Friday, February 27, 2015

Shining a Light on Rare Diseases

There are nearly 7,000 diseases and conditions that are considered rare by medical authorities in the United States. Each year, thousands of Texans are among those whose lives are changed by these diseases.

A rare disease is any disease that affects fewer than 200,000 people in the United States. As a group, these diseases affect almost 30 million Americans, or nearly one in 10 people. Two-thirds of those living with a rare illness are children. Many of these diseases are serious and debilitating, have no approved treatment, and are not currently being studied by medical researchers. It is not unusual for people with rare diseases to feel “orphaned” by the health care system.

To focus attention on these diseases and the challenges the people living with them face, the National Organization for Rare Disorders is sponsoring a nationwide observation of Rare Disease Day Feb. 28. Rep. Elliott Naishtat (D-Austin) authored a resolution in the state legislature recognizing the day as Rare Disease Day in Texas. Tomorrow, patients, physicians, medical professionals, researchers, government officials, and companies developing treatments will join together to focus attention on rare diseases as a public health issue.

Thursday, February 26, 2015

Innovative Program Fosters Primary Care Physicians

By John Dermot DeMis,
Second-Year Medical Student, UTHSCSA
US Navy Reservist

Editor's Note: The General Internal Medicine Statewide Preceptorship Program (GIMSPP) is a mentorship program offered by the Texas Chapter of the American College of Physicians. The program gives Texas medical students an opportunity to spend time with an internist practicing in a community hospital or clinic for two, three, or four weeks. Students observe the daily routine of the internist and experience the variety that the practice of internal medicine provides. The aim is to interest medical students in a career in general internal medicine in medically underserved areas. Placements are made in all regions of Texas with an emphasis on rural areas, medically underserved areas, and health professional shortage areas as defined by the U.S. Department of Health and Human Services.

The following is testimony from John DeMis, a second-year medical student who took advantage of GIMSPP and discovered his medical calling. Mr. DeMis testified in front of the House Appropriations Subcommittee on Education Funding, urging them to reestablish funding for preceptorship programs.

My name is John DeMis. I am second-year medical student at The University of Texas Health Sciences Center in San Antonio, and I will graduate in 2017. I am also a Navy reservist and Health Professions Scholarship recipient. I plan to practice internal medicine because of my experiences with the General Internal Medicine Statewide Preceptorship Program (GIMSPP).

My first-year medical school finals ended on May 23, and I wasted no time. On May 26 I was working with Dr. Pariac Mulgrew, a mentor from the Texas Chapter of the American College of Physicians. I spent my entire summer working with him, and I will summarize my experience with one word: Amazing!

Dr. Mulgrew was trained in internal medicine and subsequently completed a fellowship in nephrology. He started the largest nephrology private practice group in San Antonio, Renal Associates, and served as head of Transplant for Methodist Specialty and Transplant Hospital for many years. He has a breadth of knowledge that is both wide and deep.

However, I am here to give you my story and how the GIMSSP has shaped the course of my professional life. Although I made the decision early to serve my country as a physician for the Navy, I had no idea what kind of doctor I wanted to be when I began medical school. So, I enrolled in GIMSPP, hoping I would find a mentor who would guide me and teach me as much as possible.

Our days began at 7:30 am Monday through Friday. We would first drive to see his patients at the dialysis units. While we saw patients, he would explain to me lab values, drug actions, everything, with no help from a book. After we saw the patients, he would give a lecture while he charted. I learned about acid-base changes, the physiological changes on the cardiovascular system when a dialysis fistula is placed, etc. These lessons were invaluable for the future months of medical school because they connected the science of medicine with the people it impacted the most: the patients. Then we went to see his hospitalized patients. While we drove, he would talk about the history of the medical field, or explain a concept that I was having difficulty with, or just answer the millions of questions I had. That lasted until noon, and Dr. Mulgrew didn’t eat lunch. So Tuesday through Thursday we immediately started his clinic patients at Renal Associates. Mondays were special; his heart transplant patients, some of whom he had been managing for more than years, came to see him. What was most apparent was how much his patients cared for him. They brought home-baked food and vegetables from their garden, or they swapped pictures and stories of grandkids. He was the kind of doctor I wanted to be. Our days could last until 7 pm sometimes, but they weren’t over. He would recommend certain topics to review that night so that I could tell him what I learned the next day, where we did it all over again. In the end, GIMSPP gave me my mentor who would push me to grow.

Programs like these need to be funded and promoted by the state because they provide a unique, one-on-one mentorship for students like me. The intensive, early clinical exposure is not just a springboard for success in students’ curriculum. This program taught me what kind of doctor and what kind of person I wanted to be. I know that I will practice internal medicine now. After I serve my country, I will return to serve my home, the state of Texas, as a doctor in internal medicine. I have GIMSPP to thank for that. Please consider returning funding to this excellent program. Thank you for your time.

John Dermot DeMis
MD Candidate
UTHSCSA Class of 2017

Wednesday, February 25, 2015

Keep E-Cigarettes Out of Schools

Electronic cigarettes or “e-cigarettes” are widely accessible and growing in popularity. Several states have already passed legislation to include e-cigarettes in nonsmoking laws or to restrict the sale of e-cigarettes to minors. Texas physicians are calling on lawmakers to regulate e-cigarettes and restrict minors’ access to these products. Physicians are concerned e-cigarette use by minors could be a pathway to future tobacco use and nicotine addiction.

Houston radiologist Joel Dunnington, MD, testified before the House Public Education Committee, asking legislators to support House Bill 456 by Rep. Roland Gutierrez (D-San Antonio), which would prohibit the use of e-cigarettes on school campuses.

“The marketing to young people of these products worries physicians,” Dr. Dunnington told committee members. “We join others in expressing concern that young people using these products will also use other tobacco products. The Centers for Disease Control and Prevention has reported e-cigarette use among U.S. students in grades 6-12 doubled from 2011 to 2012. In 2013 almost 5 percent of high school students reported using e-cigarettes.”

Friday, February 20, 2015

My Doctor: My Patient Advocate

Every other year as state lawmakers gather at the Capitol to create laws and pass a new budget, Texas physicians are there, too, making sure the concerns of their patients are heard. Physicians representing the Texas Medical Association testified this week on behalf of their patients on a host of issues, including improving access to care, strengthening public health initiatives, and tackling health care costs. Being a patient advocate is a way to give back to your community, says Carlos Cardenas, MD, a gastroenterologist from McAllen.

"Each physician has a very special place, a special permission to go into people’s lives and see things that not everybody else sees. And when you see those things, and you see how people are impacted by either policies, or legislation, or whatever it might be, you see an injustice. It is your moral duty to stand up for your community and defend the access to care for your patient. I firmly believe that if you do for your community, your community will do for you."

Tuesday, February 17, 2015

Measles: The Next Disneyland Could Be Texas

By Ernest Buck, MD
Corpus Christi Pediatrician
Chair, TMA Council on Health Promotion

The Disneyland measles outbreak hasn’t made its way to Texas, yet. But it’s only a plane ride away. And depending on where that plane lands, we could be in for some big health problems.

It’s hard for Texans under a certain age to remember, but measles is a serious, highly contagious disease. It can cause serious complications in children. Some will die. This is not an exaggeration. This is reality.

Thanks to a very effective vaccine, we declared measles completely eliminated in the United States just 15 years ago. But we were wrong, in large part because not everyone gets vaccinated anymore.

The measles vaccine is safe and effective. It provides almost complete immunity to the disease. Let me repeat that. The measles vaccine is safe and effective, and it provides almost complete immunity to this terrible disease. That means children can be spared the effects of disease and do not need to die.

Until 2003, almost every schoolchild in Texas was required to be immunized against measles and nine other awful — but vaccine-preventable — diseases. Children whose physician certified they could not get a vaccination for health reasons were allowed into school without the shot. For 2004, that was about 3,000 students.

Then the law changed, allowing parents to file a form stating they had a personal or religious objection to the immunizations. District-by-district data from the Texas Department of State Health Services, which is available on its website, shows that the number of students with an exemption reached nearly 38,000 last year.

What’s more concerning, though, is that those exemptions tend to be clustered in certain communities and school districts — in and around Austin, for example, and north of Dallas. That means if one unimmunized child in one of those schools contracts measles, it will spread rapidly through his or her unimmunized classmates.

They’ll be home sick for a week or more (and a parent will likely have to miss work to care for them). One in 20 will be so ill they’ll need to go to the hospital. One or two in 1,000 could die.

It’s not just those whose parents claimed an exemption who are at risk, though. It’s also the infants who are too young to get the vaccination. And those whose immune systems are damaged by necessary medical treatments or other diseases, such as leukemia.

Here are some simple facts about measles:
  • We had no cases in Texas from 1990 through 2000. We had just 17 cases from 2004 to 2012. In 2013, 27 cases of measles were reported in Texas. Last year, we had 10.
  • This is a highly contagious disease, and someone with measles can be infectious for four days before the spots appear on his or her skin. If someone with measles coughs or sneezes in a small room, the virus can live for up to two hours in the air. Nine out of 10 unimmunized people who walk into that room will catch the measles. Ebola was not airborne; measles is.
  • The measles vaccine works. That’s why we are able to wipe the disease out in this country.
  • The measles vaccine is safe. There is absolutely no scientific evidence that the measles vaccine causes autism.
As a pediatrician, a parent, and a grandparent, I cannot urge you strongly enough to make sure your children are vaccinated — against measles, mumps, pertussis, chicken pox, and all those other diseases we can stop with a simple shot. (Pertussis, or whooping cough, is another major threat in Texas right now. It killed five children in Texas in 2013 and at least two last year; all were less than 1 year old.)

Education — on the dangers of these diseases and the unquestionable benefits of vaccinations — is the key to protecting our children.

Talk to your doctor if you have questions or concerns. But, please, be wise — immunize.

Dr. Buck, a pediatrician from Corpus Christi, is chair of the Texas Medical Association Council on Health Promotion.

Those With Exemption Rates of 1 Percent or More
District County Number Students Exempted Percent Exempted Rank
Leander ISD Williamson 916 2.59% 1
Spring ISD Harris 694 2.00% 2
Northwest ISD Tarrant 375 1.98% 3
Round Rock ISD Williamson 824 1.81% 4
Frisco ISD Collin 768 1.69% 5
Austin ISD Travis 1,364 1.60% 6
Allen ISD Collin 312 1.56% 7
McKinney ISD Collin 374 1.52% 8
Comal ISD Comal 291 1.52% 9
Plano ISD Collin 776 1.46% 10
Georgetown ISD Williamson 151 1.43% 11
Hays CISD Hays 233 1.40% 12
Rockwall ISD Rockwall 204 1.39% 13
Magnolia ISD Montgomery 165 1.36% 14
Coppell ISD Dallas 148 1.30% 15
Pflugerville ISD Travis 294 1.29% 16
Clear Creek ISD Galveston 488 1.22% 17
Lewisville ISD Denton 621 1.18% 18
Keller ISD Tarrant 400 1.18% 19
Tomball ISD Harris 143 1.17% 20
Eagle Mt-Saginaw ISD Tarrant 205 1.12% 21
Wylie ISD Collin 146 1.08% 22
Katy ISD Harris 658 1.01% 23

Friday, February 13, 2015

Ban the Tan

Divya Srivastava, MD
Dallas Dermatologist

One American dies from melanoma every hour.  Yet, this deadliest form of skin cancer is highly preventable with proper avoidance and protection from ultraviolet radiation, the No. 1 risk factor for skin cancer.  If melanoma and other skin cancers are so preventable, why does melanoma remain the most common cancer in women aged 25-29 and the leading cause of cancer death in women aged 25-30 years old?

Thirty million people use indoor tanning devices annually, and 2.3 million of them are teenagers.  Many people believe that tanning, either in the sun or in tanning beds, is safe and even healthy.  In fact, the tanning industry leads the public to believe that tanning provides health benefits.  In a 2012, a Congressional report revealed that the tanning industry purported misleading information such as denying the known risks of indoor tanning, falsely claiming that tanning is beneficial to a young person’s health, and targeting teenage girls in their advertisements.

There are 70,000 new melanomas diagnosed in the United States every year. Nearly 4,000 cases of melanoma were diagnosed in Texas in 2013.  Research has shown that just one indoor tanning session increases a user’s chances of developing melanoma by 20 percent, and that each additional session in that year increases the risk by 2 percent.  People who start tanning before age 35 increase their risk of melanoma by 75 percent.

Over the last few years, major health organizations have begun raising awareness about the harmful effects of tanning.  The World Health Organization has labeled ultraviolet radiation from tanning beds as carcinogenic to humans, raising its risk level to that of cigarettes.  The Center for Disease Control has led a campaign to defuse myths about skin cancer, endorsing that tanned skin is not healthy.

In May 2014, the U.S. Food and Drug Administration (FDA) raised the classification of tanning beds to require stricter regulations to safeguard public health. It also recommended against the use of tanning beds by minors under the age of 18.  Tanning bed manufacturers will now be required to inform customers clearly about the risks of tanning beds, warn users to get screened regularly for skin cancer, and alert users that tanning is not recommended for minors under 18 years old.

Texas has truly been a leader in protecting the public from the risks of tanning. In March 2013, Gov. Rick Perry signed a bill prohibiting minors under the age of 18 from using indoor tanning salons. Texas became the fifth state to ban tanning for minors.  

A recent study showed that these efforts by legislators and public health officials have made a difference. From 2009 to 2013, there has been a decrease in the percentage of teenage girls who tan from 25 percent to 20 percent.  This still leaves about 1.5 million teens who tan regularly, so there is still much work to do.  

While dermatologists continue to push for more improvement, it is also important to remember that simple daily protective measures can protect you from skin cancer. It is important to seek shade during the peak hours of 10 am to 4 pm, wear sun-protective clothing such as long sleeve shirts and wide-brimmed hats, and use broad-spectrum sunscreen daily with frequent reapplication.

Americans can expect to see more effective sunscreen ingredients in the near future, as Congress just passed the Sunscreen Innovation Act, which will allow the approval of new sunscreens quickly that have been available outside the United States for years.

Dr. Srivastava is a Dallas dermatologist and assistant professor of dermatology at UT Southwestern Medical Center.

Thursday, February 12, 2015

Fist-Bump Your Doc This Cold and Flu Season

While trying to find a way to greet his patients but limit the spread of cold and flu, Denton physician Jason Marchetti, MD, came up with a simple solution: the fist-bump.

A physical medicine and rehab physician, Dr. Marchetti developed an outreach campaign reminding people about the need for good hygiene, especially during flu season. He introduced the fist-bump as a scientifically validated greeting that can decrease germ transmission during hand-to-hand contact.

“This has all of the qualities of an ideal medical intervention: it’s free, it’s safe, and it can be done easily by everyone,” remarks Dr. Marchetti.

The campaign is backed by an August 2014 study, “The fist bump: A more hygienic alternative to the handshake,” published in the American Journal of Infection Control. Researchers conducted a basic experiment looking at the transmission of bacteria between hands. They looked at a “regular” as well as “strong” handshake then compared to a fist bump. Strong handshakes (firmer pressure, longer grip duration) spread double the bacteria versus a regular handshake, while a fist bump (with low pressure, brief contact, less surface area) only had 25 percent the transmittance. Their conclusion: “For the sake of improving public health,” we should adopt this more hygienic alternative to the handshake.

In his own practice, Dr. Marchetti has found that patients, young and old, have embraced the campaign enthusiastically.



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