Hawaii Filipino Chronicle Supplement Edition - May 6, 2023

The U.S. Has A Mental Health Crisis Linked to Social Media

ARTICLES INSIDE

COVID Ain’t Over Yet: New Variants Keep EmergingS3

The Growing Social Media Health Crisis: Who’s Most Affected and How to Avoid Negativity and AddictionS4

DiverticulitisS6

The Weighty Issue of ObesityS7

Filipino Pride: Jessica Cox is the World’s First Armless PilotS8

What You Need To Know About ShinglesS9

Mom Fell And Broke Her Hip – Now What?S11

What You Should Know About Diabetic RetinopathyS13

Jump Start Your Spring with Tips for a Healthy Household S14

Q & A with The National Asian Pacific Center On AgingS15

The presence of mental health illness among young adults and adolescents is startling. The Centers for Disease Control and Prevention’s Youth Risk Behavior Survey shows persistent sadness, hopelessness, depression, loneliness and suicide ideation among high schoolers are common and pervasive – close to 30%. Ample research also shows that excessive social media use can contribute to poor mental health.

Politicians like Hawaii’s own Sen. Brian Schatz are not only making the link between excessive social media practices and poor mental health, but they’ve also introduced age-requirement legislation to access social media to deal with this modern health crisis.

Clearly, not all social media users become addicted to it and there are abundant benefits to social media. For our supplement cover story, we explore this healthy balance, go over the warning signs when addiction and negativity are taking over, and provide tips from experts on healthy social media usage. Make no mistake: social media is here to stay as a technological and cultural expression. Now with over 3 billion users worldwide and growing, the crossroads of where we’re at is to make that transition from embracing social media as a modern communication form to living with social media as only one form of healthy communication. Story on S4

COVID Ain’t Over Yet: New Variants Keep Emerging

By HFC Staff

In 2020, the world halted when the pandemic hit caused by COVID-19, an infectious illness of the SARS-CoV-2 virus.

With almost two years of various degrees of lockdown, quarantine and extreme safety protocols, and the discovery of the COVID vaccine, the world has been slowly opening itself to get everyone safely back to normal and enjoying life as we know it pre-pandemic.

However, the COVID pandemic is not over yet. New variants have emerged from the original COVID virus.

According to Yale Medicine, new variants emerging are a part of the virus evolution. It’s important for the scientific community to monitor these variants to ensure that the world is prepared when a new variant is more severe than the original strain of the virus.

When we talk of variants, it’s helpful to visualize them

as branches in a tree as they sprout from the main trunk and into several branches. Since the outbreak, we have learned of numerous COVID-19 variants such as Alpha, Beta, Delta and especially, Omicron.

There have been several strains or subvariants that emerged from Omicron such as BA.5, BQ.1 and BQ.1.1, according to Yale Medicine. Just recently, XBB.1.5 emerged in January of this year. By April, another Omicron subvariant, XBB.1.16, was announced to be a “variant of interest” by the World Health Organization. In social media, the subvariant is called “Arcturus.”

First detected in India, Arcturus is now in the U.S. with a steady rise in cases with less than 10% of new confirmed COVID cases as of April 22, according to the Centers for Disease Control and Prevention.

According to experts, the subvariant is spreading fast because it avoids immune de-

tection in the body. However, it is not yet confirmed if this will lead to severe cases.

In a Washington Post interview, Paul Hunter, a professor of medicine at the University of East Anglia in Britain said: “We’ve seen this in the past. You look at the virus and it’s got mutations that should make it more virulent, but then in reality, you don’t see that.”

“It will probably become the dominant variant for a while in the US and Europe and more countries around the world, but I don’t see it driving up severe infections

more than we’ve seen in recent waves,” he added.

Despite the low chances of COVID waves, it is still important to follow safety protocols and keep updated with the COVID vaccination.

Keep your distance. In the early days of the lockdown, the six-feet-apart rule was strictly implemented by the government. Even though this rule is now lifted or less imposed, it is still a great practice to maintain a distance from others.

Wear a mask. If social distancing is not possible, don’t hesitate to wear a mask. Masks should be properly fitted and cover your nose, mouth and chin.

Step outside or open a window. Ventilation is key to lessen the spread of the virus. Keep air flowing to ensure spaces are well-ventilated. If indoors, open windows. If outdoors, make sure to get out of the crowd to keep yourself well-ventilated.

Wash hands with soap

and water. Ensure that you are washing and massaging every corner of your hands to keep them clean and sanitized to prevent the spread and transmission of the virus. Use alcohol or hand sanitizer. When handwashing is not possible, regularly sanitize your hand when you’re out and about. Moreover, you can also use your handy-dandy alcohol spray to sanitize areas you will be spending time on. For example, you can spray the table and chairs before dining at a food court. Stay at home if you feel unwell. If you are feeling sick, stay at home, isolate, and monitor yourself until you recover. If you suspect you are experiencing COVID symptoms, contact your doctor for a telehealth check-up. Get vaccinated. When a vaccine is available to you, get the vaccine shot. After receiving the initial COVID vaccine, booster shots are available for added protection and immunization.

The Growing Social Media Health Crisis: Who’s Most Affected and How to Avoid Negativity and Addiction

By Edwin Quinabo

Social media has been around long enough that its harmful effects are well documented by researchers. Poor mental health linked to social media among adolescents has become a real health crisis, researchers say.

The Centers for Disease Control and Prevention’s Youth Risk Behavior Survey found that 57% of high school girls and 29% of high school boys felt persistently sad or hopeless in 2021, with 22% of all high school students reporting they had seriously considered attempting suicide in the preceding year.

Researchers also found that the more time youth spend online, the likelihood increases for poor mental health.

Given this serious public health problem, is it time for the U.S. government to establish a minimum age for using social media like it does for cigarettes and alcohol?

Sen. Brian Schatz (D) thinks that time has come. The Hawaii senator recently co-sponsored and introduced bipartisan legislation that could prohibit users who are under age 13 from accessing social media platforms.

The legislation, called the Protecting Kids on Social Media Act, would also require parental consent for 13 through 17-year-olds and prevent social media companies from feeding content using algorithms to users under the age of 18.

Schatz and co-sponsors Sens. Tom Cotton (R-Ark), Chris Murphy (D-Conn.) and Katie Britt (R-Ala) hope by introducing this new legislation that it will help protect children.

“The growing evidence is clear: social media is making kids more depressed and wreaking havoc on their mental health. While kids are suffering, social media companies are profiting. This needs to stop,” said Sen. Schatz. “Our bill will help us stop the growing social media health crisis…”

Sen. Murphy said, “As a parent of two kids - one a teenager and one about to be a teenager - I see firsthand the damage that social media companies, 100% committed to addicting our children to their screens, are doing to our society. This is

New platforms, new devices spur proliferation and rampant use

Since social media took off in the early 2000s with Friendster, Facebook, MySpace and Youtube, its proliferation keeps growing with the addition of new platforms like Twitter, Instagram and Tiktok. In addition, more tech devices beyond the computer like smart phones to notebooks are making access to social media possible anywhere, everywhere. This tech convenience is one reason why we now have three billion social media users worldwide.

According to a Pew Research Center report, social

media users in the United States have increased by 1300% from 2005 to 2019.

Social media usage has also risen dramatically, with a recent study showing that teenagers and young adults may spend up to nine hours a day on social media.

Revolutionary benefits in the way we communicate

Social media also keeps growing because it has many benefits. And for most users who can limit their time spent online, social media’s benefits outweigh the costs. Users are drawn to social media to connect with family and friends, especially those who live in

a reality that we don’t have to accept. The alarm bells about social media’s devastating impact on kids have been sounding for a long time, and yet time and time again, these companies have proven they care more about profit than preventing the well-documented harm they cause. These algorithms are sending many down dangerous online rabbit holes, with little chance for parents to know what their kids are seeing online. None of this is out of Congress’s control, and this bipartisan legislation would take important steps to protect kids and hold social media companies accountable.”

Schatz said he expects significant pushback from tech companies. “The tech industry is going to come at this bill and every other kids online safety bill with everything it’s got, and they are going to come up with individual use cases and scenarios to try to poke holes in this,” Schatz said.

“But the burden of proof is on those who want to protect the status quo because the status quo is making a whole generation of users mentally ill.”

The U.S. Surgeon General has warned that 13 is too early for social media use and suggested that 16, 17, or 18 may be as well.

other states. It’s also a way to meet new people.

It’s also entertainment for streaming movies and downloading music. It has endless information on all topics from your favorite hobby to the latest in your specific occupation. It revolutionized current events; and revolutionized how we shop (online option). It has money-making opportunities for most businesses and small entrepreneurs.

Imelda Joaquin, a community leader, said, “I’m always interested in seeing where people travel, since that gives me inspiration for my own vacations. I also love seeing my family and friends,

especially those that I don’t see very often.”

Rhea Alarin Bautista, MD., says she focuses her time on the business use of social media versus personal.

“I am getting better, although I sometimes get sucked into drama like Selena vs Hailey. I mainly use social media for community engagement. I find that platforms like Facebook, Instagram and TikTok have a wide reach that makes it an effective tool for engaging with community members and spreading information about events, initiatives, and other community-related topics. Social media platforms allow for real-time communi-

cation and feedback, making it easier for community members to engage with each other and with organizations or individuals leading community efforts.

Depression, anxiety, loneliness linked to frequent social media use

Two recent research show social media’s darker side. The Child Mind Institute and The National Center for Health Research say people who frequently use social media feel more depressed and less happy with life than those who spend more time on non-screen-related activities.

They also link higher rates of anxiety and loneliness with frequent social media use.

Dr. Bautisata said excessive use of social media also has been linked to issues such as cyberbullying, sleep disturbances, and a distorted sense of reality.

What online activities that could lead to mental health problems?

• Placing too much emphasis on comments or likes that you share. And if you don’t receive either one, you feel disappointed or invalidated.

• Comparing your posts to other people’s posts and wanting to live up to other people’s lives.

• Trolling others or its opposite -- being cyberbullied.

• Engaging in risky behavior or doing something just to get a photo to share online.

• A fear of missing out (commonly referred to as FOMO) that leads to more and more social media usage.

Signs that you could be addicted

Similar to other types of addiction, experts say social media use could be an addiction when it becomes an obsession and starts to interfere with aspects of your life like your relationships, work, schooling of health. Other warning signs:

• Relying on social media as a way to cope with problems.

• Restlessness and irritability when not online.

• Thinking about social media whenever you aren’t using it and it is the first thing you do whenever you have the opportunity.

• Losing sleep and de-prioritizing self-care

How it works on the brain

Studies show social media apps have the same kind of effect on the brain as gambling or playing a slot machine. There is a feeling of reward when online by releasing dopamine – the feel-good chemical that is linked to having sex and eating your favorite foods.

Healthy tips to avoid social media taking over your life

For Gen Xers and older, they grew up without social media so they could have an easier time to break obsessive tendencies of living in a digital world. For today’s young adults and adolescents, they have no experience of living without the internet so common-sense social interactions and social skills to avoid the trappings of digital life might not appear to be “common-sense” at all.

Tips to control social media over usage include:

• Make in-person interactions as often as possible.

• Instead of dedicating most of your free time to social media, find a hobby or do volunteer work.

• This next one is a big commitment for the younger generation. Uninstall your social media apps. This will decrease the time you spend on social media dramatically.

• Turn off your phone while at work, at school, during meals.

• Schedule a time to use social media and keep with a pattern.

• Keep your bedroom clear of your phone, tablet or laptop.

Joaquin said, “Like many people in my circle, I could stand to scale back on my social media usage. I try to remember that there are many other ways to communicate. So instead of scrolling through my feed, sometimes I call my family and friends for direct updates on their lives instead.”

She elaborates, “As with new advancement in technology, there are pros and cons to social media. For example, it’s wonderful that we can easily keep up with people all over the world. But that shouldn’t come at the expense of tending to the relationships that we have in real life. When you are out with family and friends, consider putting your phone away so that you can be fully present in the moment.”

Dr. Bautista suggests “My advice is to find purpose in the use of social media. So many people are using these plat-

forms as a healthy creative outlet which sometimes bring passive income streams. Why not blend your passion and business in this unique platform.”

As for avoiding negative situations while on social media, she said, “social media has the potential to take situations out of context. I find that being open and transparent with what you post is key to mitigate the negativity.”

Joaquin recommends not drawing comparisons to others in social media. “Social media has fostered a sense of constant comparison among users. We put ourselves in competition not just with people we know, but even with strangers. Who eats the most delicious meal? Who wears the most elegant outfit? Who lives the most glamorous life? We need to remember that people only present a very specific version of themselves on social media, and we shouldn’t hold ourselves to that highly curated standard.”

How much time is considered healthy for social media usage

The healthy amount of time people spend on social media is relative.

Dr. Bautista spends one hour per day on weekdays and 1-2 hours on weekends. Experts do not recommend specifically how much time people should or shouldn’t be spent on social media. They recommend, instead, to be aware of the warning signs of addiction because social media can be beneficial in many ways

as well as be work-related.

“It’s important to note that not everyone who uses social media excessively will experience negative mental health effects, and that social media can be used in positive and healthy ways. However, it’s important for individuals to be aware of the potential risks associated with excessive social media use and to take steps to manage their social media consumption in a healthy way,” Dr. Bautista said.

While the potential for social media to have a negative impact is real, Joaquin said social media has the power to create strong digital commu-

nities. “For example, so many young people struggling with their identity can find solace and solidarity with friends online. It’s a matter of finding the right balance-and also developing enough self-awareness to know when your social media usage maybe taking on an outsize influence in your daily life,” she said.

Experts say if you’re suffering from mental illness and believe it is related to your social media use, try some of the techniques to taper off from obsessive, unhealthy social media practices. If this doesn’t work, they recommend you talk to a counselor or health professional about it. 

“It’s important to note that not everyone who uses social media excessively will experience negative mental health effects, and that social media can be used in positive and healthy ways. However, it’s important for individuals to be aware of the potential risks associated with excessive social media use and to take steps to manage their social media consumption in a healthy way.”

– Rhea Bautista, MD

Diverticulitis

By Dr. Jon Go

Diverticulosis is a condition where small, bulging pouches or sacs, called diverticula, form in the lining of the large intestine, or the colon. When one or more of these diverticula become inflamed or infected, the condition is known as diverticulitis.

Diverticula are common in people over the age of 40, and it is estimated that about 50% of people over the age of 60 have diverticula. It is most common in the left colon.

Most people with diverticulosis do not experience any symptoms, and the condition is often only discovered during a routine colonoscopy or other medical test.

But when a diverticulum becomes inflamed or infected, it can cause a range of

symptoms, including abdominal pain (usually on the left side), fever, nausea, vomiting, and change in bowel habits of either constipation or diarrhea. In some cases, people with diverticulitis may also experience rectal bleeding or bloody stools.

The exact cause of diverticulosis is unknown, but it is believed to be related to a combination of factors like a high-fat, low-fiber diet, constipation, and aging. When there is not enough fiber in the diet, the colon has to work harder to move stool through it, which can cause pressure to build up and create the small pouches.

If a stool gets trapped in the pouches, it can lead to inflammation or infection. Other risk factors for diverticulitis include obesity, smoking, lack of exercise, and some medications.

To diagnose diverticulitis, your healthcare provider will obtain a history, do a physical exam, blood tests, and order tests such as a CT scan. Treatment for diverticulitis depends on the severity of the condition. Mild cases may be treated with antibiotics and a liquid diet to give the colon time to heal.

In more severe cases, hospitalization may be necessary, and surgery may be required to remove the affected part of the colon. Patients may be admitted to the hospital if they have severe diverticulitis (showing systemic signs of infection or peritonitis), inability to tolerate oral fluids, failure of outpatient antibiotic ther-

apy, immunocompromised, and severe pain.

Complications can include abscess formation, intestinal fistula formation, perforation, and spread of the infection leading to sepsis. Of those who have had an episode of diverticulitis, about 20% have one or more recurrent episodes within 10 years.

To prevent diverticulitis, eat a high-fiber diet, drink plenty of water, exercise regularly, lower stress, and avoid certain foods that may get trapped in the diverticula and increase the risk of inflammation or infection such as nuts and seeds.

With proper treatment and lifestyle modifications, most people with the condition are able to manage their symptoms and prevent future episodes. Talk to your healthcare provider if you feel you are at risk for diverticulosis, and if you experience similar symptoms, immediately seek care from your healthcare provider.

JON AVERY GO, MD, ABIM is a board-certified Internal Medicine primary care physician. He is currently practicing at the Primary Care Clinic of Hawaii.

The Weighty Issue of Obesity

By Dr. Anna Lo

Obesity is a major health problem worldwide. According to the World Health Organization, in 2016 an estimated 1.9 billion adults were overweight, of these 650 million were obese, and amongst children and adolescents, over 340 million children and adolescents were considered as overweight or obese.

Obesity is defined as having a body mass index (BMI) of 30 or higher, and it is a leading cause of preventable death and disability. A major global study from The Global Burden of Disease, published in the medical journal The Lancet, estimated that about 5.02 million deaths across all age groups and sexes were attributed to obesity as a risk factor.

Obesity refers to abnormal or excessive fat accumulation that presents a

health risk. Obesity is associated with numerous health consequences, including cardiovascular disease, type 2 diabetes, cancer, joint problems, sleep apnea, and mental health disorders.

There are many factors that contribute to the development of obesity. Genetics, environment, and behavior all play a role. People with a family history of obesity are more likely to become obese themselves.

Environmental factors such as access to unhealthy foods and a sedentary lifestyle can also contribute to obesity. Behavioral factors, such as overeating and lack of physical activity, are major contributors to the obesity epidemic. An increased intake of energy-dense foods that are high in fat and sugars coupled with an increase in physical inactivity causes an

energy imbalance between calories consumed and calories expended, leading to an increase in amount of fat the body wants to carry.

Some people may have hormonal or neurologic issues that contribute to obesity. This may warrant further investigation by an appropriate health care provider as managing the underlying disorder can help treat obesity.

Obesity is a chronic disease that often requires a multifaceted approach in preventing and managing

this complex disease state. Eating a balanced diet, engaging in regular physical activity, and seeking behavioral therapy are all important strategies.

There are various nutrition programs such as the Mediterranean or DASH diets which can help patients lose weight and stay healthy. This can often be challenging and advice and support from a dietician may be helpful.

For some people, medications or bariatric surgery may be necessary. There are

several weight loss medications that are approved by the FDA for safe and effective management of obesity. Those who pursue bariatric surgeries may elect to undergo gastric bypass surgery or sleeve gastrectomy.

Discussions with an obesity specialist can help guide patients in choosing the right care for their weight loss journey.

Addressing the obesity epidemic requires a comprehensive public health approach that includes policy interventions, such as sugar taxes and labeling laws, and urban planning and education campaigns. By working together to address obesity, we can improve health outcomes for individuals and communities.

ANNA MELISSA LO, MD is board certified through the American Board of Internal Medicine, both in Internal Medicine and Endocrinology, Diabetes, and Metabolism. She is currently practicing at the Primary Specialty Clinic of Hawaii across different islands including Oahu, Lihue, and in Hilo.

Filipino Pride: Jessica Cox is the World’s First Armless Pilot

By Jim Bea Sampaga

Born in 1983 Arizona to a Filipino mom and an American dad, Jessica Cox has made the impossible possible throughout her life.

She was born without arms. But that didn’t stop her from living a normal life. She graduated high school and pursued a degree in psychology at the University of Arizona.

As part of living the “normal” life, Jessica wore prosthetic arms growing up. However, after 11 years of wearing them, she admits she never found a connection with them.

“From the day I was born, I started interacting with the world through my feet. I played with my first toys using my feet,” Jessica told Hawaii Filipino Chronicle.

“When I used prosthetics, they were slower, and I couldn’t tell whether something was hot, cold, soft, hard, rough, or smooth. So, it’s always been more natural to use my feet.”

After graduating college, she pursued a career in motivational speaking. Jessica shared that in her sophomore year in high school, she was asked to speak to a group of 7th graders.

“That was the first time I saw my story inspire other people. Since then, I’ve inspired people in 28 countries, and it supports both myself and my husband,” she said.

In her events, she teaches the skills she has learned living without arms on how to reframe challenges. “Do something that scares you,” she would often tell her au-

diences.

To take her own advice, Jessica did the impossible. She became the world’s first armless pilot. “It was my greatest fear. Not the flying part, but losing contact with the ground,” she said.

Flying an airplane was not an overnight achievement. It took Jessica three years, three states, four airplanes and three flight instructors to finally fly the right aircraft.

“I’ve only flown a 1946 Ercoupe airplane. The Ercoupe is great for local, slow flying. It cruises at about 85 mph and flies for about 500 miles. It is the only plane

ever built with all the flight controls built into the hand controls,” she shared.

“Normally there are rudder pedals to make a plane turn left and right. But I put my feet on the controls and the throttle, and I can fly.”

Finally, in 2008, Jessica earned her Light Sport Pilot Certificate. Then in 2011, she received the Guinness World Record for being the

first person certified to fly a plane with only their feet.

But Jessica is not stopping her pilot journey just yet. She’s on a mission to build the first foot-controlled airplane in history.

“I know I can help shape the perception of people with disabilities and challenge the negative assumptions people have. So, I approached

(continue on S14)

Jessica Cox in the 1946 Ercoupe airplane (Photo via www.JessicaCox.com)

What You Need to Know about Shingles

By Rainier Dennis D. Bautista, MD

As a primary care physician, I have seen numerous cases of shingles, and have seen first hand the debilitating effects of this disease on patients’ physical and emotional wellbeing.

Shingles or Herpes Zoster is a disease of the skin and the nerves caused by the varicella-zoster virus, which is the same virus that causes chickenpox. After a person has chickenpox, usually during childhood, the virus remains dormant in their nerve tissue which can become active again in times of stress or when the patient’s immune system becomes weakened, thus causing shingles.

Shingles typically cause a painful rash that appears as a band or patch on only one side of the body or face. The rash starts as a small area of

red spots that evolve into fluid filled blisters after several days. These blisters eventually grow and fill with more fluid and may merge together to form larger blisters. After some time, these blisters break open leaving behind small ulcers, which will begin to dry out and form scabs. The scabs then fall off, revealing new skin underneath. This process usually lasts for two to four weeks and can be accompanied by other symptoms such as fever, headache, malaise and fatigue.

The treatment of shingles involves antiviral medication, such as acyclovir, valacyclovir, or famciclovir. These medications can help to reduce the severity and duration of the rash, pain, as well as the risk of complications. Pain relievers, such as acetaminophen or ibuprofen, may also

be used to manage the pain. In addition to medication, there are other things that can be done to manage the symptoms of shingles. For example, applying a cool, damp cloth to the rash can help to reduce itching and discomfort. It is also important to get plenty of rest and to avoid stress, as stress can make the symptoms of shingles worse.

A common complication of shingles is Postherpetic Neuralgia, which is a type of pain that persists even after the rash has healed. This pain can last for days or even months. Next, patients who have the rash near their eye are at risk for vision loss. Lastly, patients who have shingles affecting their face and ear might suffer from paralysis of the affected side of the face, in a condition called Ramsay Hunt Syndrome. Patients who suffer from these might need additional medications as well as

consultation with specialists.

The best way to prevent shingles is to get vaccinated. The shingles vaccine is recommended for adults over the age of 50, and it is highly effective at preventing shingles and its complications, and consists of two doses taken 2 to 6 months apart.

In addition to vaccination, maintaining a healthy lifestyle can also help to prevent shingles. This includes getting enough sleep, exercising regularly, and eating a balanced diet. Quitting smoking and limiting alcohol consumption can also help to boost the immune system and reduce the risk of shingles.

It is important to note that

shingles is not contagious, but the varicella-zoster virus can be spread to people who have not had chickenpox or the vaccine, causing them to develop chickenpox. Therefore, it is recommended that people with shingles avoid contact with infants, pregnant women, and people with weakened immune systems. In conclusion, shingles is a painful and uncomfortable condition caused by the varicella-zoster virus. Although it can be treated with antiviral medication and other measures, prevention through vaccination and a healthy lifestyle is the best approach. If you suspect you have shingles, it is important to seek medical attention promptly to reduce the risk of complications.

is a board-certified Family Medicine Physician, and a Fellow of the American Academy of Family Physicians. He is currently practicing at the Primary Care Clinic of Hawaii in Honolulu, Oahu and in Lihue, Kauai.

RAINIER DENNIS D. BAUTISTA, MD, DABFM, FAAFP

Shingles

Source: American Family Physician, 2000 Apr 15

Mom Fell And Broke Her Hip – Now What?!

By Dr. Maria Ver

In 2016, I wrote a Hawaii Filipino Chronicle article about falls being the number one killer in Hawaii’s older population.

As the previous Trauma Medical Director of my hospital, Hawaii’s trend of falls being the number one type of trauma remains. With nearly 21,000 emergency room visits and over 2700 hospitalizations yearly, falls are the leading cause of non-fatal injuries in the state, and nationwide.

Hawaii averages about 114 fatalities from falls yearly. Most of the falls are “ground-level falls,” and over 70% of these falls occur at home. Hawaii hospital charges for falls cost $100 million annually, and in the US, healthcare costs relating to falls surpass $50 billion annually.

The majority of those falling is our kupuna 65 years and older, with age increasing the associated risks and complications. In the US, over 300,000 older people are hospitalized with hip fractures yearly, of which 95% are caused by falling, usually sideways.

The top three injuries resulting from falls that I see in my trauma center are head bleeds, hip fractures, and wounds, all of which are consistent with other Hawaii trauma centers. For older patients with traumatic brain injuries, over 70% of deaths and 80% of hospitalizations are caused by falls.

As a trauma surgeon, it is routine for me to evaluate and take care of the trauma patients who come to the Emergency Room. Depending on the types of injury, I then consult the appropriate specialist who would contribute to the overall treatment plan.

Despite all the medical training, it is always difficult when the one who is injured is a member of your own family.

Last summer, my moth-

er was at home and had a ground-level fall backwards after tripping over my dog. When she called my phone, she was crying in extreme pain and stated she could not get up from the floor.

My mother is in her mid60s, appears much younger than her age, and was very active otherwise. I rushed from work to the house worried, not just about her, but also about my baby who was now unattended since Mom was immobile.

When I arrived, my Mom was on the floor in obvious pain. When I examined her, I already had a very high suspicion of a hip fracture, which would be a surprise to me since I didn’t think that this “could happen to my Mom.”

My colleague and I were unable to lift my Mom due to her severe pain. Therefore, we called 911 and the ambulance came several minutes later. Before loading her to the stretcher, the paramedics had to give her strong IV pain medications to help make transport comfortable and safer.

She was taken to the nearest trauma hospital and was evaluated in the emergency room. The workup by the Emergency doctor and on-call Trauma surgeon confirmed a right hip fracture. Fortunately, that’s the only injury that she had.

The on-call Orthopedic surgeon was consulted and recommended urgent hip repair surgery. Therefore, my Mom was admitted to the hospital under the Hospitalist (inpatient medical doctor) service to prep her for surgery the next morning.

Recovery from a hip fracture may be difficult and many people lose some of their independence. Hip fractures are the most expensive fracture to treat on a per-person basis.

The hip is comprised of the femur bone in the thigh that connects to the pelvis with a ball-in-socket joint (femoral head into the pelvis acetabulum). The nature of the fall affects the type of breaks in the bone. The location of the break affects healing potential. The most commonly fractured area is the femoral neck, which connects the femur shaft to the head.

Treatment options for hip fractures are basically whether to fix them surgically or not.

Non-operative management may be recommended for those with mild fractures where the hip joint is still stable and therefore causing minimal pain. Also, if the patient has conditions that make them too high of a risk for surgery, then the risks can outweigh the benefits.

If the patient is able to walk prior to the fracture and no operation is planned, then the physical therapist gets involved early to help mobilize and get the person walking again. The Hospitalist will prescribe a pain control regimen to help make the pain manageable.

Most Orthopedic surgeons argue that all hip fractures are operative. They operate to repair these fractures, even on the elderly patient, as the immobility itself has high complications.

hip arthroplasty). The hardware used is made of titanium; a special metal that the body adapts well.

These complications include pneumonia from breathing shallow, urinary tract infections from holding in urine, and pressure ulcers from being bedbound. The infections themselves, especially in an older patient, can be deadly. Immobility also can result in blood clots and general deconditioning.

It is alarming that the mortality rate of a hip fracture is 30% within 90 days. This percentage increases if we wait over 48 hours for surgery. Therefore, the benefits of operating urgently outweigh the risks.

Fixing the hip fracture stabilizes the joint for weight-bearing, decreases the pain, and allows for an earlier return to standing and walking. Surgery options include ORIF (Open Reduction Internal Fixation using rods, plates, and screws), screw fixation, and partial or full hip replacement (hemiarthroplasty/total

The average operative time for a hip repair surgery is two to four hours, performed under general or spinal anesthesia. Once the surgeon clears the patient to walk (usually in one to two days, but as early as the same day), then the physical therapists start working with the patient.

In my center, hip fracture surgery accounts for 20% of all orthopedic surgeries. The average time in the hospital for a hip fracture patient is about four days. The physical therapists and occupational therapists (PT&OT) will assess if the patient is safe and ready to go home. The hospital Case Management team gets involved by helping families get ready for discharge home versus to another facility.

If the patient is safe and able to go home and has proper social support for help, then the case manager will set up PT&OT services to come to the house (home health) or set up visits at an outpatient facility.

My Mom had ORIF hip surgery. She stayed longer in the hospital due to intolerance to the strong pain medications, which also limited

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Biden Administration Announces End to Federal COVID Vaccine Mandates

By Zachary Stieber via The Epoch Times

The Biden administration is going to end a slew of COVID-19 vaccine mandates, including its requirement that foreign travelers provide proof of COVID-19 vaccination, officials said on May 1.

The mandate for noncitizen nonimmigrants arriving by air will end on May 12, as will mandates for federal workers and federal contractors, the White House stated.

The proof of vaccination required at U.S. land borders will also end on May 12, according to the U.S. Department of Homeland Security.

Mandates for Head Start employees and health care facilities certified by federal regulators will also be wound down in the future, the administration stated, although no specific dates were given.

Mandates imposed by some agencies, including the National Institutes of Health, will remain in place for now, the White House told The Associated Press.

The mandates were imposed by President Joe

Biden and top deputies in 2021 as the administration tried to increase the number of vaccinated Americans, despite a growing body of evidence that the vaccines bestow transient protection against symptomatic infection and hospitalization.

Some of the vaccination requirements have been blocked by court, including one for federal workers, after judges said they were likely illegal. One for large private employers was struck down by the Supreme Court, and another for members of the military was withdrawn because of a bill passed by Congress.

The White House stated that the mandates “helped ensure the safety of workers in critical workforces including those in the healthcare and education sectors, protecting themselves and the populations they serve, and strengthening their ability to provide services without disruptions to operations,” adding that the mandates “bolstered vaccination across the nation, and [the] broader vaccination campaign has

(ASK A DOCTOR: Mom Fell....from S11)

her ability to participate in PT&OT. It was recommended that instead of staying at the hospital longer to get better at home, that she be discharged to a short-term rehabilitation (STR) facility.

At the STR, she had a room with a hospital bed and nurses/aides to tend to her needs. PT&OT services were of higher intensity compared to those in the hospital. The Rehabilitation doctor (rehab inpatient doctor) checked on her daily to address her medical needs and pain control regimen. We visited her daily and encouraged her efforts to participate in her recovery.

In Hawaii, of those patients hospitalized after a fall, more than half are discharged to a skilled nursing facili-

ty. When falls result in a hip fracture, 70% are discharged to a skilled nursing facility and 11% to a rehab facility. Only 11% are discharged to home. Home health services are often arranged.

My Mom was eventually discharged home from rehab after two weeks. My dad and my brother received the teaching necessary to assist my Mom with using her walker and cane, and to help with transfers.

A list of needed supplies was given to them to prepare the house for Mom’s return. This list included a shower chair, handrail and grips for the shower, a commode, bed rail, and guidance on proper shoes.

PT&OT services were ar-

saved millions of lives.”

A White House spokesperson pointed to a blog post from the Commonwealth Fund that was based on modeling.

“White House advisors were not smart. Initially, there was no proof that forcing a third party provided additional benefit to someone who was vaccinated. Then, it was clear by summer 2021 that vaccine cannot hold transmission. Ergo mandate[s] always unethical,” Dr. Vinay Prasad, a professor at the University of California, San Francisco, wrote on Twitter.

Biden is among the officials who have made false claims about the vaccines, which don’t prevent transmission, infection, or severe illness.

ranged to come to the house to continue therapy. My Mom improved daily and was up walking with a cane by three months.

Aside from my rascal dog, the main reason for my Mom’s hip fracture was her undiagnosed osteoporosis; a condition that is common as we age where our bones become brittle and break.

All post-menopausal women are at risk of osteoporosis due to low estrogen levels. Low estrogen levels can also be seen in pre-menopausal women with hormone disorders or those who participate in extreme physical activity. Low testosterone in males is also a risk for osteoporosis. Women do fall more often than men with about

forced millions of Americans to receive multiple doses of a Moderna or Pfizer vaccine or the single-shot Johnson & Johnson version, just said that foreign travelers would meet the mandated requirements if they received one shot of the unproven, updated Moderna and Pfizer formulations.

“You’re not going to get COVID if you have these vaccinations,” he said. Meanwhile, a top COVID-19 adviser falsely said in 2022 that there are no serious side effects of the shots.

Biden previously announced that the COVID-19 public health emergency is going to end on May 12. But it was unclear whether the mandates would be rescinded at the same time.

The COVID-19 national emergency, a similar declaration, ended this month after Biden signed a bill approved by Congress.

The emergency declarations underpinned many of the mandates.

The U.S. Centers for Disease Control and Prevention (CDC), whose definition of “fully vaccinated” has

75% of hip fractures occurring in women.

Unfortunately, osteoporosis is a “silent disease” as there are often none to minimal symptoms until a bone breaks. The top three reasons for causes of osteoporosis are estrogen deficiencies, low calcium, and inactive lifestyle.

Some medications like tamoxifen and anastrozole for breast cancer treatment are designed to lower estrogen levels. We cannot control our natural hormonal changes over time, but we can focus on preventing low calcium and vitamin D levels through diet or supplements and incorporating exercise activities, like a brisk walk into one’s routine to encourage bone strengthening.

Some 81.3 percent of the U.S. population had received at least one vaccine dose as of April 26, according to the CDC. But just 16.8 percent of people had received an updated booster shot, an indication of how unpopular the vaccines have become.

The CDC stated that more than 1.1 million people have died with COVID-19 in the United States, although critics note that the deaths include people who had a different primary cause of death. For the week ending on April 26, though, the death toll was just 1,052— the lowest since March 2020.

“While vaccination remains one of the most important tools in advancing the health and safety of employees and promoting the efficiency of workplaces, we are now in a different phase of our response when these measures are no longer necessary,” the White House stated. (theepochtimes.com)

The most widely prescribed medications to treat osteoporosis are bisphosphonates like Fosamax. There are newer medications like Prolia on the market in addition to other bone-building medications currently under development.

There are ways to assess your own bone density and associated risk for fractures. A DEXA Scan is a bone density test that measures the mineral content of your skeleton. This scan can help diagnose osteoporosis as well as osteopenia, which is low bone mass.

Your PCP or specialist may consider a DEXA scan if you have one or more risk factors including advanced age (65 years old in women, and

(continue on page 13)

What You Should Know About Diabetic Retinopathy

By Dr. Steven Rhee

Diabetic retinopathy is an eye condition that affects those with diabetes. It occurs when there is damage done to the blood vessels in the retina. This complication can appear in both types of diabetes, type 1 and 2, and though symptoms may be mild at first, it can eventually lead to blindness.

Oftentimes, there are no symptoms in its early stages. However, as the condition progresses, you may experience symptoms such as blurry/Double vision, seeing flashes of light or floating spots in your vision (Known as flashes and floaters), blank or dark areas in your vision, reduced or low vision, and pain or pressure in one or both eyes.

When we eat, your body breaks down food into glucose (sugar), and then a peptide hormone called insulin, moves this glucose from your blood into different cells.

When your body lacks enough insulin (a condition known as hyperglycemia) or your diet is too rich in sugars and forms of glucose,

70 years old in men), family history, previous fractures (especially if the injury occurred after 50 years old), medications, and overall health.

The report will show bone density scores and provide a percentage risk for injury. Your doctor can use these results to determine the next steps for prevention/ treatment, and timing for your next surveillance scan.

The medical course of treatment for a hip fracture is not easy. Moreover, it is worth mentioning the emotional toll that it takes on the patient and caregivers, as this fracture, although treatable, is indeed life-changing.

My Mom has and con-

this can result in blood sugar levels rising higher than normal. This is known as having high blood sugar.

Diabetes is often associated with hyperglycemia and high blood sugar, and the longer you have diabetes and the less you monitor and maintain adequate blood sugar levels, the more prone you are to medical complications associated with this issue.

Diabetic Retinopathy is a common condition for those with diabetes because it is caused when too much sugar is in the blood, creating blockages in the bloodstream.

These blockages result in changes to the blood vessels in the retina and cut off its blood supply. This is crucial because blood carries important nutrients and without it, the retina will begin to deteriorate.

Once blockages occur, the body responds by attempting to develop new blood vessels in its place. However, these blood vessels are very fragile and often do not develop properly, which causes leaking and swelling

tinues to spend a significant amount of time rehabilitating. I can sense her frustration, anger, and sadness, that she cannot move the way she did before her injury. She has lost part of her independence. She loves to go out and travel, and now she is mostly homebound.

These events impact others in the family as well. I had to hurry and arrange for alternate childcare, as Lola/Lolo daycare (the best that there is!) was no longer available.

I worry about my dad and brother who continue to take time off from work and other parts of their lives to aid my Mom with her needs.

This one injury has af-

and results in major eye and vision complications.

Because of the effects of diabetes on the blood, anyone with diabetes is prone to diabetic retinopathy. There are, however, risk factors that may raise your risk of developing this condition that you may be cautious of, such as:

• Pregnancy

• Tobacco use

• Poor control of blood sugar levels

• High blood pressure

• High cholesterol

• Race (Black, Hispanic,

fected all of us and our daily routines, but my Mom most of all. We continue to be positive and adjust daily.

I realize that we don’t expect bad things to happen to us or our family members; but we can’t have a “bahala na” attitude and have a passive approach to our health, especially as we age.

It is important to be aware of our overall health risks, be prepared for the just-in-case, and focus on prevention. With special regard to hip fractures, if you suspect injury after a fall, it is important to go to the ER for evaluation since timely treatment decreases overall mortality.

It is important to acknowl-

betes, and come up with a treatment plan.

If you have diabetes and become pregnant, we highly suggest receiving a dilated eye exam in your first trimester and throughout the pregnancy, up to one year after.

Diabetic retinopathy cannot always be prevented, but severe vision loss and eye problems resulting from diabetic retinopathy can be. This can be done by:

• Monitoring and maintaining your blood sugar levels

• Keeping your blood pressure and cholesterol under control

• Eating a healthy and balanced diet

• Keeping your body active

• Quitting smoking and tobacco use

• Testing hemoglobin A1c levels regularly

and Native American ethnicities show the highest risk)

Unfortunately, the longer you have diabetes, the higher the risk of developing diabetic retinopathy. That is why it is crucial for those with diabetes to receive a dilated eye exam every year.

Through this, your doctor will be able to check your signs in the retina and other parts of the eye, and diagnose any eye conditions that may be brought on by dia-

edge the risks and make efforts to be safer. Speak up to your doctor about falling concerns, check your medications, and assess risks. Check your eyes and feet. Wear proper footwear. Keep moving with activities like Tai Chi and walking to strengthen your legs and balance. Make your home safe by removing clutter, having handrails, increasing lights, and being mindful of kids and pets. Start conversations with your family about contingency plans and advanced care directives for if and when something should happen.

For more information about preventing falls as a core focus of Hawaii’s Injury Prevention Plan, please

• Testing urine for ketone levels regularly

• Taking medication as directed and on schedule

• Using Insulin as directed Remember, diabetes does not mean inevitable vision loss. With proper management and an active healthy lifestyle, you can live life to the fullest and without serious health complications brought on by diabetes.

DR. STEVEN RHEE, Medical Director and Cornea Specialist with Hawaiian Eye Center.

visit health.hawaii.gov/injuryprevention/home/preventing-falls/information/.

I’d like to thank my mother Agnes Rustia Ver for allowing me to share her story. We hope that you are more informed on what to expect and prompted to take action.

I’d also like to acknowledge my orthopedic surgeon colleagues Dr. Mariya Opanova and Dr. Tim Fei who contributed their expertise to this article and very thankfully to my mother’s care.

DR. MARIA “MAREL” VER is a board-certified general surgeon for Hawaii Pacific Health, previous Trauma Medical Director of Pali Momi, and past PMAH president.

(ASK A DOCTOR: Mom Fell....from S12)

Jump Start Your Spring with Tips for a Healthy Household

By The “We Can Do This COVID-19” Public Education Campaign

As the days get longer and the temperatures warm up, spring is the perfect time to take stock of your household and your health. This season is a time of renewal and rejuvenation, offering the opportunity to make some simple moves to improve your overall well-being.

To make the most out of a spring refresh, we’ve rounded up some of our top cleaning and health and wellness tips: Clean high-touch surfaces. Cleaning surfaces in your home helps prevent the spread of germs that can make you sick, including COVID-19 and other viruses. High-touch surfaces, such as light switches, doorknobs, and countertops, should be cleaned regularly, especially after having

visitors over. Make sure to use household cleaners that contain soap or detergent to ensure you are removing germs that could cause illness.

Wipe down your electronics. Many of us might remember to disinfect our phones, but it’s easy to forget that remote controls, keyboards, tablets, and other electronics all need a good scrub to keep germs at bay. Be sure to follow the manufacturer’s instructions and recommendations for cleaning.

Break projects into small chunks. You don’t have to tackle your house from floor to ceiling to make progress on your healthy household plans. Rather, pick one 10-minute task to complete each day, such as wiping down counters, starting a load of laun-

HEALTHLINE NEWS

dry, or vacuuming the blinds. Smaller tasks can seem more manageable and will get your refresh kickstarted.

ticles in your home, helping to stop the spread of disease. In addition, you could consider adding a portable air cleaner to improve ventilation and reduce the number of germs in the air that people exhale when breathing, talking, singing, coughing, and sneezing.

cine. No one wants to get sidelined with COVID this spring, so consider getting the latest vaccine to keep your household healthy. Updated COVID vaccines are now recommended for children and adults if their last dose was before September 2022.

Restock your medicine cabinet. Take some time to check the expiration dates on your medications and then purchase new items that you might need, like nasal sprays, allergy medications, and first aid materials. It’s also a good idea to have extra COVID home testing kits on hand as well. With insurance or flexible spending accounts covering many health products, including at-home COVID testing kits, now is the time to stock up.

Almost a year since the U.S. Supreme Court overturned the landmark 1973 Roe v. Wade ruling, Hawaii officially signed into law new expansions to abortion access and protection.

In March, Hawaii Governor Josh Green signed SB 1 into passage which will strengthen the protections and

a manufacturer about modifying one of their aircraft to make it easier for me to fly,”

Jessica told Hawaii Filipino Chronicle.

Currently, Jessica and her team at Impossible Airplane are about halfway through the process of building the plane: Van’s Aircraft RV-10. According to Jessica, the aircraft cruises at 200 mph and flies for 1,000 miles.

“An engineering team is helping me design the modi-

rights of pregnant individuals’ access to abortion care.

“Hawaii will continue to be a beacon,” said Sen. Joy San Buenaventura, chairperson of the Senate Health and Human Services Committee, during the bill-signing ceremony. “Physicians need only think about their patients and need not have to worry about prosecutions or extradition.”

The bill allows physician

fications, and another group of volunteers in New Jersey is helping assemble the airplane,” she shared.

“The wings arrived partially assembled from Van’s, and I learned the work was done in the Philippines!”

Ecstatic with her new wings of pride, Jessica shares that her mom and aunt cultivated her Filipino heritage and spirit.

“I didn’t just grow up with my mom cultivating Filipino culture in our family, but also my aunt lived

Improve the ventilation in your home. Spring is a great time to check your air filters, making sure they are installed properly and replacing them as necessary. Doing so reduces air pollutants and virus parassistants to perform medical and surgical abortions during the first trimester of pregnancy. Previously, only doctors and advanced practice registered nurses could perform the procedure in Hawaii. Moreover, the bill also allows minors to get abortions without parental or guardian consent.

“We’re proud of all the hard work our representatives put in this session to pass SB 1 and further pro-

with us. It was very important to my mother to stay connected with the Filipino culture wherever we lived. We also made many trips back to the Philippines,” she said.

Jessica also shared she was able to bring her husband and mother-in-law to her mom’s hometown of Bobon, Mercedes in Eastern Samar, Philippines. In fact, her husband proudly cooks Filipino food at their home.

“My husband has

Make sure you are up to date on your COVID vactect access to abortion in Hawaii,” said Jen Wilbur, Hawaii State Director for Planned Parenthood Alliance Advocates.

“As the weather gets warmer and spring hits its full stride, it’s a great time to make sure you are prioritizing your health and well-being,” said Dr. Dillon Chen, Neurologist at UC San Diego. “One important way to do that is by making sure you’ve gotten a free, updated COVID vaccine, which can boost your immune system even if you’ve had COVID already.” For more information about COVID vaccines and to find a vaccine near you, go to vaccines.gov or text your ZIP code to 438829.

New Hawaii Law Provides Abortion Access, Provider Protection

“This session, the Hawai‘i State Legislature sent a clear message that we will protect our health care providers and anyone who seeks or supports others in obtaining abortion in Hawai‘i. As attacks against reproductive health ramp up across the country, it could not have come at a more cru-

learned to cook chicken adobo in several different ways, including with coconut milk. I’d never had coconut milk in adobo until he cooked it!” she said.

With her career and achievements, Jessica’s Filipino spirit is undeniably strong. She credits the Filipino values for her perseverance and hard work.

“If it wasn’t for [the Filipino spirit], I wouldn’t be the person I am today and share with thousands of people around the world

cial time and our lawmakers stepped up when we needed them most.”

Some states that have restricted abortion have expressed that they might prosecute people in connection with abortions performed in other states.

To protect Hawaii, SB 1 codifies into law the executive order signed by then-Gov. David Ige to stop other states from prosecuting local doctors and nurses who provide abortions to out-of-state temporary residents in Hawaii.

how to achieve the impossible,” she said.

Aside from her most famous achievement as a pilot and career as a motivational speaker, Jessica is also an entrepreneur, a black belt and Taekwondo champion, and author.

When asked about her message to the Filipino community, Jessica said: “Remember the Filipino spirit. Be proud of that spirit and the community we have no matter where we are in the world.”

(FILIPINO PRIDE....from S8)

Question and Answer with The National Asian Pacific Center On Aging

By the NAPCA Staff

National Asian Pacific Center On Aging (NAPCA) is a non-profit organization dedicated to improving the quality of life of Asian American, Native Hawaiian and Pacific Islander older adults and their families.

Available in five different languages, we operate the NAPCA Senior Assistance Center for Older Adults and Caregivers.

In this article, we share some of the important questions we received from our readers. We aim to educate and guide you in your journey into older adulthood.

Question: My husband is turning 65 soon and he is still working. He and I are covered by his employer’s medical insurance. He does not have 40 working quarter credits yet. Do we still need to join Medicare?

Answer: Most people sign up for both Medicare Part A and Part B when they turn 65. However, if they do not have more than 40 working credits that allow them to get premium-free Part A, they must pay $278 (30-39 credits) or $506 (less than 30 credits) per month.

If your husband’s employer has more than 20 employees and employer-sponsored insurance is “creditable”, he may delay signing up for Medicare until he stops working or loses the current employer coverage whichever comes first. He will not pay a penalty for delaying enrollment.

Whether delaying Medicare or enrolling in Medicare, he should check his coverage policy with his employer before making his decision.

Q: What happens if I work

HEALTHLINE NEWS

Funds For

Hilo

and get Social Security retirement benefits?

A: You can get Social Security retirement benefits and work at the same time. However, if you are younger than FRA (Full Retirement Age which is between 65 and 67 depending on the year you were born) and make more than the yearly earnings limit, your benefit will be reduced. If you are younger than FRA during all of 2023, Social Security Administration deducts $1 from your benefits for each $2 you earn above $21,240. If you turn FRA during 2023, your benefit is deducted $1 for each $3 you earn above $56,520 before your birth month. Starting with the month you reach FRA, your benefits will not be reduced no matter how much you earn.

Q: Should I pay taxes on Social Security benefits when I work while receiving retirement benefits?

A: Some people must pay federal income taxes on

Medical Center

Expansion Secured – Hawaii Island Lawmakers

Last month, Hawaii Island lawmakers announced a $50 million in capital improvement project funds have been appropriated in the state budget for Hilo Medical Center.

The funds will be used for the construction and equipment of the intensive care unit and the expansion of the medical-surgical unit.

Hilo Medical Center is the largest hospital on Hawaii Island and the designated Level III Trauma Center.

“This appropriation marks the culmination of several years of work to bring this effort to fruition, which began in 2020 when Hilo Medical Center first approached the

Hawaii Island Delegation regarding the need to accommodate the growing demand for services from the East Hawaii Community,” said Representative Mark Nakashima.

“The funding for this expansion at Hilo Medical Center will address the issues of expanded services and increased capacity that have been a problem recognized by our Hilo Represen-

their Social Security benefits. This usually happens only if you have other substantial income in addition to your benefits. The portion of benefits that are taxable depends on your COMBINED INCOME* and filing status.

If you file as an individual;

1) you pay no tax on your benefits when your combined income is below $25,000,

2) you pay taxes on 50% of your benefits when your combined income is between $25,000 and $34,000,

3) you pay taxes on 85% of your benefits when your combined income is more than $34,000.

If you file as a joint return;

1) you pay no tax on your benefits when you and your spouse have a combined income below $32,000,

2) you pay taxes on 50% of your benefits when you and your spouse have a combined income between $32,000 and $44,000,

3) you pay taxes on 85% of your benefits when you and your spouse have a combined income of more than $44,000.

*COMBINED INCOME = Your adjusted gross income + Nontaxable interest + ½ of your Social Security benefits

A and collect Social Security Benefits based on your husband’s work credits. If you have been married for over 10 years and remain unmarried after being divorced, you can apply for Social Security Benefits when you turn 62 and premium-free Medicare Part A when you turn 65.

Q: I am over 70 and it has been just over 5 years since I received permanent resident status. Now I am qualified to sign up for Medicare and I found that I must pay high monthly premiums because of the lack of Social Security working credits, but I cannot afford it. Should I still sign up for Medicare or can I keep my current individual plan that I got through the Health Insurance Marketplace?

A: If you are not eligible for premium-free Part A and are not enrolled in Medicare yet, you can keep your current individual Marketplace plan and premium tax credit benefits. However, if you choose to enroll in Medicare Part A and/or Part B later, you will have to wait to sign up and you may have to pay late enrollment penalties.

tatives,” said Representative Richard H.K. Onishi.

The State Budget Bill (HB300 HD1 SD1) that covers the Hilo Medical Center expansion is just waiting to go to Governor Josh Green’s desk for signature. For more information on the bill, visit capitol.hawaii. gov/session/measure_indiv. aspx?billtype=HB&billnumber=300&year=2023.

Q: I have been a legal permanent resident for over 15 years. My husband worked at a job during all those years. I did not work because he wanted me to stay at home and raise our three children. Last year my husband divorced me. My children are grown so he does not have to pay me anything. Am I eligible for Social Security or Medicare?

A: Yes, as a divorced spouse you are entitled to premium-free Medicare Part

Depending on your state’s income and asset limit, you may be eligible for Medicare Savings Program (MSP), which can help you pay Medicare part A/part B premiums. To be eligible for MSP, you must enroll in Medicare. Please check your eligibility with the Medicaid office in your state.

If you have additional questions regarding the above, or around the topics of Medicare, Medicaid, Affordable Care Act, or others, there are three ways you can reach us. Call our Senior Assistance Center at 1-800336-2772. Email us at askNAPCA@napca.org. Send a mail letter to NAPCA Senior Assistance Center, 1511 Third Avenue, Suite 914, Seattle, WA 98101.