Friday, December 19, 2014

Five Tips to Combat Dry Winter Skin

By Michelle Tarbox, MD
Assistant Professor of Dermatology 
Texas Tech University Health Sciences Center

As the temperatures drop and the heaters go on, the indoor air gets dehydrated, and your skin loses moisture from the environment. Think of it this way: Water likes to move downhill, even on a microscopic level. So when the level of moisture in the air drops due to the heating process, the dry air practically sucks the water out of your skin.

To balance out the loss of moisture, you can take some steps to repair and replenish your skins. Here are the five tips to help you combat dry winter skin.

  1. Cleanse Carefully. Healthy winter skin starts with careful cleansing. The wrong cleanser can strip your skin of its natural oils and make it more vulnerable to the dry winter air. Add to that the increased need for hand washing in winter due to the cold and flu season coupled with the possibility of more time in the kitchen cooking up holiday treats and meals, and you’ve literally got a difficult situation on your hands. Choose a gentle cleanser with skin-healthy ingredients such as jojoba oil or avocado oil. Avoid harsh cleansing agents such as sodium laureth (or lauryl) sulfate, and opt for more gentle cleansers such as glycerin. 
  2. Moisturize More. As the name suggests, moisturizers replenish moisture lost from the skin. I like products that contain ceramides, which are the lipid (fat) that skin makes to moisturize itself. Fats and oils are actually important for skin health, but as with dietary fats, choosing the right kind is key. Look for moisturizers that are “noncomedogenic” or nonpore clogging such as avocado oil, almond oil, mineral oil, or primrose oil.   
  3. Slather the Sunscreen. The sun still shines in the wintertime. Many people forget to use sunscreen during the cold winter months; however, as cold and overcast as it may be, UV radiation is still reaching the earth. Apply a good broad-spectrum sunscreen to all exposed skin surfaces at least 30 minutes prior to outdoor sun exposure. 
  4. Exfoliate Expertly. Exfoliation removes dead skin cells and improves how well skin can absorb moisturizers; however, it’s important not to overdo it. A gentle touch is the key to winter skin care, and this definitely goes for exfoliation. Dry winter skin responds well to gentle exfoliation including moisturizers with mild acids such as lactic acid or salicylic acid. It is a good idea to alternate these exfoliating moisturizers with your regular moisturizer to avoid irritation. 
  5. Baby Your Bathtime. It’s tempting to crank up the water temperature during your showers or baths during the cold winter months, but this can be counterproductive to your skin health. A good rule of thumb is to bathe yourself in temperatures you would use for a baby’s skin. Similar to harsh cleansers, very hot water can strip your skin of its natural oils and make it more vulnerable to dehydration. A nice, short, warm bath is your skin’s best bet for healthy winter skin. 

Thursday, December 18, 2014

Living Between the Dates

By Sid Roberts, MD
Lufkin Radiation Oncologist

Editor’s Note: This blog post was originally published Dec. 2 at the Lufkin Daily News and on Dr. Roberts’ blog

As a cancer physician, reading obituaries is, unfortunately, part of my job description. I don't mean to be morbid about it. Not everyone who gets cancer dies from it — far from it. We cure two-thirds of cancer today. But we still have a long way to go.

I recently read my father's obituary. Oh, he hasn't died yet. My mother, you see, is nothing if not organized. So both of my parents' obituaries have pretty much been written for some time now.

Obituaries are fairly emotionless documents. They also don't often convey the true sense of who a person is. Usually, an obituary is a simple compendium of facts — dates — such as when a person was born and when they died. Others before me have said that what is important is not the date of birth or death, but the "dash" in between. That dash is what symbolizes who a person is, how they lived, what they accomplished.

My father just had his 81st birthday on Sunday. He has been working full time as a financial consultant at the same firm (RBC Wealth Management) in Midland, Texas, for more than 48 years. That is a remarkable accomplishment in a field where jumping between firms is not uncommon. But loyalty was important to my dad, and to his clients. They knew they could trust him. His honesty and integrity were natural, unspoken expressions of his Christian faith. But that won't be in his obituary.

My parents love to travel, and they have taken quite a few overseas trips since he reached retirement age, even though he didn't retire! In September, my wife and I were able to go with them to Ireland on a fantastic trip. At 80, their vigor and stamina was amazing. Those two weeks together were so precious, even more so now in retrospect.

Just weeks after we got home, my father was diagnosed with pancreatic cancer. He had the usual tests and meetings with specialists to determine what, if anything, to do. His liver is involved, and his prognosis is quite poor.

I consult often with patients who are bombarded by well-meaning friends and relatives who think they know what is best and are, frankly, a bit too vocal with their opinions. Thus, seeing my father have to deal with the "You ARE going to MD Anderson, aren't you?" pretentiousness was particularly difficult. Those of you who want to comfort someone dealing with a cancer diagnosis need to learn simply to listen. Don't give advice, because (1) your story or experience is almost always irrelevant, and (2) you unknowingly aggravate the situation by making the patient feel guilty or second guess their decision. Please remember: It's not about you!

Ultimately, after much deliberation, my father opted for comfort care only. I am incredibly proud of the strength it took to make that brave decision. His cancer is not curable and his prognosis is less than six months under the best of circumstances. He chose instead to share quality time with friends and colleagues, with each of his three sons' families, and with his wife of nearly 60 years. What a blessing that time has been!

The apostle Paul wrote that he has fought the good fight and finished the race well. Thank you, Dad, for finishing strong. For demonstrating integrity and commitment in your work for more than 50 years. For your quiet faith, service, and generosity. For your love of family. For filling that "dash" between birth and death with a life well lived and memories we will cherish. Maybe we can insert that into your obituary!

Dr. Sid Roberts’ father passed away on Dec. 11. Read his obituary.

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

Wednesday, December 17, 2014

Hey, Doc Explains How to Buy Marketplace Health Insurance Coverage

Knowing what’s important when choosing a health plan, how to use benefits, and where to turn for help can be challenging for most of us when purchasing health coverage. That’s why the Texas Medical Association started the “Hey, Doc” educational campaign in 2013. We want to help Texas’ patients make the best choice possible when purchasing their health insurance through the new health insurance marketplace. This week we’re discussing the different kinds of health insurance plans available and costs.

Q. What will it cost me to buy this insurance? 

A. Your insurance costs depend on a lot of things like where you live, your age, how many people are in your family, the services you need, and whether you smoke. And your income determines whether the federal government will help you pay for your insurance.

What you pay also depends on which category of insurance you choose in the marketplace: bronze, silver, gold, or platinum. In bronze and silver plans, you might pay a lower monthly charge, called a “premium,” but you might have to pay a higher cost later when you use the insurance. The opposite happens when you buy gold and platinum plans; they tend to have higher premiums and lower out-of-pocket costs.

Here’s an idea of what those costs might look like, on average:

  • In a bronze plan, insurers pay for 60 percent of the charge for medical services; patients, 40 percent.
  • In a silver plan, insurers pay for 70 percent; patients, 30 percent.
  • In a gold plan, insurers pay for 80 percent; patients, 20 percent.
  • In a platinum plan, insurers pay for 90 percent; patients, 10 percent.

You won’t know your costs for sure until you fill out a marketplace application. But until then, you can get a rough idea using this calculator tool created by the Kaiser Family Foundation.

And remember, regardless of whether a plan is bronze, silver, gold, or platinum, don’t forget to check out the other details besides costs, like the kind of insurance and the doctor and hospital networks. Those things are important to keep in mind when comparing your options and choosing a plan that works for you and your family.

Q. What different kinds of insurance can I buy?

A. There are different kinds of insurance plans you can buy depending on how much you want to spend, the medical services you need for you and your family, and how many doctors and hospitals you want to choose from. Some plans, for example, only let you use the doctors that are in their networks; otherwise, you pay more.

Others might require you to get a referral from your regular doctor before you get other specialized treatments. You can read up on Healthcare.gov and BeCoveredTexas.org about the different kinds of insurance plans out there.

The marketplace also puts these different kinds of insurance plans into four categories: bronze, silver, gold, and platinum. The categories are based on the amount of coverage the insurance company provides for your health care, and your portion of the costs. But again, any plan in any of those categories still has to offer essential benefits. The difference is how you and your insurance company share the costs of that care.

There is a fifth option, too, called “catastrophic insurance.” But it’s only for certain people, and it doesn’t cover everything.

Q. When does my coverage start?

A. During open enrollment for 2015, if you enroll:

  • Between the first and 15th day of the month, your coverage starts the first day of the next month. So if you enroll on Jan. 5, 2015, your coverage starts on Feb. 1, 2015. And remember Dec. 15, 2014, is the last day to sign up for your coverage to take effect on Jan. 1, 2015.
  • Between the 16th and the last day of the month, your coverage starts the first day of the second following month. So if you enroll between now and Dec. 31, you coverage will start Feb. 1.
  • Between Feb. 1, 2015, and the deadline of Feb. 15, 2015, your 2015 coverage begins March 1, 2015.

Tuesday, December 16, 2014

As Flu Ramps Up, Texas Physicians Recommend Vaccination

Flu season typically peaks during the winter months. This year is no different. Physicians are now seeing more patients with the flu, or influenza. Texas physicians want to remind everyone that your best defense is getting vaccinated.

Erica Swegler, MD, an Austin family physician and member of Texas Medical Association’s (TMA’s) Be Wise — ImmunizeSM Physician Advisory Panel, said her office has had a recent increase in patients with flu and flu-type illness. “We’re seeing both types of flu virus, the A and B strains,” she said.

The Texas Department of State Health Services also reports increasing cases of flu-like symptoms and flu diagnoses each week.

The H3N2 virus that physicians are seeing, referred to as an A strain, typically signals a severe flu season, according to the Centers for Disease Control and Prevention (CDC). This could indicate a “worse-than-usual” season.

An annual flu vaccination is recommended for anyone 6 months of age and older. It’s not too late to get a flu vaccination, as cases usually increase during the holidays and into the new year.

“As long as flu viruses are spreading and causing people to get sick, a flu vaccination is still recommended,” said Dr. Swegler. “And even if the vaccine doesn’t target all the strains circulating, it provides some protection.”

Influenza can be a serious, even fatal, illness. Influenza can be especially harmful to older people, young children, people with chronic medical conditions, and pregnant women. A bonus for pregnant women who get vaccinated: The vaccine protects the mother and her unborn baby — even after the baby is born, up to 6 months of age.

“Some people are more vulnerable to catching the flu because they have certain medical conditions that prohibit them from getting vaccinated,” said Ernest Buck, MD, Corpus Christi, chair of TMA’s Council on Health Promotion. “Vaccinating healthy family members who go to daycare, school, or work every day prevents them from bringing flu home to aging or frail family members who might not handle the illness well.”

CDC says most healthy adults can infect other people a day before they have symptoms and for as many as five to seven days after they become sick. Children may pass the virus even longer — for more than seven days.

Check with your doctor if you have questions about which flu vaccine is right for you or other questions. And call your doctor if you have any symptoms of the flu — early treatment will help most people recover more quickly and can prevent the flu if you have been exposed recently.

Friday, December 12, 2014

It's Only the Flu That Killed Her

By Jeff Calaway
Senior Content Specialist,
Cook Children's Checkup Newsroom

This story was originally published at checkupnewsroom.com

Ten years ago, the Lastingers’ lives seemed so perfect. Joe and Jen were the parents to two boys, a 3-year-old daughter and another little girl on the way.

They worried about their children, but it was the standard concerns of most moms and dads. Could their children swim? Were their car seats the right fit?

One issue that didn’t cross their mind was the flu. After all, in 2004, healthy toddlers weren’t even supposed to get their flu shots. A lot’s changed since then, much of it because of the death of Emily Claire Lastinger.

“One thing that was never on our radar, not even in the tiniest way, was influenza,” Joe Lastinger said. “Emily had just started preschool at the time. She loved it. Her two older brothers were always so helpful with her. They loved her so much. Emily was advanced for her age and absolutely fearless. She was the kind of kid you dropped off on the first day of preschool and she was fine. She just ignored you and went on about her business.”

Emily was an active child, definitely not a “napper.” But she came home one day from school, tired and wanting to sleep. Her parents thought she might be sick, but didn’t think it was anything serious. The following day, the Lastingers took their daughter to their pediatrician. Tests determined Emily had the flu. Joe and Jen were told she needed rest. They should keep her at home for a few days and monitor her fever.

Over the next couple of days, Emily went back and forth from being listless to showing signs of her old self with bursts of energy. On Super Bowl Sunday of 2004, she showed signs of dehydration and was vomiting. They called their doctor again and made an appointment for 10 a.m. Monday morning.

Joe stayed home to help care for Emily because Jen’s pregnancy prevented her from lifting her daughter. As Joe went upstairs to make some work calls, he heard his wife screaming for her husband. As he bounded up the stairs he saw his daughter wasn’t breathing. After being taken to an emergency room at an area hospital in their Grapevine hometown, Emily was transferred to Cook Children’s.

“Once we got to Cook Children’s, it was all hands on deck,” Joe said. “But it was too late. When night approached, about 8 o’clock that evening, the doctors said Emily was really, really sick. They couldn’t detect any brain activity and they had exhausted what they could do.”

At around 10 p.m., the Lastingers said their goodbyes and a little while later their daughter’s short, little life ended.

“It was just a shock to us,” Joe said. “I know it’s always a shock for parents to lose their child, but we just couldn’t come to grips that she died from the flu – and it happened so quickly, in just five and a half days.”

The Lastingers still believed there had to be an underlying condition or cause for their daughter’s death, but the autopsy showed that she was a perfectly healthy little girl before she became ill from the flu.

Amazingly, as they grieved for the death of one daughter, the Lastingers rejoiced at the birth of another. Thirteen days after Emily’s death, Jen gave birth to Alea. The birth of a new child also gave them more resolve to make sure their children would be safe against the flu.

“Our eyes opened to what was happening nationally and the number of kids who had died of the flu,” Lastinger said. “We wanted to help all the kids, but we had to focus on our family first. We wanted to make sure our kids were going to be alright and it wasn’t something that ruined their lives. Our younger son Andrew was there at home when Emily died. That’s something you don’t want your kids to experience. We took care of our family then, but in the back of our minds, we knew we had to do more to help kids just like our own children.”

With their eyes now opened to the dangers of the flu, the Lastingers made it their mission to stop other parents from losing their child to the illness.

They reached out to doctors both at home and the Centers for Disease Control and Prevention (the CDC). The Lastingers learned that more than 150 children died of the flu in 2004. They met other parents who lost their children that year and they fought for changes to be made in treating children with the flu.

It’s shocking to realize how far things have come since 2004. Flu vaccines weren’t recommended for healthy kids in Emily’s age group 10 years ago. It was only recommended for children between the age of 6 months and 2 years of age, and for children with underlying health conditions like asthma.

“If it had been recommended then for our children to get their flu shots, we would have gotten them,” Joe said. “I got a flu shot. My wife got a flu shot when she was pregnant. But at that time, our kids had not been vaccinated. Reflecting on this now, it shouldn’t have happened.”

The Lastingers and others families who lost their children to the flu became advocates for children and formed Families Fighting Flu. Joe and Jen are among the founders of the group and remain board members to this day. They fought for universal flu shot recommendations and advocated for CDC to expand the recommendations for all children to receive flu shots. The expansion of the recommendation was huge because now flu shots are covered by many insurance companies.

Much has been done over the past 10 years, but Joe knows more needs to be done because children still die every year due to the flu and usually because those kids didn’t receive a flu shot or a flu nasal spray. He knows parents and children are busy, but Joe says to learn from what happened to his own family – get the flu shot.

The Lastingers tell their story today in hopes that people will get immunized against influenza. They’ve appeared on national shows like Good Morning America and Anderson Cooper 360. They have received cards and letters from people all over the world thanking them for telling their story.

Although nothing can take away the pain of losing their daughter, the Lastingers do take comfort knowing that Emily’s story may save the lives of other children.

“We think about our daughter all the time,” Joe said. “She was here for such a brief time and didn’t have the impact on the world she probably would have had. Who knows what she might have done with her life. We try to make a difference and hope that it makes a positive impact on the world like we think Emily would have made if she was still with us. I do feel like we’ve made a difference. I would love to see 100 percent of kids in our country have the flu vaccine and have 0 children die of the flu. We aren’t there yet, but I think we can get there.”

Perhaps the biggest impact their older daughter’s death made was preparing the Lastingers to deal with Alea’s diagnosis of leukemia when she was almost the identical age of Emily.

“I remember one of the doctors saying you are so calm,” Joe said. “In retrospect, we were. We thought if Alea does have cancer, at least this time we know we can do something about it. It shaped our attitude in such a positive way. Yes, cancer was horrible and painful. But it wasn’t the worst thing that happened to our family. We knew we could survive this.”

Today, Alea is doing great. She’s in the gifted and talented program at her school and playing in multiple sports at a high level.

The Lastingers have battled two diseases in their lifetime and although flu took the life of one of their daughters, they aren’t giving up on the fight.

Thursday, December 11, 2014

Hey, Doc, When I Can I Renew My Marketplace Health Insurance?

This week’s segment in Texas Medical Association’s (TMA’s) “Hey, Doc” health insurance marketplace education campaign answers more questions about aid provided to some Texans who enroll in the exchange, called subsidies, and how to renew your marketplace plan.

Q. Hey, Doc, How do I renew my marketplace plan? 

A. You should be getting notices from the marketplace and your insurance company about how to renew for 2015 the coverage you bought for 2014, and whether you still qualify for subsidies to help pay for it.

If you don’t take any action by Dec. 15, the marketplace may automatically reenroll you in your 2014 plan, or a similar one if your insurance company no longer offers it. The marketplace notice should tell you how to renew, and the notice from your insurance company should tell you if it still offers the same plan or if your plan changed. Both notices will also give you information about renewing any subsidies you are receiving. (See “Will I still get my subsidy from last year?”)

If any of your personal information changed, like your income, address, or family size, be sure to update your marketplace account. If you don’t do these updates, you could get enrolled in the wrong plan or for the wrong subsidies.

It's also possible that your insurance premiums, deductibles, and out-of-pocket costs can change even if you renew the same plan, so be sure to check. Plan networks also change, so check with your insurance company and your doctor to find out if your doctor and hospital are still included.

If you find out the plan you had is no longer good for you, you can always switch during open enrollment. You must switch by Dec. 15 for your coverage to take effect Jan. 1, 2015. But you can still change to a new plan even if you are automatically enrolled in the same one from 2014. In that case, you have until Feb. 15, 2015, to switch.

Q. Will I still get my subsidy from last year? 

A. That depends. Subsidies are provided by the federal government to help you pay for your insurance. Remember that your subsidy depends on how much money you make. (See “Who gets a subsidy?”) So if your income went up since last year, your subsidy will probably be less. You might even have to give back part of it to the government if you started making more money after you first signed up in 2014.

Also remember that you had to provide some specific information about your income when you first applied. (See “How do I apply for a subsidy?”) If you gave the marketplace permission to automatically recheck your income and tax returns, the marketplace can automatically renew the amount of financial assistance you received in 2014. If you did not give the marketplace permission to do this, you’ll have to reapply. And keep in mind that if your income has changed, you should update your application to make sure you are getting the correct subsidy and you don’t have to refund anything later if you receive too much.

The marketplace and your insurer should each send you a notice around the time of open enrollment explaining how to renew your subsidy.

Wednesday, December 10, 2014

U.S. Obesity Rate Increasing, Smoking Rate Decreasing

Nearly 30 percent of Americans are obese, according to the 2014 annual report by the United Health Foundation. That’s a 2-percent rise from last year’s numbers, which saw a decrease in the obesity rate for the first time since 1998.

Colorado ranked first for the state with the lowest obesity rate while Mississippi and West Virginia tied for last place. Texas ranked 36th with 30.9 percent of its population obese.

We are eating more and exercising less, and obesity is the result, bringing with it a host of related health problems. According to the United Health Foundation, these include “heart disease, type 2 diabetes, stroke, certain cancers, hypertension, liver disease, kidney disease, Alzheimer’s disease, dementia, respiratory conditions, osteoarthritis, as well as poor general health.” The report found one in 10 Americans has diabetes.

There was some good news, however: For the third straight year the U.S. smoking rate declined. Only 19 percent of Americans surveyed said they were smokers. In Texas, that number is even lower, with 15.9 percent of Texans reporting they smoke.

Read the report.



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