Healthline January - March 2017 by HealthLine

He�l�� VOL 3, ISSUE 1

JANUARY - MARCH 2017

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PUBLISHER’S NOTE As we kick off the New Year, we arm ourselves with a list of the obligatory resolutions: will lose weight, will stop smoking, will exercise more, will stop eating junk food and on and on. All of these resolutions are goal worthy and even necessary for us to live long and healthy lives. At HealthLine, we ask you to consider that perhaps all of these resolutions are meaningless unless we start with the foundation. The foundation that we refer has nothing to do with what we eat or drink, not eat or drink, smoke or not smoke, etc. It is not something that we cannot touch or buy or sell. It is something deeply rooted within us, a state of the mind. Even medical science believes effectiveness of the treatment depends on the mindset of the people. Face it with the right attitude but one that is difficult to practice, especially during challenging times. Gratitude - it is a state of mind that radiates from within us and impacts our physical, mental and emotional wellbeing. If we could discipline ourselves to start each day from a mindset of gratefulness for what we already have rather than lamenting what we lack, we will be better equipped to handle the vicissitudes of life that invariably come to all of us. Whether it is better health, increased wealth or whatever your fill-in-the-blank is, perhaps acknowledging the overabundance of blessings that already overtake us daily may give us what we lack on those trying days, perspective. A grateful heart puts us on more solid ground to face the future. Why? Because a grateful heart forces us to take an account of our lives and balance all that is good in our lives versus the setbacks that we encounter. When we weigh the totality of our lives, we are often surprised to find that the blessings that we take for granted each and every day far exceed the troubles that come our way. Charles Dickens, an English writer and social critic, once observed, “reflect upon your present blessings, of which every man has plenty; not on your past misfortunes, of which all men have some.” Dickens did not speak of fad diets, get-rich-quick schemes, cures for cancer, heart disease, strokes or any other of the multitude of disabling and disheartening health problems we may face. Instead, Dickens was compelling us to get back to the basics. Start with the critical foundation of a grateful heart; count your blessings each and every day. Is there such a thing as a trivial blessing? We at HealthLine would posit that there is no such thing. Each day, fill your heart with gratitude. Let your heart overflow with gratitude and infect those around you. Gratitude will not ward off every illness. What gratitude does for us is give us a fresh start, every day. This enables us to face the day’s challenges with new strength and new perspective. Gratitude, it does everybody good.

KOSHY THOMAS Publisher and CEO of Voice of Asia group

CONTENTS 06

JANUARY - MARCH 2017

GLUTEN FREE DIETS The truth about gluten free dieting

FIT AS WE AGE 07 GETTING What you need to know

PROBIOTICS BENEFITS Essential digestive health information

WEIGHT 10 LOSE Gain health! The best way forward

GLUTEN FREE DIETS HERE IS THE FACTS

- BREATHE BETTER 12 COPD Chronic Obstructive Pulmonary Disease CARE 13 DENTAL The importance of dental care for children

PROBIOTICS - BENEFITS BEGIN IN THE GUT

MOBILE STROKE UNIT SAVING TIME, SAVING LIVES

HIP AND KNEE REPLACEMENT OPTIONS

CANCER 14 BREAST What’s my risk?

15 HALOTHERAPY What is it and why does it matter? 16 MOBILE STROKE UNIT Saving time, saving lives

19 HEART HEALTH

Strategies to successful longevity

20 UTERINE FIBROSIS 13

THE IMPORTANCE OF DENTAL CARE FOR CHILDREN

What women need to know now

22 COLONRECTAL CANCER Understanding this serious condition

INFANT DEATH 23 SUDDEN How to protect your baby from SID syndrome SURGERY 24 PLASTIC Malpractice claim issues abound AND KNEE REPLACEMENT 25 HIP Outpatient surgery options VISION SYNDROME 26 COMPUTER Digital Eye Strain prevention PAIN 28 SHOULDER An active lifestyle issue for many

HEART HEALTH - WHAT YOU NEED TO KNOW

HEALTHLINEMAG.COM

CANCERS 29 HPV The most preventable human cancers

HEALTHLINE JANUARY - MARCH 2017

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COPYRIGHT AND DISCLAIMER All rights reserved. No material herein or portion thereof may be published without the consent of the publisher. HealthLine assumes no liability resulting from action taken based on the information included herein. The opinions expressed are not necessarily those of the management. HealthLine reserves the right to edit as necessary to correct errors of fact, punctuation, spelling and to comply with space constraints. Health line does not endorse the advertised product, service, or company, nor any of the claims made by the advertisement. Published quarterly by Free Press LLC, 8303 SW Freeway, Suite #325, Houston Texas, TX 77074. Tel: 713–774–5143. Email for editorial submission: voiceasia@aol.com; email for advertising inquiries and submission: ads@voiceofasiagroup.com. For reprint rights, please email: voiceasia@aol.com, Subject line: Reprint rights.

HEALTHLINE

January - March 2017

Publisher Koshy Thomas Editor-in-Chief Shobana Muratee Marketing Manager Jacob David Marketing Susan Pothanikat Accounts Manager Priyan Mathew Magazine Layout David Garvin Cover and Centerspread Story Photos Priyan Mathew - HealthLine Printing Richmond Printers LLC

Contributors

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Rebecca Meyerson, MS Denise Hulett Julie Nangia, MD Josh Axe, DNM, DC, CNS Amrita Menon Rubina Abrol, MD Jon-Cecil Walkes, MD Mohammad Ali Saeed, MD Jonathan Efron, MD Jessica Lanerie, MD Robin Diamond, MSN, JD, RN Adam Bright, MD Anith Pillai, OD Arthur Chau, MD David Le, DDS Katherine M. Schmeler, MD Jagannadha K. Sastry, Ph.D Erich M. Sturgis, MD, MPH

Thrive Nutrition - 2 Texas Caregiver Support Services - 6 The Medical Resort / Houston Hospice - 11 Sherly Thomas-Philip, Attorney at Law - 15 Harry Patel - 18 Nova Asset Management - 21 Aetna / Ace Pain Managaement - 21 Kim Dao - 27 Jason Gibbons / Wells Fargo - 31 CHI St. Luke’s Medical Group - 32

EDITORIAL Dear Reader, Nothing comes as a big surprise for those in the healthcare business since they already anticipate what’s to come and are prepared for it. At least, that’s what we want to believe. But for everyone else, health is nothing but full of surprises. Sometimes you are excited about a medical breakthrough and then you wonder why they can’t find a cure for a simple headache. Despite the information overload on health and healthcare in books, magazines, radio, TV - and more popularly online - people are always in doubt. Sometimes, it seems like a conspiracy; the way this whole healthcare system is set up is to confuse and confound you in a way that you revert to the same professionals and experts who misled you in the first place. The compulsiveness with which the new government is trying to do away with the Obama Care / Affordable Care Act and the uncertainties of healthcare in the United States today is raising hell. It may take a while before the new plan is announced. Meanwhile, we could take this as a clarion call to reassess our lifestyle to better our health. Many of you would have already made some strong resolution at the beginning of the year, and before they weaken, remind yourself that it is going to be a rough ride going forward. Keep a close watch on your health and your family’s wellbeing by keeping health records so that you are well prepared for any emergency. Finally, keep these five things in mind as you maintain a happy, healthy family: Commit, Celebrate, Communicate, Care and Cuddle. Have a discussion with everyone at home on what these words mean to each of them and make a plan to strive towards a more loving, emotionally-healthy family.

SHOBANA MURATEE Editor-in-Chief

Gluten free diet has become a popular fad in today’s society. Is it true that even if you do not have celiacs you can benefit from a gluten free diet?

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Yes, there is some truth to this. Gluten is the protein that is found in wheat, rye, barley, spelt, and is hidden in many processed foods (including natural flavors and starches). A gluten allergy is the body’s inability to break down this protein found in gluten. Celiac disease is the most severe form of gluten intolerance. It involves the body treating gluten as a foreign invader. This may contribute to leaky gut which leads to constipation, diarrhea, bloating and other skin issues.

The truth about

gluten free diets

However, even if you do not have a gluten sensitivity or celiacs disease, a gluten free diet can be beneficial for your overall health. When gluten is undigested it can lead to issues with digestion as well as attacking of your immune system. In addition to digestion issues, other physical symptoms can arise such as psorasis, skin rashes, joint pain, brain fog and overall inflammation in the body. Gluten may affect the absorption of other vitamins, minerals and nutrients.

Implementing a gluten free diet, does not have to be so hard. Here are some examples of gluten free options: rice, corn, quinoa, buckwheat and millet. There are many packaged goods that are labeled gluten free. Although it is free of gluten, it

does not mean that it is a healthy product. Aim for packaged goods with five ingredients of less. Remember the order of ingredients go from the largest amount to the least. Although we know these products do not contain gluten, we want to take note of the added sugar, salt and other preservatives that still may be present. Please visit my website to find out about the elimination program as well as healthy gluten free recipes at www.simplyhealthyliving.org Rebecca Meyerson, Certified Nutritionist Simply Health Living

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Rebecca Meyerson, MS HEALTHLINEMAG.COM

Getting Fit As We Age Regular exercise can help boost energy, help you maintain your independence, and manage symptoms of illness or pain. Exercise can even reverse some of the symptoms of aging. And not only is exercise good for your body, it’s also good for your mind, mood, and memory. Research has shown that physical activity may prevent dementia and slow the progress of Alzheimer’s disease. For the best results, pair aerobic workouts with strength and flexibility training. There are plenty of resources available to help you find the right exercises to motivate you. For group classes, contact your local senior center or YMCA. Yoga is another great option for low impact exercise with huge benefits for both the mind and the body.

Good nutrition is also important as we age. Caloric and nutrient requirements change with every life stage. Common conditions affected by nutrition include diabetes, osteoporosis, heart disease, hypertension, arthritis, and malnutrition. Strive for 4-5 servings of vegetables and 2-3 servings of fresh fruit a day to help you meet your vitamin and mineral needs. The importance of dietary protein cannot be underestimated in the diets of older adults; inadequate protein intake contributes to a decrease in reserve capacity, increased skin fragility, decreased immune function, poorer healing, and longer recuperation from illness.

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Getting and staying fit as we age should be a priority in all our lives. A commitment to healthy living can prevent a majority of the chronic health problems leading to disability and death in older adults. Common diseases and health problems such as cancer, diabetes, heart disease, stroke, arthritis and emphysema are less common in persons who choose a healthy lifestyle of good nutrition and exercise.

About 25-30% of your dietary intake should be protein. Remember, protein does not have to come from meat. Beans, soy, dairy, nuts and seeds, and peanut butter are all good sources of protein. Complex carbs and fiber are also important in our diet. Seniors are advised to get 45 to 65 percent of calories, or about 130-200 grams, from carbohydrates. Most carbohydrates should be complex carbohydrates such as sweet potatoes and other starchy vegetables; legumes; and whole grains such as brown rice and quinoa. As we age, glucose tolerance declines. Complex carbohydrates are good because they help regulate glucose and they don’t result in an insulin spike that we get with sugary foods such as soda, cake and candy. Complex carbs also have fiber. A high-fiber diet helps to lower cholesterol, stimulate intestinal motility and prevent constipation. Aim for 2530 grams of fiber per day.

Together with a regular exercise, a good diet will help you get fit and stay fit!

Denise Hulett is a nutrition, personal trainer and owner of Restorative Fitness and Nutrition in Sugar Land, Texas. She has a Master’s in health and nutrition education and focuses on helping clients use nutrition to enhance their lives and their health. For more information, visit www.restorativefitnessandnutrition.com. HEALTHLINEMAG.COM

Denise Hulett

JANUARY - MARCH 2017 I HEALTHLINE

Probiotics

Probiotics Benefits Begin in the Gut The first and most overlooked reason that our digestive tracts are critical to our health is because 80 percent of our entire immune system is located in our digestive tract. That is an astounding percentage.

Most people with health issues, such as thyroid imbalances, chronic fatigue, joint pain, psoriasis, autism and many other conditions don’t realize that these illnesses originate in the gut. Photo credit: Fotolia

In addition to the impact on our immune systems, our digestive systems are the second largest part of our neurological system. It’s called the enteric nervous system and is located in the gut. This is why it’s called our second brain!

If these issues and many others are connected to our gut health, then what elements are essential for digestive health? According to the National Institute of Diabetes and Digestive and Kidney Diseases, upward of 60 million to 70 million Americans are affected by digestive diseases. In addition, digestive disease and disorders cost the U.S. over $100 billion per year.” (1)

HEALTHLINE I JANUARY - MARCH 2017

These statistics are staggering, yet poor gut health actually affects much greater numbers than these statistics illustrate. That’s because our digestive health affects every physiological system in our body. The many toxins we’re subjected to today decrease digestive function, affecting our ability to utilize nutrients and rid ourselves of cholesterol, triggering chronic inflammation in the body, which is the cause of many chronic conditions and diseases. The secret to restoring your digestive health is all about balancing out the good and bad bacteria in your gut. If you’re going to be healthy, you MUST consider consuming probioticrich foods and supplements daily. What Are Probiotics? Probiotics are bacteria that line the digestive tract and support the body’s ability to absorb nutrients and fight infection. There are actually 10 times more probiotics in our gut then cells in our body! Our skin and digestive system by themselves host about 2,000 different types of bacteria. Probiotics benefits have been proven effective in supporting immune function and healthy digestion, as well as beautiful skin. HEALTHLINEMAG.COM

The good gut bacteria is also responsible for: • Producing vitamin B12, butyrate and vitamin K2 • Crowding out bad bacteria, yeast and fungi • Creating enzymes that destroy harmful bacteria • Stimulating secretion of IgA and regulatory T-cells Probiotics have been in our systems right from the moment that we stepped into the world. When a newborn is in the birth canal of the mother during delivery, that’s when the baby is exposed to the bacteria of his or her mother for the first time. This starts as a chain of events inside the baby’s GI tract, and the infant’s GI tract starts to produce good bacteria. If you don’t have enough probiotics, the side effects can include digestive disorders, skin issues, candida, autoimmune disease, and frequent colds and flus. Historically, we had plenty of probiotics in our diets from eating fresh foods from good soil and by fermenting our foods to keep them from spoiling. However, because of refrigeration and dangerous agricultural practices like soaking our foods with chlorine, our food contains little to no probiotics today, and most foods actually contain dangerous antibiotics that kill off the good bacteria in our bodies. Benefits of adding more probiotic foods into our diet: • Stronger immune system • Improved digestion • Increased energy from production of Vitamin B12 • Better breath because probiotics destroy

candida • Healthier skin, since probiotics naturally treat eczema and psoriasis • Reduced cold and flu • Healing from leaky gut syndrome and inflammatory bowel disease • Weight loss Get More Probiotics in Your System - Consume more sour foods. Embrace what I call the power of sour and sour foods like apple cider vinegar, specifically, and fermented vegetables. Start with adding one tablespoon of apple cider vinegar to a drink two times a day. Before breakfast and lunch or breakfast and dinner, add one tablespoon of apple cider vinegar in your meal, and then start consuming more fermented vegetables like sauerkraut and kimchi, or drinking kvass. - Consume more probiotic-rich foods like highquality goat milk yogurt, kefir or even different types like coconut kefir. - To naturally boost probiotics in your system, start to feed the probiotics. Probiotics are living organisms and if they’re going to live in your body, they need fuel, something to feed off. They need good soil and that soil is fermentable fiber. - Getting good, high-quality fiber like chia seeds, flaxseeds in your diet can actually cause probiotics to increase in your body. And the best type of fiber is soluble fiber, known as fermentable fiber. Taking a quality probiotic supplement is a great way to get more probiotics and naturally boost the good probiotics in your system. Reprinted with permission from Dr. Josh Axe, www.DrAxe.com

Dr. Josh Axe, DNM, DC, CNS is a certified doctor of natural medicine, doctor of chiropractic and clinical nutritionist. In 2008 he started Exodus Health Center with a passion to help people get healthy by using food as medicine. HEALTHLINEMAG.COM

Josh Axe, DNM, DC, CNS

JANUARY - MARCH 2017 I HEALTHLINE

Lose Weight, Gain Health

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t’s the time of the year when we take stock of our lives and make resolutions improve ourselves. The most common resolution over the last decade has been to lose weight and get healthy. When we look at statistics about how Americans’ weight has risen in the last thirty years, obesity is a real concern. What really causes worry is the increase in childhood obesity. The real danger from carrying excessive weight is the greater occurrences of diseases such as diabetes, high blood pressure, high cholesterol, and sleep apnea. However, because there are so many diet ideas, it is difficult to make sense of various protocols. For every opinion there is a counter opinion, leaving the average consumer extremely confused.

It is important to remember body weight is influenced by multiple factors, including genetics, diet, neurotransmitter function, and physical activity. However, when preventable health conditions run rampant and destroy the quality of peoples lives, it is time to take action. The cornerstone of any healthy weight management plan is a commonsense approach to food. Minimally processed whole foods should be the basis of all diets. Adequate protein is essential for weight loss, as are essential fatty acids. The United States Department of Agriculture estimates that more than 90 percent of the population fails to eat five to nine servings of fruits and vegetables weekly. Protein throughout the day helps improve appetite control. It is particularly important to start the day with a high-protein breakfast. But not everyone has time for a healthy breakfast, or even breakfast at all. Those are the days when a protein shake comes in handy. It’s also a great idea to add Chlorella or spirulina powder to your shakes. Spirulina, a blue-green Algae sold in health foods stores, provides essential

vitamins, minerals, and other nutrients, including chlorophyll. This combination of nutrients is rare to find in normal diets, making Spirulina a key part of your weight loss program. Chlorella, like Spirulina, contains chlorophyll as well as an abundant profile of vitamins and minerals. This helps to cleanse the body of toxins and facilitate weight loss. Drinking enough water is a basic axiom for good health. Any diet programs should include drinking at least six to eight glasses of water (48-64 oz) each day. That means drinking a glass of water every two hours. Don’t wait until you’re thirsty; schedule regular water breaks throughout the day instead. Also be wise - EXERCISE! More and more research now indicates that dietary supplements may support healthy weight management programs by promoting satiety and metabolic activity. In one randomized double blind placebo controlled study involving 95 obese individuals, multi vitamin & mineral supplementation supported lean body mass and healthy lipid metabolism. So as we ring in the new year, let us all decide to make a small lifestyle change. It doesn’t have to be 180 degrees--even small changes in the way we eat and the way we supplement out diets makes a profound change in the way we feel.

Amrita Menon is the founder of Vitamins and Such, a health food store dedicated to the health and wellbeing of families for over a decade. After applying her experience and life-long passion to find the best natural supplements for her family, she developed an online and brick-and-mortar store in Kingwood in 2000.

HEALTHLINE I JANUARY - MARCH 2017

Amrita Menon HEALTHLINEMAG.COM

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JANUARY - MARCH 2017 I HEALTHLINE

A New Year, A New Plan for COPD

ore than a million people in Texas live with chronic obstructive pulmonary disease (COPD), a lung disease which includes emphysema and chronic bronchitis, and makes it harder to breathe over time. While there’s no cure for COPD, it is a manageable disease.

“We are working on a large BBC workshop in the Houston-area which will start early 2017 and there here are 3 Better Breather’s Clubs currently active in Houston,” said Dr. Rubina Abrol, the Asthma Program Manager for the Lung Association in Texas. “By bringing BBC to Texas hospitals, our hope is to create a centralized network of shared purpose.” Below are additional suggestions from the Lung Association on creating a COPD Management Plan: • Mild or Moderate Exercise Even mild exercise can improve use of oxygen, energy levels, stress and depression, sleep and shortness of breath. Stretching, chair aerobics, resistance training and pulmonary rehabilitation help the heart send oxygen to the body, making it easier to breathe. • Nutrition Modifications. For some people with COPD, eating a diet with fewer carbohydrates and more fat helps them breathe easier. Eating four to six small meals a day enables the diaphragm to move freely and lets lungs fill with air and empty out more easily. • Freedom From Smoking®. Smoke and secondhand smoke are triggers for individuals with COPD. Family and friends can help by not smoking indoors or around others. The American Lung Association’s proven quit smoking program is available at FreedomFromSmoking.org, or individuals can get free support from trained tobacco cessation

Photo credit: Fotolia

The American Lung Association in Texas works with several hospitals in the Houston area to provide an extensive array of lung health resources for those with COPD, including Better Breather’s Clubs (BBC). Led by a trained facilitator, these groups provide in-person support on ways to better manage lung health for individuals living with COPD and their care providers.

counselors by calling the Lung HelpLine at 1-800-LUNGUSA. • Emotional Support. COPD is a challenging disease that sometimes stirs up difficult emotions in patients and their loved ones. While coping with COPD, many may feel depressed, sad and angry. We have a strong support network for individuals and caretakers that includes: • Respiratory therapists through the Lung HelpLine • Online support communities at Inspire.com • Local in-person support at Better Breathers Clubs. For more information about COPD, and tips on how to better manage care, visit Lung.org/copd.

Rubina Abrol, M.D., is a program manager at the American Lung Association in Texas and manages the Enhancing Care for Children with Asthma project, a health systems design change project around asthma.

HEALTHLINE I JANUARY - MARCH 2017

Rubina Abrol, MD HEALTHLINEMAG.COM

Importance of Dental Care for Children

ealthy teeth are important to children’s overall health. From the time a child is born, family members can take steps to promote healthy teeth and prevent cavities. For example, babies’ teeth can be cleaned with a soft, clean cloth or baby’s toothbrush. Also, avoid putting a baby to bed with a bottle and check their teeth regularly for spots or stains. According to Dr. David Le, DDS, Dental Director at Ibn Sina Community Medical and Dental Clinic, parents can start using a pea-sized amount of fluoride toothpaste when children are two years old, or sooner, if your dentist suggests it. “Parents can provide healthy fruits and vegetables as an alternative to sugary sweet snacks and drinks,” said Dr. Le, “ as well as scheduling regular dental check-ups.” Forming good habits at a young age can help your child have healthy teeth for life.” In addition, dental treatments that seal a child’s back teeth (molars), can prevent most cavities, but many kids -- particularly those living in poverty -- don’t get them, according to U.S. health officials. Dental sealants are liquid fluoride resin coatings painted into the grooves of the chewing surfaces of teeth. When cured with a specific light source, they quickly harden to form a shield on the teeth, which can last for years. Sealants can cut cavities by 80 percent for up to two years, and by 50 percent for up to four years, according to the U.S. Centers for Disease Control and Prevention. “Unfortunately, only an estimated 40 percent of children have dental sealants, but 60 percent do not,” added Dr. Le. “Kids without dental sealants have almost three times more risk of cavities that those who do have sealants.”

Low-income children lack dental care Poor children are more than twice as likely as those from more affluent families to have untreated tooth decay. According to Dr. Le, “dental sealants are simple, quick, easy and completely painless, there are no unwanted side effects and the benefits start immediately.” Clinics that provide free and low-cost services for children from low-income families are especially important, because those children are less likely to receive dental care. Sealant treatments are offered at Ibn Sina Community Medical and Dental Clinics at all locations in the Houston area, including: 11226 S. Wilcrest Dr., Houston 77099 15132 Old Galveston Rd (Hwy 3), Clear Lake 77598 16345 S. Post Oak Road, Houston, 77053 5012 North Shepherd, Houston 77018 What to expect The standard six-month dental visit should begin at age 2. Between ages 4 and 6, expect a first set of mouth X-rays to check for cavities lurking between the teeth. Prevention is the name of the game between ages 6 and 12, when baby teeth give way to permanent teeth. Look for your child’s dentist to suggest a sealant between ages 7 and 9. Cavity-prone molars (at the back of the mouth) are the most likely site for treatment. The first orthodontic evaluation should occur around age 7, although most children that need braces will have them at age 12 or 13.

Dr. David Le graduated from the University of Washington Dental School in 2006 and have been practicing dentistry for 10 years. He has joined Ibn Sina Foundation and provided quality dental care to the community at the Wilcrest Medical and Dental Clinic location since 2011. HEALTHLINEMAG.COM

David Le, DDS

JANUARY - MARCH 2017 I HEALTHLINE

Whatâ&#x20AC;&#x2122;s My Risk For Breast Cancer?

cancer on the same side of the family if one was diagnosed before age 50, all cases of ovarian cancer (breast and ovarian cancer are often seen

reast cancer is very common and 1 in 8 women will develop breast cancer over their lifetime. As a breast oncologist who specializes in prevention I often get asked â&#x20AC;&#x153;what is my risk?â&#x20AC;?

There are risk models that will calculate your risk of breast cancer based on some of these factors. The most common models are the Gail and Tyrer Cuzick models. If the 5 year risk is >1.67%, then medications such as tamoxifen or raloxifene can be taken for 5 years and will reduce breast cancer risk by at least 50%. These medications are usually very well tolerated and the most common side effects are mild hot flashes and vaginal dryness. If the lifetime risk is >20-25%, then additional screening such as breast MRI can be added to annual mammography, which can detect cancer at earlier stages. This is why knowing your risk is so important. If you have any of the risk factors listed above, ask your doctor to run a breast cancer risk model to calculate your risk for breast cancer and see if you qualify for medications to prevent cancer or annual screening breast MRIs. Sometimes breast cancer can run in families, and if it is due to a mutated gene, it is knows as a hereditary breast cancer syndrome. Genetic testing can be offered to families when a hereditary breast cancer syndrome is suspected. Insurance companies will often cover the cost of this testing, and medical coverage cannot be denied due to the results of genetic testing. Genetic testing is recommended if there is anyone with breast cancer diagnosed at age 45 or younger, triple negative diagnosed at the age of 60 or younger, 3 women with breast cancer on the same side of the family, 2 women with breast

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There are several risk factors for breast cancer: starting menses early, late menopause, never having children, not breast feeding, personal history of prior breast biopsies, obesity, alcohol use of more than 3 drinks/week, lack of exercise, radiation treatment to the chest and family history of breast cancer. in these syndromes), and some combinations with other cancer such as pancreatic cancer, prostate cancer and melanoma or many individuals with cancer in the family. If this describes your family, you should consider meeting with a genetic counselor to see if genetic testing for your family is indicated. It is always best to test the person with cancer in the family if they are still living. Genetic testing when indicated is very important because hereditary cancer syndromes are associated with very high rates of cancer at younger ages. For example the BRCA1 gene has a lifetime risk of breast cancer as high as 87% (half develop breast cancer before the age of 50) and lifetime risk of ovarian cancer up to 44%. If someone is found to have a BRCA1 gene, we would follow that individual closely in a breast center and consider prophylactic mastectomies versus more careful monitoring with annual mammogram, annual breast MRI and medications such as tamoxifen to reduce breast cancer risk. If you are worried about your risk of breast cancer ask for a referral to a breast center for a comprehensive breast cancer risk assessment!

Dr. Julie Nangia is Director of the Breast Cancer Prevention & High Risk Clinics at Baylor College of Medicine and Advisory Board Member Indian American Cancer Network.

HEALTHLINE I JANUARY - MARCH 2017

Julie Nangia, MD HEALTHLINEMAG.COM

Halotherapy

What is it and why does it matter?

Halo is the Greek word for salt, and Halotherapy, better known as Salt Therapy, is the natural use of dry, aerosolized salt in a climate controlled environment -- a â&#x20AC;&#x153;salt room.â&#x20AC;? Visitors inhale the salt aerosol, allowing the healing salt to reach deep into their lungs. This therapy naturally and safely treats many kinds of respiratory and skin conditions without drugs or invasive procedures. For thousands of years, people with serious and chronic respiratory and skin conditions have visited the Dead Sea to enjoy its healing properties. Even today, people travel there from all over the world to find relief. The salt mines of Eastern Europe have also been a hot spot for salt healing since the late 1800s. There, as in modern salt rooms, people still sit and breathe in the salty air for its many health benefits. Even in Ayurvedic practices, the mixture of salt and lime juice has long been known as a natural bronchodilator. As scientists and researchers have continued to learn more about the healing benefits of salt; they have determined that recreating the beneficial climate of Europeâ&#x20AC;&#x2122;s salt mines could make Halotherapy available to more individuals throughout the world. With this realization, Halo chambers or salt rooms were born. When you visit a salt room, the temperature, humidity and air flow will all be controlled during your session to create an environment that mimics the conditions found in the salt mines. The pharmaceutical grade salt is ground using a halo generator and is then blown into the room in micro particles. The micro particles enter the body through the respiratory system and act as a natural, safe alternative to medication. A typical salt session lasts 45 minutes. You may feel temporary relief after just one session, but research shows that a decrease in long-term respiratory and skin symptoms begins to appear after 10-20 sessions. Most visitors who complete a full course of 10-20 sessions find that they experience relief for a longer period and return to the salt room only as needed, or if symptoms flare up. Sandy Hinderliter is Coowner of Salt of the Earth Spa in Sugarland. She is a firm believer that natural means of healing are the best and most effective because our bodies are meant to heal themselves.

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Mobile Stroke Unit: Sav An Exclusive interview with James C. Grotta, M.D.

rey Matters, written on a poster with an image of a human brain is displayed on the glass door of the office of James C. Grotta, M.D., Neurologist, Hermann Medical Group, Director of Stroke Research, Clinical Institute for Research and Innovation, Memorial Hermann-TMC. Those words, became more impactful as we speak to him about what happens when a stroke occurs. “Stroke is most common condition that affects the brain,” Dr. Grotta said. “But people didn’t consider stroke as an interesting part of neurology until the 1970s when research suggested that strokes could be treated and prevented.” The American Stroke Association and the Centers for Disease Control report says nearly 800,000 Americans suffer a stroke each year – one every 40 seconds. About 87% of all strokes are ischemic strokes, in which blood flow to the brain is blocked. Stroke Types Typically, when you develop stroke symptoms, you call 911. When the EMS arrives, the paramedics would have to figure out if it’s a stroke, then they take you to the emergency room which would take a minimum of 30-45 minutes. Once in the emergency room, you got to have a CT (computed tomography) scan and a few blood tests before the doctor can determine whether you are having a bleeding kind of a stroke or if it is a stroke due to a blocked artery, which is the most common kind. The medicine to dissolve the clot in case of a blocked artery actually increases the risk of bleeding, which is why it is important to know the type of stroke. Certain stroke types are more common in different ethnic groups. Bleeding in the brain, although occurs in everybody, is common in certain subgroups particularly Asians and young black men because high blood pressure is more prevalent in these groups. Timing is Crucial It takes roughly an hour by the time patient is brought into the emergency room and CT scan and

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by Shobana Muratee other tests are done. That hour could mean saving 120 million brain cells. Once the artery blocks off, cells die within minutes. You must act fast to open the artery. The only FDA-approved treatment for ischemic stroke is the clot-buster, tPA (tissue plasminogen activator) but it must be given within three hours of the first signs of stroke to be most effective, and the earlier the better within that three-hour time frame. This is a medication that is used only when someone already gets a stroke and not as a preventive. Considering a conservative figure of 600,000 ischemic strokes every year in the US (since 1/5 of the total number reported are due to bleeding), only 50,000 patients (<10% of stroke patients) are treated with tPA. If we expanded our ability to treat patients and got them treated faster, we could perhaps double that number. What are the Signs and Symptoms? It’s crucial to know the symptoms of a stroke. Think of the word ‘FAST’ F= Face. Once side of the face droops or can’t move, feels numb A= Arm: The arm feels week and unable to lift S= Speech: Patient can’t talk or speech is slur T = Time: If any of ONE of those happens you must react right away. The most important thing is the history, whether you’ve had those symptoms before. There isn’t a single test that says that you are going to have a stroke. Be alert of the symptoms and call 911 when they occur. People who are at risk for stroke are essentially the same people who are risk for heart attack. High blood pleasure, high cholesterol, smoking, lack of exercise, drug abuse all increase HEALTHLINEMAG.COM

aving Time,Saving Lives the risk of a stroke and heart attack. What happens when you have a stroke? Stroke is neurological when it happens in the brain- when an artery is blocked in the brain. And when artery is blocked in heart it causes heart attack. About 15% die from strokes, but the biggest problem in stroke is that it disables people. So, if you had a stroke the more likely thing is not that you would die, but that you would be left with paralysis, inability to speak or take care of yourself. It also takes a toll on you emotionally and financially if you need to go to a nursing home or hire people to take care of you at home. (Stroke costs the United States $38 billion a year as per the American Stroke Association and the Centers for Disease Control).

Who’s prone? Are genetic factors involved? Everyone, but it mainly occurs in 50-80 years of age, but it’s also seen in young adults. If you stay healthy until 80, there’s a chance you can get a stroke at some point. When you get to be about 70, the chances are 1%-2% every year. There are genetic, racial differences but people shouldn’t think that they are safe because they are in a one gender or ethnic group. In the US, heart attacks are more common than strokes, but in China strokes are more common than heart attacks. It is a single biggest cause of death in China and many areas in Asia although it is not quite clear why. It could be a combination of factors. There is higher prevalence of bleeding type of strokes in the Asian subcontinent. In the United States, the risk of blocked artery causing a stroke is about five times greater than that caused from bleeding type of stroke. In every six stroke patients, five are going to be caused by a blocked artery and one of them caused by bleeding. In China, it’s more like two to one. Bleeding is much higher than blocked artery. HEALTHLINEMAG.COM

Mobile Stroke Unit In March 2014, Dr. Grotta and his co-investigators initiated a three-year study with the launch of the country’s first mobile stroke unit, in partnership with Memorial Hermann-Texas Medical Center. John and Janice Griffin, owners, Frazer Ltd, Houston’s leading company that builds emergency vehicles offered their help in engineering the special ambulance equipped with a CT (computed tomography) scanner, the first of its kind in the nation. Also, generous support from H-E-B, Gallery Furniture and a few others who donated money up to $1.1 million, got the first unit on the road. Dr. Grotta, who is the Director, Mobile Stroke Unit Consortium, describes it is an emergency room on wheels. The mobile stroke unit would immediately do the diagnostic test on the spot and give tPA even before the patient is taken to the emergency room, saving a substantial amount of time. Is it successful? The mobile stroke unit has trained paramedics and/ or nurses that recognize stroke. When someone calls 911 and the fire department ambulance in the city of Houston gets dispatched to pick up a possible stoke patient, mobile stroke unit is also dispatched. They arrive at the same time and evaluate the patient together. If it’s not a stroke the fire department continues to manage the patient. The mobile stroke unit operates in conjunction with the Emergency Medical Services of the Houston Fire Department, Bellaire Fire Department and West University Fire Department and covers Bellaire (inner Bellaire) within eight-mile radius of Texas Medical Center. We can currently fund only one shift every day, not a 24-hour service. We would like to have a second mobile stroke unit on the west side of town that services from out west of Southwest Memorial and Memorial City, an area prevalent for stoke and where a large population of Asians reside. It is almost three years into the study that was started in 2014, to assess the outcome of patients that are treated on the mobile stroke unit and of patients treated by standard management. So far around 270 patients have been treated and about 800 patients transported to stroke centers including Memorial Hermann-TMC, Houston Methodist Hospital and St. Luke’s Medical Center. We know that it works and we can treat patients faster, but what we don’t know is that, if we speed up treatment, would it have a significant impact or outcome. It would take three more years of study and an additional 2-3 million dollars to find out if by JANUARY - MARCH 2017 I HEALTHLINE

treating patients faster, more patients recover. Future plans include staring a mobile stroke unit in Denver and Memphis and next year, they would have an additional one in New York and Los Angeles that will be providing data. But Dr. Grotta said he would like to have more data in Houston.Funds were also received from the Patient-Centered Outcomes Research Institute (PCORI) and American Heart Association (AHA) Dr. Grotta said. Telemedicine Inside the mobile unit there is the CT scanner and cameras positioned in a way in which the doctor can get a view of the patient remotely. The paramedics and nurses can see the doctor on the computer screen and the microphone picks it up as they speak and that’s how the doctor adjusts the treatment. This is called telemedicine and it is part of the clinical trial that Dr. Grotta and his coinvestigators are working on. James C. Grotta, M.D., Neurologist, Hermann Medical Group, Director of Stroke Research, Clinical Institute for Research and Innovation, Memorial HermannTexas Medical Center, Director, Mobile Stroke Unit Consortium. In 1974 when Dr. Grotta was offered

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a job at UT Medical School that was just forming, he saw great potential in its busy emergency room to take care of acute stroke patients and to do his clinical research. He and his wife, a journalist who also got a job with the Houston Post finally moved to live in the Southwest. For over 40 years, Dr. Grotta’s research has focused on the development of new therapies for acute stroke patients. Dr. Grotta has played a leadership role in many clinical research studies of both thrombolytic drugs and cytoprotective agents after stroke. He spent two years in the U.S. public Health Service (Indian Health Service). He was a recipient of the Feinberg Award for Excellence in Clinical Stroke (1999, Physician of the Year (2006), and the Eugene Braunwald Academic Mentorship Award (2010), all from the national chapter of the American Heart Association (AHA).

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This 2½-day conference features more than 1,500 presentations that emphasize basic, clinical and translational sciences as they evolve toward a more complete understanding of stroke pathophysiology with the overall goal of developing more effective prevention and treatment. Sessions in clinical categories will center on stroke community risk factors, emergency care, acute neuroimaging, endovascular and nonendovascular treatment, diagnosis, cerebrovascular occlusive disease, in-hospital treatment, and outcomes of stroke.

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Heart Health: What You Need to

Know About Coronary Artery Disease

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he American Heart Association estimates that more than 16 million Americans suffer from coronary artery disease. It is the number one killer of both men and women in the U.S. Coronary artery disease (CAD), or coronary heart disease, is a common term for the buildup of plaque in the heart’s arteries that could lead to heart attack. These fatty deposits may develop in childhood and continue to thicken and enlarge throughout life. Called atherosclerosis, this thickening narrows the arteries and can decrease or block the flow of blood to the heart. It is the most common cause of heart disease. It is important to understand the causes and

symptoms of CAD and to know that there are actions you can take to reduce your risk of a heart attack from the disease. Coronary arteries supply blood to the heart muscle. Like all other tissues in the body, the heart muscle needs oxygen-rich blood to function, and oxygendepleted blood must be carried away. The coronary arteries run along the outside of the heart and have small branches that supply blood to the heart muscle. Therefore, any coronary artery disorder or disease can reduce the flow of oxygen and nutrients to the heart and that may lead to a heart attack and possibly death. The symptoms of coronary heart disease will depend on the severity of the disease—and they must be taken seriously. Some people with CAD have no symptoms, some have episodes of mild chest pain and some have more severe chest pain.

If too little oxygenated blood reaches the heart, a person will experience chest pain called angina. When the blood supply is completely cut off, the result is a heart attack, and the heart muscle begins to die. So it is important to recognize symptoms of coronary artery disease that can include: • Heaviness, tightness, pressure or pain in the chest behind the breastbone • Pain spreading to the arms, shoulders, jaw, neck or back • Shortness of breath • Weakness and fatigue Controlling risk factors is the key to preventing illness and death from CAD. There are several conditions and behaviors that increase the risk of CAD such as smoking, physical inactivity, obesity and having diabetes or hypertension. Family history of CAD is always a consideration and should be discussed with a physician. Additionally, being post-menopausal for women and being older than 45 for men are traditional risk factors. There are several treatments that may be prescribed for CAD, including oral medications that can decrease blood clotting, reduce cholesterol levels and lower blood pressure. These medications, and changes in lifestyle and behavior, could help reduce risk and lessen the onset of chest pain. Other treatments include coronary artery stenting and coronary artery bypass surgery (CABG.) All of these treatment options may be used alone or together in the treatment of coronary artery disease. Your risk of coronary artery disease can be minimized by controlling the risks factory that are within your control. Living a healthy lifestyle that incorporates proper nutrition, weight management and getting some physical activity can play a big role in avoiding or delaying the progression of CAD. Preventive measures instituted early are thought to have greater lifetime benefits. Most importantly, call 9-1-1 for yourself or anyone who is experiencing symptoms of chest pain, shortness of breath, palpitations or fatigue. Do not delay. Calling 9-1-1 at the first signs of a heart attack could save a life because reducing time to medical treatment is the primary factor in surviving a heart attack.

Dr. Jon-Cecil Walkes is a board-certified cardiothoracic surgeon and medical director of Cardiothoracic and Vascular Surgery at St. Joseph Medical Center. St. Joseph Medical Center, in partnership with physician owners and part of IASIS Healthcare, is a full service, general acute care hospital. For information about programs and services, visit www.sjmctx.com. HEALTHLINEMAG.COM

Jon-Cecil Walkes, MD

JANUARY - MARCH 2017 I HEALTHLINE

FIBROIDS Uterine Artery Embolization Minimally invasive treatment for uterine fibroids

Uterine fibroids are very common non-cancerous growths that develop in the uterus. They can range in size from the size of a pea to larger than a cantaloupe. In most cases, there are multiple fibroids in the uterus. 10 to 20 percent of women who have fibroids require treatment. Depending on size, location and number of fibroids, they may cause: • • • • • •

Heavy, prolonged menstrual periods Pelvic pain and pressure Back pain Pain during sexual intercourse Bladder pressure leading to frequent urination Abnormally enlarged abdomen

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Women typically undergo an ultrasound to determine the presence of uterine fibroids. MRI is used by interventional radiologists, because it provides more details. Patients should be aware of all of their treatment options. Patients considering surgical treatment should also get a second opinion from an interventional radiologist, who is most qualified to interpret the MRI and determine if they are candidates for the minimally invasive uterine fibroid embolization (UFE). UFE is performed by an interventional radiologist while the patient is conscious, but sedated and feeling no pain. It does not require general anesthesia. The interventional radiologist makes

a tiny nick in the groin and inserts a catheter in the femoral artery. Using real-time imaging, the physician guides the catheter and then releases tiny particles, the size of grains of sand, into the uterine arteries that supply blood to the fibroid. This blocks the blood flow to the fibroid and causes it to shrink over time. UFE can be done as an outpatient basis and patient typically goes home the same day. Pain and anti-inflammatory medication are prescribed following the procedure to treat cramping and pain. Many women resume light activities in a few days and return to normal activities within a week. On average, 85-90 percent of women who have had the procedure experience significant or total relief of heavy bleeding, pain and/or bulk-related symptoms. The procedure is effective for multiple fibroids and large fibroids. UFE is a very safe and well tolerated procedure. The complication rates are lower than those of hysterectomy and myomectomy. UFE is not new. It has been used successfully by interventional radiologists for more than 20 years. It is covered by most major insurance companies. Most women with symptomatic fibroids are candidates for UFE and should see an interventional radiologist to determine whether UFE is a treatment option for them.

Dr. Saeed graduated from University of Houston Honors program. After attending medical school, he completed his diagnostic radiology training at Tulane Medical Center. Following his residency, he attended the prestigious Brown Medical School and Rhode Island Hospital for his Vascular and Interventional Radiology fellowship. He has his own practice: Advance Vascular & Interventional Center.

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Mohammad Ali Saeed, MD HEALTHLINEMAG.COM

Medwin Family Medicine & Rehab 1235 Lake Point Pkwy, Suite # 103 Sugar Land, Texas 77479

• Best Family Physicians by Consumer Research Council in 2006, 2008 and 2015. • Practicing Medicine for 25 years. Manjula Raguthu M.D FAAFP, ABAARM Board Certiﬁed in Anti-Aging and Regenerative Medicine, Family Physician

832-532-0040

www.medwinfamily.com Afﬁliated with American Family Physicians Association Texas Family Physicians Association Valley Chapter, Currently involved with Multiple Philanthropic Associations and Chapters.

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1235 Lake Point Pkwy, Suite # 103 Sugar Land, Texas 77479

Surya Raguthu M.D DBIPP, ABIME Board Certiﬁed in Pain Management and Interventional Pain Physician

832-532-0050

JANUARY - MARCH 2017 I HEALTHLINE

Understanding Colorectal

Cancer

Screenings are important because often, the cancers develop from precancerous lesions, and if they are detected early, they can be removed right away. To make the most timely and accurate assessment of the patient, institutions like The Johns Hopkins Hospital are using a multidisciplinary approach to colorectal cancer. This means a team of experts from different specialties — such as oncology, surgery and radiology — discusses each case and then tailors a care plan to the specific needs of the patient. On that same line, almost all patients with colorectal cancer nowadays undergo some form of genetic testing, which looks at specific gene defects. That information helps physicians decide the type of chemotherapy to which the patient will respond best after surgery. There are three minimally invasive approaches to surgery for colorectal cancer.

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olorectal cancer symptoms can be embarrassing to address or easy to dismiss. But discussing your bowel movements with your doctor can be a lifesaving conversation. The most common signs and symptoms are rectal bleeding, which can be painless, diarrhea or constipation. However, what makes colon and rectal cancers scary is that there usually are no symptoms. Anyone can develop colorectal cancer, but chances increase markedly after age 50. The recommendation for people over 50 is to have a digital rectal exam and a colonoscopy, in conjunction with radiology tests, to look for either precancerous or cancerous conditions. Tests can be done earlier if a direct relative — mother, father or sibling — has had colorectal cancer.

The laparoscopic approach places cameras and instruments in small incisions to see exactly where the cancer is located, detach it, and remove the part of the colon or rectum that has the cancer. Transanal minimally invasive surgery allows physicians to operate through the anus, freeing up the rectum in difficult places. Robotic surgery can also remove portions of the colon and the rectum, and put everything back together. Technology is advancing at a very rapid pace. Every two or three years, there is a new piece of equipment that makes it easier to do these complex surgeries without making large incisions, ultimately improving the patient’s recovery time. Over the last 10 years, dramatic improvements have allowed physicians to treat patients with colorectal cancer and advance their quality of life. Early diagnosis is key. It makes having that conversation with your doctor about bowel movements and undergoing the recommended screenings worth it.

Jonathan Efron, M.D., heads the Division of Colorectal Surgery at The Johns Hopkins Hospital in Baltimore, Maryland. For more information, visit hopkinsmedicine.org.

HEALTHLINE I JANUARY - MARCH 2017

Jonathan Efrom, MD HEALTHLINEMAG.COM

Sudden Infant Death Syndrome: What is it and how can I protect my baby?

It is thought that it may be caused by a combination of an environmental stress (such as sleeping face down) in a vulnerable infant (it is not known yet what causes some infants to be vulnerable) during a critical period of brain/heart/ lung development (SIDS peaks between 1-4 months). The American Academy of Pediatrics updated its sleep guidelines in October 2016 to guide pediatricians and parents on how to best protect babies from SIDS based on the most up-to-date research. The highlights from these guidelines are listed below: 1. All babies should sleep on their back (face up) and on their own firm sleep surface. This means that babies should not sleep in the bed with their parents. No side sleeping or propping the infant’s head up. Soft surfaces such as couches can be very dangerous as they pose a suffocation risk. 2. Every baby’s crib/bassinet should be “naked.” This means a fitted sheet over the mattress without any extra blankets/stuffed animals/toys in the bed. This includes no crib bumpers. To keep baby warm in the winter appropriate clothes should be used. 3. A new recommendation is that infants should sleep in their parent’s room (but not in the bed with them) for at least 6 months, but ideally for the first year.

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Sudden Infant Death Syndrome (SIDS) is defined as the sudden death of an infant under 1 year of age that remains unexplained after a thorough investigation and autopsy. In the United States, SIDS is the leading cause of death in babies between 1 month and 1 year of age. A single cause for SIDS is not known.

4. Breastfeeding is associated with a reduced risk of SIDS. Any amount of breastfeeding is more protective than no breastfeeding. Consider giving a pacifier once breastfeeding has been established since this has also been shown to reduce the risk of SIDS. 5. No adults should smoke in the home or around the baby. Pregnant and breastfeeding mothers should not drink alcohol. 6. The amount of clothing covering an infant and higher room temperatures are associated with SIDS. There is no ideal room temperature that is suggested, but it is important to avoid overheating. These highlights are not all inclusive. For further recommendations on how to promote safe sleep, talk with your pediatrician.

Jessica Lanerie, M.D., is a pediatrician at the new Kelsey Seybold Sienna Plantation Clinic. She enjoys taking care of children of all ages, but has a special interest in weight management, asthma and eczema. You can read her blog posts at blog.kelsey-seybold.com. HEALTHLINEMAG.COM

Jessica Lanene, MD

JANUARY - MARCH 2017 I HEALTHLINE

Latest Study of Plastic Surgery Malpractice Claims

study of 1,438 closed malpractice claims* against plastic surgeons shows that claims are more likely to arise from complications that were known to the patient as a risk and that were discussed with the patient prior to surgery rather than resulting from substandard care. This latest analysis of allegations made by patients against plastic surgeons—and the factors that led to these claims—was produced by The Doctors Company, the nation’s largest physician-owned medical malpractice insurer.

The study also includes data on the most common patient injuries, injury severity, and rates of plastic surgery claims. Additionally, numerous examples of malpractice cases, insights from recent open claims, and risk mitigation strategies are also included.

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In the study, nearly half of all claims alleged improper performance of surgery (49 percent). Other allegations were improper management of surgical patient (13 percent), improper performance of treatment or procedure (12 percent), retained foreign body (6 percent), breach of confidentiality (4 percent), and failure to obtain consent (3 percent).

to the patient injury. Physician experts for both the plaintiff/patient and the defendant/physician reviewed claims and conducted medical record reviews. Clinical analysts then drew from these sources to gain an accurate and unbiased understanding of actual patient injuries. The top two factors that contributed to patient injury were technical performance (42 percent) and patient factors (41 percent).

The study is based on claims that closed from January 2007 through June 2015. All claims were analyzed, regardless of their ultimate outcome. The research is unique compared with other studies of malpractice claims because it includes expert insights into the specific elements that led

Copies of the full study can be found at www. thedoctors.com/plasticsurgerystudy. *A written notice, demand, lawsuit, arbitration proceeding, or screening panel in which a demand is made for money or a bill reduction and which alleges injury, disability, sickness, disease, or death of a patient arising from the physician’s rendering or failing to render professional services.

Robin Diamond earned her Master’s Degree in Nursing from Vanderbilt University. She has over 37 years of experience in health care administration, including nursing, quality, medical-legal consulting, and risk management, with 16 years in the medical malpractice insurance industry. She is Senior Vice President of Patient Safety and Risk Management at The Doctors Company.

HEALTHLINE I JANUARY - MARCH 2017

Robin Diamond, MSN, JD, RN HEALTHLINEMAG.COM

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OUTPATIENT HIP AND KNEE REPLACEMENT The Future is Here Now! Sir John Charnely invented the first successful hip replacement in 1960, and for this contribution he became a knight! The first modern knee replacement was performed in 1968. Total hip replacement and knee replacement have become the most successful procedures invented by man. Patients whose pain is not controlled with exercise, weight loss, or anti-inflammatories can now undergo hip or knee replacement and reasonably expect relief of their pain and the ability to return to sports such as tennis, golf, and bicycling. Modern total hip and knee replacements are expected to last nearly 20 years, and most patients are living the rest of their lives without having the replacements wear out or fail. Patients frequently ask me when they should consider joint replacement surgery, and the answer if fairly simple. You should have it done if you are healthy enough to undergo the surgery, and if it causes you pain or limits your ability to exercise. Until recently, all total hip and knee replacements required a several day stay in the hospital. However, we have now learned that there is a substantial risk to staying in a hospital. Hospital acquired infections and hospital medical errors can and do occur, and result in thousands upon thousands of lives lost each year. Not only do patients who have to stay in hospitals

frequently find it difficult to sleep since they are not in their own bed, but, nurses and technicians are frequently waking them up to draw blood or check them in some way. Our body is a sitting duck for the dangerous resistant bacterias (such as MRSA) that hospitals harbor. Lastly, many patients find that hospital food doesnâ&#x20AC;&#x2122;t facilitate a good appetite to help speed their recovery. Over the last few years, a few surgeons such as myself have begun to perform total hip and knee replacements and send the patients home the same day. This has now become possible though several advances including the use of a new medication tranexamic acid which limits bleeding. Less bleeding means greater safety less pain and less complications. Another advance is called Exparel, which is a new local anesthetic that can help control surgical pain for up to four days! Lastly, we have learned that patients recuperate faster when they start walking sooner, so patients who have surgery as an outpatient are assisted out of bed within the first couple hours and can start their recovery sooner. In summary, many patients who need hip and knee replacement can now have their surgery and safely go home the same day!

Adam Bright, MD is Past President of the Florida Orthopedic Society, Assistant Professor at Florida Sate College of Medicine, and Board Examiner, American Board of Orthopedic Surgery. He is been in private practice for 19 years in Sarasota, Florida, with Schofield, Hand, and Bright Orthopedics, PLLC. www.ABrightMD.com HEALTHLINEMAG.COM

Adam Bright, MD

JANUARY - MARCH 2017 I HEALTHLINE

Computer Vision Syndrome W

CVS has increased with advent of digital devices such as smart phones, tablets, and monitors. This near focus causes accommodation* issues that can cause visual disturbances after prolonged use. Accommodative esotropia is a condition that usually affects farsighted people. There are two systems that must work together in the brain for the eyes to work together and see properly: accommodation (focusing) and convergence (eye turning). When the eyes turn in to point at something up close, keeping it single rather than double, they also focus for that same distance to make the object clear. General distance only glasses, especially for the younger population, may not correct for these issues. Studies have shown that the average American spends nearly seven hours focusing on some type of digital device, whether be it computer screens, tablets, e-readers, or smart phones. This puts an enormous strain on the visual system, which is not corrected by simple distance glasses correction. The most common symptoms associated with Computer Vision Syndrome (CVS) or Digital Eye Strain are1: ● eyestrain ● headaches ● blurred vision ● dry eyes ● neck and shoulder pain

HEALTHLINE I JANUARY - MARCH 2017

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orried about your child spending too much time on digital devises? It is a serious concern for many parents when they get complains of hurting eyes. Your child or even you could be having Computer Vision Syndrome, (CVS) or Digital Eye Strain, a recent epidemic affecting our entire population.

These symptoms may be caused by: ● poor lighting ● glare on a digital screen ● improper viewing distances ● poor seating posture ● uncorrected vision problems ● a combination of these factors To help alleviate this strain, remember the 20-2020 rule: For every 20 minutes of near work, take a 20 minute break, to focus at something at least 20 feet away. Your optometrist can also help alleviate these symptoms with custom Digital Eye Strain Prescription lenses that can reduce the strain from computer strain throughout the day. These lenses are highly recommended for anyone using more than 4-6 hours at a computer screen or digital device. CVS or Digital Eye Strain can be diagnosed by your optometrist with the following tests: ●

Distance and near Visual Acuity

●

Manifest Refraction

●

Patient History

●

Binocular and accommodation visual testing HEALTHLINEMAG.COM

Symptoms include: ● Fluctuations in vision ● Burning or irritation ● Watery eyes ● Dryness

● Slit lamp examination – using a microscope to evaluate the tear film, conjunctiva and corneal tissues. ● Vital dye testing – instilling orange or green dyes to assess quality of tear film

● Tired eyes, especially after prolonged computer use

● Schirmers or phenol red testing – using a strip of litmus paper or thread to measure tear volume

● The need for frequent artificial tears or eye drops

● Meibomian gland testing – assessing the function of the glands using a microscope

● Red eyes

● Anterior segment photography – using high quality imaging to assess the health of the front portion of the eye

When you stare at a computer screen or digital device, your blink reduces by as much as 70%. Your blinking mechanism is responsible for preventing your healthy tear film from evaporating from your eye. With reduced blinking, your tear film becomes unstable, and can lead to a tear film deficiency. Reduced blink rate can also cause damage to you meibomian glands, which are located on your upper and lower lids, and are responsible for keeping a healthy tear film. Your optometrist can diagnose tear film deficiency due to CVS by performing medical testing in the office including:

Dr. Anith Pillai is a Therapeutic Optometric Glaucoma specialist. He is the owner of Evolutionary Eye Care, located in Sugar Land, TX. His clinical focus is in anterior segment disease and specialty contact lens evaluations for the management of Keratoconus and other corneal disorders, as well as Ocular Surface Disease and Dry Eye. He is also certified for Corneal Refractive Therapy, or orthokeratology, which is a laser-less vision correction for myopia (nearAnith Pillai, OD sighted) control. HEALTHLINEMAG.COM

● Patient history – lifestyle, environment, diet, medications, and certain illnesses make someone more at risk for developing tear film deficiencies.

For more information about CVS or Digital Eye Strain, visit www.evolutionaryeyecare.com

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JANUARY - MARCH 2017 I HEALTHLINE

SHOULDER PAIN

arthroscopic operation will be recommended since such tears will not heal by nonsurgical treatments. Even with the surgical repair the rotator cuft can take up to 12 months to heal completely.

Shoulder pain can often result in stiffness or a decrease in the range of motion which can interfere with our daily activities or our jobs. Such shoulder pain can be caused by the injury to the rotator cuft, the injury to the biceps tendon, or the damage of the cartilage called labrum in the shoulder.

The shoulder arthroscopy is an outpatient same day procedure. The orthopedic surgeon usually performs this procedure under the general anesthesia. However, the regional nerve block can be added to control the pain few days after the procedure.

Rotator Cuft Injury

The shoulder is covered and stabilized by four muscles collectively called the rotator cuft. A heavy lifting, pulling or pushing can injure the rotator cuft since it can be impinged under the shoulder bone called acromion, especially if the acromion becomes thickened or curved. Such injury causes the rotator cuft to be inflamed and swollen resulting in painful and limited range of motion of the shoulder. These symptoms are usually diagnosed as the Impingement Syndrome. The limited range of motion is defined as the Adhesive Capsulitis. The person with a rotator cuft injury typically complains of pain in the shoulder or pain at the upper forearm. Some patients may complain of a pain at the base of the neck. By a careful physical exam, a physician can distinguish the shoulder pain from the neck or forearm pain. Radiographic pictures are usually obtained to rule out any bone abnormality. A MRI of the shoulder can be ordered to evaluate the degree of the rotator cuft injury or to confirm any damage to the labrum. For the Impingement syndrome, a physical therapy treatment for one to three months is needed to regain the range of motion, to relieve the pain and to strengthening the rotator cuft. Steroid injections can be offered to decrease the inflammation and pain besides the nonsteroidal antiinflammatory medications. If such treatments do not relieve or improve the symptoms, an arthroscopic procedure to remove the bonny impingement from the rotator cuft is recommended.

During the arthroscopic procedure, the surgeon introduces a thin camera and instruments through few small incisions. The surgeon can visualize the shoulder space and structures, repair any cartilage or ligament injury, remove any scar or inflamed tissue, remove bone spurs and repair the rotator cuft tear. The physical therapy treatment is recommended after the arthroscopy to regain the shoulder motion and strength. If the MRI reveals a massive unrepairable rotator cuft tear, a physical therapy regiment is recommended. If the patient cannot improve his active abduction more than 90 degrees (pseudoparalysis), a total reverse replacement is recommended. Such procedure enables the patient to use the deltoid muscle instead of the rotator cuft to elevate the affected shoulder. For a very active patient with a massive rotator cuft tear, an allograft tissue (a tissue from a donor) can be used to cover the defect in the rotator cuft. Such allograft can provides enough stability for the remaining portion of the rotator cuft to lift up the shoulder. For the patient with the biceps tendon injury, if the physical therapy fails to relieve the symptoms, a debridement or reattachment to the upper forearm through an arthroscopy can be performed to relieve the pain. In conclusion, the shoulder pain should not be ignored since it can result in the severe consequences such as chronic pain, progressive stiffness and weakness. The treatment of the shoulder pain should include careful physical exams, radiographic studies, oral medications, injections and possible surgical treatments.

If the MRI reveals that the rotator cuft is partially torn more than 50% of its thickness or completely torn, an Dr. Chau received his orthopedic training at the University of Virginia and did his Fellowship at the Cleveland Clinic under Dr. Lester Borden, He is certified by the American board of Orthopedic Surgeons and specializes in total joint replacement surgery of the hip, knee and shoulder. He has practiced in the Sugar Land area since 1996.

HEALTHLINE I JANUARY - MARCH 2017

Arthur Chau, MD HEALTHLINEMAG.COM

V the most Able HPV cvncers prevent humAn cAncers

HPV is most commonly transmitted by having vaginal, anal, or oral sex with someone who has the virus but intercourse is not necessary, as the virus can be transmitted by close intimate skin to skin contact. HPV can be passed on even when an infected person has no signs or symptoms. You can develop cancer years after you have sex with someone who is infected, making it hard to know when you first became infected. A mother who is infected with the virus can pass on the infection to her child during birth through the vaginal canal. In 1979, a German scientist Harald Zur Hausen first discovered HPV, and over the next 25 years in his lab and many others, the major aspects of the HPV infections and the processes by which the virus causes cancers were elucidated. In 2008, Professor Zur Hausen was awarded the Nobel Prize in Medicine. It is now well accepted that virtually all cervical cancers, the overwhelming majority of oropharyngeal and anal cancers, and a major proportion of penile, vaginal and vulvar cancers are attributable to infection with high-risk (oncogenic) types of HPV. In HEALTHLINEMAG.COM

most of the developing world, cervical cancer is a leading cause of cancer death in women (number 1 in most of Africa and second/third in most of Latin America and South Asia). In the United States and other developed countries, there is a significant increase in the rates of oropharyngeal cancers in men, and anal cancers in both men and women.

Photo credit: Fotolia

The human papillomavirus, more commonly known as HPV, is a group of more than 150 related viruses. Some HPV types called “low-risk HPV” can cause warts and papillomas (non-cancerous tumors) and others categorized as “highrisk HPV” can cause cancers. HPV is a contagious virus and is so common that most people get it at some time in their lives. The lifetime risk of acquiring an HPV infection is approximately 80%. Most never know they are infected (no symptoms). About <5% will have significant precancer and <1% will develop invasive cervical cancer.

Because cervical premalignant disease is identifiable and treatable prior to the development of invasive cervical cancer, cancer prevention through routine examinations with Pap/ HPV testing has been very effective in reducing cervical cancer incidence and mortality in the developed world. However, this approach is very expensive and is likely not feasible in resource / infrastructure poor regions of the developing world. Furthermore, the HPV-related oropharyngeal premalignant process is almost never identifiable prior to the development of invasive HPV-associated oropharyngeal cancer. Therefore, prevention of initial infection is most JANUARY - MARCH 2017 I HEALTHLINE

Photo credit: Fotolia

desirable option and vaccination to prevent infection is the most effective approach. Fortunately, we now have very effective vaccines to prevent HPV infection. Pioneering work by Dr. Doug Lowy, current head of the National Cancer Institute, and others culminated in 2006 FDA approval. In 2007 a CDC recommendation was issued to offer these vaccines for preadolescent boys and girls 11 to 12 years of age to prevent HPV infection and the diseases that result from HPV. Catch-up vaccination is recommended for males and females through age 26. The vaccine is administered in three doses, with the second dose given one to two months after initiation and the third dose given six months after. The HPV vaccine can be given on the same day that the child receives the Tdap and meningococcal vaccines. The HPV vaccines produce a higher immune response in preteens and young teens than they do in older teens and young adults, which is why it is very important for children to get vaccinated earlier than age 14. People should receive all three doses of the HPV vaccine series long before they are exposed to HPV. Research shows that HPV vaccine protection lasts for at least 10 years, and researchers believe that the protection should last longer. The best immune response has been shown at the preadolescent age range, meaning a stronger ability to protect.

The vaccine has been extensively monitored for safety. Common side effects include pain, redness or swelling at the injection site, and possible fainting. These effects go away on their own. Brief fainting spells can happen after any medical procedure, including vaccination. Some other reactions can include low fever, headache, nausea, vomiting, and muscle or joint pain. These are all considered mild reactions. No severe or unusual reactions have been listed. There is always a risk of allergic reaction with any vaccine. In the United States, the HPV vaccinations for males and females are fully covered by insurance companies under the Affordable Care Act and Vaccines for Children. Studies have shown that being vaccinated against HPV will not affect sexual behavior. For those who practice abstinence, there is no guarantee that a future partner will have made the same choice, leaving them open to future infection. Despite this remarkable opportunity to prevent HPV-related cancers through the simple and safe step of vaccination, only 2 in 5 girls and only 1 in 5 boys in the U.S. are completing HPV vaccination series. The gravity of this missed opportunity to eradicate this disease from the next generation is that these cancers typically require aggressive multimodality cancer treatment including radiation and chemotherapy and sometimes mutilating surgeries. These treatments result in life-long impact on quality of life and daily functions, and if these cancers return after treatment they are typically incurable. Consequently, it is imperative that children complete the HPV vaccination series before their 13th birthday so that they are protected from being a victim of these cancers.

Jagannadha K. Sastry, Ph.D. Kathleen M. Schmeler, M.D. Erich M. Sturgis, M.D., M.P.H. The University of Texas-M.D. Anderson Cancer Center, Houston, Texas 30

HEALTHLINE I JANUARY - MARCH 2017

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