Houston Medical Times News by Rick Delarosa

Recognizing National Breast Cancer Month

HOUSTON

Volume 9 | Issue 10

Inside This Issue

October Edition 2019

Detecting Breast Cancer – from Vigilance to Suspicion to Confirmation By Srinath Sundararajan, M.D., FACP, Texas Oncology

Bold Goals in the Fight against Metastatic Breast Cancer See pg. 10

INDEX Legal Matters........................ pg.3 Patient Safety Award........ pg.4 Mental Health...................... pg.5 Healthy Heart......................pg.11

Your Microbiome is What You Eat See pg. 12

cornerstone of health consciousness for adult women includes being on the lookout for breast cancer. There’s plenty of evidence that this eternal vigilance is worth it. In fact, early stage breast cancer that hasn’t spread has a 99 percent five-year survival rate. The path from routine screening to suspected cancer to confirmed diagnosis usually is the shorter part of a longer cancer journey. But better understanding of these preliminary steps can help set you on the right course for a successful cancer fight. Over the past 30 years, research shows a steady decline in mortality rates due to a combination of early detection and improvements in treatment. Early detection is key because cancer in its early stages and localized to one location is the most treatable. Screening and testing methods and technologies continue to advance and include 3D mammograms which are currently available in some areas, and new blood

tests that are in development. These innovations and all screening options are intended to work in combination with this essential, albeit decidedly

and feel, and immediately report any changes to a physician. Routine breast self-exams can raise awareness and help patients to seek medical attention sooner. However, it has limitations in detecting early stage breast cancer, when symptoms do not always appear and is not a substitute for other modalities for breast cancer screening. That’s why physicians recommend additional screenings. Screenings Preventative, proactive screenings, such as mammograms, clinical breast exams, and MRI, are the most effective methods for early detection. Screenings can find cancer cells before symptoms are present. Mammograms, which use low-dose X-ray images to identify potentially-cancerous breast changes, are the most common screening. Mammograms identify any abnormal areas in the breast, such as calcifications (white spots) and masses (tumors) that

Over the past 30 years, research shows a steady decline in mortality rates due to a combination of early detection and improvements in treatment. Early detection is key because cancer in its early stages and localized to one location is the most treatable. low-tech recommendation: Discuss with your doctor your individual risk factors, such as age, menopausal status, and family history. Self-Exams Starting in their 20s, women should check their breasts monthly for lumps or unusual changes in feeling, appearance, or discharge. Pay attention to how your breasts normally look

see Breast Cancer.. page 14

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Legal Matters Peer Review of Employed Physicians By John T. Synowicki, JD

a limited basis in Texas, some physicians enter into a physician employment agreement (PEA) with providers, in addition to receiving privileges with the provider. The PEA often contains a provision that the loss of employment by the physician will result in the automatic loss of membership and s the health care industry sees privileges at the hospital through increasing alignment among immediate termination. hospitals and other health care Additionally – and more providers, a reoccurring issue is how to commonly in Texas – a situation can handle peer review for physicians who arise where the physician is employed are engaged with the provider through by an affiliate of the Hospital, or with a credentialing, but also through an group who is contracted as an exclusive employment relationship. Inevitably, provider. Under such circumstances, peer review concerns arise for some it is not uncommon for the affiliate to of those physicians, often resulting directly employ the physician, and for in separate employment and peer the PEA to contain a clause that the review evaluations of the physician. loss of employment by the physician It is important for providers to look requires the physician to immediately at these arrangements proactively, as resign from any affiliated hospitals or the structure of the relationship can other credentialing entities. This could streamline how the hospital handles trigger an automatic termination of the underlying situation. privileges and membership, or require This issue can arise where the physician to voluntarily resign his physicians are employed directly by the privileges and membership at affiliated Hou_Med_times_ad_7_2019.pdf 1 7/22/19 3:16 PM Hospital. Although this applies only on entities.

In April 2017, the National Practitioner Data Bank (NPDB) issued formal guidance on the issue of employed physicians to clarify issues surrounding loss of employment in relation to privileging issues. The NPDB clarified that where a physician was under peer review, but lost his privileges and membership due to an automatic action related to employment termination or resignation, the termination was not reportable to the NPDB. The NPDB stated the “termination was not a result of a professional review action and, therefore, was not reportable. It does not matter that the employment termination *** automatically resulted in the end of the practitioner’s clinical privileges.” National Practitioner Data Bank Insights Publication, April 2017. The NPDB publication provides several important takeaways. First, it confirmed that when the loss of privileges is automatic, it is considered an administrative action, and the loss of privileges is not reportable to the NPDB. Thus, even if there is a parallel

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peer review investigation underway at the Hospital when the physician’s employment terminates, there is no reporting requirement related to the loss of privileges, provided that the loss of privileges was automatic. Second, the NPDB guidance focuses on the result that terminated the physician’s privileges, not whether the review began due to a peer review investigation or an employment concern. Thus, regardless of whether the underlying issue starts as an employment concern or a peer review concern, if the physician’s employment terminates, and there is a provision for an automatic termination of privileges and membership, it is not reportable to the NPDB. see Legal Matters...page 14

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October 2019

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Four Houston Methodist Hospitals Recognized by Vizient As Top Performers In Patient Safety, Care

indsay Vizient announced today that four Houston Methodist hospitals have received a 2019 Vizient Bernard A. Birnbaum, M.D., Quality Leadership Award. Houston Methodist was the only hospital system in the country to receive four awards. The award recognizes hospitals for demonstrating excellence in delivering superior quality and safety as measured by the Vizient Quality and Accountability Study, which has been conducted annually since 2005. Vizient recognized Houston Methodist Hospital in the comprehensive academic medical center category; Houston Methodist Sugar Land in the specialized complex care medical center category; and Houston Methodist Willowbrook and Houston Methodist The Woodlands in the complex medical center category. “Having four of our hospitals on

this list is extraordinary. Receiving such national recognition is an honor, but I’m most proud that the reason for these awards is our concerted focus on quality patient care,” said Marc L. Boom, president and CEO of Houston Methodist. This year, 349 participating hospitals were divided into four cohorts for the Vizient Quality and Accountability Ranking. The ranking measured performance based on safety, mortality, clinical effectiveness, efficiency and patient centeredness. The ranking’s composite scoring system uses patient-level performance data from a variety of sources including the Vizient Clinical Data Base, core measures data, the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey and the Centers for Disease Control and Prevention’s National Healthcare Safety Network (NHSN).

The Vizient Quality and Accountability Ranking helps participating hospitals and health systems understand their performance against their peers and identifies structures and processes a s s o ci a t e d w it h h i g h performance in quality and safety across a broad spectrum of patient care activity. The recognition period is for work spanning from July 2018 through June 2019. The award was presented on Sept. 19 during the 2019 Vizient Connections Education Summit in Las Vegas.

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Houston Medical Times

Mental Health Addressing Texas’ Psychiatrist Shortage By Mary Leigh Meyer

lthough the entire nation is experiencing a shortage of mental health practitioners, Texas ranks far below the national average in terms of the number of mental health professionals per 100,000 residents. In fact, second to California, Texas has the largest number of Mental Health Care Professional Shortage Areas (HPSAs) in the United States. Furthermore, amplifying the difficulty of finding a solution to the mental health care provider shortage, the state faces a unique challenge as a large percentage of Texans live in a rural area. Thus, many Texans may need to travel large distances to get access to the few mental health care providers available. One way to address the lack of providers is—of course—to train additional psychiatrists. To that end, the Texas Higher Education Coordinating Board awarded a $250,000 planning grant to the Texas A&M College of Medicine. The grant prioritized primary care and psychiatry programs, especially in a rural setting.

“With the help of the grant, we hope to develop a Bryan-College Station-based psychiatry residency program,” said Andrew Harper, MD, child and adolescent psychiatrist with the Texas A&M Outpatient Psychiatry Clinic, associate department head for clinical care and clinical professor at the Texas A&M College of Medicine. “This grant will help us on several fronts as we plan and finance the project.” For example, the funds will help Harper and his team recruit top notch faculty, coordinate with community resources and potential partners and hire a consultant to make sure the Accreditation Council for Graduate Medical Education (ACGME) criteria are met. After completing medical school, a psychiatry resident undergoes a residency that lasts four years before they can become an independent practicing psychiatrist. “In our program, we hope to have three to four residents per year,” Harper said. “Our goal is to have the program running by summer 2020, so we have a lot to do between

now and then.” The grant is a part of the state’s effort to expand the graduate medical education programs in Texas. Within the last decade, the number of medical schools and spots within existing medical schools have expanded to attempt to solve Texas’ physician shortage. However, the available graduate medical education positions and residency program spots have not expanded at the same rate to match this growth. Statistically, matriculating medical residents are more likely to practice within 100 miles of their residency program. With the increase in medical school attendance, Texas has graduated more students from medical school than ever before, but those graduates are not finding a residency position in the state. As a result, many move out of state to complete their medical training and stay within 100 miles of that site to practice. Harper emphasized the importance of psychiatry residents getting an immersive training in primary care. “We know people with behavioral health problems often have shorter

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lifespans,” he said. “Similarly, some medical problems can first present in changes to mental status. “Because there is a shortage of behavioral health providers of all types and due to the stigma of psychiatric illness, a huge number of patients show up in their primary care provider’s office asking for help,” Harper said. “It is important the family medicine residents know how to treat them.”

October 2019

Houston Medical Times

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Testing New Treatment for Epilepsy Patients Seizure Onset Zone Located Immediately, Dealt With By Laurie Fickman

niversity of Houston associate professor of biomedical engineering Nuri Ince, who pioneered a dramatic decrease in the time it takes to detect the seizure onset zone (SOZ) in the brain, has been awarded $2.3 million by the National Institutes of Health to expand his testing in a large number of adult and pediatric epilepsy cases. Current treatment protocols for detecting the actual part of the brain that causes seizures, the SOZ, require prolonged monitoring of intracranial EEGs (iEEG) for days or weeks following surgical insertion of electrodes. The prolonged monitoring adds to the risk of complications that can include intracranial bleeding and potentially death. Using his newly-created machine learning algorithms, Ince observed that high frequency oscillations (HFO) in the seizure onset zone form repetitive

waveform patterns that identify their location. Using these stereotyped HFOs, Ince knows he can find the zone in an hour. He thinks he can do it in about 10-to-20 minutes. “We believe that accurate detection of high frequency oscillations in brief iEEG recordings can identify the SOZ, eliminating the necessity of prolonged monitoring and reducing the associated risks,” said Ince. “A patient could be operated on at the same time he is having the electrodes attached to his brain, eliminating the patient being sent to an epilepsy monitoring unit for days or weeks to be observed. This would mark a totally new treatment and dramatically reduce risks and burdens to families.” Each year 150,000 people are diagnosed with epilepsy and 30% of them will suffer from a drug resistant form of the disease. When medication

fails, the next course of treatment is surgical resection, or removal, of the SOZ. But first it must be located Location of the seizure onset zone varies in each patient. The procedure to locate it begins with surgical insertion of electrodes. Then the patient is bedridden until seizures occur and can be observed. Ince’s method not only saves weeks of hospitalization, but reduces side effects and costs associated with what has traditionally been an arduous, and often painful, procedure. He said speed is especially important for the treatment of infants and children who are asked to endure brain surgery to implant electrodes and then lay still in a hospital bed for

an almost impossible amount of time with the current procedure. “Nature is not fair. Infants and children often suffer the same problems as adults and if we can bring this new procedure to the operating room, it will be amazing,” said Ince. Ince’s team plans to develop an online neural signal processing system for the rapid and accurate identification of SOZ with brief invasive recording. He is joined on the work by Baylor College of Medicine neurologists Michael Quach and Jay Gavvala and neurosurgeons Dan Curry and Sameer Sheth; and University of Minnesota neurologists Zhiyi Sha and Tom Henry.

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Houston Medical Times

Mayor’s Challenge to Prevent Veteran Suicide

he Houston VA is working closely with the City of Houston and other local agencies to increase suicide awareness and prevention support for Veterans, servicemembers and their families. This effort is part of a nationwide Mayor’s Challenge where we join City of Houston Mayor Sylvester Turner and local active military and Veterans organizations to end Veteran suicide. Houston was one of the original seven cities to participate in the challenge organized by the Department of Veterans Affairs and the Department of Health and Human Services Substance Abuse and Mental Health Services Administration (SAMHSA). During a recent press conference, Mayor Turner discussed the challenge. “Partnerships between our local community, government, and non-profit agencies will allow us to reach Houston area Veterans where they live, work, and thrive,” said Mayor Turner. “We want to expand the conversation around suicide and reduce stigma for mental health and suicide.” Using a public health approach,

the Houston Mayor’s Challenge team has developed multiple new and innovative strategies to prevent suicide in service members, Veterans, and their families. • The Harris Center and the Houston VA now have a hand-off system between the two agencies to assist with the care of veterans. • A network of communication between local hospitals and the VA to assist with veteran care is being built. • The Houston Police Department and Houston Fire Department are better able to identify suicidal behavior and will begin referring people to ensure follow up care is offered. • The Houston Health Department is working with hospitals and the Houston VA to enhance care coordination for veterans who are discharged after suicide attempts. “An estimated 300,000 Veterans live in the Houston-area. We all have a role to play in preventing suicide, especially when it comes to those who have served our country with duty, honor, and courage,” Mayor Turner

said. “I’m proud of my Veterans Affairs Office for accepting the Mayor’s Challenge and joining with vital on-the-ground local agencies to address the epidemic of Veteran suicide.” “Preventing Veteran suicide is the highest clinical priority at the VA and we are committed to bringing as many resources as possible to bear to solve this issue here in Houston,” said Frank Vazquez, Houston VA medical center director. • The Houston VA opened a brand-new building for outpatient mental health earlier this year. • We offer a robust marriage and family therapy program and have hired eight licensed marriage and family therapist to assist Veterans and their families. • We have hired more than 100 new front-line mental health providers, including psychologist, social workers, psychiatrists, and more over the last year. • Houston VA has embedded mental health professionals in our primary clinics to reach Veterans where they are, and we are embedding more and more in our specialty clinics like cardiology and women’s health. • We have vigorously trained our staff of over 5,400 on how to recognize and assist Veterans in

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crisis across our VA. • We have six full time suicide prevention coordinators who work tirelessly to follow up on calls from the Veterans Crisis Line and assist Veterans in crisis. • We offer same day mental health care for veterans in crisis at our main medical center and any of our nine community based outpatient clinics “Suicide is a complex issue with no one single cause. It is a national public health issue that affects people from all walks of life, not just Veterans. But just as there is no single cause of suicide, no single organization can end Veteran suicide alone,” Vazquez said. “The Houston VA is proud to be a part of the Houston Mayor’s Challenge, working with the amazing people here today and all members of our Houston community to put an end to Veteran suicide.” 

October 2019

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Houston Medical Times

Memorial Hermann Announces Alexander Greengold as SVP, Chief Consumer Experience Officer

and addressing them with innovative solutions. We want to take the already great patient and consumer experience we provide and make it even better, and we are confident Alex will help us do that.” Greengold most recently served as VP of customer experience, support and strategy for the Dish Network Corporation. In his role at Dish Network, Greengold focused see Greengold...page 14

eremiah Johnson, MD, and Peter Kan, MD, neurosurgeons at Baylor College of Medicine and CHI St. Luke’s, have performed the first brain aneurysm treatment in North Houston using the new WEB (Woven EndoBridge) device. Using this new FDA-approved technology, physicians performed the minimally invasive endovascular treatment at CHI St. Luke’s Health– The Woodlands Hospital, where Johnson is the Chief of Endovascular Neurosurgery. The innovative approach consists of the deployment of a single soft metal WEB device through a small tube into the aneurysm to block blood flow into it, thus preventing a rupture. “The technology is designed to simplify treatment of challenging wide necked aneurysms that would normally require the insertion of multiple devices inside the vessel, such as stents and coils, or might require a major brain surgery,” said Dr. Johnson. “It’s a also a good option for patients who cannot be put on blood thinners, which are often

WEB (Woven EndoBridge) device

required for other treatment options.” “I’m thrilled that CHI St. Luke’s Health was the first one to perform this minimally-invasive procedure in North Houston, and look forward to offering this option to more patients see Aneurysm...page 14

RELAX

emorial Hermann Health System is pleased to announce the appointment of Alexander Greengold as SVP, Chief Consumer Experience Officer, effective Sept. 16, 2019. Nationally recognized for quality and safety, Memorial Hermann is bolstering efforts to further personalize care in order to deliver consistently exceptional experiences for patients, their families and its caregivers. In this newly created role for the system, Greengold will be charged with leading these efforts. “We are extremely proud to have Alex join our organization,” said Erin Asprec, EVP of Acute Care Services and Chief Transformation Officer at Memorial Hermann. “Alex is passionate about identifying consumers’ ideas and concerns

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Bold Goals in the Fight against Metastatic Breast Cancer By uzanne Stone Executive Director of Susan G. Komen Greater Central and East Texas

his year, more than 40,000 women and men in the U.S. (2,980 of those in Texas) will die from breast cancer, most of those from metastatic breast cancer (MBC). That’s one death every 13 minutes. While our focus remains ensuring every person, regardless of income or geographic location, has access to the breast health care they need, we are also passionately pursuing ways to change the outcome for those patients whose cancer has metastasized outside the breast. Komen currently funds more than 540 research teams in 39 states and 10 countries to end breast cancer. Since our organization’s founding in 1982, we have awarded nearly $1 billion in research grants, making Komen the largest nonprofit funder of breast cancer research outside the U.S. government. MBC research initiatives Our current MBC research

teams are working at every level from genetics to big data. Komen-funded researcher Nikhil Wagle, M.D., leads the Metastatic Breast Cancer Project (mbcproject.org), a patient-driven initiative that asks MBC patients to share their cancer experiences, medical records, and tumor tissues to accelerate research discoveries. The project released the first publicly accessible data set into cBioPortal, with more to come, and will soon be sharing raw data in the Genomic Data Commons (GDC). The goal of this growing data set is to allow as many researchers as possible to make discoveries that accelerate our understanding of MBC. The detection of circulating tumor DNA (ctDNA) is a promising way to potentially monitor treatment response and to predict metastatic progression. In a recent NPJ Breast Cancer publication, Komen-funded investigator Gaorav Gupta, M.D., Komen Scientific Advisory Board member Lisa Carey, M.D., and colleagues developed a new blood test

that can monitor changes in tumor mutations over time. This test may be used to predict response to therapy in estrogen receptor-positive (ER+) metastatic breast cancer, and it could help guide treatment decisions for patients. Some tumor cells can spread to distant parts of the body where they lie dormant. These disseminated tumor cells (DTCs) are difficult to eliminate and can eventually develop into metastatic tumors. In a Nature Cell Biology publication, Komenfunded investigator Candice Grzelak, Ph.D., Cyrus Ghajar, Ph.D., and colleagues show that DTCs residing near blood vessels are protected from the killing effects of chemotherapy. They demonstrate that targeting the area around blood vessels can sensitize

breast DTCs to chemotherapy and stop the development of metastatic tumors arising from DTCs. Advocacy successes and goals Our pursuit of solutions to MBC isn’t limited to the lab; we are also advocating at all levels of government for policy change that will positively impact care. Thanks in part to our lobbying efforts, the Texas Legislature passed Senate Bill 680 during the 2019 session. This bill would prohibit insurance companies from requiring step therapy. Often step therapy requires that the most affordable therapy or drug be utilized before a newer, more expensive—and perhaps more effective—treatment will be authorized by an insurance company, see Breast Cancer...page 14

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Healthy Heart Four Parts of The Body Impacted by High Blood Pressure By Mary Leigh Meyer

One In Three Adults Has Hypertension, Which—When Left Uncontrolled— Can Cause Serious Health Issues

igh blood pressure, also called hypertension, is a serious illness that affects nearly 65 million adults across the nation. “Hypertension is a silent killer that can cause very serious health issues if left untreated,” said Jason McKnight, MD, MS, primary care physician at Texas A&M Family Care and clinical assistant professor at the Texas A&M College of Medicine’s Texas A&M Family Medicine Residency Program. “Patients typically only show symptoms of hypertension if the pressure is very high. It is important to always monitor your blood pressure and take any medications prescribed, whether you feel symptoms or not.” What is high blood pressure? When health care providers measure blood pressure, they measure the amount of pressure the heart exerts

against the walls of your blood vessels. They use two numbers and often speak about them by saying “top number over bottom number.” The first number, or the number on top, is the systolic blood pressure. Systolic pressure is the pressure in your blood vessels when your heart beats. The second number, or the bottom number, is call diastolic blood pressure. The diastolic pressure represents the amount of pressure on the walls of your vessels when the heart is resting in between beats. A ”normal” blood pressure occurs with a systolic (top) number of less than 120 and/or a diastolic (bottom) number of less than 80. While there are new guidelines suggesting a change in the definition of hypertension from the traditional 140 over 90, McKnight recommends you speak with your primary care provider about the need to take action to reduce your levels if they fall above the 130 over 80 range. Impact on the heart

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Hy per ten sion can cause an enlarged heart. “The higher the blood pressure, then the harder the heart works,” McKnight said. “The harder the heart works, then the bigger the heart muscle gets.” Over time, an enlarged heart can cause congestive heart failure. On a similar note, the harder the heart works, then the more blood it needs. “If you have any blockages in the blood vessels supplying your heart, or coronary arteries, then you are more likely to experience a heart attack,” explained McKnight. “The high pressure in your vessels will increase the chance one of those blockages will break off and cause a blockage.” Hypertension can also affect the blood vessels leading to the rest of the body. The vessels may balloon out, causing an aneurysm within the aorta. If the vessels rupture, then it can be fatal. Furthermore, when pressure on the vessel wall is high, the wall could essentially split in half causing an aortic dissection. An aortic dissection can be fatal. If the person does survive,

the aortic dissection usually requires surgical repair. Impact on the brain Hypertension can cause symptoms like a major headache, symptoms of a stroke, seizures and even death. “Your blood pressure can run so high that you get a rupture in an artery of the brain. This causes an intracerebral hemorrhage,” McKnight said. An intracerebral hemorrhage is a life-threatening stroke caused by bleeding within the brain tissue. Hypertension is also associated with vascular dementia, which is dementia caused by a series of small strokes over a long period of time. Dementia is defined as a gradual and see Healthy Heart...page 13

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Your Microbiome Is What You Eat

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hen you eat, you also feed your microbiome and influence the structure of the microbial community in the gut. Understanding how all this is connected to health and disease is one of the interests of Dr. Li Jiao and her colleagues at Baylor College of Medicine. In this work they found an association between diet quality and microbiome composition in human colonic mucosa that provides a strategy that can contribute to reducing the risk of chronic diseases. “In this study, rather than looking at individual diets, we focused on dietary patterns as defined by the Healthy Eating Index (HEI)-2005 and how they relate to the microbiome,” said Jiao, associate professor of

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colonic mucosa,” Jiao said. “Most other studies of the human gut microbiome have used fecal samples. We looked at colon mucosal-associated microbiome because this microbiome is different and it is said to be more related to human immunity and the host-microbiome interaction than the microbiome in fecal samples.” The researchers used nextgeneration sequencing techniques to analyze the type and abundance of bacteria present in colonic mucosal biopsies. The samples were obtained endoscopically from enrolled consenting 50 - to 75-year-old participants who had a colonoscopy at the Michael E. DeBakey Veterans Affairs Medical Center in Houston between 2013 and 2017. The participants

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medicine–gastroenterology and member of the Dan L Duncan Comprehensive Cancer Center at Baylor College of Medicine. “In a previous study, we found that HEI-2005 is associated with reduced risk of pancreatic cancer.” Diet is considered a principal factor influencing the structure of the microbiome in the gut, which in turn significantly affects the ability of beneficial or harmful microbes to colonize it. The human gut microbiome also influences nutrient uptake, synthesis of vitamins, energy harvest, chronic inflammation, carcinogen metabolism and the body’s immune and metabolic response, factors that can affect disease risk, Jiao explained. “One new contribution to this work is that we looked at the microbiome associated with

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were polyp-free and seemingly healthy. They reported their dietary consumption using a food frequency questionnaire before the colonoscopy. Recruiting bacteria that work for your health Jiao and her colleagues found that a good-quality diet as the one recommended by the Dietary Guidelines for Americans to be high in fruits, vegetables and whole grains, and low in added sugar, alcoholic beverages and solid fats is associated with higher abundance of beneficial bacteria such as those with anti-inflammatory properties. A poor-quality diet, on the other hand, is associated with more potentially pathogenic bacteria, such as Fusobacteria, which has been linked to colorectal cancer. see Microbiome...page 13

Houston Medical Times

Healthy Heart

Continued from page 11 permanent loss of brain function. It often affects memory, thinking, language, judgement and behavior. Impact on the eyes If you ever wonder why your ophthalmologist is checking your blood pressure, then here is your answer. They are looking at the blood vessels in your eyes to search for clues about blood pressure. “The retina—the part of the eye that actually sees things—has blood vessels running through it, and we know high blood pressure causes changes in these blood vessels,” McKnight said. “In bad cases of uncontrolled hypertension, it can cause blindness, macular

Microbiome

Continued from page 12 The researchers propose that the effect diet has on the structure of bacterial communities in human colonic mucosa can lead to modifications of innate immunity, inflammation and the risk of chronic diseases. Their next step is to confirm

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degeneration and glaucoma.” Impact on the kidneys The kidneys filter excess fluid and waste from the blood, so they understandably use a lot of blood vessels to do so. “Long-standing hypertension can eventually lead to renal failure, which sometimes requires dialysis to stay alive,” McKnight said. “Over time, hypertension can cause the vessels and arteries around the kidneys to weaken or harden, which prevents the kidneys from getting enough blood.” Risk factors “The majority of high blood pressure is called essential hypertension, which means there is no major cause,” McKnight said. “With essential hypertension, you are mostly predestined to get high blood pressure

through genetics or get it due to lifestyle factors. There is no identifiable cause that we can treat, so we are just treating the high blood pressure.” Additionally, people with preexisting kidney disease or other kidney problems are more likely to suffer from hypertension. Moreover, people with hormonal issues like with their thyroid or adrenal gland can often find themselves with hypertension as well. “Sometimes medications we use to treat other medical problems can lead to hypertension,” McKnight said. “The most common of which are decongestants for allergies or colds.” Prevention A healthy diet and active lifestyle can decrease blood pressure. Exercise dilates the blood vessels,

which encourages a better flow of blood through the body. If it cannot be controlled through diet or exercise, a health care provider may suggest a medicine or another therapy. “Patients need to know how serious hypertension can be when left untreated,” McKnight said. “Many people may not know they have hypertension unless they get it regularly checked. People often do not notice symptoms until the pressure is already very high.” He encourages everyone to get regular check-ups with their primary care provider. Also, take any medications they are prescribed, whether or not they notice symptoms of high blood pressure.

the study findings in a larger study population. In addition, they want to investigate how bacterial products, or metabolites, such as short-chain fatty acids or secondary bile acids, can modify tissue microenvironment into one that either inhibits or promotes tumor growth or development of other diseases. Also, Jiao and her colleagues are interested in

investigating how the unfavorable gut microbiome in individuals consuming a poor diet would respond to tailored dietary intervention using diet, pre- or probiotics, as previous studies have produced mixed results. Other factors, such as aging, genetics or certain medications, also influence the risk of disease but we cannot modify them,” Jiao

said. “Diet, on the other hand, can be modified and thus provides a strategy to develop a microbiome that promotes healthy living. We suggest that modifying the microbiome through diet may be a part of a plan to reduce the risk of chronic diseases.”

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Breast Cancer

Continued from page 1 can only be detected from screenings. According to the American Cancer Society, women who receive regular mammograms are more likely to detect cancer early, require less aggressive treatment, and have better outcomes. Women should have clinical breast exams at regular intervals depending on age. Physicians may recommend an MRI for some women. Confirmation and Identification If a suspicious area is found,

Legal Matters

Continued from page 3 Although the NPDB guidance provides important clarification for providers, it also leaves open several questions that have not been addressed by the NPDB and which require close factual scrutiny, including, but not limited to, the following: • Does the PEA allow the employer to notify the Hospital of the

Greengold

Continued from page 8 on improving product stability and customer satisfaction, reducing technician visits, improving subscriber retention, and enhancing the customer experience through employee training, journey redesigns and digital enhancements. Greengold joined Dish Network following successful

Aneurysm

Continued from page 8 with complex brain aneurysms in the Woodlands and surrounding areas,” said Jim Parisi, president of CHI St. Luke’s Health–The Woodlands Hospital. “It’s an incredible alternative to open surgery that often allows patients to go home

Breast Cancer

Continued from page 10 even when a physician believes the newer form of treatment will be the most effective. MBC patients typically don’t have this kind of time. Texas is October 2019

Houston Medical Times

additional tests can confirm if the area is benign or cancerous. Also, breast surgeons often perform procedures to collect tissue to determine if it is cancerous and identify the tumor characteristics. Tests on tissues from the tumor help in determining staging and identifying tumor markers. Tumor markers provide valuable insights to a patient’s care team, such as how aggressive a cancer is, most appropriate treatments, and whether it is responding to treatment. If a tumor is cancerous, breast surgeons consult with patients and their care teams about the best course

of treatment for the individual patient. More surgical options and techniques are now available to help patients make a very personal decision that is right for them. Ultimately, patients are their bodies’ best advocates, and it is important for women to actively take control of their health with regular preventative checks for breast cancer. Early detection is important, but with the myriad of treatment options available and more promising treatments on the horizon, we offer women ever greater hope for successful outcomes.

termination? • Is the termination of privileges under the bylaws automatic, or is it considered a separate resignation by the physician? • Does the automatic termination of privileges apply in all loss of employment situations, or only in for-cause terminations? The answer to each of these questions could have a decisive impact in how to handle the situation.

While each situation is unique and requires a careful review of the relevant medical staff bylaws, PEA, and facts involved in each matter, tying privileges to employment may provide an opportunity for hospitals to automatically terminate a physician’s privileges and membership without having to conduct a full-scale peer review investigation.

tenures at AOL, as a senior director, and Inverness Medical Innovations, a healthcare management company, in roles that focused on customer service and retention. “Memorial Hermann is clear about its mission to personalize the care experience of each patient,” Greengold said. “The goal is to search for the problem points of existing patients and discover solutions to fix them. We will put an emphasis on redesigning digital interactions to enhance the life and

journey of the patient. It’s important to explore both new and traditional avenues in creating the most welcoming environment possible for patients, families and visitors.” Greengold earned his undergraduate degree in business and political science from Florida State University. He earned his Master of Business Administration from the University of South Florida. Greengold and his wife, Brenda, have three children.

the next day.” In 2018, CHI St. Luke’s Heath— Baylor St. Luke’s Medical Center was the first in Texas to use the PulseRider, a neurovascular device used to treat patients with wide-neck bifurcation aneurysms. One year later, advancements have been made in the area and the hospital is again one of the first to begin using WEB.

Dr. Kan became the first neurointerventionalist to be certified to treat aneurysms using the WEB device in Texas, Louisiana, Mississippi, and Oklahoma. Dr. Johnson is a nationally recognized cerebrovascular and endovascular neurosurgeon and leads the only comprehensive stroke center in North Houston.

now one of 25 states to prohibit the use of step therapy protocols for advanced stage-four cancer or metastatic cancer. We aren’t stopping there. Among our current legislative priorities are expanding federal funding for biomedical research through the National Institutes for Health and

Department of Defense, increasing federal funding and clinical trials for MBC, and keeping therapies affordable for all breast cancer patients. RACE FOR THE CURE Saturday, October 5th, 2019

HOUSTON

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Houston Medical Times

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