Houston Medical Times by Rick Delarosa

Serving Harris, Galveston, Brazoria and Fort Bend Counties

HOUSTON

December Issue 2015

Inside This Issue

TELEMENTAL HEALTH: WHY THE BOOM IS HERE TO STAY By René Quashie, Esq. Epstein Becker Green

Overweight men likely As over weight women to Face discrimination See pg. 12

INDEX Mental Health...............pg.3 Oncology Research......pg.5 Healthy Heart................pg.6 Age Well Live Well........pg.10

Memory and aging What’s normal? See pg .17

Telemental health has gone mainstream. Also referred to as telebehaviorial health, e-counseling, e-therapy, online therapy, cybercounseling, or online counseling, telemental health is the provision of remote mental health care services (usually via an audio/video secure platform) by psychiatrists, psychologists, social workers, counselors, and marriage and family therapists. Most services involve assessment, diagnosis, and/or therapy. Care models have evolved over the years, and range from hospitals establishing telepsychiatric assessment programs in their emergency departments to the creation of virtual networks of mental health professionals providing telemental health services to underserved areas.

surveyed have consistently stated that they believe telemental health to be a credible and effective way to provide care. The Case for Telemental Health

The most significant reason for the increasing popularity of telemental health is the fact while millions of Americans suffer from mental illness Many reasons exist for the or substance abuse disorders there is boom. First, telehealth is a good fit a shortage of qualified mental health for providing mental health services providers to address these issues. because providers rarely have to lay The numbers speak for themselves. hands on the patient in conventional According to the National Alliance of face-to-face encounters. Second, Mental Illness: telemental health is accepted by a large ∙∙ An estimated one in four number of payers as a legitimate use adults (about 60 million for telehealth — more so than other Americans) experiences telehealth disciplines. Finally, patients mental illness in a given year. ∙∙ About 14 million people live with a serious mental illness.

∙∙ About 9 million adults have co-occurring mental health and addiction disorders. ∙∙ 20 million Americans suffer from substance abuse. In addition, there is a critical mental health provider shortage. According to a Mental Health America’s 2015 report regarding the state of mental health in America, only 40 percent of Americans with mental illness report receiving treatment: Moreover: ∙∙ One mental health provider exists for every 790 individuals. ∙∙ A report to Congress found that 55 percent of the nation's 3,100 counties have no practicing psychiatrists, psychologists or social workers.

Mental health parity laws, ∙∙ Approximately 20 percent of notwithstanding, cost of care remains youth ages 13 to 18 experience an issue — not to mention the severe mental disorders in a social stigma and mistrust of mental given year. health providers that exists in many ∙∙ 7 percent of American adults communities. live with major depression. Telemental health is bridging the ∙∙ An estimated 18 percent of gap. Numerous studies have shown American adults live with the effectiveness of telemental health services. For example, a recent study anxiety disorders. see Telemental Health page 16

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Mental Health

Are you feeling SAD this holiday season? By Jamal Rafique, M.D., Board Certified Psychiatrist Executive Medical Director Behavioral Hospital of Bellaire

Seasonal affective disorder (SAD) is a type of depression that occurs at a certain time of the year. Primarily, it affects people during the winter when the reduced level of sunlight disrupts the body’s internal clock, and stress increases during the holiday season. Serotonin and melatonin are two neurotransmitters that also play a role in seasonal affective disorder. Diagnosis of seasonal affective disorder can be made if the person experiences depression for at least two consecutive years during the same season each year. Seasonal affective disorder, like other forms of depression, is diagnosed more often in women than men. It can occur with adults and adolescents, and symptoms usually begin to worsen during November and continue to get worse throughout the holiday season in December. Symptoms of depression may begin slowly and consist of: ∙

depressed mood,

∙

hopelessness,

∙

loss of energy,

∙

loss of interest in activities the person previously enjoyed,

∙

difficulty concentrating, and

∙

social withdrawal.

Unlike other forms of depression, people with seasonal affective disorder sleep more and eat more, most especially craving food high in carbohydrates. Once a person has been diagnosed with seasonal affective disorder, the health care professional will do a complete physical exam and basic blood tests to rule out some of the potential physical causes of depression. The winter and holiday season are very stressful for people already diagnosed with depression. The initial recommended treatment for seasonal affective disorder is light therapy. Light therapy consists of using a special lamp with a natural bright light source for at least thirty minutes a day. Natural light lamps or boxes for the treatment of seasonal affective disorder are easy to locate, even being sold on www.amazon.com for prices ranging from $40.00 to $200.00. Many people report that their symptoms start improving in just a few days after beginning light therapy. In some cases, starting light therapy during the early months of fall may help prevent an episode of seasonal affective

disorder. Some other tips for people diagnosed with seasonal affective disorder or any type of depression to deal with the holiday season are: ∙

Exercise caution with drinking alcohol, as alcohol can increase depression,

∙

Set holiday spending limits to avoid increasing depression over financial crises,

∙

Do not over commit yourself for holiday responsibilities,

∙

Plan low-key activities that will allow you to relax, and share responsibilities with others,

∙

Get plenty of rest, adequate exercise,

∙

Focus on the present times and plan activities that will increase social support.

Social support is extremely important during this season for people with seasonal affective disorder or any type of depression. Support groups can be located through the National Alliance on Mental Illness web site, www.nami.org, or the Depression and Bipolar Support Alliance web site, www. dbsalliance.org. Avoid isolating and living in the past. For some patients who do not respond to light therapy or have a more serious form see Mental Health page 16

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Blood test results vary from drop to drop in fingerprick tests Rice study: Six to nine drops of blood may be needed for consistent measurements By Jade Boyd Rice University When it comes to needles and drawing blood, most patients agree that bigger is not better. But in the first study of its kind, Rice University bioengineers have found results from a single drop of blood are highly variable, and as many as six to nine drops must be combined to achieve consistent results.

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The study, which appears online this week in the American Journal of Clinical Pathology, examines the variation between blood drops drawn from a single fingerprick. The results suggest that health care professionals must take care to avoid skewed results as they design new protocols and technologies that rely on fingerprick blood.

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"We began looking at this after we got some surprising results from our controls in an earlier study," said lead investigator Rebecca Richards-Kortum, Rice's Malcolm

Meaghan Bond

Richards-Kortum and Bond designed a simple protocol to test whether there was actual variation, and if so, how much. They drew six successive 20-microliter droplets of blood from 11 donors. As an additional test to determine whether minimum droplet size might also affect the results, they drew 10 successive 10-microliter droplets from seven additional donors. All droplets were drawn from the same fingerprick, and the researchers followed best practices in obtaining the droplets; the first drop was wiped away to remove contamination from disinfectants, and

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The benchmark controls are used to gauge the accuracy of test results from the new technology under study, so the variation among the control data was a sign that something was amiss. What wasn't immediately clear was whether the readings resulted from a problem with the current experiments or actual variations in the amount of hemoglobin, platelets and white blood cells (WBC) in the different drops of blood.

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the finger was not squeezed or "milked," which can lead to inaccurate results. For experimental controls, they use venipuncture, the standard of care in most hospitals, to draw tubes of blood from an arm vein. Each 20-microliter droplet was analyzed with a hospital-grade blood analyzer for hemoglobin concentration, total WBC count, platelet count and three-part WBC differential, a test that measures the ratio of different types of white blood cells, including lymphocytes and granulocytes. Each 10-microliter droplet was tested for hemoglobin concentration with a popular point-of-care blood analyzer used in many clinics and blood centers. "A growing number of clinically important tests are performed using fingerprick blood, and this is especially true in low-resource settings," Bond said. "It is see Blood Test page 16

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Oncology Research

The fault in our… evolution! By: Jorge Augusto Borin Scutti, PhD Houston Medical Times

Have you ever thought how complex our immune system is to recognize cancer cells? Researchers have tried to develop cancer vaccines for decades but unfortunately this achivement does not translate into success in clinical trials. This complexity is due to the compromise nature of how the evoultion selects our immune system to respond not only against strange particles or different cells but normal cells as well. The immune system’s capacity to detect and most of the time destroy abnormal cells may prevent the development of many cancers. However, cancer cells are sometimes able to escape and avoid detection and destruction by the immune system. Just to remind the readers, cancer cells come from a normal cell driven by mutations that lift the brakes on cell proliferation. In this case cancer can

be considered as a genetic disease. In the other hand most of cancer patients suffer because their immune system is weak and inefficient. My last articles were about how immune system is impaired in cancer patients and how they can contribute to the tumor growth and development. One of the key issues refers to the reduction of the expression of tumor antigens on their surface making it harder for the immune system to recognize them as well as expressing protein on their surfaces that induce immune cell inactivation and releasing substances that suppress immune responses and promote tumor cell proliferation, growth and survival. In this case cancer can be considered as an immunological disorder – cause or consequence? Evolutionary approaches are critical for understanding cancer progression and immune response at level of cells and tissues. Indeed, in general different species have developed over a dynamic tumor suppressive system to avoid cancer development. T cells (T lymphocytes) are a type of lymphocyte that plays a central role in cell-mediated immunity. The main feature

of T cells is their ability to discriminate between normal cell and abnormal cell in the body. The future of T cell depends of thymocytes – originate from bone marrow stem cells, which migrate to the thymus where they will mature and undergo positive and negative selection. The destiny of developing T cells is specified by the interaction of their antigen receptors (TCR) with self peptides – MHC complexes, that are displayed by thymic antigen presenting cells (APC`s) where a several subsets of thymic presenting cells are strategically positioned and they coordinate the selection of a functional and self-tolerant T cells repertoire. When these cells move deep into the thymic cortex they are presented with self-antigens. Only those thymocytes that interact with MHC class I and MHC class II (mild interaction) will receive a survival signal. This process ensures that the selected T cells will have an MHC affinity that can serve useful functions as immune response against cancer – This process is called positive selection. In the other hand negative selection remove thymocytes that are capable of strongly binding with

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self-MHC peptides and probably generate an autoimmune disease. In immune response field this event become a problem once cancer cells are derived from normal cells and the immune system is trained to tolerate such proteins (antigens) and then responses to the proteins remained weak - weak immunogenicity – ability to induce a proper immune response and mostly are mediated by T cells – Double edge sword? Moreover, it must be taken into account some specific mutations on cancer cells. Now, this is the positive side about evolution – some mutated proteins produced by cancerous cells can work as a whistle call to immune cells, signaling the presence of a cell that has become, in part, foreign. Some researchers have discovered some vaccines made from mutated proteins found in cancer cells have improved immune response to cancer generating personalized cancer therapies in clinical trials. This approach could also work in other cancers that harbor a several mutations such lung and colon. Personalized immunotherapies targeting mutations may become feasible in the near future. medicaltimesnews.com

December 2015

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Healthy Heart

Winter Workout Challenge: Stay Active For Your Heart! By Apiyo Obala Director of Communications, American Heart Association

The weather is getting cooler, the days are getting longer and you’re finding it more challenging to stay motivated and on track with your health goals. It can be challenging for some, especially during the holiday season, to stick to an exercise schedule even if it is as simple as going for a daily walk. There is no reason to take a break from physical activity when the temperature drops! In fact, exercising in cooler weather has advantages over working out in warmer weather.

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For one, you don’t have heat and humidity to deal with, which let’s face it, can be a deciding factor in whether to workout outside or stay indoors! Instead, start thinking about the chillier winter weather as an extra motivator to make you feel more awake and invigorated. The American Heart Association recommends 150 minutes of moderate exercise a week which can be broken down into 30 minutes per day, five times a week. One of the fastest and simplest ways to do this is simple: walking. Walking is one of the easiest ways to exercise. All it takes is a little bit of time. Did you know that you are more likely to stick with walking than any other form of exercise? That’s great news for five important reasons: ∙∙

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It’s efficient. 30 minutes of walking a day can help improve your circulation, lower your cholesterol and blood pressure and, help you lose weight. It’s free. The only thing you need to start is a pair of supportive walking shoes. It’s simple. There’s no equipment required, nothing complicated to

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learn, and you can do it right where you are. Just step outside. ∙∙

It’s easy to fit in. Run errands, walk the dog, take a lunchtime walk, catch up with friends or spend time with your significant other during an evening walk. You can even bundle up your kids and make walking a family activity. There are dozens of ways to fit in bursts of walking this season.

∙∙

It’s customizable. By changing up the time, distance, pace and route, you can create the right walking program for you.

Walking is a great low- impact way to start exercising, but once you hit your stride with walking you may also want to consider incorporating circuit training. An exercise

circuit (a cycle of 5-6 moves, run a few times through) is a great way to stave off boredom and get a lot done in a shorter amount of time. Ideally, your circuit will include a cardio burst of 1-2 minutes, followed by 3-5 exercises that work various parts of your body. You don’t need a gym membership to do circuit training, you can create your own mini-circuit at home! Challenge yourself to stay active, start walking today. Just 30 minutes a day can help improve your circulation, lower your cholesterol and blood pressure and help you lose weight. Do It Yourself Circuit: ∙∙

Jump rope, jog in place or run your steps (start with 1 minute and progress to 2).

∙∙

10 pushups (You can modify with knees down if you are having trouble holding a straight body pushup position; remember to keep your palms flat on the floor).

∙∙

20 crunches (with feet flat and knees up, legs bent in the air at 90 degrees or straight up, or your favorite variation).

∙∙

20 hip lifts (flat on your back, arms down on the ground at your sides with fingertips pointing see Healthy Heart page 16

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Harris Health’s Stacey Mitchell Wins National Forensic Nursing Award Stacey Mitchell of Harris Health System received the Virginia A. Lynch Pioneer Award in Forensic Nursing by the International Association of Forensic Nurses, the highest honor bestowed by the more than 3,000-member association with membership in 27 countries.

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This award reco gnizes an individual who has made exceptional contributions to the field of forensic nursing through clinical programs development, scientific achievement, legislation changes or educational activities. Virginia A. Lynch was a founding Stacey Mitchell member of the association and a cases, Harris Health’s robust pioneer in what is today forensic program is available 24/7/365 nursing. and often times collaborates with “I am humbled to receive this various law enforcement agencies award,” Mitchell says.” This award from the greater Houston area. means so much to me and the team. Mitchell became intrigued It recognizes our work in advancing with forensic nursing in the early care for forensic patients.” Mitchell has 25 years of 1990s when the profession was nursing experience including 21 in emerging and she was working the field of forensic nursing. She on her master’s degree. Her first currently serves as administrative success in the specialized job was director of Risk Management and as coordinator and creator of a new Patient Safety and Forensic Nursing forensic program for a hospital in Services for Harris Health System. Richmond, Virginia. She worked In 2009, Mitchell began the there nine years making it a success. Forensic Nursing Program at In 2002, she moved to Houston to Harris Health, a unique program work for the Harris County Medical that serves a wide range of cases Examiner’s Office to launch the including violence, trauma and forensic nursing death investigator injury, and sexual, child, domestic program. The team of investigators and elder abuse. The program is worked closely with families of an integral part of Harris Health’s deceased, performed crime scene Level I and Level III trauma centers assessment and documentation. at Ben Taub Hospital and Lyndon Additionally, the nurses performed B. Johnson Hospital, respectively. post-mortem sexual assault kits on When a patient is identified homicide victims. for forensic care, a forensic nurse Mitchell is nationally certified oversees all aspects of care including immediate crisis counseling and as a sexual assault nurse examiner evidence gathering. The nurse (SANE) for pediatric and adult is trained on the dynamics of patients and is active in multiple forensic medicine and proper nursing organizations including evidence collection. This includes American Association of Legal detailing injuries, taking photos, Nurse Consultants and the and securing hair and specimen International Association of samples. Forensic Nurses, where she has While most hospitals do served as president and as a forensic files on sexual assault member on the board of directors.

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Respite allows caregivers to take time away from their duties and do things that will rejuvenate and recharge them. Whether it’s catching up on sleep, visiting with friends or just quiet time alone, respite gives caregivers a break while knowing that their loved ones are being taken care of.

Kay’s husband suffers from Alzheimer’s disease. Fortunately, he regularly gets services that she says have probably saved her life. Kay is a family caregiver—one of many who provide care without pay for a family member or another loved one. And while she gladly took on the task of caring for her husband, she soon realized that her role as a caregiver was taking a toll on her. “I was caring for him seven days a week and getting more and more depressed.” The services her husband receives are known as respite. Respite allows family caregiver to take time away from their duties and do things that will rejuvenate and recharge them. Whether it’s catching up on sleep, visiting with friends or just quiet time alone, respite gives caregivers a break while knowing that their loved ones

Joyce, whose mother has Alzheimer’s and lives in a long-term care facility, said “It’s being able to take some down time to relax and do the things we need to do so that when we are with our loved one, we are definitely recharged in a way that will allow you to have more quality time with your loved one.”

are being taken care of. Family caregivers like Kay play a vital role in taking care of people who might otherwise being institutionalized. But it’s a huge job – and it can be exhausting. Like Kay, family caregivers take on the task out of love. But love is no panacea when the caregiver is worn out from his or her duties. The stress that often accompanies caregiving can lead to physical, emotional, and mental exhaustion, or “caregiver burnout.” Burnout can occur when caregivers don't get enough help, or if they try to do more than they are able -- either physically or financially. Burned-out caregivers experience fatigue, stress, anxiety, and depression. Some may also feel guilty if they spend time on themselves rather than on their ill or elderly loved ones. Cara Magrane, Respite Care of San Antonio, said, “Respite is a break—an opportunity for caregivers to have some time for themselves, so they can continue to care for the person they love.”

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Respite is more than just time off—it’s an investment in the caregiver’s health and well-being that pays returns by ensuring that the caregiver has something to give. Magrane said, “We often don’t think of ourselves as caregivers as needing a break; we think we’re OK and it’s the person we’re caring for who needs the care and attention,” she said. “But it’s like the oxygen mask in an airplane: if you can’t put the mask on yourself first, you’re not going to be able to serve the person you’re caring for.

“We need to make sure that respite is not something people feel guilty about; it’s important for you to continue to be able to care for that person you love. You have to take that break – you have to self-preserve” Lauren Greenwade, program director at AGE of Central Texas, said “Respite care is for the caregiver and it’s a safe place to leave a loved one so they can go and do what needs to be done.” Rosalba, a San Antonio mom who uses respite to help her as she cares for her 15-year-old son who has cerebral palsy, said, “It’s good to know that you’re not a bad mom because someone is coming to your house and helping you with your child. And he benefits because he has a happy mom. It’s healthy for me, it’s healthy for him and it’s healthy for the family in general.” For more information about respite care, please visit www.dads.state.tx.us/ taketimetexas

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Overweight men just as likely as overweight women to face discrimination in retail settings

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Men who are overweight are just as likely as overweight women to experience interpersonal discrimination when applying for a job or shopping at retail stores, according to new research from Rice University and the University of North Carolina, Charlotte (UNCC).

"They didn't experience 'formal' discrimination or illegal types of discrimination," Ruggs said. "Before we had the actors apply for jobs, we confirmed the company was hiring. None of the overweight men were kept from applying for positions.

"We were interested in looking at biases toward men who are heavy in employment settings," said Enrica Ruggs, assistant professor of psychology at UNCC. "A lot of the research that has looked at weight stigmatization or discrimination toward heavy people has tended to focus on women. It's perceived as more of a critical issue surrounding women, so we wanted to see if men experience some of the same types of detriments that women face."

"But they did experience greater amounts of interpersonal discrimination or subtle negative behavior toward them," Ruggs said. "Employees they interacted with would try to end the interaction early, there was less affirmative behavior like less nodding or smiling; there was more avoidance types of behavior like frowning and trying to get out of the interaction," she said.

Ruggs earned her doctorate at Rice under the guidance of Mikki Hebl, professor of psychology and management,

and started the research at Rice. She and Hebl conducted two studies for the paper, "Weight Isn’t Selling: The Insidious Effects of Weight Stigmatization in Retail Settings."

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In the first study, non-overweight men went out into the field and applied for jobs at retail stores in the southern U.S. Then researchers had the same men apply for jobs at different stores wearing overweight prosthetics. The researchers also wanted to investigate if overweight men would be subjected to discrimination as customers, so the same men posed as customers and visited other retail stores. In both situations, the "actors" were given scripts to closely follow. "We wanted to see if there were differences in treatment they received when they were not heavy versus heavy," Ruggs said. Researchers found that when the men applied for jobs or were shopping as customers in their overweight prosthetics, they experienced more types of subtle discrimination, or what the researchers call "interpersonal discrimination."

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Researchers had the actors use a scale of 0-6, with zero meaning no discrimination and six meaning extremely discriminatory. "We have these measures on a scale

and the means or averages were different compared with when they were heavy and not heavy," Ruggs said. "The overweight men rated stores at 2.3 compared with 2.0 when they were their average weight. Observers who were pretending to shop inconspicuously watched the interactions and provided independent evaluations. Their results were consistent with the actors, as they witnessed greater interpersonal discrimination when the men were heavy compared with when they were not. It may not seem like a lot, but it's statistically significant. It suggests that men who are heavy are experiencing really negative behaviors more often than men who are not heavy. "Their chances of getting employment could be less, or if they're shopping as customers, it has implications for their decision-making processes in terms of purchasing things," she said. What if the male retail employee is overweight? The second study, which was conducted in a lab setting, found the same see Overweight Men page 18

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New York businessman, philanthropist gives $30 million to cancer research

contribution. Andy Sabin is my hero — a great philanthropist, environmentalist, free spirit and visionary with a heart of gold.”

The Andrew Sabin Family Fellowship Program encourages Andrew Sabin Family Fellowship Program aims to advance creative, independent thinking and MD Anderson’s goal to end cancer high-risk, high-impact research. It will foster researchers whose work has superlative merit and who demonstrate Andy Sabin, of East Hampton, to end cancer,” said Ronald DePinho, the potential for continued, enhanced N.Y., has committed $30 million — M.D., president of contributions toward MD Anderson’s the philanthropist’s largest grant to MD Anderson. “The vision of mission to end cancer. It is anticipated date — to support research at The Andy Sabin and his family will have that up to eight Sabin Fellows will be Andrew Sabin University of Texas MD Anderson a positive, far-reaching impact for funded initially, but the total number have to spend 50 percent of their Cancer Center. generations to come. On behalf of of awards will depend on the merits of time fundraising in order to sustain The gift, through the Andrew my colleagues at MD Anderson and each application. innovative projects,” said Sabin, who Sabin Family Foundation, establishes has served on the MD Anderson the Andrew Sabin Family Fellowship Cancer Center Board of Visitors since Program and an endowment that 2005 and is president of Sabin Metal in its first year will fund up to eight Corporation, the largest privately two-year research fellowships at owned precious metal refiner and $100,000 each. The purpose of the recycler in the country. “Through this program is to support the brilliant program, they have the opportunity ideas of world-class cancer researchers instead to focus on important work in fundamental science, translational that can truly help people who suffer and population science research. from cancer.” “This transformational gift will The gift will help MD Anderson nurture the genius and excellence of “I wanted to provide a vehicle so researchers make substantial strides outstanding young scientists willing the patients we serve, we extend our that highly qualified researchers at the in the fight against cancer, said to push the boundaries in our quest sincere thanks for this forward-thinking world’s premier cancer center don’t see Andrew Sabin page 18 ©2014 Tiff’s Treats

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Telemental Health Continued from page 1

showed that providing telemental health services to patients living in rural and underserved areas significantly reduced psychiatric hospitalization rates. Another study concluded that the effects of telemental health on low-income homebound older adults were sustained significantly longer than those of in-person mental health services. Note, however, obstacles remain, including how to properly assess non-verbal cues by video, technical difficulties, and the lack of proper education and training of many providers regarding telehealth. Practice Guidance There is a well-developed library

of practice guidelines available regarding telemental health. The American Psychiatric Association, American Psychological Association, National Association of Social Workers, Association of Social Work Boards, TeleMental Health Institute, for example, all have guidelines or statements related to telemental health. The American Telemedicine Association has developed a series of practice guidelines over the years related to telemental health. There are also other resources such as the telehealth resource centers that provide guidance on telemental health. Legal & Regulatory Issues

There, however, a number of significant legal and regulatory issues implicated by the use of telemental health, including privacy and security, follow-up care, emergency care, treatment of minors, and reimbursement. While telemental health touches on some federal laws and regulations (e.g., HIPAA), most of the significant issues involve state law. For example: • Psychiatrists, as practicing physicians, must comply with all the obligations that apply to physicians practicing telehealth generally. Very few states exempt mental health from physician requirements despite the fact

that many psychiatrists never lay hands on patients. Texas is one of the few states that explicitly carves out mental health services from other telehealth requirements. Demand for mental health services is unlikely to recede given the shortage of mental health provider around the country. Telemental health will increasingly be viewed as a viable solution by more and more clinicians, payers, and policymakers. There are, however, significant legal and regulatory considerations all stakeholders must wrestle with should adoption continue apace.

Mental Health

Continued from page 3 of depression, antidepressants may be recommended. Antidepressants generally take two to three weeks to demonstrate full benefits in reducing depression. It is very important that everyone who has

depression receives therapy from a qualified professional. If you or someone you know is suffering from seasonal affective disorder or any type of depression, please contact a mental health professional without delay.

The Behavioral Hospital of Bellaire offers a no-cost mental health assessment and has staff on duty 24-hours a day waiting to take your call. By picking up the phone and calling, you may just be saving a life.

The Behavioral Hospital of Bellaire is located at 5314 Dashwood Drive, Suite 200, Houston, TX 77081. For the 24-hour hotline, please call (713)-600-9500.

Blood Test

Continued from page 4 important to understand how variations in fingerprick blood collection protocols can affect point-of-care test accuracy as well as how results might vary between different kinds of point-of-care tests that use fingerprick blood from the same patient." Bond and Richards-Kortum found that hemoglobin content, platelet count

and WBC count each varied significantly from drop to drop. "Some of the differences were surprising," Bond said. "For example, in some donors, the hemoglobin concentration changed by more than two grams per deciliter in the span of two successive drops of blood."

Bond and Richards-Kortum found that averaging the results of the droplet tests could produce results that were on par with venous blood tests, but tests on six to nine drops blood were needed to achieve consistent results. "Fingerprick blood tests can be accurate and they are an important tool for health

care providers, particularly in point-of-care and low-resource settings," Bond said. "Our results show that people need to take care to administer fingerprick tests in a way that produces accurate results because accuracy in these tests is increasingly important for diagnosing conditions like anemia, infections and sickle-cell anemia, malaria, HIV and other diseases."

Healthy Heart

Continued from page 6 toward feet, feet flat with your knees bent at 90 degrees; press feet and shoulders into floor as you lift your hips as high as you can; lift and lower). ∙∙

∙∙

30-second plank hold yourself up in a pushup position; body as a straight line, or with knees down). 10 triceps dips on a chair/couch (Sit on chair with feet flat and knees bent at 90 degrees; hands at sides, palms pressed into the chair with fingertips facing forward; take one large step with right foot, and join left foot beside it. Bend your arms to 90 degrees as you lower

December 2015

and lift; keeps abs tight). The best thing about circuit training is that it is a great way to jump start weight loss, build muscle and increase your strength overall and it can be done without expensive equipment. As you push through your fitness challenges this winter, think about what motivates you to live a heart healthy life and use that as motivation to push through your fitness plateaus. Make sure you have and are part of a strong support network. Having a support network is key to staying on track. Keep in mind that a support network, can be virtual like joining an online community or physical, like taking

a group fitness class at your gym or local community center. Friends and family can be a great source of support in motivating you to stay on track with your fitness goals. Suggest a daily or weekly “workout date” with a friend or family member and promise to hold each other accountable to keep the date. Doing an activity with another person doubles as social time and will make fitness seem like less of a chore. Anyone who has ever successfully met their fitness goals will likely agree that accountability and a strong support network play a huge role in helping them to stay focused. Just remember, your health is a long term commitment to yourself. Focus on

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the task at hand, living the healthiest life possible by taking proactive steps to reduce your risk for heart disease and stroke. The American Heart Association has great resources available online that can provide more information on health and wellness, risk factors of heart disease, stroke, and more at www.heart.org. To find out more about American Heart Association Houston events like the Paul “Bear” Bryant Coach of the Year Awards on January 13, 2016, visit us online at bryantawards.com or join the conversation on social media at #bryantawards.

Houston Medical Times

Memory and Aging: What’s normal? By Madison Matous Texas A & M Science Center

There’s a definite difference between forgetting where you left your keys and finding yourself completely lost on a familiar route home. As we grow older, lapses in memory, like these, are the root cause of much angst. In fact, many worry that even slight “brain farts” could be a sign of something more troubling – like dementia. To help clear up the confusion, experts from the Texas A&M Health Science Center College of Nursing, explain the difference between normal age-related forgetfulness and symptoms that may indicate a larger health problem, and when to seek help. “As one ages, there are changes in our memory, but very often the

person you met last night Cause for concern: Forgetting recently learned information

Page 17

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Reason: Forgetting a person’s name is something a lot of people encounter and is not cause for concern. Seaback and Ehlert both agree that forgetting recently learned information, as in a few minutes ago, is one of the most common signs of dementia. Normal: Forgetting where you put your keys Cause for concern: Forgetting where you put your keys, but not being able to remember where you last had your keys. Reason: With normal memory loss you may misplace your keys, but you are able to trace your steps and figure out

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question is when is it normal, when is it abnormal and when I need to go see my primary care physician,” said Wanda Seaback, clinical assistant professor at the Texas A&M College of Nursing.

where your last had your keys. Those with dementia are not able to problem solve and cannot remember when and where they last had their keys.

Around the age of 65 it’s important times to take note of significant memory changes, as this is the age in when a majority of patients are diagnosed with dementia. However, if you are in your 40s or 50s and notice disturbing changes in memory, talk to your primary care physician as, although rare, early-onset Alzheimer’s can develop around this age.

Cause for concern: Not being able to remember what the season is or the last major holiday

So, what types of memory loss are normal and what is cause for concern? Seaback and colleague Pat Ehlert, also a clinical assistant professor at the Texas A&M College of Nursing, provide examples for some of the most common normal age-related memory lapses, as well as dementia-related symptoms to be on the lookout for: Normal: Forgetting the name of a

Normal: Not being able to remember the date or day of the week

Reason: Like when you lose your keys, with normal memory loss you are able to figure out what day it is on your own by looking at a calendar. People with dementia become increasingly disoriented as the disease progresses, and cannot take the steps to figure out the problem on their own.

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December 2015

Houston Medical Times

Page 18

Overweight Men

HOUSTON

Continued from page 12

types of subtle discrimination was taking place, this time with the customer being the discriminator. Researchers created marketing videos of five products that were generally neutral in terms of having wide appeal for a wide target market, items like luggage and coffee mugs. The actors, in this case both men and women, were again portrayed as overweight and not overweight in the different videos that test subjects were told would be used to launch a new product to be sold online. The goal was to see how customers evaluated those employees and determine whether having heavy employees influenced customer evaluations of the products and the organization. Participants of the study were given a questionnaire to fill out after watching the marketing videos. Researchers found that participants who viewed the heavy employees' videos reported more negative stereotypical thoughts about the employee. Specifically,

they thought overweight representatives were less professional, their appearance was less neat and clean and they were more careless. These stereotypical thoughts in turn led to negative evaluations of the employee as well as the organization and the products. "It's really unfortunate,” Ruggs said. “There are these really subtle influences that can have large negative effects on heavy men in the retail settings -- that's whether they're applying for jobs, they're actual employees or as customers," she said. "These findings are another reminder that there is still more work to be done in terms of creating equitable workplaces for all employees, potential employees and consumers. This is something organizations can take an active role in," Ruggs said. "One of the problems is that people currently have very few positive images of heavy individuals excelling in work settings. Organizations can try to influence

perceptions and attitudes about heavy employees by positively highlighting these employees and individuals more in overall marketing and branding efforts. It's time to change the narrative of what is considered normal, beautiful and professional. One step is to provide better role models through the messaging that is out there, be it through media advertisements as well as through equitable hiring of employees of all sizes who interact with customers," she said. Ruggs added that customers or applicants who experience subtle biases might be less willing to spend money at the store or patronize the store again or recommend it to their friends. She said companies can do better job training on customer relations as part of the employees' new-hire process. The study was published in the Journal of Applied Psychology.

Continued from page 14

the means to explore nontraditional solutions, progress in the fight against cancer will remain slow,” said Dmitrovsky. “The Andrew Sabin Family Foundation’s legacy gift will help advance research that can mean real hope for cancer patients and

Sabin devotes much of his time and energy to advocating on a national level for increased cancer research funding. He also is widely known as an avid environmentalist, conservationist and wildlife enthusiast —to the extent that four species — two frogs,

in Peru and New Guinea; a lemur, in Madagascar; and a chameleon, in Tanzania — are named after him. “Having a species named after you ensures your name will live in perpetuity,” said Sabin. “Likewise, this fellowship program at MD Anderson will be there in perpetuity. I hope one of the fellows comes up with a cure. It would make me very proud to know that this gift made a difference.”

Memory and Aging Continued from page 17

forget how to manage a budget.

in a familiar place

Normal: Forgetting a certain word that is on the tip of your tongue, but eventually remember

Reason: Everyone has experienced forgetting what you came into a room for, but people who become lost easily in places they were once familiar with is something to talk with your primary care physician about.

Cause for concern: Not being able to hold a conversation Reason: The main thing here is that with normal memory loss, we eventually remember the word or what we were trying to express. People with dementia become fixated on a phrase or even a single word, which prevents them from having a normal conversation. Normal: Going to a room and forgetting what you came in for

When memory loss begins to affect your daily life, it becomes a real issue. As in the examples above, losing something or forgetting a word every now and then isn’t going to affect your everyday life, but the underlying issues behind concerning signs, like problem solving and not being able to retrieve portions of important information will.

Cause for concern: Becoming lost

“A lot of times, people with

December 2015

Editor Sharon Pennington Director of Media Sales Richard W DeLaRosa Creative Director Lorenzo Morales Distribution Vincent DeLaRosa Accounting Liz Thachar Contributing Writers Jorge Augusto Borin Scutti, PhD Denise Hernandez MS,RD,LD Office: 713-885-3808 Fax: 281-316-9403

Andrew Sabin

Ethan Dmitrovsky, M.D., executive their loved ones. We are grateful to vice president and provost of MD Andy Sabin and his family for this Anderson. opportunity to enable outstanding “Without the intellectual curiosity scientists to strive toward achieving our of leading young researchers who have collective goal to end cancer.”

Published by Texas Healthcare Media Group Inc.

dementia will recognize that something is not quite right, but are unable to pinpoint exactly what is going on,” Ehlert said. For this reason, it is important for family and friends to be on the look out for these signs, and if they recognize them, encourage loved ones to see their primary care physician. Memory loss affects everyone at some point in their life, but it is important to be aware of the signs of dementia. To help ward off memory loss in any case, Ehlert suggests remaining physically active and keeping your brain active by reading, playing word or number games and strategy games with family and friends.

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December 2015

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