Serving Harris, Galveston, Brazoria and Fort Bend Counties
HOUSTON
February Issue 2017
Inside This Issue
Common Myths About Heart Disease By Suzie Flores Director Of Communications American Heart Association
“It’s a man’s disease.” “But I’m too young.” “Breast cancer is the real threat.” If you’ve heard or said any of these before, you’re not alone.
Pioneer in minimally invasive Heart surgery joins BaylorCollege of Medicine See pg. 12
INDEX Legal Health..................pg.3 Mental Health...............pg.4 Oncology Research......pg.6 Pharmacy Corner..........pg.8 Marketing Essentials.....pg.10
The real fact is, relying on these false assumptions can cost you your life. It’s time to set the record straight. Your health is non-negotiable; we need to separate fact from fiction so that together, we can stop this killer once and for all. Myth: Heart disease is for men, and cancer is the real threat for women Fact: Heart disease is a killer that that is more deadly than all forms of cancer combined. While one in 31 American women dies from breast cancer each year, heart disease claims the lives of one in three. That’s roughly one death each minute. Myth: Heart disease is for old people
Is it Necessary to Detox ? See pg. 18
Fact: Heart disease affects women of all ages. For younger women, the combination of birth control pills and smoking boosts heart disease risks by 20 percent. And while the risks do increase with age, things like overeating and a sedentary lifestyle can cause plaque to accumulate and lead to clogged arteries later in life. But even if you lead a completely healthy lifestyle, being born with an underlying heart condition can be a
risk factor.
fainting, pain in the lower chest or Myth: Heart disease doesn’t affect upper abdomen and extreme fatigue. women who are fit Myth: Heart disease runs in my Fact: Even if you’re a yoga-loving, family, so there’s nothing I can do marathon-running workout fiend, about it your risk for heart disease isn’t Fact: Although women with a completely eliminated. Factors like cholesterol, eating habits and smoking family history of heart disease are at can counterbalance your other healthy higher risk, there’s plenty you can habits. You can be thin and have high do to dramatically reduce it. Simply cholesterol. The American Heart create an action plan to keep your Association recommends you start heart healthy using Life’s Simple 7: getting your cholesterol checked at Get active, control cholesterol, eat age 20, or earlier, if your family has better, manage blood pressure, lose a history of heart disease. And while weight, reduce blood sugar and stop you’re at it, be sure to keep an eye on your blood pressure at your next smoking. What’s stopping you from taking action? check-up. Myth: I don’t have any symptoms Fact: Sixty-four percent of women who die suddenly of coronary heart disease had no previous symptoms. Because these symptoms vary greatly between men and women, they’re often misunderstood. Media has conditioned us to believe that the telltale sign of a heart attack is extreme chest pain. But in reality, women are somewhat more likely to experience shortness of breath, nausea/vomiting and back or jaw pain. Other symptoms women should look out for are dizziness, lightheadedness or
February marks the national celebration of American Heart Month, when the American Heart Association shines its torch on the number one killer of all Americans – heart disease. Over the past decade, the AHA has made remarkable progress in engaging and education women through its Go Red for Women® Campaign; however, there is still much work to do and awareness to raise so more women can be reached and more lives saved. To find out more, visit goredforwomen.org.
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Legal Health
FIVE KEY PROVISIONS TO THE OIG’S NEW EXCLUSION RULES By Mark S. Armstrong Epstein, Becker & Green, P.C.
the Federal healthcare program, the following five provisions are most likely to impact healthcare providers: 1. Ten Year Limitations.
The U.S. Department of Health and Human Services (“HHS”), Office of Inspector General (“OIG”) has the authority to exclude individuals and entities from Federally funded healthcare programs. The exclusions, whether mandatory or permissive, may be imposed for a number or reasons. Recently, the U.S. Department of Health and Human Services (“HHS”), Office of Inspector General (“OIG”) published its final rule that amends regulations regarding the OIG’s exclusion authority. The new regulations reflect the expansion of the OIG’s exclusion authority in the Affordable Care Act (“ACA”) and the Medicare Modernization Act (“MMA”). While the final rule provides guidance on the OIG’s new and expanded bases for exclusion from
Statute
of
In its final rule, the OIG adopted a ten-year limitations period for exclusion. The OIG reasoned that in litigated False Claims Act cases, the OIG is in the best position to consider exclusion after there is a judgment. If the case settles, the OIG can consider all of the relevant factors, including the defendant’s willingness to agree to appropriate compliance terms when determining whether to seek exclusion. The OIG concluded that the 10-year exclusion period allows the OIG to consider all of the relevant factors before making an exclusion decision and balances the defendant’s need for certainty with the OIG’s desire to protect the Federal healthcare programs and beneficiaries.
permissive exclusion authority to include obstruction of audits. Under its expanded authority, the OIG may exclude individuals or entities convicted for obstruction of audits related to certain enumerated offenses or in connection with “the use of funds received, directly or indirectly, from any Federal healthcare program.” In finalizing its rule, the OIG commented that “compliance with audit processes and requests is integral to fraud prevention and detection by payors and by law enforcement.” 3. Permissive Exclusion for Failure to Provide Payment Information.
The final rule further expands the OIG’s authority to exclude persons for failure to provide payment information. 2. Permissive Exclusion for The final rule targets individuals who Obstruction of Audits. refer for furnishing or certify the need The final rule expands the OIG’s for services. The OIG noted that
while a referring physician may not know whether a patient is a Federal healthcare program beneficiary, the exclusion is for a failure to supply payment information and does not require a physician’s knowledge of how the referred or certified services might be paid. 4. P e r m i s s i ve E xc lu s i o n for False Statements or Misrepresentations of Material Facts. The final rule implements the ACA’s permissive exclusion authority for knowingly making or causing to be made “any false statement, omission, or misrepresentation of a material fact in any application, agreement, bid, or contract to participate or enroll as a provider of services or supplier under a Federal healthcare program,” The OIG commented that it will evaluate see Legal Health page 21
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Mental Health
more realistic and healthy goal (ala Moderation Management). At the Addictions onset of your treatment, you’ll have to figure out what path works best By John M. Grohol, Psy.D. to a substance or alcohol need for you and your needs. additional help. There are many different terms An addiction can strike a person There is no single right way to used in drug addiction to describe when they least expect it, as they’re treat a drug or alcohol addiction. the problem. Older diagnostic trying to handle an increase in their And while popular groups like manuals differentiated between workload, childcare or child-rearing, Alcoholics Anonymous preach those who abused a drug or alcohol mental health issues, family issues, that abstinence is the only way and dependence upon the drug, but or for no reason whatsoever. It often begins innocently — trying to relieve the stress of everyday life, or just to try something new. Before the person knows it, they’re turning to the drug or alcohol as a way of coping with any negative feelings or stress in their lives. They may find they need more and more of the drug or drink in order to gain the same benefits from it. Efforts to scale back or to stop altogether are difficult or next-to-impossible. Drug addiction and alcohol you can kick an addiction, others the DSM-5 doesn’t. The DSM-5 addiction is usually not easily believe that learning to undo the (the newest diagnostic manual of overcome on one’s own. Most behavioral cues that lead a person mental disorders) simply refers to people who face an addiction to drink or take drugs in excess is a substance use disorders to describe
Call 713-600-9500 for a free assessment, 24/7.
any addiction to any drug or alcohol (with different codes that identify the substance being abused). For the most part, all of these terms — addiction, drug abuse, substance abuse, alcoholism — can be used interchangeably. We’ve compiled this library of addiction information and resources for you to explore. We encourage you to take your time with these resources, print out things you’d like to read more carefully, and bring anything you have additional questions about to your family doctor or a mental health professional. The good news is that addictions are readily treated nowadays, typically with a combination of psychotherapy and social support. Don’t be put off by the number of things written about addiction — because it’s a serious mental illness, a lot has been written about it! Read what you need, and leave the rest for another day.
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Physicians are on the medical staff of Behavioral Hospital of Bellaire but, with limited exceptions, are independent practitioners who are not employees or agents of Behavioral Hospital of Bellaire. The facility shall not be liable for actions or treatments provided by physicians. Model representations of real patients are shown. Actual patients cannot be divulged due to HIPAA regulations. 162038 6/16
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TM Go Red trademark of AHA, Red Dress trademark of DHHS.
Heart disease and stroke cause 1 in 3 deaths among women each year – more than all cancers combined. Together we can prevent heart disease and stroke. Take action at GoRedForWomen.org
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Oncology Research
Is it possible track cancer cells? By Jorge Augusto Borin Scutti, PhD Houston Medical Times
Without doubt, several features of the management of metastatic cancer need improvement. Patients, physicians and researchers are anxious about their risk of cancer relapse and are frustrated at the lack of reliable exams for the early detection of recurrence, even though there are no data to suggest that detection of asymptomatic recurrences a few weeks or months earlier is of any benefit. Furthermore, tissue biopsies are poor diagnostic procedures: they are invasive, cannot be used repeatedly, and are ineffective in understanding metastatic risk, disease progression, and treatment effectiveness. According to Marc Lippman, MD and Kent Osborne, MD in their article entitled Circulating tumor DNA, “Identifying
resistance to a new therapy and progression of disease at the earliest moment would avoid needless toxic effects of therapies doomed to fail and would permit earlier initiation of other potential therapies”. But, is it possible track cancer cells in order to define how they look like? Or what kind of mutations or drug resistance they would carry on? Circulating tumor cells (CTCs) are tumor cells that have shed into the vascular or lymphatic site from a primary tumor, for example breast, prostate and melanoma, and are carried around the body in circulation. Recent advances in molecular biology and others techniques such microscopy, cell biology and immunology now allow robust, reliable and reproducible detection of from a simple blood test. The use of “liquid biopsy” as a diagnostic and prognostic tool in cancer patients is an attractive method, since it is noninvasive and easily repeated. This particular approach allows cancer patient monitoring during the treatment, as well as the
detection of diverse genomic alterations that are potentially manageable to targeted therapy or are associated with treatment resistance. Conventional methods of detecting cancer markers or detection of soluble tumor associated protein as cancer biomarkers in blood such CA (carcinoembryonic antigen) and MUC1 have reasonable sensitivity, but changes in levels don’t always reflect tumor response or progression. Recently, assays of circulating tumor cells have been shown to be prognostic before initiation of a new regimen. In order to isolated and analyze the CTCs (using any filtration devices) must allow: 1) their identification and enumeration and their characterization through immunocytochemistry, fluorescence in situ hybridization (FISH) DNA
and RNA assays, and all other relevant molecular techniques using DNA and RNA. Further, morphological and molecular characterization is vital to show important predictive information and report changes in CTC biology. To date, a diversity of research methods have been developed to isolate and enumerate CTC in blood. Some examples include Cell Search, Epic and Maintrac, which can be used to verify the success of chemotherapeutic agent or to supervise the treatment during hormone or maintenance therapy. Moreover, there are some methods that allow us to measure circulating DNA that could be linked to the primary cancer of the patient through specific mutations. see Oncology Research page 21
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Pharmacy Corner
Chronic obstructive pulmonary disease (COPD) By Abimbola Farinde, PharmD
There are two varieties of chronic obstructive pulmonary disease (COPD) which are chronic bronchitis or emphysema. While there are nonpharmacological interventions for COPD such making healthier lifestyle changes, exercise, or good nutrition, there are also pharmacological interventions that can be employed. There are a number of medications that can be used to alleviate or ease the symptoms of COPD. The treatment of COPD can be a complex undertaking because the major symptoms of the disease do not generally appear until a significant amount of lung damage has occurred and with time the condition becomes progressively worse over time. The selection of a treatment regimen for COPD must be
February 2017
focused on decreasing or controlling symptoms and reducing the risk of serious complications. While there are pharmacological agents available to manage the condition, one of the most important steps that any person can undertake but find to be problematic is to stop smoking. Smoking cessation is a tried and test method of keeping COPD from becoming worse. For any person who has attempted to quit smoking it can be perceived as a daunting task but it is a goal that can be accomplished. Another challenge that can be faced with COPD is working to effectively manage the condition once it reaches the final stage. There are fewer options to effectively manage the condition with time so providers have the task of selecting options that can help to sustain an individual’s quality of life.
and levalbuterol can help to alleviate shortness of breath or cough that can be experience by patients with COPD. The short-acting inhalers can be used on an as needed basis to manage the periodic symptoms of COPD. The long-acting inhalers or bronchodilators such as tiotropium or formoterol are generally used in the later stages of COPD and over a longer duration of time compared to the short-acting inhalers. There is also the use of inhaled steroid for the reduction of swelling that can occur in the airways. These agents provide First of all, bronchodilators can therapeutic options that can be used be used to relax the muscles of the to effectively manage patients who lungs and assist with the opening of are given a diagnosis of COPD. The the airways. Examples of short acting inhaled steroids such as fluticasone bronchodilators such as albuterol or budesonide can help to prevent
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COPD exacerbations and associated inflammation. The combination inhalers that include the combination of bronchodilators and inhaled steroids can utilize the two mechanism of action to target the symptoms of shortness of breath, hoarseness, swelling, or inflammation all in one. The use of the oral steroids are generally reserved for individuals with moderate to acute COPD exacerbation and can help to prevent the progressive worsening of COPD. Agents that are considered to be newer when compared to the other classes are the phosphodiesterase-4 inhibitors that help to minimize airway inflammation and open the airways and lastly theophylline is a fairly inexpensive drug that can be used see Pharmacy Corner page 21
Houston Medical Times
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Marketing Essential
10 Commandments of Online Reputation Management for Physicians By Stewart Gandolf, MBA CEO Healthcare Success
Dear Doctors and Staff, Let us take the guesswork out of fracture referrals. No more waiting for appointments! We at the Orthopedic Care Center wish to offer your patients and staff easy scheduling of patients.
Across the board, reputation is an ever-present ingredient in health care marketing.
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Informed and empowered consumer/patients do their homework, researching symptoms, medical conditions and hospitals. From branding to public relations (and everything in between), a
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(and sometimes exclusively) by your online reputation. It is the “management” side of Reputation Management that is most often neglected. A physician carefully stacks the familiar building blocks, carefully aligning data points that include education, training, experience, academic papers, presentations, recognitions, etc.—all the stuff that fills a multi-page Curriculum Vitae (CV). And for the sake of conversation, let’s assume the CV is “sterling,” and the provider is a skilled communicator, has a caring
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physician’s reputation is a key “bedside manner,” and is trusted, component and influence factor. well-know and well-liked by close And as many as 8 out of colleagues, staff and patients. All ten people will look online for good stuff. information about individual The First 10 Rules. (What doctors. And all of that happens would you add to this list?) long before they make an Although there’s very little cost appointment…and what they find—positive, negative, neutral involved, the Internet has many or nothing at all—influences their facets and reputation management requires a systematic commitment decision to call or not to call. of time and effort. (You may want Perception is the reality: Who some professional help, particularly you are online is who you are to to get things going at the outset.) most people. Here are some of the essential Many doctors fail to appreciate concepts for effectively managing that their reputations extend far your online status: beyond their immediate circle ∙ Your reputation lives in of professional colleagues and two places: online and current patients. In fact, far more in-person. Pay attention people—the consumer public, to both daily. Few things prospective patients and many other physicians—know you first see Marketing Essential page 21 February 2017
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Pioneer in minimally invasive heart surgery joins Baylor College of Medicine and Baylor St. Luke’s Medical Center Dr. Joseph Lamelas, an internationally recognized expert in minimally invasive heart surgery, has joined the Michael E. DeBakey Department of Surgery at Baylor College of Medicine as associate chief of cardiac surgery in the division of cardiothoracic surgery. He will conduct surgeries at Baylor St. Luke’s Medical Center, part of CHI St. Luke’s Health. Lamelas, who has completed more than 14,000 cardiac surgical operations in his career, has played a significant role in advancing the field of minimally invasive cardiac surgery, as well as developing facilitating instruments. He has trained more than 700 physicians from around the world in this approach over the last 12 years. “Dr. Lamelas is a true pioneer in the field of minimally invasive valve surgery,” said Dr. Paul Klotman, president, CEO and executive dean at Baylor College of Medicine. “He will be a great addition to our impressive cardiothoracic team.”
Lamelas joins Baylor from Mount Sinai Medical Center in Miami, Fla., where he served as the chief of cardiac surgery for the past eight years. Lamelas has been in practice in Miami for more than 26 years. “As an internationally renowned cardiothoracic surgeon, Dr. Lamelas brings an extraordinary mix of experience and talent that will be a true benefit to our cardiovascular program at Baylor St. Luke’s Medical Center and the community,” said Gay Nord, president at Baylor St. Luke’s Medical Center. While he practices all facets of cardiac surgery, his main focus over the past 12 years has been minimally invasive cardiac surgery. Lamelas has developed techniques to facilitate minimally invasive approaches for repairing simple congenital cardiac defects, removal of cardiac tumors, aortic valve surgery, mitral valve surgery, double and triple valve surgery, as well
as replacing the ascending aorta without splitting the sternum. “The procedures involve a small incision on the right side of the chest and do not involve opening the breast bone. Utilizing specialized equipment and instruments, access to and exposure of the heart chambers and valves are obtained,” said Lamelas. Minimally invasive valve surgery allows for a shorter stay in the hospital as well as a quicker return to a full and normal level of activity. Most valve surgery patients are candidates for this procedure. “The addition of Dr. Lamelas is an enormous asset to the department of surgery, Baylor College of Medicine and the Houston community,” said Dr. Joseph Coselli, vice-chair of surgery and chief of cardiothoracic surgery at Baylor College of Medicine. “His minimally invasive approach offers patients an important option that allows them to return to their daily lives faster.” “I’m proud to be able to continue my career at an institution that was there when cardiac surgery began and now be a part of its history,” said Lamelas. “It will help me disseminate my knowledge and experience in cardiac surgery. In addition, I will have the opportunity to train the surgeons of the future in
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minimally invasive surgery and make this more of a reproducible and widely adopted technique that will benefit a larger population of patients.” Lamelas, who was born in Cuba and came to the United States with his family at the age of 2, is also fluent in Spanish. Lamelas is board certified in thoracic surgery and a member of the American Association of Thoracic Surgeons and the Society of Thoracic Surgeons. He also is a fellow in the American Board of Surgery, American College of Cardiology, American College of Chest Physicians, and American College of Surgeons. Lamelas has lectured both nationally and internationally and his work in the field of minimally invasive valve surgery has been extensively published.
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After the typical hot Texas summer, everyone looks forward to cooler weather, but not the cold and flu season that comes with it. Understanding the difference between having a cold and having the flu can help determine the proper treatment Prevention for a faster recovery. Every flu season is different, and even healthy people can Practicing good health habits such get very sick from the flu and spread as covering your cough, washing your it to others. There is no vaccine to hands often, and staying home when prevent colds, but there is for the flu. you are sick can help stop the spread of The best way to prevent the flu is germs and prevent respiratory illnesses like the cold and flu. by getting vaccinated every year! Keep countertops clean, especially Cold when someone in your family is The common cold is a contagious sick, and avoid sharing hand towels. upper respiratory infection caused by Clean the areas where the most germs cold viruses, and should not last more reside like doorknobs, faucets, remote than a week. controls, light switches, telephones and WWW.ELTIEMPOCANTINA.COM WWW.LAURENZOS.NET WWW.TONYMANDOLAS.COM
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Since colds are caused by a virus, antibiotics will not cure it. However, if cold symptoms last longer than a week, you should go to the doctor because you could have a bacterial infection that may require antibiotics. To help you feel better while you are sick, get plenty of rest and drink lots of fluids (i.e. water, clear juices or broths). If needed, use a humidifier to soothe dry air passages. Flu Treatment For the flu, there are prescription
February 2017
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mobile devices. According to the Centers for Disease Control and Prevention (CDC), everyone who is at least six months of age or older should get the flu vaccine this season. For the 2016-17 season, CDC recommends use of the flu shot instead of the nasal spray flu vaccine. Getting vaccinated is especially important for the following groups: ∙
Anyone with certain medical conditions including asthma, diabetes, heart disease, and chronic lung disease.
∙
Pregnant women
∙
Young children
∙
Anyone 65 years of age and older.
∙
Anyone who lives with or cares for others who are at high risk of developing serious complications.
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You Asked: Why does my eyelid twitch at random times?
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Sleepiness, stress, straining and stimulants could spur spasms, but they should stop in a blink
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By Nicole Bender Texas A & M Health Science Center
messages between neurons, or nerve cells.
You are up late eyeballing a term paper, and suddenly, part of one eyelid starts twitching. Virtually everyone has experienced that jittering sensation around the eye, and in annoyance, we often wonder, “Why is this happening?”
Stress and lack of sleep have also been tied to muscle spasms in general. “The cause isn’t definitively known, but when stressed, the body produces epinephrine, or adrenaline,” Rosa said. “This fight-or-flight reaction stimulates muscle function to prepare the body for quick action.” Prolonged muscle activity could lead to small, sporadic contractions of muscle tissue throughout the body and perhaps in the eyelid.
Single eyelid twitches are called myokymia, which are uncontrolled muscle contractions of the eyelid. Random, involuntary spasms, ordinarily felt in the lower eyelid The twitches may also be and sometimes in the upper eyelid, are normal and often subside within exacerbated by any number of other reasons: inflammation of the eyelid minutes. “There is typically no reason to be known as blepharitis; sensitivity concerned about these slight tremors, to irritants such as light, wind or pollution; excessive alcohol, caffeine
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which are common,” said Robert H. Rosa Jr., MD, professor of surgery and medical physiology at the Texas A&M College of Medicine. “However, they could be a cause for concern if the twitching persists intermittently for more than a few weeks.”
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Although it may be impossible to pinpoint a single cause of an eyelid twitch, Rosa said they may be provoked by fatigue from lack of sleep, straining of the eyelids for too long or physical exertion. Stress, side effects of medication and consuming alcohol, tobacco or caffeine may also be a trigger of spasms. “Stimulants, like caffeine, can escalate activity in the nerves and muscles,” Rosa said. “Caffeine blocks neurotransmitters, like adenosine, that make us tired and cue the release of excitatory neurotransmitters, like serotonin and noradrenaline, that stimulate activity.” Neurotransmitters are brain chemicals that transmit
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or tobacco use; dry eyes; conjunctivitis, which is commonly called pinkeye; or corneal scratches. If you think your eye is infected or injured, you should contact your health care provider. “On rare occasions, twitching of the eyelid may manifest itself into a more chronic condition known as benign essential blepharospasm,” Rosa said. As the use of the term “benign” implies, the condition is not life threatening, but again, the cause is unknown. Benign essential blepharospasm is a form of dystonia, which is a neurological movement disorder characterized by uncontrolled, extended and frequent muscle contractions. “Its symptoms could progress, potentially leading to blurred vision, elevated light sensitivity or tremors extending to other areas of the face,” Rosa said. Hemifacial spasms are another type see Eyelid Twitch page 22
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Houston Medical Times
Is it Necessary to Detox? By Denise Hernandez, MS,RD,LD Houston Medical Times
After the New Year has spun around once more, the myriad of diets begin to emerge for all those looking to make healthy changes to their lifestyles. One method of dieting, includes detoxes. Most detoxes include drinking several ounces of fluids in the form of juice or water, while taking herbal supplements. They claim that these combinations will help us flush toxins out of our system and in turn help us get to our weight goals. What the detox proponents might not
February 2017
adhering to a detox program. Her program involved drinking lots of fluids and taking several herbal remedies, including valerian root. She was admitted to a hospital with the following symptoms: confusion, repetitive behavior, such as teeth grinding for over an hour, and a seizure. Another case discovered similar complications in a man who also followed a detox program involving fluids and herbs, namely valerian root. Why did these individuals experience states of confusion followed by seizures? It was all due to hyponatremia, a condition that occurs when the level of sodium in your blood is abnormally low. Sodium levels drop when high levels of fluid are involved. The
mention is that detoxification is a natural human bodily process. Our organs and immune system can handle detoxification on their own. Healthy eating combined with plenty of fluids is the best detox.
funny thing was that these two had not consumed fluids high enough to cause hyponatremia. Doctors believe that the valerian root altered their thresholds, which enabled hyponatremia to develop at an earlier stage.
This year many doctors are warning patients to steer clear of detoxes because of their potential health risks. One case was reported in the journal, BMJ Case Reports, where a woman developed a potentially life threatening complication after
If your resolution this year is to be healthier, do so with proven and safe techniques. Contact a professional today to help you get there in the safest manner possible.
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Former MD Anderson President Dr. Charles A. LeMaistre Passes Away at 92 Charles Aubrey “Mickey” LeMaistre, M.D., past president of The University of Texas MD Anderson Cancer Center and a pioneering crusader against the harmful effects of tobacco use and catalyst of the field of cancer prevention, died on Jan 28th in Houston. He was 92. LeMaistre came to MD Anderson as president in 1978 after serving seven years as chancellor of The University of Texas System. “Mickey was one of the great icons of 20th century medicine who pushed boundaries, drove innovation and positioned MD Anderson to be the world’s most impactful cancer center,” said Ronald A. DePinho, M.D., president of MD Anderson. “His excellence is reflected to this day in the halls of our institution and in the countless lives saved around the globe.” During 18 years as the second full-time president of MD Anderson, LeMaistre led the institution through a period of substantial growth in programs, personnel, facilities, private philanthropy and reputation. One of LeMaistre’s early decisions as MD Anderson president was establishing a cancer prevention program,
which developed into an international model of research and service initiatives that advanced the science and application of cancer prevention and population sciences. Dr. DePinho reflected that “many individuals for generations to come will never experience the pain and suffering of cancer due to Mickey’s efforts in cancer prevention.” As a young physician, LeMaistre served on the first U.S. Surgeon General’s Advisory Committee on Smoking and Health, which in 1964 issued its landmark report identifying cigarettes as a major health hazard. Smoking control was an important part of his cancer prevention message when he was national president of the American Cancer Society in 1986. He chaired the 1981 National Conference on Smoking OR Health, a coalition of 21 organizations, and the 1985 International Summit of Smoking Control. From 1979 to 1983, he was president of the Damon Runyon-Walter Winchell Cancer Fund. “Mickey’s passing causes us to pause and remember his tremendous contributions to the growth and scope of
MD Anderson,” said John Mendelsohn, M.D., MD Anderson’s third full-time president and director of the Khalifa Institute for Personalized Cancer Therapy. “MD Anderson experienced happy and productive years under Mickey’s leadership, and I was fortunate to have the privilege of building upon his legacy when I succeeded him as president in 1996.” LeMaistre combined his skill as a physician, educator and academic administrator with a confident and charismatic style in guiding the cancer center during considerable change in the American health care system. He recruited many scientists and clinicians, developed cost-saving outpatient services, implemented a decentralized approach to management and completed a major building program that doubled the institution’s size. After retiring in 1996, LeMaistre was named a life member of MD Anderson’s Board of Visitors, a gesture of affection bestowed by the community volunteers he had recruited to help advance the institution’s mission. He also was recognized with the honorific title of chancellor emeritus by the UT System Board of Regents in 1994. In early 2006, LeMaistre returned to MD Anderson as a part-time professor of behavioral science in the Division of Cancer Prevention and Population Sciences, which he founded years earlier. He spent the next two years writing about
Charles Aubrey “Mickey” LeMaistre, M.D.
tobacco-related issues, including the evolution of public policies on tobacco control. The book is will be published later this year. LeMaistre is survived by his wife, Andreae. Other survivors are four children from his first marriage to Joyce, who died Dec. 5, 2003, six grandchildren and three great-grandchildren. They include two sons, C. Frederick LeMaistre, M.D., of Nashville and William S. LeMaistre of Houston; two daughters, Anne Philo LeMaistre, M.D., of Austin and Helen Meyer of San Antonio.
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Page 21
Legal Health
Continued from page 3 the circumstances of the conduct and acknowledged that it was not its intention to pursue exclusion “based on inadvertent errors and minor oversights”.
process to allow early reinstatement of individuals who are excluded because of the loss of their healthcare licenses for reasons related to their professional competence, professional performance, or financial integrity. Under the new 5. Creation of early reinstatement rule, individuals who lost their license procedures for exclusion may apply for early reinstatement related to the loss of a license. if they obtain, or are permitted to The final rule creates a new retain, a healthcare license in another
state, or retain a different healthcare license in the same state, or if they do not have a valid healthcare license but can demonstrate that they would no longer pose a threat to Federal healthcare programs and beneficiaries of such programs. Early reinstatement, however, is not available for an individual whose license was revoked or suspended for reasons related to
patient abuse or neglect. The final rule, which becomes effective February 13, 2017, may make it easier for the OIG to exclude healthcare providers. For that reason, it is important for healthcare providers to implement an effective compliance plan that reflects changing government regulations and requirements.
Oncology Research Continued from page 6
However, clinical practice is slow to embrace the liquid biopsy as a routine. Numerous reasons may explain this: (i) the huge number of procedures described for potential detection of CTC biomarkers without a consensus on the ideal technical approach; (ii) the
multiplicity of potential biomarkers for evaluation, in particular, circulating tumor cells (CTCs) vs. circulating tumor DNA (ctDNA); (iii) the difficulty in controlling the pre-analytical phase to obtain robust and reproducible results; (iv) the present cost of the
currently available techniques, which limits accessibility to patients; (v) the turnaround time required to obtain results that are incompatible with the urgent need for delivery of treatment. As we can see, there are some limitations in this context but
I do believe that we are getting close to answer this question: What is the best blood cancer biomarker for personalized medicine?
Pharmacy Corner Continued from page 8
to help improve quality of breathing for the management of a patient’s and minimize the development of COPD this is a discussion that should occur between the physician and the exacerbations. patient. The selection of a drug or When it comes to the task of regimen for COPD management can determining which drug is best suited be based on the presentation and
severity of one’s COPD symptoms and effective management is based on this criteria. The proper administration of the drug I that is ultimately selected can be learned from both the physician and the pharmacist that care for the
patient. It is through appropriate administration that any of the drugs can work to provide optimal benefit and achieve the desired therapeutic goal.
Marketing Essential Continued from page 10
have a higher priority for doctors…concern for their professional reputation is hard earned and constantly protected in their daily work. Physicians need no reminder of the “in-person” part. But the “online” part— which is often out-of-sightout-of-mind—deserves equal concern and attention. ∙∙ What’s online can hurt you and it can help you. The Internet is the home of “digital word-of-mouth.” Comments—either good or bad—tend to be seen as a form of endorsement, crowd sourcing, or social proof. Patient recommendations and testimonials can, and often do, significantly
influence the decision process and provider selection of other patients. ∙∙ The Internet never forgets. Never. It’s frustrating to think that user-generated comments often remain online (and available) even when they are incorrect, inaccurate, and often undated. Because things are “continuously available” online is further reason to keep your figurative stethoscope on this vital sign.
these primary (and slightly LinkedIn, Twitter, YouTube, and overlapping) information blogs. Keep your own material fresh arenas… and engaging, and don’t overlook Search Engine Results – use mentions that might appear in the a variety of keywords and search social media platforms of others with Google, Bing, Yahoo! Search, (such as discussion groups, events, Ask, Aol Search and others. Pay blogs, etc.) particular attention to listings or Physician Rating and Review results that have a community Sites – Compile a list (and connection. check each listing regularly) of
Local Directory Listings – regularly check “find a doctor” sources with online Yellow Pages/ SuperPages, business listings, insurance-provider lists, hospital databases, Google Plus pages, ∙∙ Proactively work your online community, “area connect” or “city presence at least once per search” directories, medical society week. It’s just good business listings and the like. sense to see yourself as other Social Media – Primarily see you. Carefully examine your own faces such as Facebook, medicaltimesnews.com
online listings. A 2011 study of 4,999 online physician rating sites identified these 10 as the most commonly visited sites with user-generated content: HealthGrades.com, Vitals. com, Y e l p. c o m , Y P. c o m , RevolutionHealth.com, RateMD. com, Angieslist.com, Checkbook. org, Kudzu.com, and ZocDoc.com. (That leaves only 4,989 others.) February 2017
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Houston Medical Times
You Asked: Why does my eyelid twitch at random times? Continued from page 16
of dystonia that occurs when the facial nerve, stemming from the foreside of the ear, becomes compressed by a blood vessel in the skull and causes the muscles on one side of the face to contract. These contractions tend to initially present themselves in the orbicularis oculi, which is the muscle that closes the eyelid.
these conditions remain quite rare.
For those bothered by it, twitching can be helped with simple lifestyle modifications. “Treatment of general, non-chronic eye twitching is quite simple,” Rosa said. “For most people, increasing sleep, reducing stress, and limiting caffeine, alcohol and tobacco should help the twitching subside.” If accompanied by other symptoms, Applying a warm compress to the these extremely rare reactions could area may relax the eye muscles and be indicative of a more serious brain minimize spasms, and over-the-counter or nerve disorder, and a health eye drops will lubricate the membranes care provider should be contacted of the eye to reduce dryness. immediately to treat the underlying Those who experience benign condition. Such chronic eye twitching essential blepharospasms or hemifacial may be symptomatic of neurological spasms can usually be relieved of diseases including multiple sclerosis, the annoying twitching by being Parkinson’s disease, Bell’s palsy and administered botulinum toxin, or Tourette’s syndrome, among others. Botox, which paralyzes the muscle for Still, people experiencing only the a few months. However, the effects occasional twitch should not panic; are only temporary, and patients
require further injections. A more permanent solution for severe cases involves surgically removing some of the muscles and nerves in the eyelids or decompressing the vascular pressure on the affected nerve. A number of therapies such as physical, massage, nutritional and acupuncture are among a number of methods to aid in muscle relaxation that could prove beneficial for alleviating contractions. “Overall, eye twitches are not generally a reason to fret,” Rosa said. “Monitor the frequency and severity of the spasms, and should you begin to have growing concerns about their persistence, contact your health care provider. Commonly, we expect twitches to be over in the blink of an eye.”
Conroe Regional Medical Center and Clear Lake Regional Medical Center Achieve Level II Trauma Care Designation The American College of Surgeons (ACS) and the State of Texas have designated HCA Gulf Coast hospitals Conroe Regional Medical Center (CRMC) and Clear Lake Regional Medical Center (CLRMC) as Level II Trauma Centers. The two hospitals are the first to be awarded this designation in the greater Houston area. Recovery is greatly increased when a severely injured patient receives care at a designated trauma center within the first hour of injury. The Conroe and Clear Lake medical centers’ trauma programs are staffed 24 hours a day by in-house trauma surgeons and specially trained trauma nurses. Physician specialists are available 24/7 to treat traumatic injuries.
needed,” said Troy Villarreal, CEO of the HCA Gulf Coast Division. “Those areas have been experiencing huge growth, and as the leading hospitals in their areas, CRMC and CLRMC need to provide the people who live there with the best trauma care possible. Achieving this Level II Trauma Center status “Conroe Regional Medical is another example of how we are Center and Clear Lake Regional always striving to serve the residents Medical Center are proud to offer of our communities. Level II trauma services to the “HCA Gulf Coast Division citizens of the communities they identified a strong need for a Level serve, services which are sorely II trauma center several years ago to February 2017
support the continued growth in the Conroe and Clear Lake areas. We are proud of the staffs of CRMC and CLRMC for successfully achieving this esteemed status,” Villarreal continued. “This only came about after extensive criteria were met, site reviews, and evaluations were carried out. Achieving Level II designation is extremely difficult, and our staff’s dedication to it is already resulting in more lives being saved in the Conroe and Clear Lake areas.”
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