USA Health N E W S
FEBRUARY 2019
JUPITER • PALM BEACH GARDENS •
WEST PALM BEACH • ROYAL PALM BEACH • WELLINGTON • LANTANA • BOYNTON • BOCA RATON
Palm Beach Accountable Care Organization
2018 Holiday Gala
GIANNA M. TROMBINO, EMHA
P
hysician owned and operated Palm Beach Accountable Care Organization, “PBACO” held its Annual 2018 Holiday Gala for their respected physician members and ACO employees at the Kravis Center in West Palm on December 8th, 2018 to celebrate another year of high quality patient care in South Florida. Background and History of PBACO: PBACO started in 2012 and has 650 Physicians in its impressive high quality network. With Aprox 80,000 Medicare and 100k Commercial patients. Commercial payers United, Cigna, and Blue Cross Blue Shield have contracted with the PBACO. Joining Palm Beach Accountable Care: Providers who decide to join
the PBACO benefit in a myriad of ways, apart from being joint owners, which allow them to be true advocates for their patients and focus on doing the right thing. With a dedicated assign-
ment team, to foster growth and patient retention, a consultant team, to guide them in ACO best practices for performance, and from having electronic health record (EHR) specialists at their
disposal to guide them in meeting MIPS/MACRA requirements, HIPAA compliance, and CMS quality measures. The PBACO team also ensures practice have adequate templates for Annual
Wellness visits (which help meet many CMS quality measures) and Transitional Care Management. The EHR is currently working on electronic Clinical quality measurement workflows to prevent and address gaps in patient care. PBACO has a mobile app that alerts doctors when their assigned patients are admitted, discharged, or transferred to any hospital in Florida, interfaced with the state health information exchange. PBACO’s initial approach to delivering quality care is by empowering the primary care physicians to act as beneficiary advocates through building a relationship of trust, understanding and dependability. The goal is to get the beneficiary, who has open access to any primary care physician specialist, or hospital, to remain aligned closely with their PBACO physician. The physician will identify the unique healthcare needs of each beneficiary to create a personalized healthcare plan. For more information please call the Palm Beach ACO at 561429-2680 or visit them online at www.pbaco.org
2 | USA HEALTH NEWS
FEBRUARY ISSUE • 2019
What to Know About the Flu Season
F
lu activity rose significantly over the last week, with nearly every state in the union now reporting widespread activity. The Centers for Diseases Control and Prevention (CDC) expects influenza activity to remain elevated for the next several weeks. Since October 1, 2018, there have been up to 15.2 million cases of the flu, up to 7.2 million flu medical visits, and up to 186,000 flu-related hospitalizations, the CDC estimates. Adults ages 65 and older have the highest hospitalization rate, followed by children younger than five years. Deaths caused by pneumonia and influenza have been hovering at or above the national threshold for the past few weeks, including at least 28 pediatric deaths so far. Despite the fact that this year’s overall flu activity is turning out to be milder than last year’s, doctors are still encouraging anyone 6 months and older to be vaccinated. Flu season can last until May, and several more cases of the flu are expected to be diagnosed before the season is over. VACCINE IS BEST WAY TO AVOID THE FLU Within the last week or so, the number of states reporting widespread activity increased from 45 to 47 states. The states with the most severe activity include Alabama, Alaska, Arkansas,
“If you develop symptoms of the flu — such as fever, chills, and aches and pains — it’s best to start an antiviral medication within 24 to 48 hours,” Mushatt said. There’s no cure for the flu, but if taken within 48 hours, these medications can help you recover more quickly. The sooner you begin taking antivirals, the more benefit you’ll get from them. “The longer you wait, the more damage the flu virus does to your body and the more the antiviral needs to catch up,” he said.
Colorado, Connecticut, Georgia, Indiana, Kentucky, Louisiana, Maryland, Massachusetts, Mississippi, Nebraska, New Jersey, New Mexico, North Carolina, Oklahoma, Rhode Island, South Carolina, Texas, Utah, Vermont, and Virginia. The flu strain called H1N1 has been the most commonly reported strain throughout the country this year, with flu strain H3N2 being the predominant strain in the southeastern region of the United States. And the CDC reported that this year’s vaccine is proving to be very effective. While it’s still too early to say exactly how effective it’s been, the 2018-2019 vaccine is a better match to the dominant strains that are circulating this season.
“Typically, H3N2 is particularly virulent, and vaccines targeting it are less effective than those aimed at other strains, so H3N2 infections tend to be more severe,” Dr. David Mushatt, an infectious disease specialist and section chief of infectious diseases at Tulane University, told Healthline. “So if H1N1 continues to be the predominant strain this year, unlike last year, then it will be a less severe flu season.” It’s not too late to get a shot, which is your best line of defense against influenza. WHAT TO DO IF YOU START HAVING SYMPTOMS If you start to experience flu symptoms, it’s important to visit your doctor or an urgent care as soon as possible.
In addition, doctors recommend staying home to avoid spreading the flu further. This is especially important if you work in a setting with those most vulnerable to the flu, such as older people or small children. Get plenty of rest, stay hydrated, and take over-thecounter medications for fever and achiness. While the vaccine is your best bet to protect yourself against influenza, health experts recommend the second best thing: washing your hands and using hand sanitizer frequently. Steer clear of people who are sick and avoid public surfaces and touch screens, which are known hotspots for harmful bacteria. As the peak of flu season approaches, it’s crucial to take these necessary preventive measures and consider getting the flu shot if you haven’t already.
USA Health N E W S
Jennifer Justo Publisher Gianna M. Trombino, EMHA Editor in Chief Sergio Aguilar Graphic Design Eduardo Sam Distribution USA Health News Contact Us: 4516 Brook Drive West Palm Beach, FL 33417 Avertising and all other inquiries should be directed to
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Things to Do with Kids in Palm Beach County LAKE WORTH STREET PAINTING February 23, 2019 - February 24, 2019 Lake and Lucerne Avenues, Downtown Lake Worth, FL
PALM BEACH INTERNATIONAL BOAT SHOW March 28, 2019 - March 31, 2019 Flagler Drive, West Palm Beach, FL
ASIAN CULTURAL FESTIVAL 2019 Friday, February 22, 2019, 12:00 AM West Palm Beach Palm Beach County, FL Source: cityplace.com
THE HONDA CLASSIC February 25, 2019 - March 3, 2019 PGA National Resort & Spa, 400 Avenue of the Champions, Palm Beach Gardens, FL 33418
SPRING TRAINING - WASHINGTON NATIONALS & HOUSTON ASTROS February 23, 2019 - March 24, 2019 The Ballpark of The Palm Beaches 5444 Haverhill Road West Palm Beach, FL 33407 SPRING TRAINING - MIAMI MARLINS & ST. LOUIS CARDINALS February 23, 2019 - March 24, 2019 Roger Dean Stadium, 4751 Main Street Jupiter, FL 33458
BREW AT THE ZOO April 6, 2019 Palm Beach Zoo, 1301 Summit Boulevard, West Palm Beach, FL 33405
DELRAY AFFAIR April 12, 2019 - April 14, 2019 Downtown Atlantic Avenue, Delray Beach, FL 33483 WELLINGTON BACON & BOURBON FESTIVAL March 22, 2019 - March 24, 2019 Community Center & Amphitheater, 12100 Forest Hill Blvd. Wellington, FL 33414
SWEET CORN FIESTA April 28, 2019 Yesteryear Village, South Florida Fairgrounds, 9067 Southern Boulevard, West Palm Beach, FL 33411
2019 • FEBRUARY ISSUE
USA HEALTH NEWS
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Palm Beach Accountable Care Organization 2018 Holiday Gala
4 | USA HEALTH NEWS
FEBRUARY ISSUE • 2019
Recognizing Signs of Mental Illness in Children Mental health disorders are more common in young children than many people realize — and a number of them aren’t getting the help they need. Here’s how to spot the signs.
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our 2 year old has been in full-blown tantrum mode for over an hour. Toys are being flung across the room, punches are flying any time you get near, and there’s even the risk of being bitten if you dare to get too close.
Rannazzisi says that signs your child might need help include:
Is this typical toddler behavior, or the sign of early mental health issues? Your 7 year old doesn’t want to go to school. Every day she comes home crying, and every morning she begs to skip. You see the panic in her eyes. You know it’s real. But is she just a kid who doesn’t like school, or is this what anxiety looks like for her? If you’ve found yourself in situations like these, wondering whether or not your child needs the help of a mental health professional, you’re not alone. A recent study released in JAMA Pediatrics estimated that 7.7 million children — roughly 16.5 percent nationwide — have at least one mental health disorder. Yet, about half of those children don’t receive any kind of treatment from a mental health professional.
The reasons for this disparity in care can be extensive.
accurate when it comes to lack of treatment.
THE FLAWS IN THE DATA
She pointed out that kids with ADHD are primarily treated by their pediatrician or family care practitioner, without the need for seeing a mental health professional.
Given those barriers, it’s no wonder more kids aren’t receiving the help they need. But Dr. Marian Earls, board-certified in both general pediatrics and developmental and behavioral pediatrics, and an American Academy of Pediatrics (AAP) representative, isn’t convinced the numbers from the most recent report are entirely
IDENTIFYING ISSUES SOONER Still, as a developmental and behavioral pediatrician, Earls is interested in ensuring mental health issues are caught as early as possible.
“I think the bigger take-home to this research is the number of kids who have disorders,” she said. “We should be regularly asking kids about how they’re doing, identifying issues as they’re emerging, and working on earlier intervention, before these issues become a crisis.” Parents can play a role in helping that to happen by bringing concerns to their child’s pediatrician as soon as they have them.
• significant mood changes including persistent negative mood or frequently changing moods • significant behavior changes, for example a straight A student begins failing classes • excessive fear or worries • loss of interest in people, objects, and activities they used to enjoy • difficulty concentrating • a decline in self-care (e.g., hygiene, grooming) • difficulty initiating or maintaining social relationships • physical symptoms such as headaches, stomachaches, changes in appetite, and sudden weight loss or gain • self-injurious behavior • substance use Because she specializes in identifying issues with very young children, Earls mentioned paying attention to feeding problems and interactions with others even as early as infancy. For school-age children, she said that their willingness to go to school or participate in the family can bring up reasons for potential concern.
Quality & Convenience You Can Depend On... • State-of-the-Art Equipment • Board Certified Radiologists • Evening and Weekend Hours • Complimentary transportation • Accepts All Insurance
Open & Hi-Field MRI • 64 Slice CT Nuclear Medicine • PET/CT • Ultrasound Digital Mammography • Digital X-ray DEXA Bone Density • Echo • Cardiac Stress Test/Cardiac PET • Holter Monitor Coronary CTA
phone 561-795-5558 • fax 561-792-7300 www.independentimaging.com Wellington • Belle Glade • Lake Worth
2019 • FEBRUARY ISSUE
USA HEALTH NEWS
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Wellington Regional Medical Center hosts its Annual Physicians Appreciation Dinner at the Winter Equestrian Festival
Low-dose CT lung screening
could save your life!
WELLINGTON REGIONAL MEDICAL CENTER WANTS YOU TO KNOW YOUR RISK Lung cancer is the second most commonly diagnosed cancer in the United States among men and women and the leading cause of death. * According to the American Cancer Society, early detection using low-dose CT scans can help reduce mortality by 20 percent, compared to standard chest X-rays. Before your first lung cancer screening, you’ll need to schedule an appointment with your doctor to discuss the benefits and risks of lung cancer screening. You and your doctor can decide whether lung cancer screening is right for you.
10101 Forest Hill Boulevard | Wellington, Florida 33414 * American Cancer Society
Learn more at wellingtonregional.com Or call 561-500-LUNG (5684)
Low-dose CT scans offer: • Proven technology to detect lung cancer at earlier stages • The best chance for early detection, treatment and survival • Reduced radiation exposure.
Individuals who can benefit from lung screening are: • Between the ages of 55 and 77 • Asymptomatic with no signs of symptoms of possible lung cancer • Current smokers • Non-smokers who have a history of smoking at least one pack a day for 30 years • Former smokers who quit within the last 15 years
Wellington Regional is designated as a Lung Cancer Screening Center by the American College of Radiology. Our Clinical Navigators are here to walk you through each step, from scheduling your screening, to any follow up necessary. The hospital offers a $99 cash pay rate if the screening is not covered by insurance.
10101 Forest Hill Boulevard | Wellington, Florida 33414 Physicians are independent practitioners who are not employees or agents of Wellington Regional Medical Center. The hospital shall not be liable for actions or treatments provided by physicians. For language assistance, disability accommodations and the nondiscrimination notice, visit our website. 181434 3/18
Learn more at wellingtonregional.com Or call 561-500-LUNG (5684)
8 | USA HEALTH NEWS
FEBRUARY ISSUE • 2019
American Cancer Society Hosts “Making Strides Against Breast Cancer” WRITTEN BY: GIANNA M. TROMBINO, EMHA
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merican Cancer Society’s, “Making Strides Against Breast Cancer” walk and run was sponsored and presented by Seacoast Bank in downtown West Palm Beach on Saturday, October 27th. One hundred and sixty-nine teams participated in the walk, which raised over $106,600. According to the American Cancer Society, “Making Strides Against Breast Cancer walks raise awareness and funds to save lives from breast cancer. Each event is a noncompetitive 3 to 5-mile walk that brings people together to make a difference for everyone who has been touched by breast cancer. The events raise money to fund innovative research, provide free information and support, and to help people reduce their breast cancer risk or find it early when it’s most treatable. From the opening ceremony to the post-walk entertainment, a Making Strides event is a celebration of survivors and opportunity to remember loved-ones lost. It’s a day that shouldn’t be missed and won’t be forgotten.”
According to the American Cancer Society, apart from skin cancers, the most common type of cancer women face is cancer of the breast. The American Cancer Society estimates about 252,710 new cases of invasive breast cancer will be diagnosed this year alone. Although, there is no way to prevent breast cancer; there are early detection screenings for women that can help lower the risk of breast cancer. Early Detection and Diagnosis: The American Cancer Society recommends every woman have a baseline mammogram around age 35, to establish what is nor-
mal in her breasts. After receiving the baseline mammogram, it is recommended women have a mammogram every one to two years between the ages of 40 and 49 years old, and once a year after age 50.
and its surroundings the Women’s Center at Independent Imaging offers breast cancer screening.
Your doctor may recommend mammography earlier or more frequently if your medical history indicates that you are at risk for breast cancer.
Independent’s three convenient locations in Wellington, Lake Worth, and Belle Glade offer Digital Mammography, a diagnostic screening tool for women that provides a low-dose X-Ray of the breasts. Digital Mammographs primary purpose is to detect lesions in the breasts.
There are a number of different tests available to look for and diagnose breast cancer, including digital mammography and 3D digital mammography. For those residing in Palm Beach County
Independent Imaging’s Wellington location also offers 3D Digital Mammography. 3D Digital Mammography uses a flat panel detector, offering superior image quality and performance,
including fewer instances of retakes and more advanced views, which ultimately results in lower dose for patients. The Women’s Center at Independent Imaging: At Independent Imaging, we understand the concerns of women who come to our facility for diagnostic testing. Our professional and compassionate associates treat patients in a courteous and respectful manner. Please call Independent Imaging at (561) 795-5558 for more information or to request an appointment.
2019 • FEBRUARY ISSUE
USA HEALTH NEWS
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Living Your Best Life At Any Age! BY TOMMY ROZYCKI, CPT
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healthy lifestyle is something that can and should be enjoyed by all individuals, regardless of age. This can be achieved through proper eating habits and daily exercise. Fitness is a lifelong process and is different for every individual. There are countless benefits, both mental and physical, attributed to a daily exercise routine. Resistance Training (Free weights, machines, bodyweight, resistance bands, etc.) has been proven to increase bone density, which is important for everyone but especially crucial for those who suffer from Osteoporosis. Aerobic exercises will help keep your Cardiovascular System strong and working properly. Aim to keep your heart rate elevated for the duration of your workout. Remember to start and finish each session with some light stretching to avoid injuries. Aim for a minimum of 30 minutes of moderate activity each day. Adding regular exercise into your daily routine will also contribute to improved mobility and functionality. Yoga, Walking, and Water Aerobics are just a few examples of exercises you can
try implementing into your daily schedule. At the end of the day, we each want to experience the best quality of life possible and exercising regularly will help you feel better each passing day. The food you consume is like the gas you put into your car, if you expect it to perform well, you must give it the proper fuel. A healthy lifestyle is unattainable without proper nutrition
and hydration. Eating the right foods will be one of your best weapons in combating common afflictions such as Obesity, Hypertension, and High Cholesterol. Eating the proper foods and drinking adequate water daily will help you reach and maintain a healthy weight range. Other benefits include, but are not limited to: a stronger immune system, improved digestion, and more energy!
Tommy Rozyc k i ZyckFit ® P ers onal Tr aining
561- 309-9 5 8 7
www.z yckfit.com Private/Semi-Private Training Available
4 0 0 To n e y P e n n a D r i v e Jupi t e r, F L 3 3 4 5 8 S u i t e D
Cook at home instead of eating out as often as possible. When shopping, check the ingredients and nutrition label on every product. Eating smaller portions and knowing when to stop when you’re full will help you from overeating and feeling bloated after meals. Do your best to avoid adding extra salt and sugar to your meals when possible. Make smart decisions and you will start feeling better within days. When
you eat right, you feel right! It’s never too late to make changes to your daily routine. This is especially true if it is going to have a positive impact on your health. Small changes over time are all it takes to make a significant difference in your quality of life. “Take care of your body. It’s the only place you have to live.” - Jim Rohn
10 | USA HEALTH NEWS
FEBRUARY ISSUE • 2019
CyberKnife – Specialized Radiation Option to Treat Cancer Thoracic Surgeon, Urologist, ENT, and/or Primary Care Physician. The Radiation-Oncologist is the specialist that is ultimately responsible for the complex planning and treatment process.
BY ANURAG AGARWAL, M.D.
I
n October 2018, the Nobel Prize for Medicine was awarded to two scientists who have helped us better understand and apply Immunotherapy to treat cancers. Lung cancer, for example, will be diagnosed in over 200,000 people in 2018. Immunotherapy is an option for certain patients with advanced stage disease. This is an exciting time in medicine with lots of basic science lab research being actively used to help patients. Another example of a cutting edge treatment option – for lung cancers and for many other cancers – is CyberKnife radiation. The treatment of cancer is complicated and can involve Surgery, Radiation, and/or Chemotherapy (including other systemic options like immunotherapy). A very special type of radiation technology is called CyberKnife Stereotactic Body Radiation Thearpy (SBRT). This is a very precise technology that allows experienced medical teams to deliver radiation in a way that achieves significantly higher cure/control rates than traditional treatments, for the properly selected patient. For example, in certain early stage lung cancers, the cure rate with CyberKnife is the same as Surgery! Historically, this was
If you would like to learn more about whether or not CyberKnife might be appropriate for a specific situation, please schedule a confidential consultation with Dr. Agarwal at his Wellington office [561-795-9845]. He has been using CyberKnife since 2001, longer than any other physician in Florida who is actively treating oncology patients.
never possible before SBRT options as patents only got radiation if they were too sick to have surgery. Now with CyberKnife they can choose a non-invasive (no cutting) option that gives them a similar cure rate in certain situations! CyberKnife is not experimental. It has been approved by Medicare and insurance companies for many years. The term “knife” is a bit misleading, as there is no actual knife, no cutting, no anesthesia, no blood loss. The CyberKnife is a non-invasive treatment, which means that this machine [see picture] is programmed to deliver invisible x-rays in a sophisticated fashion to the body, usually
in 1, 3, or 5 treatment-sessions. Often treatments are completed in a single day or one week. This is done safely on an outpatient basis (avoiding costly and sometimes complicated hospital admissions). You usually get an individual treatment on a given day over about an hour, and then go home immediately afterwards. Like all medical options, you need a team of experienced physicians to help guide you. This is not an appropriate treatment for every cancer patient. There are always potential side-effects with any type of cancer treatment. But, for select patients, it can be a wonderful choice. Examples of
what might be treated with CyberKnife include: (1) Lung Cancer (2) Brain Cancer (a primary brain cancer, or another type of cancer that spreads to the brain) (3) Prostate Cancer (4) Cancer that has spread to the Liver, Spine, and certain other areas (5) Benign conditions (not cancers) like Acoustic Neuromas (also called Vestibular Schwannomas), Meningiomas, Aterio-Venous Malformations It is important to get expert input from an experienced team. Sometimes this involves a Medical Oncologist, Neurosurgeon,
21st Century Oncology accepts most insurance plans, and Dr. Agarwal can usually schedule a new patient consultation or 2nd opinion within 1-2 working days, provided appropriate medical records and imaging are provided. Anurag Agarwal, M.D.
Board-Certified, Radiation-Oncology Diplomate, American Board of Radiology Proton-Beam Fellowship sub-specialty training, Harvard Medical School, Mass General Hospital Affiliate Assistant Professor of Radiation Oncology, Univ. of Miami Miller School of Medicine Affiliate Assistant Professor of Clinical and Biomedical Science, FAU Schmidt College of Medicine Radiation Oncologist, 21st Century Oncology, Wellington, FL
New Type of E-Cig as Bad as Regular Cigarette for Your Lungs A new type of e-cigarette caused just as much harm to lung cells as traditional cigarettes, according to a study.
T
NEW NAME, SAME OLD TOBACCO Heat-not-burn tobacco products are the most novel iteration of electronic smoking. But unlike e-cigarettes and vaporizers, they don’t use nicotine-infused liquid (“e-juice”).
obacco products are already incredibly popular in some overseas markets, but they haven’t made inroads into the United States yet. Promoted in a similar fashion to e-cigarettes as a safer alternative to traditional smoking, public health experts worry that “heatnot-burn” products could be the next big phase for the tobacco industry.
They use real tobacco. Inside the device is a carefully calibrated heating mechanism that heats the tobacco to roughly 570°F (299°C), below the temperature of combustion, creating an inhalable aerosol.
Because of their novelty, there is little scientific research on these devices about their safety and usefulness for smoking cessation. But in a damning new study, researchers say they aren’t any better for you than either traditional cigarettes or e-cigarettes.
to IQOS vapor and directly compared what they saw to the effects of cigarette smoke and e-cigarette vapor.
WHAT THE STUDY FOUND The paper, published this week in the journal ERJ Open Research, looked at the in vitro effects of vapor produced by IQOS devices (IQOS is the brand name of a “heat-not-burn” tobacco product by Philip Morris International, an American tobacco company) on human cells found in the lungs and airways.
All three were found to be toxic to lung cells, with the IQOS device’s vapor having a comparable toxicity to traditional smoking.
Researchers exposed bronchial epithelial cells and primary human airway smooth muscle cells
“We observed different levels of cellular toxicity with all forms of exposures in human lung cells. What came out clearly was that the newer products were in no way less toxic to cells than conventional cigarettes or e-cigarette vaping,” said Sukhwinder Sohal, PhD, one of the authors of the study and a health sciences re-
searcher at University of Tasmania’s Respiratory Translational Research Group. The study concludes that IQOS devices, like cigarettes and e-cigarettes, have the potential to lead to inflammation, oxidative stress, and other deleterious effects on the lungs and airways. Over the long term, this can lead to serious health problems typically seen in smokers, including chronic obstructive pulmonary disease (COPD) and lung cancer. The authors say that their study is an important first step in understanding the potential harm of “heat-not-burn” tobacco products.
Part of the appeal of such devices is that they are able to offer a distinct “throat-hit,” part of the physical sensation of smoking cigarettes, that’s sometimes lacking in other vaporizers or e-cigarette models. “Heat-not-burn” products are not yet available in the United States, but in test markets in Europe and Asia, where they have been available in some cases since 2014, they have proved to be incredibly popular. John Ayers, PhD, vice-chief of innovation at UC San Diego Division of Infectious Disease and Global Public Health, has been tracking the popularity of “heatnot-burn” through practical methods like Google searches.
“It seems like the tobacco control community gets thrown into confusion when tobacco products get renamed or revised. That’s what I’m afraid is going to happen with IQOS, like what happened with e-cigs,” he told Healthline. In the US, IQOS devices are currently under review by the Food and Drug Administration as “Modified Risk Tobacco Products” (MRTP). The MRTP designation refers to “tobacco products that are sold or distributed for use to reduce harm or the risk of tobacco-related disease associated with commercially marketed tobacco products.” To achieve this designation, an applicant must demonstrate that the product has the ability to “significantly reduce harm” and disease related to tobacco. It must also benefit overall health on a population level, accounting for individuals who don’t use tobacco products. According to Sohal, based on their research, IQOS does not meet this definition. “The burden is on the tobacco industry to generate evidence that their newest products, like IQOS, are potentially less harmful than cigarettes,” said Ayers. “Until then, the regulatory environment assumes they are yet another tobacco product.”
Skin Cancer you have Options Do you know all of your skin cancer treatment options? Skin cancer is the most common of all cancers. According to the American Cancer Society, about 3.5 million cases of basal and squamous cell skin cancers are diagnosed in this country each year. At 21st Century Oncology, our radiation oncology team works with you to develop the right skin cancer treatment program for you. We offer gentle, compassionate care using some of the most technologically advanced treatments available, including brachytherapy and electron therapy. In some cases, treatment is as short as 10 days, with excellent cosmetic results. • No Knife • No Cutting • No Downtime Call 21st Century Oncology to find the right treatment option for you. Compassionate Care Close to Home
888-370-0692 www.21CO.com
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12 | USA HEALTH NEWS
FEBRUARY ISSUE • 2019
Hypertension and salt intake its complications. We will also focus on the physio-pathological role of diet in its development, especially salt intake.
Even though the causal relationship has been demonstrated for decades, the mechanisms by which salt intake increases PA are still not fully understood.
Blood pressure is the force that the pulsating flow of blood exerts on the walls of the arterial vessels, being at the same time the factor that determines the propulsion of the blood and ensures the normal perfusion of the tissues.
BY EDWIN PARRILLA-ROSARIO, MD
H
igh blood pressure is a very common pathology worldwide, in both developed and developing countries. It is a high-prevalence cardiovascular risk factor and is currently thought to be responsible for 4.5% of the global burden of morbidity according to the World Health Organization (WHO). For 2025, researchers estimated that 29.2% of the adult population will suffer from hypertension (1.56 billion individuals). Being a major public health problem, studies on this pathology have multiplied over the years. All come together on the fact that this disease is multi-factorial, is that it is involved in many complications often serious or lethal. Through this article we will try to define Hypertension and to highlight its gravity by describing
Hypertension is currently defined by systolic blood pressure (SBP)> or = 140 mm Hg and / or diastolic blood pressure (DBP)> or = 90 mmHg, measured twice in at least two consultations. In the majority of cases (90%) hypertension is essential, which means it is not the direct consequence of a single anomaly but of various contributing factors: genetic, environmental and behavioral, with a major importance of nutrition, especially salt intake. The low sodium diet is one of the determining factors in the management of hypertension in all hypertensive patients, but also in its prevention in the general population. High blood pressure is a dangerous pathology, not only, it can cause disorders by itself, during acute attacks of hypertension (hypertensive emergencies), but in addition, its permanent or repeated action on the arterial system leads to a vascular degradation and serious complications in different organs:
The dominant hypothesis suggests that habitual salt consumption increases extracellular volume (since absorption of sodium in the intestine is accompanied by water absorption) and this leads to a high blood pressure.
• The heart: Facing a higher blood pressure in the arteries, the heart must provide more work: the heart cells (cardiomyocytes) hypertrophy early (their size and therefore that of the heart increases) and then they exhaust and die. Hypertensive cardiopathy is one of the leading causes of heart failure. • Kidneys: High blood pressure will progressively alter the renal vessels that harden and lose function, which is why hypertension can lead to kidney failure. • The peripheral vessels: The constituent tissues the vessels degenerate little by little, they lose their elasticity and become more rigid: high blood pressure is a main factor in arteriosclerosis. It can also lead to arterial disease of the lower limbs (lack of blood supply in the legs), and causes claudicating.
• The brain: Hypertension can cause rupture of the artery wall or atherosclerotic plaques, causing ischemic or hemorrhagic stroke. The seriousness of the complications of hypertension thus imposes a global approach concerning its treatment and its equilibration. Studies involving the predominant role of the diet in the physio-pathology of this disease are numerous. They all agree on the incrimination of high dietary sodium consumption in the genesis of this disease. As a result, reducing dietary sodium intake is an economical way to reduce the burden of high blood pressure and associated cardiovascular diseases. It has recently been calculated that lower sodium consumption may reduce the incidence of high blood pressure by 30%.
An essential hormone intervenes in this hypertensive mechanism, it is the anti-diuretic hormone. Given the harmful role of sodium consumption on blood pressure, the World health Organization (WHO) recommends daily consumption of less than 2g/day. In real life, daily sodium intake exceeds requirements more than twice. In the United States, this consumption is estimated at 3.6 g of sodium or 9 g. of salt per day. Arterial hypertension is a major health problem worldwide. Even if its evolution is more often insidious, its real gravity consists in the serious complications that it causes. The studies related to the causes and the treatments of hypertension are numerous, however, they all agree on the fact that its first treatment is of a disconcerting simplicity, and consists only in limiting the amount of salt intake in the diet.
Taking Statins May Raise Risk of Type 2 Diabetes in Vulnerable Patient WRITTEN BY: GIANNA M. TROMBINO, EMHA
P
atients who are taking cholesterol-lowering statin drugs may raise their risk of developing Type 2 diabetes by 30 percent. The ten-year study, conducted at the Albert Einstein School of Medicine in New York, randomly assigned obese patients to either an intensive lifestyle program, treatment with metformin, or a placebo drug. The test patients’ blood fats and blood pressure were measured annually. Blood glucose was measured twice a year, at which point new statin treatment was recorded. The most commonly prescribed statins were simvastatin (40%) and atorvastatin (37%). The likelihood of being prescribed a statin drug rose substantially after a diagnosis of diabetes. At the beginning of the trial fewer than 4 percent of the patient volunteers were taking statin drugs, but usage gradually increased over the length of the research so that by at the completion of the 10-year study period, about one third of patients were
taking them. When treatment groups were combined, taking a statin was associated with a 36% heightened risk of being diagnosed with Type 2 diabetes, compared to those who had not been prescribed these drugs. The researchers theorize that statins
contribute to the development of diabetes by impairing the production of insulin, the hormone that lowers blood glucose. Commenting on the study, Dr. Ronald Goldberg, director of the Lipid Disorder Clinic and associate director of the Diabetes Research
Institute at the University of Miami, said the research, “shows evidence that statins increased insulin resistance, and that the people who developed diabetes appeared to have less ability to respond to the insulin resistance by making more insulin.”
The research study was published in the journal, BMJ Open Diabetes Research & Care. Sources: Goldberg, M.D., R. (2018). BMJ Diabetes Research & Care. Diabetes Research Institute at the University of Miami Florida.
2019 • FEBRUARY ISSUE
USA HEALTH NEWS
Wellington Regional Medical Center CEO Robbin Lee Retires
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MEALS
14 | USA HEALTH NEWS
FEBRUARY ISSUE • 2019
Kathleen’s Chicken Cacciatore Recipe If you don’t want to cut up a whole chicken, you can use pieces, or cut the entire process in half by using two cooked rotisserie chickens. If using cooked rotisserie chickens adjust the amount of cooking time by half. Serves 6-8 Ingredients: 2 raw broiler chickens (2-4 pounds each) Salt and freshly ground black pepper to taste 1/4 cup vegetable oil for browning chicken 1/4 cup extra-virgin olive oil 1-2 yellow onion, cut into 1-inch cubes (about 1 cup) Garlic cloves 4-6 cut in pieces 1 cup dry white wine or chicken stock One 28-oz can Italian plum tomatoes with liquid, crushed 1 28 oz can tomato sauce 1 tbsp. dried oregano 2 cups sliced mushrooms (optional) 2 red and 2 yellow bell pepper, cored and seeded, cut into 1/2inch strips Directions: Cut each chicken into pieces and cut breast into halves. Season the chicken pieces generously with salt and pepper. Heat the vegetable oil in a wide braising pan with 2 tablespoons of the
olive oil until a piece of chicken dipped in the oil gives off a very lively sizzle. Add as many pieces of chicken to the pan as will fit without touching (do not crowd the chicken; you can always brown it in batches). Remove the chicken pieces from the skillet as they brown, adding some of the remaining pieces of chicken to take their place. After browning all the chicken and removing it from the skillet, add the onion to the fat remaining in the pan and cook until translucent. Peel and cut garlic, add the garlic cloves. Pour the wine or chicken stock into the pan, bring to a boil, and cook until reduced by half, about 3-6 minutes. Add the tomatoes and oregano, season lightly with salt and pepper, and bring to a boil. Place the chicken into the sauce, adjust the heat to a gentle low boil, and cover the pan. Cook, stirring a few times, for 20 minutes. Meanwhile, heat the remaining 2 tablespoons olive oil in a large skillet over medium-high heat. Add the mushrooms and peppers, and toss until the peppers are wilted, about 8 minutes. Season the vegetables with salt. Add the peppers and mush-
rooms to the chicken pot. Cook on medium to med-low heat covered, until the chicken and vegetables are tender, 20 to 30 minutes.
(Check the level of the liquid as it cooks; there should be enough liquid to barely cover the chicken. If necessary, add small amounts
of water to maintain the level of liquid as the chicken cooks.) Serve with your favorite pasta or whatever vegetable is in season.
Roasted Butternut Squash Salad BY: KATHLEEN LABONTE
Lightly caramelized slices of roasted butternut squash make a tasty and pretty salad, dressed up with toasted almonds, caramelized onion, crumbled cheese, and glistening swirls of Reduced Balsamic Vinegar. Serve this as an antipasto, a first course, or a side dish. With roast meat or poultry, it can be a main course salad too. Any sweet-fleshed winter squash is suitable, but I find the butternut squash is delicious. Makes 4 to 6 servings INGREDIENTS For Baking the Squash 3 pounds butternut squash (1 large) 2 tablespoons extra-virgin olive oil 1/2 teaspoon salt For Dressing 3 teaspoons extra-virgin olive oil 1/8 teaspoon salt, or more to taste 1 med red onion, lightly fried in 1 tsp. olive oil 1/4 cup slivered almonds, toasted in the oven or on a dry skillet 1 tablespoon or so Reduced Balsamic Vinegar (recipe follows), thickened for drizzling 2 tablespoons or more crumbled cheese (optional), such as aged goat cheese or crumbled pieces of Pecorino Romano. PREPARATION Preheat the oven to 400°. Toast slivered almonds for garnishing the salad while the squash is roasting, or after.) To prepare butternut squash: With a sharp
vegetable peeler or paring knife, strip off some of the peel from the squash. You don’t need to peel it all: leaving the rest of the peel will help the squash to retain its shape (If you are roasting an acorn squash remove just the protruding ridges. With a sharp heavy knife, cut the squash in half lengthwise, and scoop out all the seeds and fibers. Place each half-cut side down; trim the ends, then cut semicircular slices of squash, all about 1 inch thick. Put all the pieces in a pile on a large baking sheet, preferably nonstick or lined with parchment. Drizzle the 2 tablespoons oil over the squash, sprinkle on the salt, and toss to coat with the seasonings, then spread the pieces out to lie flat, not touching. Bake about 20 minutes, then flip the pieces over. Bake another 15 minutes or so, until the squash is just tender all the way through (poke with a fork to check) and nicely caramelized on the edges. Assembling the Salad Let the squash pieces cool on the pan until you’re ready to serve. Arrange them-in a symmetrical design or in a casual pile-on a large serving platter or on individual salad plates, with two or three slices per portion. Refresh them with drizzles of olive oil, sprinkles of salt. Scatter the almond slivers over, and then streaks or swirls of warm balsamic reduction. Finally, crumble bits of cheese all over.
2019 • FEBRUARY ISSUE
USA HEALTH NEWS
| 15
Shin Splints: What they are and How to prevent them WRITTEN BY: LA PODIATRY GROUP
S
o, you have made the commitment - the commitment to exercise and get yourself in tip-top shape. You started running. You bought running shoes and are all set to go. Your first run goes well, you went further than you thought, almost a full mile. You are proud and excited, you can do this! And you do it, every day for a week. But then, it starts ….a pain and soreness in your shin. The pain is enough that you can’t keep running. You didn’t bump it against anything; you see no redness, no bruising, and no swelling. What it is? While stress fractures to the tibia (leg bone) do happen after starting running programs and if you run long distances, the most common cause of pain in the front of the leg along and near the ‘shin bone’ is shin splints. Shin splints can be defined as pain and discomfort in the leg from repetitive running on hard surfaces or overuse use of the muscles that bring up the foot. Aching, throbbing and tenderness along the inside of the shin
or directly on the shin are the most common symptoms associated with shin splints. The pain is felt when the area along the tibia (shin) where muscles attach becomes inflamed.
athletes who develop shin splints have flat feet (excessive pronation) which exacerbate the strain on the leg muscles. In such cases, the runner should obtain orthotic support, in conjunction with the strengthening and stretching exercises.
While more appropriately named periostitis, we will continue with the more common term known as shin splints. Another symptom is pain when you press on the inflamed area. Shin splint pain is most severe at the start of a run, and sometimes will go away during a run once the muscles are loosened up. On the contrary, a stress fracture of the tibia, shinbone, will hurt all the time. The shin splints can result from tired or stiff calf muscles putting too much stress on tendons, which become strained and torn. Over-pronation of the foot aggravates this problem, as does running on hard surfaces, and running in stiff shoes. Beginning runners are the most susceptible to shin splints for many reasons, but the most common is that they’re using leg muscles that haven’t been stressed
Finally, think about your running form. Are you leaning forward too much? Are you slouching? If you are doing any of these you may be putting too much strain on your muscles
in the same way before. Another reason beginning runners develop shin splints is because of poor choices in running shoes or running in something other than running shoes. Those runners who have started running again after long layoffs are also at a higher risk of developing shin splints because they often run too far initially on return.
Dr. Dina Hansen-McCoy Dr. Elizabeth Davis Dr. Khoa Pham Dr. Daniel Heck Dr. Lori Lane Dr. Shelley Plumb Dr. Arthur Hansen
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Rest is the best treatment, with a slow return to normal activity so long as the pain is no longer present. Reducing the inflammation is vital and can take from 2-3 days up to 2-3 weeks. Ice to the area two to three times per day, a course of anti-inflammatory medications, and stretching and strengthening exercises are useful along with the rest. Some
If, after following the above recommendations, the pain continues, it is possible that micro-fractures may form in your tibia; these are stress fractures. You won’t experience a sudden break, just a gradual increase in pain until it becomes quite severe. If you have extreme shin pain, see a doctor for an x-ray. Shin splints are extremely common among beginning runners, whose enthusiasm for their new sport has over-stepped the limits of their legs. Take a look at your running program; you may be doing too much too soon.
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