only scientifically proven to be effective, they protect you and your loved ones from infectious diseases.

Thursday, December 5, 2019

Walking the Walk with My Patients

Amanda Mohammed, MD
Dallas Family Physician
Member, Texas Medical Association 

Editor's Note: An earlier version of this article was originally published on Women in White Coats.

The idea behind not only talking the talk but walking the walk: Daily I have conversations with patients on how to improve their medical conditions by implementing dietary modifications and routine exercise. I try my best to give patients the tools to succeed, including what exercise routines they may be best suited for given their medical conditions. But I felt like there was more I could do to implement change.

I believe strongly in living a life that mirrors what I advocate in my work. When I discovered “Walk With a Doc,” I realized it fit my goals. Walk With a Doc is a doctor-led walking group that is a part of a national grassroots movement dedicated to encouraging healthy living. It provides a safe, fun and free environment that allows for discussion with doctors about topics that there seldom is time for during an office visit. In addition, it creates a relaxed atmosphere to get to know your patients outside of a white coat.

How It All Began

This program was started in 2005 by Dr. David Sabgir, a board certified cardiologist in Columbus, Ohio. The TMA (Texas Medical Association) sponsors the walks for its member physicians in Texas. It is one of the many ways being a TMA member has opened opportunities for me to be involved in my community. I believe with the demands of a full time physician, we can get distracted from advocacy and feel we don’t have enough time in our day.

However, the reality is we have to incorporate our passions in our work, or it will never be an “ideal” time start anything. I joined Walk With a Doc in June of 2019 in my first year out of my medical residency, and now have now lead 4 walks in the Dallas area. I’ve met wonderful people in the process that ordinarily I’m sure I would not have encountered otherwise.

What I Have Found

What is most satisfying is having my own patients walk alongside me outside of the office setting. It is truly inspiring communities through movement and conversation. Being able to connect with others in your own neighborhood and establish connections that extend beyond chronic medical conditions and medications is essential for overall wellness.

Dr. Mohammed (second from right) walks alongside patients
at a Walk With a Doc event in Dallas.
Photo courtesy of Amanda Mohammed, MD
Exercise is critical for maintaining a healthy body and lifestyle. Not only does walking at least 30 minutes a day help lower the risk of obesity, it also enhances your mental health, blood pressure and reduces your chance of developing diabetes.

Walk With a Doc  events take place all over the world. Medical students, resident physicians, practicing physicians and community members are involved in making this program a success.

If you are interested, and want to learn more, please come out for our next walk! For more information regarding Walk With a Doc and how to get involved please visit contact me via Instagram @dr.mandamo

Dr. Amanda Mohammed, MD is a practicing Family Medicine Physician in Dallas, Texas. She enjoys traveling, visiting local coffee shops, volunteering, photography and live music. You can follow her on Instagram @dr.mandamo.

Wednesday, November 27, 2019

“Everyone else is doing it”: A Breakdown of Vaping, the Dangerous Trend Among Teens

By Emily Hazen, DO
Pediatric Resident at The University of Texas at Austin Dell Medical School
Member, Texas Medical Association

Make no mistake, vaping – the inhaling of a vapor produced by an electronic cigarette (e-cigarette) or vaping device – is becoming increasingly more common in our society.  So much so, medical professionals believe it’s caused a deadly outbreak of lung-related illnesses across the country. Among all the different age groups, adolescents are the most susceptible to developing an addiction to vaping. If you aren’t familiar with the dangers of vaping, here’s what you need to know:

What is vaping, in the teenage cultural sense?
Vaping is considered to be the new “behind the dumpster” – and, for that matter, in front of the dumpster, in the car, in the classroom, at the football game – favorite teen activity.

The Facts
  • Vaping is associated with using electronic vaping products (EVPs) or electronic nicotine delivery systems (ENDS), like e-cigarettes (e-cigs), vape pens, e-hookahs, tanks, mods, and dab pens (devices used solely for vaping THC, the ingredient in marijuana that makes people high).
  • What is JUUL? JUUL is the most popular brand of battery-powered e-cigarette among young people. It’s shaped like a USB flash drive, so teenagers who use them can be very discreet. People who vape JUUL products commonly refer to vaping as “Juuling.”
  • A JUUL “pod” has the same amount of nicotine as a pack of 20 regular cigarettes.  
  • E-cigarettes work by heating a nicotine-containing liquid to produce an aerosol that is inhaled.
  • E-cigarette aerosol is NOT harmless “water vapor.” It can contain: nicotine, ultrafine particles, flavorings such as diacetyl (a chemical linked to a serious lung disease), volatile organic compounds, cancer-causing chemicals, and heavy metals such as nickel, tin, and lead.

The Stats

The Attraction of Electronic Vaping Products
  • EVPs are considered by users as a trendy way to smoke. Cigarettes are now considered unfashionable.
  • Electronic vapor products are sleek and inconspicuous.
  • They are available in many flavors, including fruits, menthol, and mint. 
  • They’re taxed at a lower rate compared to conventional cigarettes
  • Advertising companies easily target and manipulate youth by using celebrity promoters to fulfill powerful psychological needs like popularity, peer acceptance, and a positive self-image, while marketing EVPs as products to help people quit smoking, a claim the FDA has dismissed
  • Young people have described the feeling after smoking as a “little head high” or “little buzz.”
  • These devices also can be used to vape THC liquid and other drugs.

The Catch
  • Vaping is just a new, easier way of becoming addicted to nicotine. It makes teens statistically more likely to go on to use real cigarettes and increase the risk for addiction to other drugs.
  • Surprise! Nicotine harms adolescent brain development, which continues into the early to mid-20s. This is a crucial time for development of brain synapses related to attention, learning, mood, and impulse control. 
  • Users may not know what is in the vaping solutions. Many of the products and substances can be modified by suppliers or users. They can be obtained from stores, online retailers, from friends and family, or “off the street.”    
  • There is not enough vaping history for scientific evidence regarding what will happen in 10, 20, or even 50 years – which makes the dangers of vaping all the more concerning.

The Impact 
  • New outbreak of pulmonary (lung) disease related to THC-containing vape products. 
  • As of Nov. 20, 2019, there have been 2, 290 cases of lung injury (EVALI) associated with use of e-cigarettes or vaping products, reported to the CDC.
  • Forty-seven deaths have been confirmed in 25 states and the District of Columbia.
  • As of Nov. 5, 2019, 15% of these patients are under 18-years-old and 38% of patients are 18 to 24 years old.
  • On Nov. 8, the CDC identified vitamin E acetate – a compound used in many foods, supplements, cosmetics, and vaping products – as a “potential toxin of concern” after it was found in 29 patients from ten different states. The CDC says it will continue investigating other substances and products because there could be more than one cause of this outbreak. A new report released by the CDC points to more evidence vitamin E acetate is a factor in the EVALI outbreak and why the illnesses are appearing in 2019 specifically.
  • Extremely high levels of the chemical vitamin E acetate have been found in many cannabis-containing vaping products. 
  • The outbreak is occurring as the popularity for e-cigarette products rises. Companies are producing and marketing EVPs with a mix of ingredients, complex packaging and supply chains, and with that, potentially including illicit substances.

The Federal Government Steps In
What’s the government doing?

What can parents do?
  • Set a good example by avoiding nicotine-containing products. 
  • Learn about the different types of e-cigarettes available and the risks for using them.
  • Talk to your children openly and without judgment. 
  • Refer to this Tip Sheet for Parents, published by the CDC

How are physicians and other health care providers getting involved?
  • As physicians educate themselves about the different types of e-cigarettes, vapes, and substances, they may warn all patients, especially young ones, about the risks of all forms of tobacco product use, including vapes. 
  • A primary care physician might ask if you’ve used e-cigarettes or similar devices and ask about symptoms when screening for the use of tobacco products.
  • If patients admit to using any of these products, a physician may ask: The type of vaping they do (nicotine, THC, or both); Source of the product (location purchased and whether its commercial or homemade or otherwise); and the type of device used.
  • Doctors may encourage patients who use these products to avoid buying from informal sources or “off the street,” and advise against modifying or adding any substances to these products that are not intended by the manufacturer.
    A physician could consider vaping-related lung disease for any young patient complaining of coughing, shortness of breath, or chest pain. Often these symptoms are also accompanied by nausea, vomiting, or other stomach-related concerns.
  • Physicians will report any case of confirmed vaping-related pulmonary disease to your local or state health department.
Resources for further reading and guidance for parents:

“The Real Cost” Campaign 

Safer ≠ Safe 

Wednesday, November 20, 2019

ROBERTS: How, where people die – is it good?

By Sid Roberts, MD
Lufkin Radiation Oncologist
Member, Texas Medical Association

Editor’s Note: An earlier version of this article was originally published on Dr. Roberts’ blog and The Lufkin Daily News.

All of us, at some point, have pondered what it means to have a “good” death.

A common theme is to fall asleep in one’s own bed and simply not wake up. Woody Allen famously said, “I’m not afraid of death; I just don’t want to be there when it happens.” The underlying desire is comfort, serenity, peace.

According to the Centers for Disease Control and Prevention, the Top 10 causes of death in the United States in recent years were heart disease, cancer, accidents, lung diseases, stroke, Alzheimer’s disease, diabetes, influenza and pneumonia, kidney disease and suicide.

These Top 10 account for three out of four deaths, and most are chronic diseases marked by decline over years with increasing need for medical care and hospitalization along the way. Yet all along there is this denial of illness and death.

We used to be familiar with death.

Before the 1940s – prior to antibiotics, chemotherapy, heart surgery – people usually died in their homes over the course of a few days or weeks. Sir William Osler (1849-1919), frequently described as the Father of Modern Medicine, called pneumonia – a leading cause of death in his time – the “friend of the aged” because it was an “an acute, short, not often painful illness.”

With the advent of the intensive care unit (ICU) and an ever-expanding medical-industrial complex, we now admit approximately 4 million patients to the ICU each year and we see about 500,000 ICU deaths annually.

The contrast between death at home versus in a technology-overrun ICU could not be more stark. In 2010, more than one-quarter (28.6%) of Americans died in the hospital. Yet 9 out of 10 Americans say they would prefer to die at home if they were terminally ill and had six months or less to live.

Unfortunately, death in the hospital is rarely pretty. Believe me, hospitals do not want patients dying in their facilities. It messes with statistics and quality ratings. It also is far more expensive. So, if hospitals don’t want us dying there, it costs more money, and we say we would prefer to die at home, where is the disconnect?

There are several problems. Doctors don’t like talking with their patients about death and dying. Physicians don’t want to appear to be giving up hope by talking about end-of-life care, nor do they want to appear helpless, as if nothing more can be done.

Patients, having watched one too many TV medical dramas, believe that technology and medicines are so good now that they can overcome any illness, even at the very end of life.

Perhaps the most egregious of these technological and communication disconnects at the end of life is with a procedure called cardiopulmonary resuscitation – the “Code Blue” you hear overhead periodically in hospitals. A code blue is an actual life-threatening emergency situation in which a patient is dying – typically their heart has stopped beating and/or breathing has ceased – and an entire medical team works to revive him/her with medications, chest compressions, intubation (inserting a tube into the patient’s airway to help with breathing), electrical shocks and more.

Cardiopulmonary resuscitation (CPR) can be life-saving in the community setting when a person suffers a heart attack or drowning, for example. According to 2014 data, nearly 45% of out-of-hospital cardiac arrest victims survived when a bystander administered CPR.

For hospitalized patients who suffer cardiac arrest (essentially, who die), the overall rate of survival from a “full code” procedure leading to that person being healthy enough for the hospital to discharge them is barely 10%. But most people, when asked in a scientific study, believe the survival rate to be more than 75%.

Unfortunately, the quality of life of patients who do survive resuscitation in the hospital often is not good. Rarely do the few survivors return to their previous functional status, which in hospitalized patients was probably poor to begin with. There can be brain damage from prolonged lack of oxygen, bruising and pain from broken ribs, and need for prolonged rehabilitation or nursing home placement.

But unless you – or a family member speaking for you – explicitly states otherwise, this likely will happen to you if you are coded in the hospital. And despite the resuscitation attempt, you will very probably die anyway. Is this really what you want your final minutes to look like?

The good news is that we have far more control over where and how we die than one may think.

First, talk with your spouse and your kids – and your doctor – about how you wish to die and where you wish to die if you were to find out you have a terminal illness.

Second, make every effort to write your wishes down. In Texas, there is a document called a Living Will available online at Both English and Spanish versions are available.

This directive to physicians and family or surrogates lets you, the patient, tell your doctors and others what types of treatments you do or do not want if you are terminally ill and no longer able to make medical decisions.

In addition to this advance directive, Texas law provides for two other types of directives that can be important during a serious illness. These are the Medical Power of Attorney and the Out-of-Hospital Do-Not-Resuscitate Order.

Don’t wait until a crisis to make your wishes known. It may be too late.

Finally, hospice care is available through Medicare, Medicaid and most private insurers to help patients achieve the “good” death they say they want; not by hastening death, but by helping terminal patients fully live the life they have left as comfortably as possible – and most often at home.

Monday, November 11, 2019

Concussions in the Student-Athlete – What They Are and What to Do About Them

By Christopher Ng, MD
Pediatric Resident at The University of Texas at Austin Dell Medical School
Member, Texas Medical Association

We’ve all seen the play: a helmet-to-helmet tackle in football, an off-balanced rebound where a player hits the floor in basketball, or a slide tackle where the tackler gets clipped in the head in soccer  even cheerleaders falling on top of one another after a stunt goes wrong. The injured athlete gets up and goes to the sideline to be evaluated, and is diagnosed with a concussion. But what is a concussion? What are those docs on the sideline looking for? And for our teenage athletes – What can we do to prevent lasting brain damage that will affect you for the rest of your life? 

A concussion is a type of traumatic brain injury that’s caused by a force of impact to the head – or a hit to the body – causing the head and brain to move back and forth. The brain bounces around inside the skull, damaging it. Sometimes the injured person loses consciousness or is in an altered mental state. Concussions are relatively common in sports, accounting for almost 10% of all high school athletic injuries. The concussion count might be even higher considering how many people – especially student athletes – don’t report their symptoms.

When a player gets hit in the head, the sports doctors or athlete trainers on the sidelines typically will ask a series of questions and memory quizzes to assess the player’s cognitive condition (whether he or she is thinking clearly). They also will check for other things that suggest the injured player is incapable of going back into the game, including imbalance, slurring of speech, and poor coordination. If there’s any question of a concussion at all, the player will be pulled from the game until further evaluation. The doctor also will conduct a physical exam to ensure there are no fractures or other injuries that need immediate referral to an emergency department.

Concussion symptoms do not always develop immediately after the injury but typically present within hours to the first few days after the injury. Some examples are:

  • Headache,
  • Confusion and disorientation,
  • Memory problems or amnesia,
  • Blank staring or “stunned appearance,”
  • Problems with walking or dizziness,
  • Vomiting, and
  • Emotionality.

One Myth

Many people think a player must “pass out” or lose consciousness on the field to have a concussion, but most concussion sufferers actually never lose consciousness. However, most people who are “knocked out” do suffer a concussion. And sometimes a person can experience a concussion without visible structural damage on imaging tests like CT scans or MRIs. That’s why any head injury needs to be treated with a serious approach.

Next Steps

After someone suffers a concussion, the first thing to do is to schedule a follow-up appointment with either a sports-medicine specialist or the player's primary care doctor. There, the physician can assess the patient to see if any further symptoms are developing. He or she will assess the player over time until the doctor clears the player to undergo the school’s return-to-play protocol. It’s crucial that the injured athlete doesn’t reinjure his or her head. A player who gets hurt during this healing period risks suffering a condition called second impact syndrome, which could cause serious injury like brain swelling, brain herniation (pressure in the skull that moves brain tissues), or even death.

Athletes should return to practices and games only when they have demonstrated full recovery. Most schools’ return-to-play protocols set a step-by-step course to return to action. The timing to return to school and to competition is gradual and varies player to player. The average recovery period is two to three weeks. Most doctors recommend that players undergo brief physical rest for one or two days after the injury. Until recently, medical experts recommended that players rest for even longer. However, newer studies reveal that players who start noncontact, supervised, light aerobic activity (walking or riding a stationary bike) might have a quicker recovery. Therefore, new recommendations are being developed based on those findings – as long as the light exercise doesn’t severely exacerbate the athletes symptoms.

What About Schoolwork?

When it comes to activities requiring cognitive abilities like schoolwork or testing, players should get back to the books only if their symptoms allow it. Long amounts of screen time are discouraged, as that can worsen symptoms. Once players can concentrate up to 30-45 minutes at a time without their symptoms worsening, they can return to school. Recuperating players take an average of one to two days off from school post-injury. Once back at school, a recovering player might initially need adjustments – such as break times at the nurse’s office or reduced class time. This should be worked out among the student-athlete, his or her parents and medical team, and the school.


Some physicians may prescribe medications for lingering symptoms a player might have, such as headache, nausea, vomiting, or sleep issues, but these typically are needed only for a few days post-injury. If symptoms continue for more than three to four weeks, a player may want to ask his or her primary doctor about seeing a specialty team for care.

Long-Term Effects

In general, most athletes recover from a concussion without severe repercussions. However, a second head injury – or multiple concussions over the course of a sports career – can lead to more permanent damage. Chronic traumatic encephalopathy, a neurodegenerative disease caused by repeated blows to the head, is undergoing more study and discussion in mainstream media.
Having a concussion can be a scary and troublesome injury to overcome. However, with the right medical team in place, players can quickly recover and return to play without compromising their future.

Thursday, October 31, 2019

Stage 4 Needs More: A Granddaughter's Continued Journey into Breast Cancer Advocacy – Part 5

By Olivia Suárez
Media Relations Coordinator
Texas Medical Association

Editor’s Note: This post is the last installment in a five-part series about the author’s personal perspective on metastatic (stage 4) breast cancer, and her return visit to Washington D.C., in October (Breast Cancer Awareness Month), to advocate for research funding and increased awareness of the disease. In this final story, the writer describes the last of her meetings to urge federal lawmakers for support, and reflects on what this year’s “Stage IV Stampede” means to her.

This series is a follow-up to the author’s five-part 2018 series, “Adversity to Advocacy: A Granddaughter’s Story of Stage 4 Breast Cancer,” about how the loss of a loved one motivated the author to travel to our nation’s capital to speak out against metastatic breast cancer.

Mrs. Estela Shimanek, the author's late grandmother.
Photo by Olivia Suarez
As I walked through the halls of the various Senate buildings, a rush of excitement came over me. Here I was, again in Washington D.C., advocating for increased research and funding for metastatic (stage 4) breast cancer – otherwise known as MBC. I wanted to continue the efforts after my grandma Estela died from the disease in August 2018. On this day, Friday, Oct. 11, I found myself not only engaging with congressional staff, but guiding the rest of my team of fellow advocates. I felt good about how the rest of the day would go. 

Voicing Our Truth

My fellow METAvivor MBC patient advocates from Texas and I entered U.S. Sen. John Cornyn’s office just before our 1 pm meeting, and asked for Patrick, a staff member there.
A few minutes later, Patrick Michaels, Senator Cornyn’s legislative aide on health, entered and shook everyone’s hands.

 “Hi Patrick,” I said, “Olivia. We actually met last year.”

A look of recognition crossed his face. “Oh yes, I remember,” he said. “Good to see you again.”

Our little team of Texas MBC advocates – six women from across the state, survivors and loved ones of those were not so fortunate – followed him into a conference room. The others wanted me to introduce us. I told Patrick that we were here to raise awareness about stage 4 breast cancer, and that 30% of people who are treated for early stage breast cancer will have their cancer metastasize, meaning it spreads to other parts of the body. When the cancer reaches this stage, it is incurable, I told him. I informed Patrick that patients live anywhere from 18 to 36 months after diagnosis. We asked them to support bills increasing MBC research funding.

Then Sharon and Jennifer opened up about their experiences.

Sharon, an MBC patient from Houston, told Patrick she had been diagnosed with inflammatory breast cancer, a rare and aggressive form in which cancer cells block lymph vessels in the skin of the breast, making it swollen and red. Patients with this type of cancer do not live as long as women diagnosed with other types of breast cancer.

Tears streamed down her face as she described her fate. I reached into my bag to grab her some tissues.

(L to R): Denise, Sharon, Patrick, Anne, Jennifer, Olivia, and
Valerie meet in U.S. John Cornyn's office to share their
experiences with stage 4 breast cancer. Photo by Olivia Suarez
Jennifer spoke about how she, a woman in her early 30s, discovered a lump in her breast, which led her to see a doctor. She shared how she discovered she had a genetic mutation – despite having no history of breast cancer in her family – and that her cancer appeared before the recommended age to receive a mammogram (age 40 and above). We felt her frustration, and her heartbreak.

Patrick responded empathetically, sharing how his own grandmother died from metastatic breast cancer, and that he would do everything on his end to make sure Senator Cornyn will hear our requests. We believed his sincerity.

From Senator Cornyn’s office we headed over to the Rayburn Office Building, where U.S. Representatives offices are located on the other side of Capitol Hill. The next two meetings were scheduled at the same time, so we split up. Valerie, Jennifer, and Anne met with the office of U.S. Rep. Kenny Marchant from District 24 (the Dallas-Fort Worth area). I went with Sharon to visit the congressional aide for U.S. Rep. Sheila Jackson Lee from District 18 (in Houston).

(L to R): Sharon, Sheerine, and Olivia pose for a selfie after
meeting in Rep. Sheila Jackson Lee's office.
Photo by Olivia Suarez
Sharon and I arrived at Representative Lee’s office and met with a staff member named Sheerine, who didn’t know much about metastatic breast cancer. Nonetheless, she listened and sympathized with us, especially as Sharon teared up when she shared her story. It turns out that not only has Representative Lee cosponsored both the Metastatic Breast Cancer Access to Care Act and Cancer Drug Parity Act, she is also a breast cancer survivor herself. Sharon and I left the meeting feeling confident about getting the congresswoman’s support for our cause.

We rejoined the rest of the team for our last meeting, in the office of U.S. Rep. Michael Burgess, MD’s office. His legislative aide, Casey, engaged with us by asking questions about the bills we want the congressman to support. She told us that Representative Burgess, who is a ranking member of the Subcommittee on Health, is all for prioritizing health concerns, given his physician background. She assured us that his office will urge other congressmen and women to cosponsor both bills and sign the letter to the National Cancer Institute on updating the SEER Registry, the database that tracks cancer-related statistics.

(L to R): Jennifer, Olivia, Casey, Anne, and Sharon talk about a number of initiatives to help patients with stage 4
breast cancer. This marked the final meeting for Team Texas, who came out to Washington, D.C. for METAvivor's "Stage IV Stampede." Photo by Olivia Suarez

Final Thoughts

The author in downtown Washington, D.C.
Photo by Stefany io. Visuals
I left Capitol Hill extremely satisfied with how the day played out. Last year’s Stage IV Stampede will always hold a special place in my heart because it was a new experience for me. But this year, having that experience under my belt, I was more confident about addressing issues affecting MBC patients and their loved ones. I empathized even more with the stories of other patients. The grief I have from losing my grandma to stage 4 breast cancer still lingers, but it’s allowed me to fight for something greater than myself.

I wish my grandma never got sick. I wish she was still here to live out the rest of her days. But had this tragedy not happened, I never would have learned about METAvivor, I never would have gone to D.C. (twice!) and met with congressional staff. I never would’ve met the amazing women battling MBC or advocating for a cure – friendships I will always cherish.

I can only hope that one day, stage 4 survivors get what I believe they deserve – more funding, more visibility… and more time to live. Until then, we must keep fighting.

(For more information or to get involved, visit

Stage 4 Needs More: A Granddaughter's Continued Journey into Breast Cancer Advocacy – Part 4

By Olivia Suárez
Media Relations Coordinator
Texas Medical Association

Editor’s Note: This post is the fourth installment in a five-part series about the author’s personal perspective on metastatic (stage 4) breast cancer, and her return visit to Washington D.C., in October (Breast Cancer Awareness Month), to advocate for research funding and increased awareness of the disease. In this installment, the author chronicles her first congressional meetings on Capitol Hill as part of METAvivor’s “Stage IV Stampede.”  This series is a follow-up to the author’s 2018 five-part series, “Adversity to Advocacy: A Granddaughter’s Story of Stage 4 Breast Cancer,” about how the loss of a loved one motivated her to travel to our nation’s capital to speak out against metastatic breast cancer. Part 3 chronicled the Washington, D.C. march, the community “Die-in,” and meeting her Texas advocacy teammates. 

It was barely noon on Friday, Oct.11, and already it was an eventful day. I’d joined more than 200 people for METAvivor’s “Stage IV Stampede,” a march to Capitol Hill calling for a cure for metastatic, or stage 4 breast cancer (MBC). We then paid our respects to the 114 men and women who die daily of this disease, with a silent vigil on the Capitol lawn. When I met the three other Texas advocacy team volunteers who also would lobby lawmakers on Capitol Hill for support, I realized I was the only one with experience doing so… which intimidated me a bit.

Team Texas Takes on Congress

The METAvivor Texas team – Jennifer, Anne, and Sharon, and I – had an hour before our first meeting in U.S. Sen. Ted Cruz’s office. The three of them wanted to sit down and map out what each of us would say. They admitted they felt a bit overwhelmed with all of the talking points METAvivor leaders advised us to cover with congressional staff.

They all looked at me. 

“You’ve done this before, what do we need to focus on?” Jennifer, an MBC patient and mother of two from Round Rock, asked me. 

I took a moment to consider the most important objective in today’s congressional meetings.

“Your story,” I said. “The congressional staff we meet with today want to know about how this disease has affected you personally. All of the information about the proposed bills and funding is in their folders we give them.”

“That’s good to know. Okay, I can do that,” Jennifer said. 

“Me too,” Sharon, an MBC patient from Houston, agreed. 

I did want to talk about my grandma whose death from MBC last year inspired me to be here, but since I had been to these meetings before, I wanted to give Sharon, Jennifer, and Anne (Jennifer’s aunt) a chance to talk about their personal experiences. Instead, I would list the bills we want lawmakers to support. If there was time to talk about my grandma, I would speak up. 

I checked the time. It was noon. Our first meeting would start in 15 minutes. 

“Don’t be nervous, y’all are going to do great,” I told them as we headed out.

Two Join the Crew

When the four of us arrived in Senator Ted Cruz’s office, we met two other women sitting in the lobby, who we learned were part of our group.

Denise was a patient-advocate as I am, who used to work with Valerie, the woman next to her. Valerie appeared to be my age.

 “This is my first Stampede,” Valerie said, “but I have experience lobbying here on The Hill, so I can definitely help talk about the bills in our folder.”

Hearing that made me smile. Team Texas would do great.

We met with Samara Brown, Senator Cruz’s legislative aide for health. The group picked me to begin the conversation. I talked about METAvivor, its mission, and how MBC is often overlooked in breast cancer awareness discussions.

Then Jennifer and Sharon, the two MBC survivors in our group, shared their stories. They seemed a bit nervous at first, but found their stride. (Who wouldn’t be?! We were in a congressional office, asking a federal lawmaker’s representative for help in fighting this disease!)

The other three patient-advocates – Valerie, Denise, and Anne – filled in on the rest. Samara actively listened and said she would fill the senator in on why we want him to co-sponsor two Senate bills, the Metastatic Breast Cancer Awareness Act and Cancer Drug Parity Act, among other objectives.

We left Senator Cruz’s office more confident. All of the knowledge and experience I got last year was coming back to help me.

(L to R): Jennifer, Denise, Sharon, Olivia, Samara, Valerie, and Anne meet in U.S. Sen. Ted Cruz's office to discuss MBC initiatives. Photo by Olivia Suarez
Next we headed to U.S. Sen. John Cornyn’s office to see Patrick Michaels, his health legislative aide. I felt good going into this next meeting because I met with Patrick last year to discuss these same issues. I remember he was receptive of our cause. Hopefully this year we would get the same response from him.

“Alright y’all,” I said to the team. “I feel good about this next meeting. We’ve got this.”

Watch for the final part of Olivia’s story, “Voicing Our Truth” on
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