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Defender Special Edition
EYE CARE:
Focus on good vision
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By MARILYN MARSHALL Defender
ealthy eyes are an important part of your well-being, and there are numerous things you can do to see your best. From getting regular eye exams to eating right to knowing your family eye health history, you can help maintain good vision for years to come. African-Americans should be especially diligent about eye care, since they are at higher risk for vision loss from certain eye diseases. Dr. Nancy Webb, an ophthalmologist and chief of Ophthalmology at Kelsey-Seybold Clinic, said there are three eye disorders in particular that impact Blacks.
GLAUCOMA
“There is a higher prevalence of glaucoma in African-Americans, especially after the age of 40,” Webb said. “A family history of glaucoma also increases your risk. In general, there are no symptoms with the most common form of glaucoma, which we call open angle glaucoma. “We call it ‘the thief in the night’ because one can be slowly and progressively losing peripheral vision and have no awareness of this visual loss,” Webb said. “There is no pain associated with it either.” Webb said screening of asymptomatic individuals is the key to diagnoses and prevention of vision loss. “We measure intraocular pressure, which is usually high at the time of diagnosis, but not always,” Webb said. “We also assess optic nerve appearance, visual field testing and corneal thickness to make a diagnosis of glaucoma. “Once we have diagnosed glaucoma, the
first line of treatment is eye drops to lower intraocular pressure. We sometimes use combinations of drops. When drops are not effective or not tolerated, we can do a laser procedure to control the pressure. We also have surgical alternatives when drops or laser do not achieve the desired pressure,” Webb said.
DIABETIC RETINOPATHY
Diabetes is one of the most serious health problems facing African-Americans, and diabetic retinopathy is a complication of uncontrolled diabetes. “The best way to treat diabetic retinopathy is to try to prevent it through tight blood sugar control and rigorous adherence to a diabetic diet,” Webb said. “Weight loss and exercise are also
10 VISION FACTS
important in controlling diabetes.” She said once diabetic retinopathy has been diagnosed, the treatment depends on the severity of the retinopathy. “Diabetes can affect the walls of the blood vessels in the retina. The walls can become weak and develop microaneurysms which can bleed and leak fluid. This is called background diabetic retinopathy and can respond well to laser,” she said. “If left untreated, this can lead to proliferative diabetic retinopathy, with fragile new vessels forming which can bleed, leading to scarring of the retina, bleeding into the vitreous, and in some cases, traction on the retina and retinal detachment. “Sometimes injections into the (transparent jellylike tissue filling the eyeball behind the lens) of medications which can prevent the development of these new vessels is helpful.”
1. An estimated 828,000 African-Americans have diabetic retinopathy.
2. More than 520,000 African-Americans have glaucoma. 3. Approximately 14 million individuals 12 and older have visual impairment, among which more than 80 percent could be corrected.
4. Approximsately 6.8 percent of U.S. children under 18 have a diagnosed vision condition.
5. An estimated 61 million U.S. adults are at high risk for serious vision loss, but only half visited an eye doctor in the past 12 months.
6. More than 1.2 million people 40 and older are legally blind. 7. The annual economic impact of major vision problems among adults 40 and older is more than $51 billion.
8. Vision disability is one of the top 10 disabilities among adults
18 and older and one of the most prevalent disabling conditions among children. 9. Vision loss causes a substantial social and economic toll for millions of people, including disability, loss of productivity and diminished quality of life. 10. Nearly 25.7 million Americans 40 and older have cataracts. Sources: National Institute of Health, CDC, Prevent Blindness
CATARACT
Webb said cataracts are prevalent in AfricanAmericans, and diabetics also have a higher incidence of cataract, especially with poorly controlled diabetes. “Cataract is a clouding of the natural lens of the eye,” she said. “It may or may not be severe enough to be visually significant. If a patient does have a visually significant cataract, surgery with cataract extraction and replacement of the cloudy lens with an artificial lens is highly successful and done as a day surgery procedure.” Web said symptoms include blurred vision, problems in glare situations such as driving at night and problems from oncoming headlights, problems with glare from the sun and fuzzy vision when reading. According to the National Eye Institute, by age 80, more than half of all Americans either have a cataract or have had cataract surgery. The symptoms of early cataract may be improved with new eyeglasses, brighter lighting, anti-glare sunglasses, or magnifying lenses. If these measures do not help, surgery is the only effective treatment.
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health
Things to know about
eye cancer
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By MARILYN MARSHALL Defender
ancer of the eye is rare, but it is still a serious disease that can impact a patient’s vision and more. Here are things to know about eye cancer from Dr. Dan Gombos, M.D., a professor in the Department of Head and Neck Surgery at MD Anderson Cancer Center, and clinical co-director of the Retinoblastoma Center of Houston. • The most common eye cancer is actually metastatic, spreading from the place where it first started to another place in the body. Breast, lung and gastrointestinal cancer are the most common cancers that spread to the eye, usually in more advanced stages. “If a woman has breast cancer and it’s early stage one, it’s very unlikely to involve the eyes or the brain,” Gombos said. “If you wait until it’s more advanced then you’re putting yourself in a situation where either the eye itself is directly involved or the brain and the visual areas of the brain might become involved.” • The most common cancer that develops in the eye is uveal or ocular melanoma. “Fortunately for AfricanAmericans, rates of those cancers are much lower,”
Gombos said. Whites are most at risk for ocular melanoma, and Gombos said when it is found in African-American patients, they are usually of mixed heritage. “African-Americans also have lower rates of nevi,” which are birthmarks in the back of the eye,” he said. • Retinoblastoma is a rare cancer that involves children, most often infants ages 1 to 2. “The key finding is a white reflex,” Gombos said. “Normally when you take a picture of the eye you get that red look. People try to edit it out, but that represents a healthy retina. If you get a white reflex that is always abnormal. “There are other things that can cause a white reflex, such as a cataract or anomaly in the back of the eye. Whenever you see it, however, bring it to the attention of a pediatrician and hopefully a pediatric ophthalmologist. In rare instances it can be potentially fatal,” Gombos said. “If a parent has a history of retinoblastoma, they must let us know, because there’s a risk in some families that the gene that causes it might be passed along to the child. Fortunately, this is a malignancy we are able to cure in most instances, but if we don’t get to it early enough a child can lose vision,” he said.
Inside Eye disorders in children 3B Texas Children’s Hospital
Hurricane preparedness 4B Best practices for correcting vision 6B Eye care do’s and don’ts 6B MD Anderson Cancer Center
Take action to reduce cancer risk 8B Memorial Hermann
Addressing mental health needs 10B Kelsey-Seybold Clinic
Type 2 diabetes skyrockets among youth 12B
Message from the Publisher
Sonceria Messiah-Jiles
It’s often said that the eyes are “the window to the soul,” but they’re much more than that. For those of us who have our sight, it shapes our entire world. The Defender is proud to bring you another special health edition, this time focusing on eye care. We cover everything from disorders affecting children to glasses vs. contacts. You will also find important information from our partners – Kelsey-Seybold Clinic, MD Anderson Cancer Center, Memorial Hermann Health System and Texas Children’s Hospital. According to the federal government’s National Eye Institute, there are more steps you can take to keep your eyes healthy.
1. Get regular eye exams. By visiting your eye care professional for a comprehensive dilated eye exam, you can see if you need glasses or a new prescription, or discover if you have an eye disease. 2. Know your family’s eye health history. It’s important to know if a family member has been diagnosed with a disease or condition, since many are hereditary. 3. Maintain a healthy weight. As African-Americans, so many of our health problems are caused by obesity. Being overweight increases your risk of developing diabetes and other systemic conditions, which can lead to vision problems. We often take our sight for granted. Take some time to focus on your eyes.
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Eye disorders in children
Early and accurate detection of eye disorders in children can be challenging. Screening is usually done by the pediatrician and family physicians. However, it can be difficult for primary care physicians since many young children may not be willing to participate in the screening process and some diagnoses are complex. Some eye disorders in children must be diagnosed in an early age to prevent permanent vision loss. The involvement of pediatric ophthalmologists is important since they have specialized training, expertise and examination equipment. Here are three of the most common childhood eye disorders from Dr. Honey Herce, pediatric ophthalmologist at Texas Children’s Hospital.
AMBLYOPIA (LAZY EYE)
that can begin during preschool years. This can be difficult to diagnose since the deviation may not be evident unless the child is looking at something far away. Other symptoms can be that the child closes one eye on bright days may also be describing an intermittent exotropia. Treatment can include observation (if rarely occurring), glasses, alternate patching or surgery. Hypertropia or hypotropia can be due to a palsy or weakness of one of the nerves controlling the eye muscle. This can be difficult to diagnose and may be found with a tilting of the head to the side of the palsy. Any acquired deviations (sudden eye extreme eye crossing of one eye, etc.) should raise suspicion for a specific cranial nerve palsy (nerves affecting the eye muscles) that can be an early sign of an underlying neurologic disorder. can be in the form of glasses or contact lenses. If there is no strabismus (eye misalignment) and the vision is still poor with the appropriate glasses, occlusion therapy or patching of the normal eye may be needed. In children with strabismus, surgery may be needed. In children with deprivation amblyopia due to cataracts, surgery is needed.
It is a reduced vision in the eye that is not directly attributable to any structural abnormality of the eye or visual pathway. It has a prevalence of about 2 percent in the population, making it the most common cause of uncorrectable loss of vision in children. If diagnosed early (usually by preschool age), it can be treated well and many patients can regain STRABISMUS (CROSS EYES) their vision. However, if not found until later, (age 9 This is a misalignment of the eyes that can be to 10), amblyopia becomes constant or intermittent, more difficult to treat and or can be a small or large can result in permanent videviation. It is estimated sion loss. Learn about red eye & leukocoria that 4 percent of the U.S. There are three major on Friday, July 17 population has strabiscauses of amblyopia, each mus. with its own special diagnoDifferent types of sis and problem. strabismus can be due to a glasses problem or an It can be due to strabismus (misalignment of the eye muscle problem. Eye crossing usually begins at eyes), the most common type of amblyopia; refraca young age (2 to 7) but can be seen as young as 6 tive error (need for glasses), the most difficult type months of age. to detect; or a disruption of light passing through the Because of their high refractive state, these chileye (deprivation amblyopia), the most severe type in dren are forced to focus excessively and it induces an terms of loss of vision. eye crossing. Treatment with eyeglasses and someTreatment of amblyopia depends on the cause. It times bifocals is needed to align the eyes. begins with the appropriate optical correction, which Exotropia is typically an intermittent deviation
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EPIPHORA (EXCESSIVE TEARS)
Excessive tearing is a common pediatric problem. Childhood epiphora that is noted soon after birth can be due to a blockage of the tear drainage system. Tear duct obstruction is the most common cause of childhood epiphora, occurring in over 5 percent of infants in one or both eyes. Tear duct obstructions prevent the tears from draining through the system normally. This type of tearing often improves spontaneously by 6 to 12 months of age in 90 percent of patients. The signs and symptoms of a nasolacrimal duct obstruction include tears welling up on the surface of the eye and overflowing on the eyelashes, eyelids and down the cheek. The eyelids can become red and swollen and can sometimes be stuck together with yellowish green discharge. Medical treatment includes tear sac massages and antibiotic eye drops for any signs of infection. However, if the tearing persist after 1 year of age, surgical probing of the drainage system may be required. Other conditions that can cause epiphora should also be evaluated for, including glaucoma, uveitis (inflammation in the eye) or a foreign body in the eye.
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health
Hurricane preparedness 101
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ith the start of another hurricane season it is important families, especially in the GulfCoast region, are prepared for any potential storms that may impact our area this year. There are a number of precautions you can take now to ensure you and your family have the necessary plans and equipment in case of an emergency. “During and after a hurricane, you may need supplies to keep your family safe and healthy,” says Shelly Lopez Gray, a clinical nurse coordinator at Texas Children’s Pavilion for Women. “Remember that a hurricane could cut off your power and water supply. You also may not be able to drive because of damage to your car. Roads may be flooded or blocked.” If a hurricane is likely in your area, consider doing the following: • Listen to the radio or TV for information. • Secure your home, close storm shutters and secure outdoor objects or bring them indoors. • Turn off utilities if instructed to do so. Otherwise, turn the refrigerator thermostat to its coldest setting and keep its doors closed. • Turn off propane tanks. • Avoid using the phone, except for serious emergencies. • Ensure a supply of water for sanitary purpose such as cleaning and flushing toilets. Fill the bathtub and other larger containers with water. • Find out how to keep food safe during and after an emergency. For information on infant nutrition during
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healthnotes Hurricane season
Tips for expectant moms and families As hurricane season is underway, it’s important to remind yourself what to do in case an emergency occurs. It’s even more important to consider your options if you’re expecting or have small children in your family. Below are some tips from Shelly Lopez Gray, a clinical nurse coordinator at Texas Children’s Pavilion for Women.
For families
a disaster, visit https://adventuresofalabornurse.files. wordpress.com/2014/07/infant-nutrition-during-a-disaster.pdf. You should evacuate under the following conditions: • If you are directed by local authorities to do so. Be sure to follow their instructions. • If you live in a mobile home or temporary structure since these are particularly hazardous during hurricanes, no matter how well they are fastened to the ground. • If you live in a high-rise building since hurricane winds are stronger at higher elevations. • If you live on the coast, on a floodplain, near a river or on an island waterway. After hurricane After a disaster, let your family and friends know you are safe! You can do so by registering yourself as “Safe and Well” with the American Red Cross. Concerned family and friends can search the list of those who have registered themselves as “safe and well.” The disaster distress helpline provides 24/7, year-round crisis counseling and support by calling 1-800-985-5990.
Start by creating a family communication plan and make sure everyone in your immediate family knows what your plan is. Having a communication plan is essential as it helps each member in your family know how to get in touch with one another during an emergency. Here’s how you can create yours: • Family communication plan –Visit the FEMA website – ready.gov – to get a copy of this. Fill it in and keep a copy in a safe place. • Let’s get ready! – A “Sesame Street” workshop provides tips, activities and other easy tools to help the whole family prepare for emergencies. Visit sesamestreet.org. • Be a hero – Visit ready.gov/kids. Here, your children can help make a plan, build a kit and get involved with planning.
If you’re expecting Pregnant women should take additional precautions during hurricane season as they are more vulnerable during a disaster. In the event you evacuate, you should seek prenatal care, even if it’s not with your regular doctor. It is very important to realize you may deliver at an alternate hospital or birthing facility. Think about where you would deliver in the event of road closures or if you are instructed to evacuate, especially if you’re close to your delivery date. Here are some suggestions to stay prepared: • Have a copy of your most up-to-date prenatal records. • Keep a copy of your immunizations, and the immunization records of your children, with you. • Have the names and numbers of physicians or hospitals at your planned evacuation location.
Dangers of leaving kids in hot cars It is mid-summer and temperatures are continuing to climb in Houston. It’s become so hot outside you could fry an egg on the sidewalk! During the summer kids are out of school, families take vacations and routines change. As a result, children are being seriously injured or dying from being left in a hot car. A child’s body heats up three to five times faster than an adult’s and can’t regulate heat in the same way causing damage that is more severe over a shorter period of time. Remember, if you see a child alone in a vehicle, take action and call 911. “Unfortunately, this happens almost every day across the United States and Texas typically experiences a vast
majority,” said Kristen Beckworth, manager of the Center for Childhood Injury Prevention at Texas Children’s Hospital. “So far this year, eight children in the U.S. have died due to heat stroke from being left in a hot car.” This tragedy can be prevented, though. There are simple tactics families can practice to ensure children are kept safe in the hot summer sun. For example, leave your cell phone or purse in the back seat with your child to remember to take out all of your belongings when exiting the car. You also can set an alarm or a reminder on your cell phone to go off when you know you’re going to reach your destination.
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Texas Children’s Health Plan covers children from newborns to teenagers. We even cover adults and pregnant moms through STAR Medicaid. Families with children who qualify for CHIP pay $50 or less a year. Those who qualify for Medicaid pay nothing. CHIP and STAR Medicaid offer a wide range of benefits including checkups and shots, dental services, medications, and more. With Texas Children’s Health Plan you also get: ■
Over 2,100 doctors.
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A 24-hour nurse hotline.
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Transportation to doctor visits at no cost.
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Pregnancy support program and classes.
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Help losing weight through the Keep Fit Program.
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Learn how to play soccer from the Houston Dynamo coaches.
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Fun, free member events!
For more information, to receive an application, or to find an event in your
MK-1208-007
area, visit us online or call today.
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BEST PRACTICES FOR
CORRECTING EYESIGHT By ASWAD WALKER Defender
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ith the litany of health issues befalling African-Americans, eye care often gets neglected. But statistics suggest taking steps to care for and correct eyesight should become a priority. According to the National Center for Health Statistics, at least 2.6 million African-Americans 18 years and over suffer from vision loss (blindness or trouble seeing even when wearing glasses or contacts). The most common steps taken to correct eyesight – glasses and contact lenses – usually come down to personal preference, according to ophthalmologists. Lasik, and other refractive surgeries – procedures used to improve the refractive state of the eye and decrease or eliminate dependency on glasses or contact lenses – are growing in popularity. “Before deciding between contacts and glasses, keep in mind that one is not necessarily better than the other; each has its pros and cons,” said Dr. Nancy Webb, M.D., chief of Ophthalmology at Kelsey-Seybold Clinic. According to Webb, glasses offer many benefits over contact lenses, including requiring less cleaning and maintenance, and no eye touching (decreasing the risk of eye infections), and being cheaper in the long run since they don’t need to be replaced as often. Webb said because contacts sit directly on the eye, vision, particularly peripheral vision, is unobstructed allowing for freer participation in sports and outdoor activities without fear of eyeglasses falling off or breaking. Dr. Garvin Davis, M.D., an ophthalmologist with the Robert Cizik Eye Clinic (an affiliate of Memorial Hermann), specializes in retina surgery and personally prefers glasses out of all corrective options. “Glasses protect the eyes from accidents we see all the time,” Davis said. “We have one of the busiest trauma centers in the nation and see many strange accidents including weed whackers
cente
hitting the eyes.” Davis also discussed eyeglasses’ No. 1 competitor. “Contacts are my least favorite. They put your eyes at risk because people often abuse them. It’s clear there is a social misunderstanding of how they work,” said Davis, who noted that contacts offer sharper and better vision, without shrinking the image as glasses do.
PROS & CONS
Webb and Davis gave pros and sons of refractive surgery. “I’m not personally a fan of Lasik,” Webb said, “as it takes a normal cornea and reshapes it to an abnormal shape which makes it difficult to determine the proper strength for an intros ocular lens when these individuals later need cataract surgery, as well as often causing dry eye. Davis offered another view. “There are benefits to refractive surgeries. You don’t need glasses anymore. There are no contacts popping out which can be dangerous in certain professions,” said Davis who acknowledged there are always small risks whenever there is surgery. If going the surgical route, Webb doesn’t recommend bargain shopping, but rather going to a center respected for its work. “If you want to have Lasik go to a respected center like Baylor College of Medicine to get an honest opinion on whether you are a good candidate for a successful outcome. Don’t go to the place advertising a low price in the newspaper.” Webb and Davis also shed light on vision myths. “Though some say otherwise, over the counter reading glasses are just fine,” Webb said. “And reading in dim light, contrary to what your mom told you, does no harm.” Davis mentioned the danger of believing eyes heal themselves over time. “Delays in evaluating your eyes lead to more issues and problems,” he said. Both Webb and Davis emphasize the need to have annual eye exams after age 40, particularly for issues that impact Blacks more than others. “In the Black community, glaucoma is the leading causes of blindness,” Davis said. “It’s
silent, going largely under-recognized and under-detected. Blacks have a much higher rate of developing glaucoma than others, and are less likely to have the health care to detect it.” Risk factors for glaucoma include a family history of glaucoma, being Black, and having diabetes, the leading cause of preventable blindness. “Diabetes is the third leading cause of blindness in the western world because patients don’t follow up, don’t see their ophthalmologist, and don’t take care of their diabetes,” Davis said. “What’s exciting to me is, if you have glaucoma or diabetes and recognize it early, we can keep you seeing for the rest of your life. It’s all about control and follow-up.”
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Eye care do’s & don’ts Do
• Eat eye-friendly foods: fruits and vegetables, especially dark, leafy greens and carrots; and fish high in omega-3 fatty acids. • Wear protective eyewear for sports and hobbies with flying objects. • Wash your hands often, especially before handling contacts or glasses. • Rest your eyes, closing them when possible. If you can, take breaks every 20 minutes. • Get a yearly eye examination, checking especially for glaucoma. • Remove glasses or contact lenses before swimming or entering a hot tub. • Follow the recommended contact lens replacement schedule prescribed by your optometrist. • Store lenses or glasses in their proper storage case and replace the case at least every three months. • Use only fresh solution to clean and store contact lenses. • Clean glasses or contacts regularly and carefully. • Wear sunglasses with 100 percent UV protection. Cataract formation probably is aggravated by sun exposure.
Don’t
• Stare at the sun and other bright lights, including laser pointers. • Share your lenses with others. • Touch your fingers to your eyes after shaking hands with someone. • Stare too long at computer screens and TVs. • Use tap water to wash or store contact lenses or lens cases. • Use homemade saline solutions. There are multiple reports of such solutions causing serious eye damage. • Put contact lenses in your mouth or moisten them with saliva, which is full of bacteria and can cause an infection. • Run with scissors, or any sharp objects that could potentially poke your eyes. • Smoke, since smoking is a major risk factor for macular degeneration which can have a devastating effect on vision. • Use certain drops marketed for red eyes. They have a rebound phenomenon which results in more frequent use with diminishing returns. Sources: Dr. Nancy Webb, Dr. Monroe Benaim, American Optometric Association
About eye care professionals
ogist – A physician who specializes d surgical care of the eyes and visual ntion of eye disease and injury. An has completed at least four years of ducation, four years of medical school, ship and three years of residency. An can deliver total eye care, including viexams and diagnoses.
Optometrist – A health service provider educated and trained by an accredited optometry college in a four-year course, but has not attended medical school. They are licensed to examine the eyes, determine vision problems, and prescribe glasses, contact lenses and eye exercises. Some states permit optometrists to give limited treatments of certain eye conditions. Optician – A technician who makes, verifies and
ng the Houston area for over 80 years
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delivers lenses, frames and other optical devices upon prescription. Functions include prescription analysis and interpretation, determination of lens forms, and adjustment, replacement and repair. Training requirements vary, with some community colleges and technical schools offering associate’s degrees. Source: American Academy of Ophthalmology
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Take action now to reduce cancer risk By MD ANDERSON CANCER CENTER
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ore than two-thirds of cancer cases are preventable through healthy lifestyle behaviors. At the University of Texas MD Anderson Cancer Center, it’s our mission to provide the latest, easy-to-understand information to help you stay on top of your health and lower your cancer risk. These health tips can get you started.
Eat healthy
Stress can make you desire foods high in fat, carbohydrates and sugar. Instead, eat more plant proteins, like vegetables, nuts, beans, fruits and whole grains. You’ll get important nutrients to restore your energy levels. Plus, it’ll help you maintain a healthy weight, which lowers your cancer risks.
Try this
• Prepare your own meals using whole foods, such as fresh fruits and vegetables. • Fill three-quarters of your plate with plant-based foods. • Eliminate sweetened beverages like sodas and sports drinks. • Avoid high-calorie, low-nutrient foods such as chips, candy, fast food and crackers. • Drink more water. • Limit salt intake.
Exercise regularly
It’s tempting to forgo exercise when you’re tired, but resist the urge. The feel-good chemicals released during exercise can help ease anxiety. You should aim for at least two-and-a-half hours of moderate physical activity, or 75 minutes of more vigorous physical activity each week. Long-term weight control can help lower your risk of getting cancer. Fat cells produce hormones and other chemicals that alter your immune system and hurt your body’s ability to stop or slow the spread of cancer.
Try this
• Make a plan. At the beginning of the week choose the days and times you plan to exercise. A plan helps make exercise part of your lifestyle, not just a New Year’s resolution. • Exercise at least three times a week. • Aim for 150 minutes of moderate physical activity or 75 minutes of more vigorous physical activity each week. • Exercise in the morning. The ideal time of day to exercise is when you have the most energy. For most people, this is early in the morning or before 10 a.m. • Include strength training, but limit to two or three days each week. Your muscles need time to recover. • Choose the right fuel. What you eat before and after you exercise can boost your results and energy level. Two to four hours before exercising, choose complex carbohydrates. And, drink lots of water.
Get some sleep
Troubled by restless nights? You’re not alone. Nearly 62 percent of American adults experience problems sleeping a few nights each week. Lack of sleep can cause moodiness and difficulty thinking, focusing and remembering. Chronic sleep loss also may lead to weight gain, high blood pressure and a weakened immune system. Several studies also show that people who regularly having trouble sleeping may be at a higher risk of developing cancer.
Until more is known, getting a good night’s rest should be a priority. Most adults should aim for seven to eight hours of sleep each night. If you feel sleepy or groggy, you may not be getting enough sleep.
Try this
• Keep to a sleep schedule. Go to bed at the same time and wake up at the same time. • Create a bedtime routine. Do the same relaxing activity every night before bedtime, like take a bath, read or listen to music. • Limit caffeine and do not use nicotine. Caffeine and nicotine are stimulants that interfere with sleep. Limit caffeine intake to less than two servings per day, and try not to consume caffeine after noon. • Avoid alcohol. While it may induce sleep, alcohol
interferes with sleep during the night. It’s best to stop drinking alcohol four to six hours before bedtime. • Keep naps short. During the day, you build up a “sleep debt” that helps you fall asleep at night. Long daytime naps may interfere with your night sleep. • Use your bedroom for sleep only. Try not to eat or watch TV in bed. Limit the use of electronics – laptops, cellphones or tablets – in bed. Make sure your bedroom is dark, quiet and cool There’s never a bad time to make a change for the better. You can reduce your risk for cancer by eating a healthy diet, being physically active, protecting your skin, avoiding tobacco and getting screened and vaccinated. The healthy choices you make today will have a lasting impact on your health and quality of life. Learn more about what you can do to reduce your risk for cancer.
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“I beat you, cancer” Sonia Byrd | Cancer Survivor With teams of experts working across our vast community, MD Anderson has a determination to defeat cancer that has never been stronger. To learn more, call 1-855-894-0145 or visit MakingCancerHistory.com.
Ranked one of the leading hospitals in the nation for cancer care in the America’s Best Hospitals survey published by U.S. News & World Report for 26 years.
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Memorial Hermann addressing mental health in the Houston region
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These clinics are not designed to provide continuous outpatient follow-up for mental health needs; rather, they serve as a part of the mental health safety net as an alternative to expensive emergency room visits. Clinicians work with patients needing immediate access to psychiatric services, and refer them to the Psychiatric Response Team case managers and other community agencies as appropriate. To assist outpatient follow-up, the clinic staff helps patients establish an appointment with an outpatient provider or directs them to resources and referrals. These clinics promote better health outcomes for patients with mental health treatment needs, decrease unnecessary emergency room visits, and decrease inpatient hospitalizations and incarcerations due to noncompliance with mental health treatment plans.
By MEMORIAL HERMANN
n Harris County, 36.8 percent of all patients given a primary diagnosis of a mental health disorder in the ER were uninsured in 2013. According to the Mental Health and Mental Retardation Authority of Harris County (MHMRA), the high rate of uninsured residents in Harris County has resulted in many untreated mental health illnesses. With a shortage of psychiatric facilities, coupled with a lack of financial resources, both insured and uninsured patients seek treatment from emergency room physicians and clinical staff untrained in psychiatry. These patients often experience long wait times while emergency personnel attend to others with more pressing physical needs. Additionally, patients visiting Houston emergency rooms with a primary diagnosis of mental health conditions are 3.4 times more likely to be hospitalized following the emergency room visit compared to persons with a primary diagnosis unrelated to behavioral health. In response to the community need, Memorial Hermann’s dynamic mental health services include the Psychiatric Response Team and Case Managers, Mental Health Crisis Clinics and Home Behavioral Health Services Program. These innovative programs are staffed with professionals with the expertise needed to provide appropriate care and ongoing support for mental health patients, both inside hospitals and in the community.
Home Behavioral Health Services
Psychiatric Response Team
Since 2000, on call 24 hours a day, the Psychiatric Response Team has worked across the Memorial Hermann Health System to provide mental health expertise to all acute care campuses, delivering care to the emergency rooms and inpatient units. The team is composed of master’s-level licensed clinicians and responds to all patients with behavioral health needs, ranging from depression and psychosis to chemical dependency. The clinicians evaluate, stabilize, arrange for transfer and develop aftercare plans for patients. A coordinated communitywide effort, the team refers patients to more than 200 mental health community treatment providers within Harris, Fort Bend and Montgomery counties. This large referral network allows the program to leverage the mental health community’s resourced patients to obtain care for non-resourced patients; patients are seen
regardless of ability to pay. No longer is it one ER/nurse/ physician competing with the rest of the ERs for a limited amount of psychiatric resources.
Mental Health Crisis Clinics
After identifying Humble and Spring Branch as having the highest clusters of chronic mental health issues, in 2014 Memorial Hermann opened two Mental Health Crisis Clinics to respond to each community’s significant gap in mental and behavioral health services. These clinics operate as “urgent care” mental health service providers for individuals in crisis situations.
Patients with behavioral health issues in addition to medical conditions have few options for treatment. Facilities that treat mental or behavioral issues will not accept patients with existing medical conditions such as feeding tubes, pregnancy, cardiac disorders and other conditions. Alternatively, hospitals and outpatient clinics that provide care for medical treatment do not offer services to treat mental health issues. With few to no resources available in the community, coupled with the high cost of treatment, most patients fall through the cracks of the healthcare system and seek treatment only through emergency rooms when their behavioral issue worsens. The Home Behavioral Health Services Program is a team of specialty nurses and social workers who help patients with medical conditions and behavioral issues in their homes. Treatment offerings include developing coping skills, medication compliance, disease management education, and help with accessing resources such as transportation and medications. Team members also work collaboratively with other established mental health programs such as the Memorial Hermann Crisis Clinics and Case Management programs. Referrals are made from case managers in emergency rooms, hospital intake departments, physician offices, community clinics and home health staff, who often determine if patients currently receiving medical treatment are in need of behavioral or mental health services as well. Patients with and without resources are accepted, and services are available 24 hours a day, seven days a week. The project’s goal is to reduce emergency room visits by patients whose behavioral issues can be managed within the community setting.
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JULY 16 | 2015 | DEFENDER
FEELING SICK BUT NOT SURE WHAT TO DO? SPEAK WITH A REGISTERED NURSE FOR ANSWERS TO YOUR HEALTH QUESTIONS. When you or a family member is feeling sick, but you’re not sure if you need to see your doctor or go to the hospital, call the free Nurse Health Line. Experienced nurses will help you decide when and where to go for medical care. These trained nurses are available around the clock, seven days a week to answer your health questions by phone. Anyone living in Harris or the surrounding counties can use this free service. Funded through the Centers for Medicare & Medicaid Services and the Texas Health and Human Services Commission.
Free 24/7 Nurse Health Line 713.338.7979 (Toll-Free) 1.855.577.7979 Individuals with life-threatening conditions and emergencies should call 9-1-1.
sponsored by Memorial Hermann Community Benefits Corporation
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DEFENDER | JULY 16 | 2015
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health
Type 2 diabetes skyrockets among kids, teens By TRACY CARTER, M.D.
O
nce a medical rarity, children with adult diabetes are becoming common. Boys and girls who range from chubby to obese are being diagnosed in increasing numbers with Type 2 diabetes. Most are barely into their teens. Some are as young as 6.
Is your child at risk?
African-American children are especially vulnerable. A study by the Centers for Disease Control and Prevention (CDC) determined that African-American and His- Tracy Carter, M.D. panic kids have a 50 percent chance of developing diabetes compared to the 40 percent chance that Americans have overall. In Type 2 diabetes, the cells in your child’s body don’t respond normally to the insulin produced by the pancreas, and glucose builds up in the bloodstream. This is called insulin resistance. Eventually, the sugar levels get too high for the body to handle. That could lead to other conditions in the future, like heart disease, blindness and kidney failure. Type 2 diabetes most often affects kids who are girls,
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W A Y S
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overweight, have a family history of diabetes, and are Native American, AfricanAmerican, Asian or Hispanic. Diabetes and its complications can take a toll on life expectancy when untreated. Diabetics diagnosed before the age of 15 have a life expectancy 17 years shorter than those who develop the condition when they are older – and 27 years shorter than that of non-diabetics. And the problem is growing worse. By 2050, the number of teen diabetics will increase by nearly 50 percent to more than 84,000, according to a 2012 study by the CDC in the journal Diabetes Care. There’s no definitive cause for the rise in Type 2 diabetes among children. As with adults, obesity, poor diet and a sedentary lifestyle are contributing factors. According to the American Diabetes Association, children born to parents with Type 2 diabetes are more likely to develop the disease than those with non-diabetic parents. Some children who have Type 2 diabetes have no signs or symptoms. Others experience:
C O N Q U E R
• Increased thirst and urination. • Increased hunger. • Fatigue. • Blurred vision. • Slow healing sores or frequent infections. • Areas of darkened skin, often in the armpits or neck. • Unexplained weight loss.
Tips to help prevent diabetes
To help avoid Type 2 diabetes, children should: • Eat portion-controlled, healthy food choices. • Be active, every day if possible. • Maintain a healthy weight. • Have regular physical exams. Have your child regularly checked by a pediatrician. Simple blood tests can identify diabetes. Ask about lifestyle strategies and medical options for managing or avoiding this disease. And set a good example for your children by committing to a healthy lifestyle. Dr. Carter is board-certified in Pediatrics and Internal Medicine and sees patients at Kelsey-Seybold Clinic –The Vintage. Her clinical interests include adolescent medicine. To schedule an appointment, call 713-442-0000.
C A N C E R
Exceptional Cancer Care Just Got Even Better In our beautiful new facility, everything is under one roof – from our connected team of experts to state-of-the-art technology for radiation therapy.
Kelsey-Seybold’s nationally accredited Cancer Center is focused on not only treating patients, but on providing personal, coordinated care that encourages healing. Now, with state-of-the-art technology for radiation therapy and our beautiful and spacious facilities, we’re better equipped than ever to help our patients be victorious over cancer. It’s just one more way our exceptional cancer care has gotten even better.
Kelsey-Seybold.com/CancerCenter | 713-442-1080
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