Thursday, May 26, 2016

The ABCs of Hepatitis: What It Is; How to Prevent It

By Janice Stachowiak, MD
Lubbock Internist
Member, TMA Be Wise ― ImmunizeSM Physician Advisory Panel

May is Hepatitis Awareness Month. While May is almost over, you can benefit anytime by knowing how to prevent hepatitis, inflammation of the liver. Liver inflammation can have several causes, including alcohol, medications, and viral infections. I will focus on viral causes of hepatitis, especially those that can be prevented by vaccines. In the United States, the most frequent types of viral hepatitis are hepatitis A, hepatitis B, and hepatitis C.

Hepatitis A:

Hepatitis A usually is caused by consuming contaminated food or water or through person-to-person contact, such as when an infected person does not wash his or her hands properly after using the bathroom and touches other objects. Some people with hepatitis A have no signs of illness, some have a mild illness, and others are severely ill. Symptoms of Hepatitis A can include fever, fatigue, loss of appetite, nausea, vomiting, stomach pain, dark urine, light or clay-colored stools, and jaundice (yellowing of the skin and eyes). These symptoms can last a few weeks to several months.

The older a person and the more medical problems they have — especially prior liver disease — the more severe symptoms are likely to be. In rare cases, hepatitis A can be life-threatening. Once someone recovers from hepatitis A, he or she has antibodies to protect from further episodes of hepatitis A for life. Hepatitis A also does not cause a long-term infection that can lead to cirrhosis (scarring of the liver).

The best way to prevent hepatitis A is through vaccination. Vaccination is recommended for children 1 year of age or older, travelers to certain countries, and other adults at high risk for severe illness should they have contracted hepatitis A, such as people with chronic liver disease. The hepatitis A vaccine is given as two shots, six months apart. Adults 18 years of age or older can get a combination vaccine that protects against both hepatitis A and B; this is given as three shots over six months. Protection begins approximately two to four weeks after getting the hepatitis A vaccine. If you are traveling outside of the United States this summer, you can check if the hepatitis A vaccine is recommended for your destination. Getting vaccinated two or more weeks before departure is best but even getting the shot a few days before you leave will offer some protection.

Hepatitis B:

Hepatitis B can be transmitted several ways: Through sexual contact; the sharing of needles, syringes, or other drug-injection equipment; the exposure to blood from needle sticks or other sharp instruments; or from mother to baby at birth. People living with diabetes or on hemodialysis (a procedure to treat kidney failure that filters waste and removes extra fluid from the blood) can be at increased risk. In some Asian countries hepatitis B is so prevalent, mother-to-child transmission is common. For some people, hepatitis B is a short-term illness. For others, it can be a long-term, chronic infection. The younger a person is when he or she contracts hepatitis B, the greater the risk of long-lasting infection. Chronic hepatitis B (a long-term condition) can lead to cirrhosis or liver cancer.

Most adults will develop symptoms with an acute hepatitis B infection (a shorter-term severe case), while most children will not. Symptoms of acute hepatitis B infection are similar to hepatitis A: fever, nausea, vomiting, dark urine, and jaundice. An acute infection can last a few weeks to several months. People who develop chronic hepatitis B can remain symptom-free for as long as 20 to 30 years after the initial infection. Acute and chronic hepatitis B can be diagnosed with blood tests. Treatment is available for people with complications from chronic hepatitis B, but it doesn’t work in all cases.

Again, the best way to prevent hepatitis B is through vaccination. All children should get their first hepatitis B shot at birth and complete the series by 6-18 months of age. All children and adolescents younger than 19 years of age who were never vaccinated should get the shots. Any adult at increased risk or who wants to be protected against hepatitis B can be vaccinated. I received my hepatitis B shots while I was in medical school.

Hepatitis C:

Hepatitis C usually is spread when blood from an infected person enters the body of someone else who is not infected. The most common form of transmission is sharing needles or equipment to inject drugs. Less commonly, a person can get hepatitis C through sexual contact.

Approximately 70 to 80 percent of people with acute hepatitis C do not have symptoms. Many people with acute hepatitis C will develop chronic hepatitis C that can lead to cirrhosis and liver cancer.

Testing for Hepatitis C is recommended for:

  • Anyone born between 1945 and 1965;
  • Anyone who received a blood transfusion or organ donation before 1992;
  • Anyone treated for a blood clotting disorder before 1987;
  • Anyone who has injected drugs — even only once; and
  • Anyone infected with HIV.  

The treatment options for people with chronic hepatitis C have greatly improved during the past several years. However, no vaccine currently is available for hepatitis C. The best prevention is to avoid the behaviors that can spread the virus, such as sharing needles.

Dr. Stachowiak, an internist from Lubbock, teaches at Texas Tech University Health Sciences Center in Lubbock. She is a member of TMA’s Be Wise – ImmunizeSM Physician Advisory Panel and is a member of the South Plains Immunization Network.

Wednesday, May 18, 2016

Walking the Walk: Making Choices

By Ana Leech, MD
Houston Palliative Care and Hospice Physician
Medical Director Memorial Hermann Hospice IPUMedical Director of Palliative Medicine Memorial Hermann Southwest

Editor’s Note: Physician Ana Leech, MD, shares her family’s experience caring for her father, who has a terminal illness. As a hospice and palliative medicine physician, Dr. Leech is able to tell her story from both a personal and medical perspective. This is the second part in a series. Read part one here.

My mom doesn’t know what hospice is. No one does unless he or she needs the services. In reality, even many doctors who refer patients to hospice don’t really understand it. So it was no surprise that Mom rejected it when I first introduced the idea to her. Her first comment was “No. I want to take care of him at home.”  

But hospice wants her to take care of him at home. The whole system assumes that is what will happen. Hospice would help.

Dad is apparently more symptomatic than he leads on. Mom reports he is experiencing nausea, depression, fatigue, and insomnia. She manages with the medications he already has, but the situation is not optimal. I really can’t be objective enough to help her, and I have a personal rule to never care for a loved one, particularly now. The hospice team would be able to manage all those symptoms so he feels better — if only my parents would agree to it.  

Palliative and hospice care are relatively newly recognized in the world of medicine. The general population and much of the medical community are misinformed about the services and care we provide.  

Palliative care is a medical specialty that concentrates on symptoms and quality of life. I like to say I am a “symptomatologist” and quality-of-life expert. The palliative care team is composed of doctors, nurses, chaplains, and social workers. They care for patients with serious illness, providing symptom relief. The team addresses physical as well as spiritual and emotional concerns. Patients can request palliative care when they have a serious illness and they wish to continue treatment plans. Patients who have a palliative team helping them with their symptoms have been shown to be more satisfied with their care and sometimes live longer, even though they tend to stop active treatments sooner. Palliative care is provided alongside other traditional specialties, and insurance companies pay for the services just like they do for any other medical care.
Hospice is not a location, but a service that is specific for patients in the last six months of life. Most patients on hospice are at home (or a nursing home if that is where they routinely live), and their families care for them. The hospice team, also made up of doctors, nurses, chaplains, and social workers, visits the patient on a regular basis to provide physical and emotional support. The team provides all the equipment, medications, and supplies the patient needs. Patients on hospice are expected to decline and die within a few months, so trips to the hospital are not considered beneficial. Instead, the team comes to the patient when there is a problem.
Hospice has four levels of care:
  1. Routine: The patient is at home and his or her family provides the care or the patient is in a nursing home and the family pays for the room and board charges. All medications, equipment, and supplies are provided. Nurses visit routinely and as needed to provide care.  
  1. Respite: The patient is comfortable, but his or her family needs a break to go on vacation, get some sleep, etc.  In this situation, the hospice company provides 24-hour care in a hospice facility for up to five days a month.  
  1. Crisis Care: The patient is not doing well and symptoms are not managed, but the patient and family do not want to leave home. The hospice will place a nurse on site 24 hours a day for one to two days until symptoms improve. The nurse works even more closely with the team doctor during this time.  
  1. Inpatient: The patient is not doing well, either very uncomfortable, in pain, short of breath, or with any other symptom that is not managed well at home. The patient can go to the hospice facility to get a higher level of care with 24-hour nursing care and daily physician visits. This is a short-term stay until symptoms are controlled.  
The levels of care are fluid, and patients transfer from one to the other without difficulty. There is an on-call nurse available 24/7. Insurance usually pays for hospice — including medications needed for comfort — at 100 percent (at least Medicare does).

It has been a few weeks since this all started. Dad is physically okay, but has declined mentally so much. His symptoms resemble Alzheimer’s, and I can’t imagine how difficult it must be for families of dementia patients. He is confused at times, paranoid, and forgetful. He ruminates on opportunities lost, and can’t remember all the good things he accomplished. It is so painful to watch him (and Mom) go through this.

Mom called this morning. It is getting harder to care for him. His thought processes make it very difficult, and he insists on driving, which is a terrible idea. On the phone, Mom was crying, something I have seen her do just a few times in my life. It hurts so much to live through this. I love Dad dearly and already miss him, but watching my parents suffer is worse than death. In a weird way, I feel that death would be comforting now.  

The hospice team met with Mom later that afternoon. Because I hold medical power of attorney, I took care of the paperwork; in his current state, Dad is so paranoid he thinks we are trying have him committed, which couldn’t be further from the truth.

I am glad it is done. It hurts, but I am glad Mom is set up with help now. A doctor with experience caring for dying patients is in charge now. A whole team to support her through this, and beyond, is holding her up. I can be a daughter now and let the hospice team do the medical management, while I concentrate on the emotional journey.

Dr. Leech is a Houston palliative care and hospice physician. She is medical director at Memorial Hermann Hospice IPU and medical director of palliative medicine at Memorial Hermann Southwest.

Friday, May 13, 2016

AMA Task Force to Reduce Opioid Abuse

Patients with a substance use disorder need treatment — not stigma

Junkie. Stoner. Crackhead. We’ve all heard these terms, used to describe individuals who struggle with drug addiction. These terms are dismissive and disdainful; they reflect a moral judgment that is a relic of a bygone era when our understanding of addiction was limited, when many thought that addiction was some sort of moral failing and should be a source of shame. We need to change the national discussion. Put simply, individuals with substance use disorders are our patients who need treatment. Mental Health Month — in May — is a good time to remember this important fact — and to ensure we carry the message throughout the year.

Scientific progress has helped us understand addiction — also referred to as substance use disorder — is a chronic disease of the brain. It is a disease that can be treated, successfully. No one chooses to develop this disease. Instead, a combination of genetic and environmental factors — similar to other chronic diseases like diabetes and hypertension — can result in physical changes to the brain’s wiring, which lead to tolerance, cravings, and the characteristic compulsive and destructive behaviors of addiction that are such a large public health burden for our nation.

Every day, 78 Americans die as a result of prescription opioid and heroin overdose, and the rate of heroin-related overdose deaths increased dramatically and claimed 10,574 lives in 2014. In addition to these tragic figures, the nation is seeing an increase in opioid-related exposures and poisonings in children. And there has been a distressing rise in health problems in newborns as a result of women being exposed to opioids during pregnancy (known as “neonatal abstinence syndrome”). Misuse by older adults also has become an increasing concern. The rate of opioid-related hospital admissions has increased significantly over the past two decades across all ages. Because of higher rates of addiction in the “baby boomer” generation, illegal and nonmedical drug use among older adults is expected to increase in the future. The bottom line is that physicians must lead the nation in changing the tide of this epidemic.

The Texas Medical Association and the American Medical Association Task Force to Reduce Opioid Abuse want to ensure that America’s physicians, patients and policymakers take action in three ways:

  1. We must end substance use disorder stigma, increase access to medication-assisted treatment (MAT) for opioid use disorder, and support the expanded use of naloxone — a life-saving medication that can reverse the effects of an opioid-related overdose. People with a substance use disorder deserve to be treated like any other patient with a medical disease, and physicians are helping the nation understand how to do this. That is one reason the Task Force encourages increased education and training for MAT.
  2. We encourage physicians, dentists and other prescribers of controlled substances to register for and use prescription drug monitoring programs (PDMP) — as one tool to identify when a patient may need counseling and treatment for a substance use disorder. The trend among policymakers has been to use PDMPs to identify “doctor shoppers.” While this is important, our point is to understand why a patient is seeking medication from multiple prescribers or dispensers — and to offer a pathway for treatment and recovery. The information in PDMPs can play a helpful role in identifying patients in need of help.
  3. We must do a better job with prevention: Intervene early with teens who start using alcohol and/or marijuana; and encourage safe storage and disposal of drugs and alcohol. Unused medications increase the risk of nonmedical use by adolescents who live in the home, or by their friends. Unused medication also can be ingested by young children who are curious about what is inside the pill container. Educating the public on the importance of storing opioid medications locked and out of the reach of children, and properly disposing opioid medications following the end of use, can encourage these safe practices. 

And physicians should actively screen for and treat accompanying psychiatric disorders in all our patients to ensure that they continue to receive the highest level of care, since these patients might have even greater risk than the general population to misuse opioids. Furthermore, our patients would benefit from more active screening, brief intervention and referral to treatment.

There are additional issues that we must address. Pregnancy should not limit a woman’s access to opioid medications for adequate pain relief. Pregnant women should not be coerced to withdrawal from opioid treatment. And punitive measures taken toward pregnant women, such as criminal prosecution and incarceration, should be eliminated. There are no proven benefits and, in fact, doing so deters pregnant women who use opioids from seeking prenatal care, leading to poor child health outcomes. The threat of punitive measures also can cause pregnant women to withhold critical information about their drug use to their physician. A pregnant woman should have the same freedom as others to openly discuss options with her physician, choose a course of treatment, and be monitored/supported by her physician.

We also need to guard against limiting MAT services. For example, many states have enacted limits on MAT for patients in Medicaid programs, who are incarcerated, or who have “failed” a prior treatment program. Just as an evidence-based treatment policy would not discriminate against a diabetes patient for being low-income, having been arrested, or not adhering with his or her diabetes treatment program, MAT’s proven success should not be limited by these approaches either.

As physicians, we see the harsh reality faced by our patients with a substance use disorder. Stigmatizing patients helps no one. Our goal, as physicians and dentists, is to treat our patients and help them live as fully functional members of society. There are people in recovery at every level of government, the private sector and throughout our towns and communities. That is because treatment works.

Resources that the task force encourages physicians to use include:

Thursday, May 12, 2016

Top Health Leaders Discuss Zika: Is Your District Ready?

Texas physicians and other health leaders gathered yesterday at the Texas Medical Association to brief Texas legislative staff members about the state’s Zika preparedness. The meeting looked at ways individuals, communities, counties, and health agencies should respond if and when mosquitoes within the state become Zika virus carriers and start infecting Texans. That is known in public health circles as local transmission.

The Zika briefing dominated the second “University of Health” infosession for legislators and their staff, presented by the Texas Public Health Coalition (TPHC), a group of more than 30 organizations dedicated to advancing core public health principles at the state and community levels.

Read This: What Texans Need to Know About Zika

So far, there have been no cases of local mosquito transmission within the continental United States, but that can (and will) change, warned physicians.

“We are going to be a state that’s affected [by Zika], there is no doubt. We have the right topography and climate for it,” said TPHC Chair Eduardo Sanchez, MD, MPH.

John Hellerstedt, MD, commissioner of the Texas Department of State Health Services (DSHS), agreed.

“We in public health would not be doing our job if we weren’t planning for the eventuality that Zika would become locally transmitted. Large areas of Texas could be impacted,” he said.

Dr. Hellerstedt told members of the audience, which included fellow physicians, other health leaders, and the media in addition to the legislative staffers, that DSHS is putting together a comprehensive Zika response plan, to be shared with state leaders and the public soon. Currently, DSHS is raising public awareness of the Zika virus and what individuals and communities should do to combat a potential spread.

For now, it’s all about awareness, and the mosquito.

“Completely eradicating the species [of mosquito that transmits Zika] is very, very difficult and probably not the goal we should have in mind in terms of how to combat this,” Dr. Hellerstedt said. “The goal that we should have in mind is to avoid mosquito bites: Deny their breeding habitat (remove standing water); wear insect repellant and long clothing; put up screens; create as many barriers as you can [between yourself and mosquitoes]. That’s what we need to be doing now, and that’s what we need to continue to be doing even if we find Zika being locally transmitted.”

TPHC vice chair John Carlo, MD, MS, added that much of Texas’ focus should be on the state’s poorest communities, where decent housing and access to health care are lacking and where a Zika outbreak would have a devastating impact.

“While infectious diseases put us all at risk, the reality of who’s going to suffer — every time — is the poor,” he said. “If you start really looking at how we can actually make this community stronger, we need to look at how much access our poor have to health care in general. Because without that, you really do not have a way to maintain a resilient community.”

Dr. Carlo also stressed the importance of public health agencies as an effective tool against the Zika virus.

“We really need to be looking at how much we support health agencies across the state, how much we are enabling them to make the decisions they need to be making in terms of how they are staffed and how they are supported,” Dr. Carlo said.

Eduardo Olivarez, chief administrative officer for Hidalgo County Health and Human Services, spoke about his agency’s efforts fighting Zika. Hidalgo County borders Mexico, a country with reported cases of local Zika transmission. He told audience members Texas faces several challenges in its fight against Zika. “You’re not going to be able to spray this problem away,” he said.

Mr. Olivarez recommended ways to increase Texas’ response to Zika, including creating a comprehensive tire recycling program (water collected in tires is a popular breeding ground and habitat for mosquitoes), enforcing minimum building/housing standards (so homes have proper infrastructure to keep mosquitoes out), and funding binational surveillance of infectious diseases so that Texas can be more prepared if Mexico reports a disease outbreak, and vice versa.

“Help us fight the good fight,” Mr. Olivarez implored audience members. “Fight the bite by getting involved with your church or civic leaders or civic organization, and you, personally, help us deal with this.”

Tuesday, May 10, 2016

The Joy of Bicycling, the Protection of a Helmet

By Lori Anderson, MD, FAAP
Pediatrician, Amistad Community Health Center
Assistant Clinical Professor, Dept. of Pediatrics, 
Texas A&M College of Medicine

“Nothing compares to the simple pleasure of riding a bike.”  John F. Kennedy

May is Bike Month. It’s a great time to hop on a bike and start pedaling. You might not know where you will go or what you might see! I love to get on my bike and go to our local nature trails with my birding binoculars. I watch the wildlife while wandering from trail to trail. When I get home, I feel as though I’ve had an adventure, and can’t help but smile.

Bicycling gives a sense of freedom, it keeps you moving, and it’s fun. Every child should learn to ride a bike and be safe while riding. When safety is not one of the priorities, serious injuries can occur.

Parents fall short when they do not insist on their child wearing a properly fitted helmet for all bike, skating, scooter, and skateboard activities. Helmets are similar to what seat belts used to be. Too many deaths occurred before society accepted that everyone in a car should wear a seat belt. Every child riding a bike should wear a helmet.

On average 250 children in the United States younger than 14 years die annually in bike crashes; 300,000 seek emergency room care. Head injury is the most common cause of serious disability and death in bicycle crashes. Yet national estimates report only 15-25 percent of child cyclists wear helmets.  A properly worn helmet can reduce the risk of head injury by as much as 85 percent.

The Texas Medical Association, with support from the Texas Pediatric Society and the Texas Academy of Family Physicians, hosts hundreds of helmet giveaways across the state each year.

These events provide properly fitted helmets to thousands of children, and give physicians a chance to counsel families on helmets and bicycle safety. I have had the pleasure of participating in several bike helmet events. It’s always rewarding. While fitting a helmet, I love talking to the kids about the pleasures of riding a bike, and the importance of always wearing a helmet.

In addition to promoting helmet use, communities need to promote safe bicycle routes to school, store, playground, ball field, and friends’ homes.

A helmet can save your life when you’re otherwise absorbed in a beautiful moment, and simply enjoying the pleasures of a ride on a bike!

Dr. Anderson is a Corpus Christi pediatrician and supporter of TMA’s Hard Hats for Little Heads program.

Thursday, May 5, 2016

Infographic: Mom’s Shots Help Prevent Illness in Baby

Protecting newborns from two serious, possibly deadly illnesses — whooping cough (or pertussis) and flu — starts with Mom before baby is born. As we honor moms this Mother’s Day, the physicians of the Texas Medical Association (TMA) urge pregnant moms and moms-to-be to get recommended shots to protect themselves and their babies.

“By getting vaccinated during pregnancy, moms can pass illness-fighting immunity on to their babies,” said R. Moss Hampton, MD, Midland, an obstetrician-gynecologist. “Newborns can’t get their whooping cough and flu shots until they are a few months old, so mom’s shots help baby fight off these illnesses.”

Whooping cough is especially dangerous for infants younger than 1 year of age. It is highly contagious, and the Texas Department of State Health Services says more than half of babies less than a year old with pertussis must be hospitalized. Many will have serious complications, like pneumonia or apnea (slowed or stopped breathing), and some become so sick they will die.

The Centers for Disease Control and Prevention (CDC) recommends women get the Tdap vaccination (a combination vaccination that protects against tetanus, diphtheria, and pertussis) during each pregnancy. While the vaccination may be given any time during pregnancy, CDC suggests pregnant moms receive it between 27 and 36 weeks of gestation, or during the third trimester.

Vaccinating mom provides double protection, said Dr. Hampton, a member of TMA’s Be Wise — ImmunizeSM Physician Advisory Panel. “Mom is less likely to catch and pass whooping cough on to her baby, and baby is protected until he or she has had all whooping cough shots, which occurs around 18 months of age.”

The same is true of mom’s flu shot, which she can get anytime during pregnancy: It provides protection both to her and to the baby. Flu is dangerous for both pregnant women and babies. It can put pregnant women in the hospital or even kill them, and babies too. Expectant moms with flu also have more risk of problems for their unborn baby, including early labor and delivery. Because babies can’t get their flu shot until they are 6 months old, mom’s flu vaccine helps pass on protection to the little one.

Vaccination advice does not pertain just to mom, though. Because babies can catch pertussis from anyone near them, physicians recommend all those who will come into contact with the baby be up to date on their whooping cough vaccination, including parents, siblings, grandparents, childcare providers, and health care workers.

For the best protection, CDC recommends family members get the pertussis shot at least two weeks before they have contact with the baby. And because babies don’t always arrive on their due date, getting vaccinated a few weeks before the anticipated birth is best, said Dr. Hampton.

Flu, too, is passed easily from person to person. CDC recommends flu shots each year for anyone over 6 months of age, so that means all family members and caregivers should be vaccinated for flu, as well.

If you’re pregnant, physicians recommend you ask your doctor about Tdap and flu shots. TMA published a whooping cough infographic (see below) and whooping cough fact sheet, in English and Spanish. TMA also has a flu infographic and flu fact sheet in English and Spanish.

Tuesday, May 3, 2016

Lung Cancer Screening Saves Lives

By Sid Roberts, MD
Lufkin Radiation Oncologist

This article originally appeared on Dr. Roberts' blog.

For more than 50 years now, we have known the dangers of smoking. That smoking causes heart disease, emphysema, and lung and other cancers is not in dispute. For fifty years, we did not have an effective screening tool for lung cancer.

Now we do.

Medical imaging has improved so much that we are now able to do computerized tomography (CT) scans with significantly lower dose to the patient and at a low enough cost to warrant widespread use as a screening tool. Not everyone needs a scan, of course. But smokers who are at high risk of developing lung cancer now have an option for screening, much like mammography for early detection of breast cancer.

In 2011, the results of the National Lung Screening Trial (NLST) were published in the New England Journal of Medicine, arguably the foremost medical journal in the world. This trial screened current or former heavy smokers aged 55 to 74 with low-dose CT scanning of the chest and compared it to standard chest x-ray. The NLST primary trial results show 20 percent fewer lung cancer deaths among trial participants screened with CT compared to those who got screened with chest x-rays. This is huge news, because we haven’t cured a lot of lung cancer over the last 50 years! Based on these results, the Centers for Medicare & Medicaid Services (CMS) decided in 2015 to start paying for the procedure on January 1, 2016.

According to the American Cancer Society, in 2016 an estimated 224,390 people in the U.S. (117,920 men and 106,470 women) will be diagnosed with, and 158,080 men and women will die of, cancer of the lung and bronchus, the leading single cancer killer in the U.S. If everyone who was eligible got screened, more than 30,000 deaths from lung cancer could be averted every year.

There are more than 94 million current and former smokers in the U.S. at high risk for lung cancer. In 2014, an estimated 18.1 percent, or 40 million U.S. adults, were current cigarette smokers. Unfortunately, smoking rates in East Texas are higher than state and national averages. That means a lot of East Texans are eligible to be screened.

Starting last fall, CHI St. Luke’s Health Memorial began offering low-dose CT lung cancer screening to eligible patients. Medicare covers ages 55-77 (commercial insurance 55-80, but Aetna 55-79). Even within those age ranges, an eligible patient must be a current smoker (or quit no more than 15 years) with at least a 30 pack-year history of smoking (for example, smoking 1 pack per day for 30 years, or 2 packs per day for 15 years). And, eligible patients must have no symptoms of lung cancer (such as coughing up blood or unexplained weight loss of more than 15 pounds in the last year). If lung cancer is suspected, a standard CT chest should be done.

Finally,  Medicare requires “shared decision making” on the risks and benefits of lung cancer screening, which means you must meet face to face with your primary care provider to get an order for screening.

Since we started screening at CHI St. Luke’s Health Memorial, more than 70 patients have been screened. Six abnormalities have been found (including an incidental kidney mass), and two lung cancers have been diagnosed. Those two cancer patients’ lives may have been saved by screening; only time will tell.

Of course, the best way to prevent lung cancer is by not smoking. Ever. Quit if you do smoke. And if you meet the criteria listed above, talk to your doctor about getting screened for lung cancer.

Dr. Sid 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
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