Wednesday, June 14, 2017

HPV Vaccination Prevents Cancers in Men, Too

Men: A shot that prevents cancers — the human papillomavirus (HPV) vaccination — is for you, too, though not nearly enough males are getting it. Sadly, physicians say, vaccination rates in males are extremely low, and doctors are seeing more cancers in men caused by HPV.

Nearly half of men aged 18 to 59 years (45.2 percent) have HPV infection, according to this month’s issue of the national medical digest JAMA Oncology. Yet just one in 10 (10.7 percent) of those males eligible for the HPV shots had been vaccinated, based on data collected through the National Health and Nutrition Examination Survey (NHANES).

For years, scientists have touted the HPV vaccination’s power to reduce cervical cancer in women. Now, during Men’s Health Week, Texas physicians urge men to get vaccinated against HPV to prevent cancers. HPV causes several cancers in men and women, including oropharyngeal (cancers of the head and neck such as the throat and mouth), penile, anal, cervical and vaginal. Some cases are fatal.

“HPV vaccination could change the course of health for many men,” said David Lakey, MD, of Austin, chair of Texas Medical Association’s (TMA’s) Council on Science and Public Health. “The decision to get vaccinated during adolescence or even young adulthood could mean you don’t have to suffer from an HPV-caused cancer such as throat or genital cancer, down the road.”

More than 79 million Americans are estimated to have some strain of HPV infection. HPV is the most common sexually transmitted infection in the United States, yet there is no treatment for HPV. Half of the infections are believed to occur before people reach age 24. Usually, HPV infection goes away on its own. But when it doesn’t, the infection may cause cancer years later.

According to the JAMA article, more than 9,000 cases of HPV-related cancers are diagnosed each year in men. HPV has been found to cause 63 percent of penile cancers and 91 percent of anal cancers. Throat cancers are becoming increasingly common. Nearly 16,000 oropharyngeal cancers, found in the tonsils and base of the tongue, are diagnosed in the United States each year, according to the Centers for Disease Control and Prevention (CDC). And nearly all genital warts (90 percent) are caused by HPV infections, affecting some 160,000 men each year.

Physicians and other health experts recommend the HPV vaccination for both males and females until age 26. Ideally, adolescents receive two HPV shots for best protection — before being exposed to HPV.

But in Texas, only about one-quarter to one-third of teen males are fully vaccinated against HPV, according to the 2015 National Immunization Survey-Teen.

Older teens and young adults who weren’t vaccinated in adolescence can still benefit from HPV vaccination, said Dr. Lakey, who developed and leads TMA’s HPV Working Group. For those over age 15, however, CDC recommends three shots for full protection.

“If you’re a young male and you haven’t gotten the HPV vaccination, ask your doctor about it,” said Dr. Lakey. “It’s certainly easier and better to prevent a cancer than have to endure potentially lengthy, uncomfortable, and costly medical procedures to treat one.”

TMA’s infographic and fact sheet, both in English and Spanish, explain the importance of HPV vaccination.

Monday, June 12, 2017

Four Ways Men Can Safeguard Their Health

By Alan Howell, MD
Temple Infectious Disease Specialist
Member, TMA Be Wise — Immunize℠ Physician Advisory Panel

We’ve all heard the adage, “An ounce of prevention is worth a pound of cure.” Knowing how my household functions, and having taken care of countless men who were certain they would get better if only they “wait a little longer,” one would assume that saying was coined by a woman. Interestingly, Henry de Bracton, a 13th century English cleric and jurist (and surprisingly a man!), is the person credited with the statement.

Men’s Health Week (June 12-18) is upon us, providing those of us with a Y-chromosome a reminder to take a more active role in our personal and family health maintenance. To this end, here are several steps we can take to ensure continued good health:

  • Schedule an appointment with your primary care physician (PCP). An ongoing dialog is necessary for your PCP to provide proper education and care. If it’s been a long time since your last visit, this is the time to get reacquainted!

  • Stay on top of your vaccination needs. TMA has created a concise adult immunization infographic to provide a basis for you and your physician to determine which vaccinations you might need.

  • Kick the tobacco habit. I know, I know… you’ve heard this before. I’m not saying kicking the habit is easy. Some patients may be successful on their own. Others may need assistance. There is no right or wrong way when it comes to tobacco cessation. Your PCP, however, is an important advocate when it comes to addressing — and meeting — this goal.

  • Exercise and eat right. Obesity (Body Mass Index greater than 30) can cause a raft of additional health issues: stroke, heart disease, arthritis, and gout, to name a few.  Additionally, people who are obese spend more on medical needs each year than people of normal weight (approximately $1,400 greater). The national goal is for each state to have an obesity rate of less than 15 percent. No state has met this goal, and Texas currently DOUBLES that figure — 32.4 percent of Texans are obese. Exercise and diet are key to addressing the issue. Be a role model for your family! Healthy attitudes (as well as unhealthy attitudes) can be passed on to our children. By incorporating exercise and healthy foods into your daily routine, you can give your children a gift from which they will benefit for the rest of their life.

Bottom line: Guys, seize this reminder week to take the first step to better care for yourself. You can benefit from a healthier, happier, longer life with just a few positive tweaks. Get active. Eat healthier. Stop smoking. See your doctor for a checkup. Get your shots.

It starts today.

Tuesday, June 6, 2017

Plan a Healthy Summer Vacation

By Jason Terk, MD
Past President, Texas Pediatric Society
Keller Pediatrician
Member, TMA Be Wise Immunize Advisory Panel

The CDC's travel guide. Click to visit.
This summer, many folks will be hitting the roads, seas, and skies for travel destinations both luxurious and humble. If your travel includes international destinations, it is important to be aware of what health precautions you and your family should take. Some of these precautions will require advance planning.

When my patients ask me what they need for travel to a specific destination, I always consult the most reliable source, which is the Centers for Disease Control and Prevention (CDC) website. If you point your browser to this link, you can search for any international location and find information specific to that destination about whether you will need certain vaccines or malaria prevention medications. If you find that either are required for travel to the destination(s) you will be visiting, plan ahead to consult your doctor or visit a local travel medicine clinic.

One additional new concern is the threat of Zika transmission from the bites of mosquitoes. I cannot overemphasize this point: Pregnant women, or women who might be or are planning to become pregnant should not travel to areas with risk for Zika transmission — including the Miami area and the Rio Grande Valley. For non-pregnant couples, because Zika is also sexually transmitted, precautions must be taken during and following travel to Zika-risk areas. Non-pregnant women should abstain from sex or use a barrier contraceptive during and following travel for a period of at least eight weeks to reduce risk of transmission to their sexual partners. Because Zika persists in semen longer than in other body fluids, men should abstain from sex or use a barrier contraceptive during and following travel for a period of at least six months to reduce risk of transmission to their sexual partners. All travelers to Zika-risk areas should use an effective insect repellent that contains DEET, picaridin, IR3535, or oil of lemon eucalyptus on their bodies and a permethrin-containing insect repellent on their clothes. Bed netting may be used in rooms that are not screened or air-conditioned. Talk to your doctor and visit this link for more information.

Got a smartphone? Download the CDC’s TravWell app to help plan a safe and healthy trip. The app lets you build a trip to get destination-specific vaccine recommendations, get a checklist of what you need to do to prepare, and customize a healthy travel packing list. It also lets you store travel documents, keep a record of your medications and immunizations, and set reminders to get vaccine booster doses or take medicines while you’re traveling.

Wednesday, May 17, 2017

Women’s Health: Challenges and Advancements

By Raymond Moss Hampton, MD 
Midland Obstetrician-gynecologist; regional chair and professor, Department of Obstetrics and Gynecology, 
Texas Tech University Health Sciences Center at the Permian Basin

Women’s Health Week began this Mother’s Day, which presents a great opportunity to consider some issues facing women’s health care. Women’s health care is in the midst of some exciting, yet challenging, times. So much is changing, and so many good things are happening for women!

For example, advances in minimally invasive surgery, contraceptive options, prenatal diagnosis (diagnosing a fetus’s illness before birth), and preimplantation genetic testing (testing embryos for genetic disorders before implanting them in the mother during in-vitro fertilization) are now prevalent. Ultrasound capabilities show us pictures of the fetus we once never dreamed possible! Therapeutic options for gynecologic cancer, pelvic prolapse (when a pelvic organ drops and pushes against the vagina), urinary incontinence, or infertility issues give patients more choices with better results than ever before. Vaccines, such as the HPV vaccine, have now been shown to prevent not only cervical cancer but also vulvar cancer, anal cancer, and several head and neck cancers.

Advances in patient safety, quality improvement, and collaborative care are producing encouraging results in better patient outcomes and better care.

Of course, the challenges are significant at all levels, as well. Women in third-world countries face numerous health care disparities. In many places, there are no doctors or hospitals. Infectious diseases such as Ebola and Zika are significant threats. There are few vaccination programs, blood banks are found only in large medical centers, and free standing emergency departments are a dream. Given those obstacles, how can we help those people achieve basic levels of care?

Even here in the United States, we are not immune; women have their own set of health care challenges. The national health care debate and the repeal of the Affordable Care Act will directly affect many women’s access to care. Reproductive rights, in its many forms, is another hot topic on the national level.

In Texas, severe maternal morbidity (illness) and mortality (death) rates are unacceptably high. Access to care is threatened, and health disparities across our state are significant and affect most adversely those who are underinsured or uninsured. The unequal distribution of physicians and health care providers continues to affect health care adversely in our rural areas. Hopefully, our lawmakers will come together and pass legislation that will improve access, advance new technologies, and effectively address the unique challenges facing our state, so that we are able to give all of our patients the high-quality care they need and deserve.

We physicians face challenges too, as we attempt to care for our patients. We are all adjusting to bundled payments and electronic health records, and wondering how we will be affected by programs such as the Medicare Access and CHIP Reauthorization Act of 2015, which outlines how physicians are paid for caring for Medicare patients. Patient satisfaction scores, workforce shortages, and rising insurance premiums weigh heavily on most of us.

All of that said, Women’s Health Week offers a great opportunity to stop and ponder the next generation of women’s health care; there is so much to think about! Are we up for the challenge? I think so, because we physicians are all dedicated to the patients we serve. And we remember and are motivated by the many wonderful women in our lives, and the challenges they have faced and overcome.

Let us all work together to improve their health in every way we can. They deserve our best.

Tuesday, May 2, 2017

Nurses Are Not Physicians

By Don R. Read, MD
President, Texas Medical Association

This article was originally published on TribTalk by The Texas Tribune

Advanced practice registered nurses (APRNs) perform a vital, important function in our health care delivery system. I value them as members of my own care team and rely on them to provide excellent patient care. However, they are not physicians, any more than I am a nurse. Texas is correct to keep its team-based care approach. It ensures patients receive care from each member of the patient care team, based on his or her knowledge, training and expertise.

In 2013, physicians and nurses joined to help write a landmark state law that improved access to care and strengthened the team-based approach to providing health care to all Texans. Texas physicians still strongly support that collaborative care model, in which each team member practices to the top of his or her professional license. A collaborative model ensures patients receive safe, cost-effective and efficient care.

Yet now some nursing groups apparently reject that model. They want to practice independently as if they are physicians — without attending medical school. They claim more patients would receive care, at a lower cost, if lawmakers grant them independent practice authority.

First, there is no evidence — in Texas or elsewhere — to support the notion that granting nurse practitioners authority to diagnose and prescribe independently would improve patients’ access to care. States that have granted practice autonomy to nurse practitioners have not seen nurses rush out to rural communities to hang their shingles and start treating patients. Instead, most nurse practitioners continue to practice alongside physicians in clinics and hospitals as they always have, clustered in the same metropolitan and suburban communities.

In Texas, 52.5 percent of APRNs practice in the state’s five largest counties (Harris, Dallas, Bexar, Travis and Tarrant). Not surprisingly, 51.9 percent of primary care physicians practice in those same five counties. And while patients need primary care, only slightly more than half of America’s APRNs (52.5 percent) practice primary care. And the number of APRNs entering a primary care field has dropped by 40 percent since 2004.

Second, the evidence tells us that independent practice for these nurse practitioners actually will increase costs in our already overpriced system. Studies show nurse practitioners tend to order more expensive tests and diagnostic scans than doctors, and they are quick to refer patients to specialists — all of which drives up the cost of care. Research found that patients under APRNs’ care were hospitalized 41 percent more often than patients cared for in the same settings by physicians. And one-quarter more of the APRNs’ patients saw specialists than those under physicians’ care.

The nurses’ arguments simply do not hold water.

Meanwhile, collaborative care models such as the patient-centered medical home continue to prove their effectiveness. Nearly one-third (29 percent) fewer patients have visited emergency departments, almost 40 percent fewer patients have been hospitalized, and total medical costs are down nearly 9 percent since implementation of various patient-centered medical homes around the country.

What’s more, “primary care” often is acute, complex care, especially in rural areas. Primary care physicians (with the support of their health care teams, all working to the top of their training and abilities) care for car-accident victims, children with severe allergic reactions, people with chest pain, gunshot victims, burn victims and women about to deliver babies. Those patients and the tens of thousands of others across Texas with similar complex needs require immediate help from people who know best what to do.

The Texas Medical Association strongly opposes House Bill 1415 by Rep. Stephanie Klick, R-Fort Worth, and Senate Bill 681 by Sen. Kelly Hancock, R-North Richland Hills, which would broaden APRNs’ practice authority. Instead, TMA supports improvements to the current health care collaboration model as we work to improve access to care, especially in underserved areas.

Nurse practitioners are a vital part of Texas’ health care workforce. But as many nurses who’ve later gone to medical school readily admit, nurses simply do not know what they do not know; there are limitations built in to their training.

APRNs are not “physician substitutes.”

The typical physician completes 12,000 to 16,000 hours of clinical training in medical school and residency. The typical APRN completes 500 to 1,500 hours. That foundation, while appropriate for the nursing field, is simply is not a substitute for the comprehensive care physicians are trained to — and expected to — provide.

Thursday, April 27, 2017

10 Things to Know During National STD Awareness Month

By Junda Woo, MD, MPH
San Antonio obstetrician gynecologist 
Medical Director, San Antonio Metropolitan Health District
  1. Syphilis is back. Rates of this ancient scourge jumped 19 percent from 2014 to 2015, more than any other reportable STD, according to the Centers for Disease Control and Prevention (CDC). Most cases are among men who have sex with men. Men who have sex with men should get tested annually for syphilis, chlamydia, gonorrhea, and HIV.

  2. Rates of chlamydia rose too — 1.5 million people were diagnosed with this infection in 2015. Since most women with chlamydia show no symptoms, the CDC says all sexually active women should be tested every year until age 25. Yet fewer than half of insured, eligible women under 25 were tested for chlamydia in 2015, according to data collected from U.S. health plans.

  3. In 2009, Texas made it legal for doctors treating STD patients to provide an extra antibiotic prescription for the patient’s partner. This practice is called Expedited Partner Therapy. While it is better if every partner sees a doctor, that doesn’t always happen. When doctors provide partner prescriptions, re-infections of chlamydia drop 20 percent, and re-infections of gonorrhea drop 50 percent.

  4. Anyone who is treated for chlamydia, gonorrhea, or trichomoniasis — all easily curable STDs — should be retested in three months to catch re-infections, according to the CDC.

  5. About 1 in 6 sexually active people have herpes, but only one-tenth of infected people know they are infected. The CDC does not recommend routine blood tests for herpes, in part because the tests are not that accurate, and false positive tests cause emotional distress.

  6. Everyone between the ages of 13 and 64 should be tested for HIV at least once in their lives.

  7. There is now a daily pill that prevents HIV. If you are HIV-negative but your partner is HIV-positive, or you are man who has sex with men and you have multiple partners, ask your doctor about pre-exposure prophylaxis (PrEP). 
… And for physicians:
  1. Patients say they want their doctors to ask about sexual health. Doctors may feel uncomfortable asking intimate questions. The CDC offers this guide: https://www.cdc.gov/std/treatment/sexualhistory.pdf.

  2. Many people in the LGBT community are reluctant to “come out” to doctors because of previous negative experiences. For free continuing medical education (CME) on LGBT health and tips on creating an LGBT-friendly office, go to LGBThealtheducation.org.

  3. Doctors can brush up their knowledge about syphilis (“The Great Imitator”) and get free CME with the National STD Training Curriculum: https://www.std.uw.edu/.

Monday, April 10, 2017

With Throat Cancer Increasing, Doctors Urge Vaccination to Prevent It

Doctors are diagnosing more throat cancers caused by the human papillomavirus (HPV). HPV also causes other cancers, such as cervical, but throat cancer is quickly becoming the most common. The good news: the HPV vaccination, if people receive it early enough, can prevent most of these cancers, which are found in the tonsils and base of the tongue.

Four percent of U.S. adults aged 18 to 69 have a type of HPV that puts them at high risk for throat, or oropharyngeal, cancers, according to a new report from the Centers for Disease Control and Prevention. Nearly 16,000 oropharyngeal cancers are diagnosed in the U.S. each year, according to the CDC.

The cancer’s prevalence has pushed it into the spotlight this month, which has been designated Oral, Head and Neck Cancer Awareness Month. During April, Texas physicians urge parents to vaccinate their children against HPV to prevent cancer later in life.

“The vaccine is nearly 100 percent effective if it’s given before someone is exposed to HPV,” said Texas Medical Association member Erich Sturgis, MD, a head and neck surgeon at the MD Anderson Cancer Center in Houston. “Taking this preventive action during adolescence can mean better health down the road.”

Physicians and other health experts recommend the HPV vaccination for preteen boys and girls, aged 11 and 12 years, but youths can receive it as early as age 9. A second dose of HPV vaccine should be given six to 12 months after the first dose.

HPV is the most common infection in the nation spread through intimate skin-to-skin or sexual contact. Almost all — eight in 10 — sexually active people will have the virus sometime in their lives.

HPV infections can cause healthy cells to become abnormal. Typically, the body can clear the infection. But when it can’t, the infection can cause cells to become cancerous years later.

Dr. Sturgis says the HPV vaccination is important for both boys and girls, but stresses its importance for boys. Doctors can diagnose cervical cancer early through screening (the Pap test), he said, but currently no screening is available for throat cancers, so they usually are advanced when diagnosed. And while HPV-related throat cancers are expected to surpass cervical cancer by 2020, Dr. Sturgis said experts say that may occur sooner.

Men are three to five times as likely to get throat cancer as women, with most cases occurring in white, middle-aged males. Smoking and alcohol use previously caused most oropharyngeal cancers, but HPV now accounts for at least 70 percent of these cancers.

“Unfortunately, the generation of people getting HPV-related throat cancers didn’t have the benefit of vaccination,” said Dr. Sturgis. “Now we have the opportunity to protect the next generation from a very devastating disease.”

Older teens and young adults who weren’t vaccinated in adolescence also can benefit from HPV vaccination. Both males and females can get the shots until age 26. For those over age 15, however, the CDC recommends three shots for full protection. People should ask their physician about how many doses are needed and when.

TMA has published an infographic and fact sheet about the importance of HPV vaccination, both in English and Spanish.

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