Health VOL 2, ISSUE 3
JULY - SEPTEMBER 2016
Line
A VOICE OF ASIA PUBLICATION
Integrative Medicine Approach For
ASTHMA Vitiligo:
Whitening Of The Skin Quivering Heart Beat May Be Sign Of Coming soon
ATRIAL FIBRILLATION
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PUBLISHER’S NOTE
Remember the people who came before us You may be aware, up until 1965, most immigrants came to the United States from European countries. During that time, then-President Lyndon B. Johnson, relaxed the immigration rule and signed the Medicare program into law. Following 1965, over 80% of all immigrants came from non-European nations. That includes students that came for advanced education in Engineering and other fields. By 1970 there was a steady flow of nurses from all Asian countries and from the Indian sub-Continent. They all came with one goal in mind: To live the American dream, help the families in their homeland, raise and educate children and have nice family life. That was their focus. There was not enough time to think about anything else. Time went fast, those who were busy building families are now retired, cut off from the corporate world and are left to taste the life of being a senior. To their grown up sons and daughters, the parents are the children now. For many families, health of seniors is a closed secret that stays within the four walls of their homes. Not just seniors but the health of women and children is also closely guarded in many families. HealthLine engages readers with latest and lifesaving articles by eminent physicians, scientists, and medical professionals about prevention, treatment and management of health and healthy lifestyle. Our efforts to organize a Health and wellness Expo is catching up very fast. Physicians, hospitals and other service providers are welcoming the idea. You wouldn’t want to be left out. Please reserve the day for your health! Help us to help you. Sincerely
KOSHY THOMAS
Publisher and CEO of Voice of Asia Group 713-774-5140
CONTENTS
6 8 10 11
JULY - SEPTEMBER 2016 ISSUE
Quivering Heart Beat May Be Sign Of
Atrial Fibrillation
12.
Alzheimer’s Disease: The Basics
13.
ARMD The Thief Of Eyesight
14.
Living Kidney Donation A Son’s Gift Of Life To His Mother
17. 18.
Can Visiting Your Dentist Save Your Life?
20.
Clinical Treatment Programs For Deformational Plagiocephaly
21. Integrative Medicine Approach For
Asthma
Breakfast
Is The Most Important Meal Of The Day!
Vitiligo:
Whitening Of The Skin
HEALTHLINEMAG.COM
Vaccinate Don’t Procrastinate
Cataracts
22.
Coronary Heart Disease In Women: Symptoms, Diagnosis And Risk Factors
24.
Is Anesthesia Harmful For Young Children?
26.
Occupational Therapy Changing Stroke Survival To Stroke
28.
Ways to Decrease Blood Pressure Naturally
30.
Early Childhood Interventions (ECI) In Autism Spectrum Disorders
31. 32. 34.
The Silent Scourge Of Juvenile Arthritis Obesity And Risks Of Comorbidities Eating Well With Scleroderma
HEALTHLINE JULY - SEPTEMBER 2016
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HEALTHLINE
July- September 2016 Publisher Koshy Thomas Editor-in-Chief Shobana Muratee Marketing Manager Jacob David Marketing Susan Pothanikat Accounts Manager Priyan Mathew Magazine Layout AR Media Cover Photo Fotolia (All Rights Reserved)
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Advisory Board Catherine Papasakelariou, MD Arjun Ghose RN, MBA, CEO, DD Abraham P Thomas, MD Hanh Trinh, MD Chandra Mittal, PhD Lovell A. Jones, PhD, F.H.D.R. Farida Abjani, RN, CEO
Our Contributors Ankur Kamdar, FAAP, FACR Ann Marie McDonald, MBA, MED Bindu George-Chacko, MOT, OT/L Catherine Papasakelariou, MD David B. Troxel, MD Deborah Banerjee, PHD, MS Dip S. Jadav, MD Ebony N. Mitchell, MSN, RN Hailey Brown, CPO, LPO Jaime Benrey, MD. Cardiologist Linda Kaminski, MS, RD, CDE Manisha Ghei, MD, ABIM, ABIHM, IFMCP Meenakshi Bhattacharjee, PHD Mini John, OD Nancy L. Glass, MD, MBA, FAAP Purvi Parikh, DDS Rebecca Meyerson, MS Sobha George, MSN, CEN
EDITORIAL
Dear Reader,
When safety takes precedence over health it is time for change - starting with one's self. Although there are uncertainties as to how the new government would play out, one thing seems to be very distinct - the future of healthcare in the US will take a plunge. Apart from rising drugs costs and health care, reliable sources indicate that health insurance premiums are likely to escalate in the coming year. How do we prepare for such a crisis? Planning ahead would put you at ease. Our upcoming HealthLine Wellness Expo on September 17, 2016 in Stafford, Texas will provide a platform for dialogue and free consultation with healthcare providers and insurers to prepare you better. Although the Zika virus was checked in time from becoming endemic in the United States, reports claim that the virus is likely to surface in small pockets in southern states such as Florida, Louisiana and Texas. These are states where the Aedes aegypti mosquitoes mostly transmit the virus. During the Republican National Convention in Cleveland, "CBS This Morning" interviewed Cleveland Clinic CEO Dr. Toby Cosgrove to speak on Obamacare and medicine. According to him, Obamacare is seen as being accessible. "We got 20 million more people covered," he told his interviewers. More interesting were his comments on medicine. "Professionals think that this is an exciting time in medicine," agreeing with host Charlie Rose. "Two things that are really exciting are Genomics and Neurological Disease; you can see neurological disease just explode …the things we can do for people.” “But also we are challenged by Alzheimer's and Autism - the two ends of life," he added. For educators and the media, it was a direct indicator of what new challenges are in store for us. HealthLine magazine continues to bring our readers the latest reports on some of these areas. Like our previous ones, this issue too covers important topics including neurological diseases, Autism and Alzheimer's. Our next issue (Oct-Dec 2016) will be a Special Issue with loads of articles, to be released in September for the event. This is your opportunity to send in your articles and we will ensure that it reaches many thousands of readers. Better still, we would like for you to join us at the event and feel firsthand the gratitude of the people. Priceless! Healthline welcomes its newest Advisory Board Members: Dr. Lovell A. Jones and Farida Abjani and thanks them for your valuable contributions.
SHOBANA MURATEE Editor-in-Chief
Quivering Heart Beat May Be Sign of
Atrial Fibrillation
Atrial fibrillation, also called AFib or AF, affects almost three million Americans. AFib is a quivering or irregular heartbeat called arrhythmia that can lead to blood clots, stroke, heart failure and other heart-related complications.
Basically, the heart has its own electrical system. This system makes the signals that start each heartbeat. The heartbeat begins in one of the two upper chambers of the heart, called the atria. With AFib, cells in the atria send extra electrical signals. These extra signals make the atria beat very fast and unevenly so that the atria may quiver instead of contracting. Problems occur if the atria do not contract because then enough blood is not moved into the two lower chambers of the heart. This can cause you to feel dizzy or weak. Blood that doesn’t keep moving can pool and form clots in the atria and then these clots can move into other parts of the body and cause serious problems, such as a stroke.
discuss treatment choices with you that may include: lTreating an underlying disorder that puts you at risk for AFib, like correcting an abnormal thyroid or electrolyte problem, or treating a blocked heart artery lRestoring a normal heart rhythm with an electrical shock (cardioversion) or with an antiarrhythmic medicine lUsing medicine to control your heart rate lPreventing the risk for blood clot and stroke with blood-thinning medicines lDoing catheter ablation or a surgical maze procedure. These use different methods to destroy certain areas of heart tissue and to interrupt the electrical signals causing AFib. One of these procedures may be a choice when medicines do not work, or as an alternative to long-term medicine.
Some of the causes of AFib can include having a previous heart attack, high blood pressure and thyroid problems. However, in many cases, the cause of AFib is unknown. Some of the symptoms of AFib are palpitations, feeling weak or tired, shortness of breath, chest pain or tightness, dizziness and fainting spells. According to the American Heart Association, AFib is the most common serious heart rhythm abnormality in people over the age of 65 years. Even though untreated atrial fibrillation doubles the risk of heart-related deaths and causes a four- to five-fold increased risk for stroke, many patients are unaware that AFib is a serious condition. Treatment and prevention Recommended treatment for atrial fibrillation depends on your age, symptoms, how long you have had the condition, among other factors. You will have a complete evaluation to find out if you have any abnormalities that caused your heart to go into AFib. This might be blocked heart arteries or a thyroid problem. Your doctor will assess your particular case and
Photo Credit: Fotolia
Managing risk factors for stroke and preventing heart failure are important parts of any treatment plan for AFib. Avoiding AFib and subsequently lowering your stroke risk can be as simple as foregoing your morning cup of coffee. In other words, some AFib cases are only as strong as their underlying cause. If hyperthyroidism is the cause of AFib, treating the thyroid condition may be enough to make AFib go away. See a doctor if you suspect you have AFib. Advanced diagnostic tools and treatments, like those found at St. Joseph Medical Center’s Cardiology department, can help determine the right plan for you. Treatment for AFib, early detection of heart disease and adopting heart healthy habits can lead to a longer, healthier, more active life.
JAIME BENREY, MD. CARDIOLOGIST. Dr. Jaime Benrey is a cardiologist affiliated with St. Joseph Medical Center. St. Joseph Medical Center in the Heights offers a 24-hour physician-staffed emergency center, outpatient cardiac clinic, diagnostic imaging, inpatient care and a wide range of surgical services.
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Photo Credit: Fotolia
Integrative Medicine Approach for
Asthma
Asthma is a chronic respiratory disease characterized by airway edema (swelling), inflammation, excessive mucus production and spasm of the muscles in the lung and respiratory tissues. Concerning is that the incidence of Asthma is on the rise in the US, especially in young children. It is the most common cause of missed school, emergency room visits and hospitalizations in American children. The prevalence of asthma is also rapidly rising in many other industrialized nations of the world.
While there is no one cause for asthma, certain things may predispose us to its development. Stress, exercise, environmental pollution, poor nutrition, eating a Standard American Diet, respiratory infections, repeated antibiotic treatments, allergies, obesity, hormonal imbalances can be some common triggers. Allergies, asthma and sinusitis often occur together in a predisposed individual and should be dealt with at the same time. There are many pharmaceutical treatments for asthma, but unfortunately, they all focus on sup-
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pressing symptoms and not addressing the root cause(s) of asthma, in fact, many when used long term, can be potentially harmful. As an Integrative and Functional Medicine physician, I believe that food can be an extremely powerful adjunct to treating asthma and potentially reversing the condition, and it is very important to remember is that certain foods can trigger and also perpetuate an asthma attack. Foods that can trigger asthma are, sugar, processed foods, hydrogenated and trans fats, conventional pasteurized dairy, food additives & preservatives (MSG, sulfites, Sulphur dioxide), food colors & dyes (Tartrazine, the yellow food dye), and eating cold and frozen foods. These should most certainly be avoided. Testing for food allergies and sensitivities, followed by food elimination/reintroduction under the guidance of a qualified physician who can assist you through the process, may be extremely helpful in finding unusual food triggers for your asthma. Avoid conventional animal products which are laden with hormones and antibiotics. HEALTHLINEMAG.COM
Some other dietary strategies that may help in preventing and recovery from asthma are as follows: Drinking plenty of water throughout the day will keep the mucus thin and help it being eliminated easily. Foods rich in sulfur like broccoli, broccoli sprouts, Brussel sprouts, egg yolks, onions, garlic are helpful in increasing phase 2 detoxification of the liver which may be deficient in many asthmatics due to genetic variations in certain key enzymes of this pathway. Onions, garlic and mustard are rich in antimicrobial compounds and also contain high amounts of an anti-inflammatory phytonutrient quercetin just as citrus foods do. Green leafy vegetables are filled with phytonutrients and healthy b vitamins. Eating high omega-3 containing fatty fish a few times a week will help reduce inflammation in the airways. Make sure the fish you eat is not farm raised as those are filled with toxins including the heavy metal mercury which can make asthma worse. Flaxseeds can also help by building the body’s levels of anti-inflammatory omega-3 fatty acids.
Most individuals with asthma are deficient in stomach acid and replacing that under the guidance of an Integrative and Functional medicine physician can certainly help support the body. Some drugs like Tylenol may worsen asthma due to depletion of the master antioxidant of the body, glutathione. NSAIDS like ibuprofen and naproxen, and commonly used drugs like aspirin can also trigger and worsen an attack. Many commonly used antibiotics can do the same.
Asthmatics are low in many essential nutrients and my advice is to get tested for nutrient deficiencies as these are easily reversible. Targeted supplementation always under guidance of a trained physician may help immensely in supporting the body in asthmatics. Some nutrients that may help in this process are Magnesium; B vitamins especially, vitamins B3, B5, B6, folate, B12; Vitamin C; Vitamin D; Omega 3 fatty acids which all help reduce inflammation and support relaxation of the airway muscles and the immune system; and N-acetyl cysteine (helps build antioxidant levels and thins the Certain environmental issues are also essential mucus in the airways). All supplement products to keep in mind: Avoid second hand smoke at all on the market are not the same and many may costs! Clean up your indoor air as it can be many have contaminants, allergens and fillers which times more toxic than the outdoor air you breathe may cause problems in certain people, so always according to the EPA. Aerate your home frequently exercise caution and only use therapeutic grade nutritional supplements which have allergy stateby opening doors and windows a few times every ments, are third party tested, and under guidance day even in cold weather. Do not use toxic cleaning of a knowledgeable practitioner. supplies in your home as they contain persistent organic pollutants which can persist in our home Some therapeutic grade essential oils like pepperand bodies for decades and cause inflammation mint and eucalyptus oils can also help support the and long-term damage to the body. Consider respiratory tissues when diffused or inhaled. These switching to natural cleaning products. Get rid of oils can also be added to carrier oils like coconut carpeting in your home. Use a dehumidifier if you oil and rubbed on the chest, neck and sinus areas have dampness, and always look for possibility of for relief. mold issues in your home. Use protective mattress covers and air purifiers to reduce the impact of I am confident that if you suffer from asthma and dust mites and animal dander on your respiratory use these simple and easy strategies, you will find system. Our dear four legged furry friends should them helpful in supporting your body in its path to recovery. I see this routinely in my Integrative and be out of your bedroom if you suffer from asthma Functional Medicine practice. or allergies.
MANISHA GHEI, MD, ABIM, ABIHM, IFMCP. Dr. Manisha Ghei MD, ABIM, ABIHM, IFMCP is the Founder and Medical Director of Praana Integrative Medicine & Holistic Health Center, PLLC, in Sugar Land, TX. She is Board Certified in Internal Medicine and Integrative Holistic Medicine and is a pioneer in the field of Functional Medicine being certified in the first ever cohort of practitioners from all over the world to become IFMCPs. She has extensive training in not only Internal Medicine, Integrative Holistic Medicine and Functional Medicine, but also Yoga, Meditation, Ayurvedic Lifestyle and Nutrition. HEALTHLINEMAG.COM
JULY - SEPTEMBER 2016 I HEALTHLINE
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BREAKFAST
IS THE MOST IMPORTANT MEAL OF THE DAY! You probably have heard the statement that breakfast is the most important meal of the day. For kids, this is especially true. Studies have shown that kids who eat breakfast are more likely to perform better in school and on cognitive tests, and they’re more energetic throughout the day.
*Kefir is a culture milk product that contains probiotics 2. Eggs: Make an egg omelet, adding in avocado and throwing in any leftover vegetables from the night before. Scrambled, hard-boiled, or over easy eggs are other easy options.
Photo Credit: Fotolia
After your body has fasted for eight to 12 hours, 3. Brown rice porridge: Combine leftover it needs a boost of energy to increase your meta- brown rice with almond milk or organic soymilk. bolic rate and help it run smoothly for the rest of day. Skipping breakfast typically causes our bodies to go into starvation mode and can cause subsequent overeating and stress on our bodies. Kids who do not eat breakfast or start the day with meals high in sugar are more likely to snack on junk food as their energy levels drop throughout the day. Breakfast should always contain protein and a healthy fat. Eggs and yogurt contain protein that build and repair muscles, and healthy fats like nuts and avocados burn fat. To accompany their protein and fat intake, at least four grams of fiber will help satiate your child over the course of the day. This combination will effec4. Oatmeal: Make oatmeal (preferably steel-cut tively buoy brainpower, increase concentration, and improve their mood throughout the day. oats) and toss in a handful each of toasted nuts and fresh berries. Season with cinnamon, nutmeg, and What are some good foods to get kids going in the vanilla to taste. Avoid packaged flavored oatmeal that is high in sugar. morning? Some great breakfast options include:
5. Toast: Toast a few slices of sprouted whole grain bread and top with a few tablespoons of unsweetened peanut butter, almond butter, or cashew butter.
1. Berry breakfast smoothie: Blend 1 cup mixed berries (fresh or frozen), ¼ cup milk, kefir* or almond milk, 2 tbsp. peanut butter, and ¼ tsp. vanilla *When possible, purchase organic yogurt, milk, eggs, and fruits. extract.
REBECCA MEYERSON, MS. Rebecca Meyerson has a master’s degree in nutrition, food science, and exercise science. She is a certified nutrition counselor through the American Association of Nutrition Consultants. Meyerson recently founded Simply Healthy Living in Bergen County, New York, with the mission to promote holistic wellness through a balanced lifestyle incorporating super foods, supplementation, and exercise.
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Vitiligo: Whitening of the skin Vitiligo affects approximately 2% of the world’s population, and all races. It most commonly presents prior to the age of 20, and approximately 20% of people with vitiligo have a blood relative with the same skin condition. Initially, vitiligo begins with lighter colored areas of the skin, and these may turn completely white. New areas may develop, and these may also follow certain patterns. Hair, such as scalp hair, eyebrow hair, or eyelashes, may also be affected. Although it is not contagious, it can be distressing, particularly in people of darker skin tones. The exact trigger for vitiligo is not known, but research has shown that it is causedwhen melanocytes are destroyed by our own immune systems. Melanocytes produce color for our skin and hair, thus loss of these results in white areas. What causes our immune systems to kill off melanocytes is not clear, but it is thought this may represent an autoimmune disease. This is particularly true in patients who develop generalized vitiligo, where skin loses color on both sides of the body. In some cases, the color may return, but may be permanent without treatment. Vitiligo is diagnosed clinically and through a few tests. If vitiligo is suspected, a Dermatologist may take a small sample of skin to confirm the diagnosis. This is a quick procedure performed under local anesthesia, and is relatively painless. Further, blood tests may be ordered to look for other autoimmune diseases. In addition, patients may be referred to an Ophthalmologist, or eye doctor, to check for uveitis, which is inflammation of a part of the eye that may also be found
withvitiligo. After all tests have been run, a Dermatologist can determine the best treatment option for individual cases. Treatment cannot cure vitiligo, but it can help pigmentation return. This is especially important for those with darker skin tones or those with extensive skin involvement, as some improvement may affect overall physiological well-being. One of the most commonly used treatments for vitiligo is light therapy. The use of UVB or UVA light therapy can help with repigmenting skin, but it can be slower. It is recommended that patients who would like to use light therapy do so under the supervision of a Dermatologist, as uncontrolled use of UV light can lead to skincancer development. Another treatment that is available is the use of creams such as steroids. These also work slowly, but may work better in conjunction with light therapy. If vitiligo is localized to a few spots, skin grafts, where pieces of normal pigmented skin are transferred to areas of vitiligo, can help as well. It is important to note that vitiligo treatment is an area of active research, with new treatments on the horizon. Photo Credit: Fotolia
Our skin, the largest organ of our bodies, is a complex network of cells. Further, it can be the outward manifestation of our general health and well being. As such, any changes or blemish can be disturbing, both physically and psychologically, Vitiligo, a progressive depigmentation or whitening of the skin, is one such skin condition.
While treatment is underway, camouflaging areas of vitiligo can also we useful. There are numerous cosmetic options from body makeup or self –tanners that can disguise the appearance of lighter areas. Although the use of these may take practice, the results can appear natural. It is also important to note that people with vitiligo should use sun protection, with an SPF of 30 daily. It is known that sunburn can worsen vitiligo and those with this skin disorder may burn more easily. Vitiligo can be a distressing skin condition, but it is important to note that there aretreatment options available to improve it. With this skin disorder, as with any other skin problem, is it important to seek the help of a board certified Dermatologist to customize the best treatment options for you.
CATHERINE PAPASAKELARIOU, MD. Dr. Catherine Papasakelariou is board certified by the American Board of Dermatology. Although Dr. Papasakelariou enjoys all aspects of dermatology, her areas of special interest include acne, eczema, pediatric dermatology and cosmetic dermatology. During her free time, she enjoys spending time with her husband and two children, family bike rides and travel. HEALTHLINEMAG.COM
JULY - SEPTEMBER 2016 I HEALTHLINE
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Alzheimer’s Disease:
The Basics
Photo Credit: Fotolia
could struggle with new words or have problems making good decisions. If an individual has these symptoms, it does not automatically mean they are caused by Alzheimer’s. A physician should be consulted to conduct tests to identify the cause.
Puppies, kittens, babies, warm hugs: I hope I got your attention for a minute. What do you know about Alzheimer’s Disease? Is it as scary a subject for you to think about as writing a will is to many people? Let’s be real it is a scary topic. Alzheimer’s disease is a progressive form of dementia that can ultimately lead to death. An estimated 5.4 million Americans of all ages have the disease so the chance that you will know someone with disease at some time is high. Dementia is an umbrella term used to describe impairment that shows up as problems with cognitive functioning so, problems in memory, speech, language, judgement, reasoning and other thinking abilities. In our everyday life, we could have for example, problems making a meal, paying bills or travelling to a familiar place. We
The most common initial symptom for Alzheimer’s disease is a worsening in the ability to remember new information. This occurs because according to current research, the area first damaged by the disease is that area of the brain responsible for forming new memories and then gradually other areas of the brain are also damaged. No single test exists currently to diagnose Alzheimer’s disease so the physician will use a variety of approaches and tools to help make a diagnosis. Alzheimer ’s disease is ranked as number six in the Top ten diseases in the United States ,however it is the only disease without a cure. The medications currently available temporarily improve symptoms but do not slow or stop the disease progress.Using the appropriate available treatment options as well as keeping the person with the disease socially engaged and supported, can improve the quality of life of individuals with dementia and their caregivers. The Alzheimer’s Association can help you understand the disease and also give you information on current research on reducing your risk of dementia. Visit alz.org/texas or call our 24/7 HELPline: 1-800- 272 3900
ANN MARIE MCDONALD, MBA MED Ann Marie is the Interim Program Officer of the Houston & Southeast Chapter of the Alzheimer’s Association. She has worked with the Alzheimer’s Association in various capacities for over ten years.
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Photo Credit: Fotolia
ARMD
The Thief of Eyesight
Age related Macular Degeneration (ARMD), is one of the most debilitating eye diseases. The macula is the area of the retina that impacts central vision. Central vision becomes blurry and distorted making it hard to make out peoples’ faces, hard to see details for reading or writing, and making it hard to drive a car. ARMD is the leading cause of vision loss among people age 50 or older. There is a strong family link with ARMD. Many genetic factors affect people with ARMD. People may have ARMD in one or both eyes. There are many risk factors for ARMD. Smoking, family history, genetics and race are all risk factors. There are greater chances of Caucasian patients developing ARMD. There are different stages of ARMD like early, intermediate, and late AMD. Late AMD can be grouped in two different stages: Wet ARMD and Dry ARMD. Dry ARMD has pigmentary changes to the macula along with decreased vision. Wet ARMD is more severe vision loss caused by leaky blood vessels underneath the macula. Treatment of AMD has changed over the years. Most of the treatment is aimed to stop the growth of new blood vessels and decrease the leaking of these blood vessels. When a person or a loved one has ARMD, so
much is affected by their low vision. Reading, writing, driving, and social activities are all altered. However, many services exist to help patients with low vision. Early detection is crucial to preventing late AMD. This first step in diagnosis is an annual dilated eye exam which will give a better view of the retina. An amsler grid (a central grid used to monitor central changes) is also helpful to see changes in the central vision. Patients with early changes to the macula need to adapt lifestyle changes like exercising, diets with green leafy vegetables and fish, and stop smoking. Patients with intermediate or late ARMD may consider taking supplements that have AREDS 2 formula vitamins. The AREDS 2 formula have 10mg lutein and 2mg zeaxanthin to reduce the risk of late ARMD. Some example of these eye vitamins are: Preservision (AREDS 2), Icaps, viteyes, EyePromise, and Pro-Optic AREDS 2 Formula. These supplements are available through various pharmacies and online retailers. If you have not had an eye exam within the past year, it is absolutely necessary to schedule one as soon as possible. It pays to be pro-active with your eye health.
MINI JOHN, OD. Therapeutic Optometrist Owner of American Eyes Optical Missouri City, Texas
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Living Kidney Donation A son’s gift of life to his mother
Diabetes and high blood pressure are the two most common causes of end-stage kidney disease. The progression of both conditions over more than 15 years ofGams life led to chronic kidney disease. By 2010, the 66-year-old mother of four boys was in borderline kidney failure, and her nephrologist warned her family to be prepared for dialysis. When we learned this, we as a family started looking at options and one of those options was transplantation, says her 43-year-old son David. Two of my younger brothers had families with young boys, and my youngest brother was just beginning to blossom into his life, so they were not great candidates. I made the decision that I wanted to donate a kidney to my mom if we were a match. In the beginning she disagreed. As a mother she didnt want to take her sons kidney. Traditional Vietnamese views hold the eldest son responsible for taking over the role of father in the household when the father passes away, which is why most Vietnamese families value having a son as the firstborn child. She didnt want to do anything to put me at risk of dying before she did. The family discussed transplantation with her for more than a year. We as a family urged her to leave no stone unturned in fighting for the precious gift of life, David says. We told her, God gave you this most sacred gift and you have to do everything possible to protect that. Mom, you have to stay around for your grandkids. She was very courageous in going against her traditional beliefs and in her willingness to undergo a major operation at her age. By 2011, Gam had four grandchildren under the age of five and kidney function of only 7 percent, not enough to meet the needs of daily life. When function falls below 5 percent, dialysis is highly recommended. She was weak and tired but still treading water, David says. We made the decision to have the lab work done to determine if
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my mother and I were a match. Once they determine youre a match, they evaluate you to see if youre healthy enough to donate a kidney. I passed all the exams and was cleared as a donor. As Gam was going through the evaluation process, she encountered an obstacle: the transplant team found lesions on her liver in one of the last remaining tests. The doctors could not move forward until they were certain the lesions were benign. She would have to undergo a CT scan, which involved injecting a dye through an IV,David says. The extra work her kidneys would have to do to flush the dye from her body would lower her kidney function further and push her into dialysis. Rather than do that, the family decided to let nature take its course. If the transplant couldnt be done, we could accept that we didnt make a decision that would require dialysis. We thought that it wouldnt be long before she required dialysis and when that happened, we would go forward. So after we had the entire transplant workup, we put it on hold. Gam remained at 7 percent function for about another year. After routine lab work late in 2014, the family learned that her kidney function was less than 5 percent. They highly recommended dialysis, David says. I said to the transplant team, Lets get that workup. Because it had been over a year, they had to redo all the labs. When they did the liver scan with dye, it turned out to be natural lesions that occur with age. David was standing in an Ace Hardware when he received the call about the results of the last test. For a brief moment, time stood still, he says. I told the transplant team that I needed six weeks to tie up all loose ends and we agreed on a transplant date in late August. I recall how beautiful the trees and grass were as I was driving home, and remember thinking that all I wanted was for my mother to be okay, because she was too HEALTHLINEMAG.COM
frail to deal with complications. I asked God to please grant me this one wish and promised never to ask for anything else. The donation and transplant were done on August 22, 2014, at Memorial Hermann-Texas Medical Center. Davids initial recovery was harder than his mothers.The day after her surgery she was a totally new person, he says. She woke up and said, Im hungry. When are we going to eat? She was strong, healthy and very hungry. Before the transplant she never felt like eating because she was always sick and tired and weak. Since the transplant, Gam has enjoyed spending time with her grandchildren. I see the four little boys every day and value my health more than I ever did, she says. After so much pain and suffering, its wonderful to feel great again. Im amazed at what my son did and cant believe that it truly happened. I thank God every day and pray that my son will never have any problems as a result of the surgery. David believes that his mothers decline and his deep involvement in the state of her health happened at that particular time in his life for a reason. My work was so time consuming that I never saw my mother, he says. About five years ago I saw her for the first time in about six months, and my jaw just hit the ground. She looked terrible, like she was dying. I thought what does work matter? Thats when I told her, Mom, Im going to help you. My family has always been healthy, but Mom grew up poor in Vietnam with bad eating habits and not enough drinking water. Because we had all been healthy, we thought even with diabetes, shell be fine. Thats how we treated it for 15 years.
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Medwin Family Medicine & Rehab
When he started participating fully in his mothers health, he learned that she was taking several medications and injecting insulin. I started talking to her doctor and asking, Why is she taking this? Whats that medication for? We took over. My job could wait. The family investigated other transplant centers but chose Memorial Hermann. We felt more comfortable there, he says. How you feel about your team makes a big difference in your result. If youre considering donating or transplantation, choose a team that makes youfeel strong, confident and at home. David, Gam and their family would like to thank the entire team at the Trnsplant Center at Memorial Hermann-Texas Medical Center and the McGovern Medical School, especially Helen Matthis, kidney transplant coordinator; Mark Hobeika, M.D., assistant professor of surgery, division of Immunology and Organ Transplantation; J. Steve Bynon, M.D., FACS, chief of abdominal transplantation, director and professor, division of Immunology and Organ Transplantation; Wasim Dar, M.D., assistant professor of surgery, division of Immunology and Organ Transplantation; Horacio Adrogue, M.D., medical director of renal and pancreas transplantation and associate professor of medicine, division of Nephrology; Aleksandra De Golovine, M.D., assistant professor of medicine, division of Nephrology; Sylvia Connor, RN, transplant coordinator; Van Nguyen, RN, inpatient coordinator; Gloria Chen, LCSW, CCTSW, David’s social worker; Leslie Simmons, RN, pre-transplant coordinator for Gam; and Penelope Loughhead, LCSW, CCTSW, Gam’s social worker. HEALTHLINEMAG.COM
1235 Lake Point Pkwy, Suite # 103 Sugar Land, Texas 77479
• Best Family Physicians by Consumer Research Council in 2006, 2008 and 2015. • Practicing Medicine for 25 years. Manjula Raguthu M.D FAAFP, ABAARM Board Certified in Anti-Aging and Regenerative Medicine, Family Physician
832-532-0040
www.medwinfamily.com Affiliated with American Family Physicians Association Texas Family Physicians Association Valley Chapter, Currently involved with Multiple Philanthropic Associations and Chapters.
Ace Pain Management Physical Therapy and Stem Cell Treatment
• We offer Physical Therapy, Rehabilitation, Sports Medicine and Pain Management.
www.acepain.com 1235 Lake Point Pkwy, Suite # 103 Sugar Land, Texas 77479
Surya Raguthu M.D DBIPP, ABIME Board Certified in Pain Management and Interventional Pain Physician
832-532-0050
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The Medical Resort at Sugar Land
The orthopedic rehabilitation program at The Medical Resort at Sugar Land helps patients in regaining function following a joint surgery or recovering from a traumatic fall or injury. We utilize advanced protocols for elective joint replacements and spinal surgeries. O U R F E A T U R E S
• Private luxury suites. • State of the art therapy gym and equipment. • Individualized physical, occupational, respiratory, and speech therapies with services available 7 days a week. • Comprehensive nursing care for surgical wounds and pain management. • Therapy courtyard with putting green. • Free high speed internet access. • Restaurant style dining room with custom meals. • Beauty salon with services that include manicure, pedicures, and facials.
1803 Wescott Ave. Sugar Land, TX 77478 (Next to Costco) 281-329-4300 • Fax: 281-240-3477 • www.tmrsugarland.com Member: IACCGH
• SENIORS FOCUSED WEBSITE • TXCSS RESOURCE DIRECTORY Brian Mertz • UPCOMING CAREGIVER EVENTS CEO • ADVERTISE IN OUR RESOURCE DIRECTORY
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Can visiting your dentist save your life?
Recent studies have concluded that poor oral health has a direct link to heart disease, stroke, and other health problems. However, by implementing certain simple habits, you can improve oral health, your general health, and significantly lessen your risk for heart disease.
The proper care and maintenance of your teeth and gums will have a positive effect on your overall health. Ignoring the health of your mouth will lead to more than just sore teeth and bad breath — it will invite all sorts of health problems, including diseases like oral cancer. Researchers have found a relationship between gum problems and heart disease, bacterial pneumonia, stroke, and even problem pregnancies. The Role of Diet and Lifestyle in Oral Health The following are some common dietary habits that can affect oral health: Sugar consumption. A diet consisting of sugary foods has been known to contribute to tooth decay. Bacteria in the mouth thrive on food that is allowed to rest on and around the teeth. These bacteria use the sugars to produce tooth and gum-destroying acids. Smoking. Besides not being healthy for the
lungs, dental care experts warn that smoking or chewing tobacco products can also cause gum disease, tooth decay, and other serious medical conditions, like throat and gum cancer. Research has documented toxicity levels found in various tobacco products to have adverse effects on gum tissue and interference with blood flow. Tobacco also stains the teeth and contributes to bad breath. Drinking alcohol. Drinking any type of alcoholic beverage can contribute to oral problems by causing dehydration in the mouth. A dry mouth permits bacteria growth to run rampant. Abusing alcohol can obviously cause even more problems. Healthy Mouth, Healthy Body To maintain your oral health and overall good health, doctors agree you should see your dentist routinely to head off any problems early. You should also practice good oral hygiene at home by properly brushing and flossing your teeth regularly to prevent plaque from accumulating and causing problems. In my opinion, a person cannot be healthy with an unhealthy mouth. Everything a qualified dentist can do to offer a healthy smile, a patient should reinforce by accepting healthy dental care and general health care habits.
PURVI PARIKH, DDS. Dr. Purvi Parikh had earned her DDS degree from the renowned NYU School of Dentistry after emigrating from India. She has been practicing general dentistry for nearly 20 years. Dr. Parikh settled in Houston-Metro region with her family after moving from the New York City area. She owns and operates A to Z Dental in Sugar Land where she has been praised for her special style of “ Gentle Dental Care.” HEALTHLINEMAG.COM
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Vaccinate Don’t Procrastinate
The Astonishing Link Between Human Papillomavirus, Oral Sex, and Oropharyngeal Cancers Among Adolescents and By 2020 there will be more Oropharyngeal Cancers (OPC) in men than Cervical Cancer in women based on its rate of increase over the past 20 years.The Annual report to the Nation on the Status of Cancer reported that OPC’s comprise 78.2% of HPV related cancer in men and 11.6% in women (Jemal and et al, 2013). Despite this fact, most pre-adolescents, adolescents, and young adults lack sufficient knowledge of how HPV is contracted and that HPV can be a consequence of vaginal, anal, or oral sex. Proper utilization of Gardisil vaccines, three over a six month period, by individuals between the ages of 9-26 before their first sexual encounter, could aid in decreasing the number of HPV cases and deaths related to cancers associated with the disease. As of 2010, Texas’s vaccination rate continued to lag with only about 32% of girls age 13 to 17 receiving all three doses (Jemal and et al, 2013). Thus providing support for better HPV educational programs to increase knowledge and vaccination rates among pre-adolescents, adolescents, and young adults.
HPV cases, the incidence of HPV at 20 million new infections yearly, cause direct medical care cost of more than $16 billion to the American Healthcare System. Studies have shown that younger people with HPV positive Oropharyngeal Squamous Cell Carcinomas (OSCC) lacked traditional risk factors, linking the cause to open mouth kissing and a lifetime increase of oral or vaginal sex partners (D’Souza, Agrawal, Halpern, and et al, 2009). References Centers for Disease Control Morbidity and Mortality Weekly Report. (2012). National and State Vaccination Coverage Among Adolescents Aged 13-17 Years, United States, 2011. Retrieved from http://www.cdc. gov/mmwr/preview/mmwrhtml/mm6134a3. htm
Jemal, A., Simard, EP, Dorell, C.; et al. (2013). Annual report to the nation on the status of cancer, 1975-2009, featuring the burden and trends in human papillomavirus (HPV)- Associated The Centers for Disease Control have noted Cancers and HPV Vaccination Coverage Levels. that each year the incidence of HPV, the most Journal of National Cancer Institute. common sexually transmitted and post vagi- DOI: 10.1093/jnci/djs491. nal delivery transmitted infection, affects more than 21,000 women as well as more than 12,000 D’Souza, G., Agrawal, Y., Halpern, J., Bodison, men, (CDC, 2013). Highlighted as having more S., Gillison, ML. (2009). Oral sexual behaviors than 150 strands and recognized as highly af- associated with prevalent oral human fecting those 15-24, 25% of the sexually experi- papillomavirus infection. J. Infection Dis. enced population and 50% of newly diagnosed 199(1263-1269). DOI: 10.1086/597755.
EBONY N. MITCHELL, MSN, RN Ebony N. Mitchell, MSN, RN has been employed with Houston Methodist Hospital in Otorhinolaryngology and Ophthalmology Operating rooms over the past 14 years. She specializes in assisting physicians with the treatment of adult and pediatric patients experiencing disparities of the ears, nose, throat, and eyes
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Clinical Treatment Programs for Deformational Plagiocephaly Deformational plagiocephaly is identified in young infants and defined as an asymmetrical skull shape. The asymmetry involves flattening on one side of the back of the head and is often accompanied by misaligned ears, forehead protrusion, and/ or tightness of the neck muscles. Steps to address cranial deformities include: diagnosis, presentation and severity, initiating orthotic treatment and orthotic management principles1. Diagnosis Often identified within the first 12 weeks after birth, initial efforts are focused on conservative treatments such as repositioning and stretching to attempt to improve cranial symmetry. Infants with milder deformities may respond well to early and consistent repositioning efforts. Other infants, e.g. those with congenital muscular torticollis, may experience little to no change in the overall head shape. In some cases, the deformity worsens in spite of diligent efforts by the parents. Presentation and Severity By 4 to 5 months of age, moderate and severe deformities are not likely to be significantly improved with continued repositioning efforts and a cranial remolding orthosis (CRO) may be prescribed. Cranial vault asymmetry is the difference in diagonal measurements from the forehead to the back of the skull on the opposite side.
A moderate deformity is identified with 8mm or more of asymmetry; a severe deformity presents with 12mm or more. Initiating Orthotic Treatment Infants’ heads double in size from birth to adulthood, and 80% of the cranial growth occurs within the first 12 months. It’s important to capitalize on the rapid growth of the skull to create symmetrical and permanent changes in the cranial structures. Orthotic Management Principles In general, the earlier the orthotic treatment program is initiated, the faster cranial reshaping is achieved due to the ability to direct ongoing cranial growth patterns.A digPhoto Credit: Fotolia ital scan of the infant’s head is obtained and used to create a custom orthosis. The CRO is designed to allow cranial growth in the flattened areas while holding the contours of the rounded areas. Routine follow-up visits ensure positive outcomes and treatment programs with the CRO last between 3 and 6 months. The orthotic treatment of deformational plagiocephaly is a time-focused and time-limited process for infants with moderate to severe cranial asymmetry. Concurrent therapy programs may be necessary to address the neck muscle tightness, and ongoing collaboration with all medical team members ensures that optimal outcomes are obtained.
HAILEY BROWN , CPO, LPO. Hailey Brown CPO, LPO is a certified and licensed orthotist and prosthetist who works exclusively with pediatric patients from Austin and the surrounding areas. Brown was educated at the School of Rehabilitation Medicine at the University of Washington, and has been with Hanger Clinic for ten years.
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CATARACTS When we look at something, light rays are focused by the lens in the eye to provide a sharp image of what we see. The lens must be clear in order to focus the picture properly. If the lens has become cloudy, the image will be blurred, and this is called a cataract. Most cataracts are due to aging, but they can also develop as a result of trauma, surgery, medications, and medical ailments. Symptoms of a cataract include blurriness, glare, poor night vision, double vision, and the perception of colors being faded. Cataracts develop slowly, so you may not notice any changes in your vision in the initial stages. However, as the cataract progresses, you may find that it interferes with your daily activities. A cataract can be diagnosed through a comprehensive eye examination. Once you are diagnosed with a cataract, you will require regular monitoring of its progress. When a cataract causes significant effects to your vision or ocular health, the cataract should be treated. There
are no medications or eye drops that can treat cataracts; surgery is the only treatment. This surgery is performed by an ophthalmologist, a medical doctor (M.D.) who specializ-
Dr. Lovell A. Jones Lovell A. Jones, Ph.D., F.H.D.R. is the Executive Director of the Health, Disparities, Education, Awareness, Research & Training (HDEART) Consortium. He is the first African American to be honored with dual Emeritus Status, at the University of Texas M.D. Anderson Cancer Center and at the University of Texas Graduate School of Biomedical Sciences. He presently on the faculty at Prairie View A&M University College of Nursing.
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es in diseases and surgery of the eye. With cataract surgery, your eye’s cloudy natural lens is removed and replaced with a clear artificial lens. Your vision will be restored to its clarity prior to the development of the cataract, and you may have no further need for glasses after the procedure. Recovery is quick, with a return to most activities the day following the operation.
DIP S. JADAV, MD. Dip S. Jadav, M.D. is an ophthalmologist and founder of Outlook Eye & Laser Center in Sugar Land, TX. His office accepts Medicare, Medicaid, and most other insurances. His office has translators for Hindi, Gujarati, Urdu, Bengali, and Spanish. HEALTHLINEMAG.COM
New Advisory Board Member
New Advisory Board Member
Farida Abjani Farida Abjani holds a Bachelor’s degree in nursing from Grand Canyon University. She is an experienced registered nurse and despite having a thriving for-profit hospice firm in Houston she serves on boards of several charities and has helped raise thousands of dollars. Farida is among the 30 most influential women of Houston 2016, was named "IT Girl 2016" by Houston Chronicle which recognizes women for their successful career as well as Philanthropic efforts and was recognized as Women who run Houston 2016 also by Houston Chronicles. Texas Department of Aging and Disability Services have appointed her as an advisory board member to the Texas Respite Advisory Committee (TRAC) for the year 2016-2018.
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CORONARY HEART DISEASE IN WOMEN: SYMPTOMS, DIAGNOSIS AND RISK FACTORS The top three conditions that result the most number of deaths for women in the US are heart disease, cancer and stroke. Heart disease kills more women than anything other condition and one in four women in the US dies of heart disease. Coronary heart disease, the most common form of heart disease, is caused by blood vessels blocked fully or partially by plaque (a waxy substance produced by our bodies), leading to heart attacks, angina or stroke. Many women underestimate their threat of coronary heart disease.
Most of the scientific studies that discuss recognizing symptoms of heart disease have focused on those that are typically experienced by men. It is important to be aware that heart disease symptoms are different in women. One common symptom of a heart attack is tightness or pressure in the chest. However, some women may not experience this symptom even though they may be having a heart attack. Some of the non-chest pain related symptoms in women are - neck, jaw, shoulder and upper back pain, difficulty breathing, pain in the one or both arms, discomfort in It is now known that the symptoms of coronary the stomach along with nausea and vomiting, dizheart disease in women differ from those of men. ziness, feeling very tired and sweating. Since the
DR. DEBORAH BANERJEE, PHD, MS, HOUSTON HEALTH DEPARTMENT. Dr. Banerjee is an epidemiologist and health scientist. She was conferred her PhD from University of Texas School of Public Health at Houston. She has worked for the Houston Health Department as a public health practitioner for more than 8 years. Currently, she is the Bureau Chief of Office of Planning, Evaluation and Research for Effectiveness. She studies health disparities and health inequities and strives to bridge the gap between research and practice.
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symptoms in women are somewhat vague, when women actually seek a physician’s care, they have already had a heart attack. In addition to this, women are typically the family caregivers and tend to not pay enough attention to their health and symptoms of disease. This can result in downplaying their symptoms and delay in seeking care. There is no single test that can diagnose heart disease in women. Your physician will examine your medical history, your family history, your risk factors, and one or more of the following tests –electrocardiogram (EKG), stress test, electrocardiography, chest X-Ray, blood tests and coronary angiography (National Heart, Lung and Blood Institute, Accessed on 5/18/2015) in order to determine whether you have heart disease. What are some of the risk factors for developing heart disease in women? Most people are aware of factors such as unhealthy eating habits and lack of physical activity. In addition, the other important risk factors are diabetes, depression, excess stress, high blood pressure that is not managed, smoking, family history and low levels of estrogen after menopause that can increase the risk of developing heart disease in women. Some of the risk factors cannot be modified such as family history. But, the other risk factors that can be modified such as adopting better eating habits, regular physical activity, blood pressure monitoring and control and stress reduction are ways in which people can reduce their risk. Cardiovascular diseases kill more women than the next five causes combined, including all cancers. Source: Texas Heart Institute, Accessed on 5/18/2015 HEALTHLINEMAG.COM
6213 Skyline Drive, Suite 2100, Houston, Texas 77057
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Is Anesthesia Harmful for Young Children?
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Perhaps your child’s (or your grandchild’s) physician has recommended a surgical procedure for your little one, and the surgeon says that he/she will need to be anesthetized for the procedure. Of course you are worried about the procedure, but now there’s a new concern: you may have heard on the news that anesthesia may be harmful for the brains of young children. What are those concerns? What should you do as a parent (grandparent)? For a number of years, there has been concern in the scientific community that anesthesia may be harmful for the developing brain. Those concerns initially came from animal experiments, in which young mice and rats were anesthetized, and then underwent memory tests and training exercises. Rats that had anesthetics at an early age did not perform as well as those who did not have anesthesia. But children are not rats! Population studies looking back at children who had anesthesia early in life have also shown some concern for learning disabilities in children who have had mul-
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tiple operations and anesthetics. Of course, children who require multiple procedures are different from their peers who did not require multiple surgeries early in life. Many of those children had birth defects, or were born prematurely, etc. It is not clear whether the illness itself, the surgical procedure, or specific anesthetic medications might be influencing the developing brain. Further, several of these studies were done using anesthetic agents and techniques that we no longer use today. Most of the concerns that you may hear about are related to these look-back studies, with some of the surgeries done 15 years or more prior to the educational or neurologic testing.It is important to know that not all clinical research studies in children have found these concerning issues; some have been more reassuring. Clearly, more research is needed to help us understand what might be causing learning problems in these children; unfortunately, the studies that need to be done take many years to complete, since the most sophisticated follow-up studies are generally done after children enter school. HEALTHLINEMAG.COM
What should parents do at this point? If your child’s physician recommends surgery, there are steps you may want to consider: 1) Ask about the timing of the surgery, or medical alternatives to surgery, 2) Ask about the relative risks of delaying the surgery versus the potential risk of exposing the child to surgery and anesthesia before the age of 3 or 4 years, 3) If your child needs more than one procedure, ask the surgeons to coordinate doing the procedures at one time, with one anesthetic, 4) If you are undecided about whether to proceed with surgery or not, ask for a 2nd surgical opinion, or ask your pediatrician for his/her advice. Pediatric Anesthesiologists, specialists in the care of children undergoing anesthesia or sedation, are also happy to respond to parental concerns about this issue. The pediatric anesthesia and pediatric surgical professional organizations are in agreement that necessary surgery should never be postponed or cancelled because of the potential risk of anesthetic toxicity. Ask lots of questions! Choose physicians who are skilled and experienced in the care of children, and request that your child’s procedure be performed in a facility that has trained staff and resources to provide the very best care for your child. For more information, check the SmartTots website for the latest consensus reports on the issue of anesthetic neurotoxicity. SmartTots is a public-private partnership between the US Federal Drug Administration (FDA) and the International Anesthesia Research Society (IARS), formed to examine this question and to facilitate funding for the research. The most recent Consensus Statement, from October 2015, may be found at http://smarttots.org/smarttots-releases-updated-consensus-statement/
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NANCY L. GLASS, MD, MBA, FAAP. Dr. Glass is a pediatrician, pediatric anesthesiologist, pain physician, and pediatric hospice doctor who has been caring for sick children for more than 30 years. She is Professor of Anesthesiology and Pediatrics at Baylor College of Medicine and Texas Children’s Hospital, and Associate Medical Director at Houston Hospice. Dr. Glass is the Immediate Past President of the Society for Pediatric Anesthesia, representing more than 3,000 Pediatric Anesthesiologists in the US and Canada. HEALTHLINEMAG.COM
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Shawna Becker OT Shir Rao PT Justine Wilkinson OTA
Occupational Therapy changing Stroke Survival to Stroke Occupational Therapists or OTs have always been part of the interdisciplinary team of professionals that assist stroke patients in their recovery. OTs assess and instruct the stroke patient on using adaptive or compensatory methods to be as independent as possible with self-care tasks such as dressing, grooming or bathing.
dalities now available that offer cutting edge technology to obtain maximum outcomes.
One such modality is electrotherapy called PENS or Patterned Electrical Neuromuscular Stimulation. PENS provides a form of neuro stimulation that allows the patient to get a normal pattern of movement in the affected arm or leg that is typiOTs use a variety of tools to speed that recov- cally lost or difficult to elicit after a stroke occurs. ery process and there are state of the art mo- OTs at the Medical Resort of Sugar Land are all cer-
BINDU GEORGE-CHACKO, MOT, OT/L Director of Rehabilitation Services at The Medical Resort Sugar Land Bindu Chacko is the Director of Rehabilitation at The Medical Resort Sugar Land. She has over 14 years of clinical expertise in the field of therapy as well as a background in teaching. She currently serves on the Advisory Board for the PIMA Medical Institute and is an active member of the Texas Occupational Therapy Association.
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tified in the use of this advance technology and use it frequently to accelerate recovery in their stroke patients. The use of PENS can be also very beneficial not only to the stroke patient but for patients with a variety of conditions such as poor exercise tolerance, decreased strength and coordination, arthritis, total joint replacements and general weakness. It has been proven by numerous studies that neuroplasticity is absolutely possible even years after suffering a stroke with the use of state of the art modalities such as the PENS. And here at The Medical Resort Sugar Land we have the best OTs who will execute the excellence needed in stroke success! Lilia Lizama OTA Justine Wilkinson OTA
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Ways to Decrease Blood Pressure Naturally Lifestyle plays an important role in treating your high blood pressure. If you successfully control your blood pressure with a healthy lifestyle, you might avoid, delay or reduce the need for medication. About one in three Americans have, high blood pressure, and only about half of those people have their condition under control. High blood pressure, also called hypertension, can be caused by lifestyle factors or by genetics or, usually, a combination of both. For people who aren’t able to bring their levels down naturally, medication may be necessary. But if your high blood pressure is a result of unhealthy habits, making some simple changes may help reduce or even eliminate your need for prescription drugs. With your doctor’s okay, give these tricks a try and see if they work for you. Maintain a healthy weight Weight is one of the most important determiners of blood pressure. Once someone’s BMI is over 25 to 28, taking off a few pounds will make a big difference in treating high blood pressure Exercise regularly Most healthy people should get at least 150 minutes of moderate-intensity exercise a week. If you need to lower your blood pressure, though, the American Heart Association has some additional advice: Within that 150 minutes, aim to get 40 minutes of higher-intensity (moderate to vigorous) activity three or four times a week. If you want to go to the gym for an hour a day and run or take classes, fantastic. But if a brisk walk around the neighborhood fits your lifestyle better, than that’s great too. Lower salt intake Most Americans including 86% of those with high blood pressure take more salt than is advised by the government’s Dietary Guidelines for Americans. If you’re one of them, reducing your intake to less than the recommended limit of 2,300 milligrams (about a teaspoon) a day may make a big difference in your blood pressure and even better if you can stay below the 1,500 mg dai-
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ly limits of the American Heart Association's. Follow the DASH Diet For an even bigger impact on blood pressure levels, try the DASH Diet, also known as Dietary Approaches to Stopping Hypertension. You’ll lower your salt intake on this plan, but you’ll also eat more fruits, vegetables, whole grains, and low-fat dairy products. The DASH Diet can lower the top number systolic pressure anywhere from 8 to 14 points. The diet is high in foods that have calcium, magnesium, and antioxidants, all of which contribute to lowering blood pressure. It's also rich in potassium, which can help blunt the impact of any sodium you consume. Lower the frequency of eating out Americans eat too much salt in large part because restaurants add so much of it to their cooking, according to a 2016 report from the Centers for Disease Control and Prevention. This can be confusing even to customers who try to make smart choices, since high-sodium foods don’t always taste salty. Stop smoking After a cigarette break, blood pressure rises for a short time. Interestingly and even though it’s bad for your heart in other ways it doesn’t seem to raise levels very much in the long-term. But besides those temporary spikes, there’s another reason to kick the habit: Smoking dulls taste buds, so smokers tend to add more salt their food more and have a harder time decreasing sodium intake. Cut your calorie intake One simple way to reduce your salt intake may just be to reduce your overall food intake. If you eat 25% more food, you’re likely getting 25% more salt. Plus, eating more food than you need, will probably make you gain weight, which also raises blood pressure. The smartest thing to cut out first is processed foods. Find a way to relax Stress can cause blood pressure to rise, both short- and long-term. So finding something that helps you relax HEALTHLINEMAG.COM
can be an important part of preventing or reducing hypertension. What that something is, exactly, is up to you but research suggests that yoga, meditation, spending time with pets, laughing, may be good choices. Just like with exercise, you have to choose something that you enjoy and that you can do consistently as part of your daily lifestyle
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Control Alcohol intake Moderate alcohol consumption up to one drink a day for women and two for men may have beneficial effects on blood pressure. But any more than that seems to do just the opposite. We know that heavy drinking raises blood pressure, in addition to increasing your risk for other chronic conditions.
seem to help. There are other reasons you may want to spend more time in the great outdoors, though in addition to getting the necessary vitamin. Get better sleep If you’re not getting enough sleep either because you’re burning the midnight oil or you’re dealing with a sleep disorder you may be at greater risk for high blood pressure. Take a nap Napping may do your heart some good. Adults with high blood pressure who took hour-long naps every day saw their systolic blood pressure drop an average of 5% over the course of the day in a 2015 study, compared to those who didn’t rest. Those who napped also had to take fewer blood pressure medications than those who didn’t, and seemed to have less damage to their arteries and their heart. Consider other health issues Go over your medical history and any drugs and supplements you’re taking with your doctor. Sometimes you can be on medicines that raise your blood pressure, or you can have an underlying condition like a thyroid imbalance or a kidney obstruction that needs to be treated.
Watch your coffee habit Moderate coffee intake doesn’t seem to make much of a difference in blood pressure levels, but more and more people are seen drinking huge amounts of highly caffeinated beverages and that very likely has a negative effect on blood pressure. Get outdoors Low levels of vitamin D which the body gets from fortified foods, supplements, or the skin’s exposure to sunlight have been linked to high blood pressure. But most research has found that taking supplements doesn't
Breathe deeply Slow breathing and meditative practices such as qigong, yoga, and tai chi decrease stress hormones, which elevate renin, a kidney enzyme that raises blood pressure. Switch to tea Lowering high blood pressure is as easy if you drink tea. Study participants who sipped three cups of a hibiscus tea daily lowered systolic blood pressure by 7 points in 6 weeks on average, say researchers from Tufts University. Those who received a placebo drink improved their reading by only 1 point. The phytochemicals in hibiscus are probably responsible for the large reduction in high blood pressure, say the study authors. Many herbal teas contain hibiscus; look for blends that list it near the top of the chart of ingredients for low blood pressure.
MEENAKSHI BHATTACHARJEE, PhD. Dr. (Mrs) Meenakshi Bhattacharjee, Faculty Fellow and Executive Director of Applied Algal Research, Biosciences @ Rice university. She is an internationally renowned Biotechnologist and Cyanobacteriologist and a recipient of several National and International Awardsfor her cutting edge research on Algal and Environmental biotechnology. She has authored over 200 publications. HEALTHLINEMAG.COM
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EARLY CHILDHOOD INTERVENTIONS (ECI) IN AUTISM SPECTRUM DISORDERS Intensive, highly structured early interventions leads to significant developmental gains for many children with ASD in the areas of language, self -care, social and academic development. It also increase the parent’s ability to teach a child with ASD. Autism Spectrum Disorder (ASD) is one of the most common developmental disorder mostly seen in males. Multi-disciplinary interventions are needed as soon as delay or disorder is identified. It starts with pediatrician identifying the delays and directing the parents or care providers to developmental pediatrician or appropriate health care professionals. Early Childhood Interventions (ECI) has an important role in providing services to families of infants and toddlers with qualifying developmental delays or disabilities. ECI serve children from birth to36 months. Services may be provided at home or other places such as child care centers or community setting. Some of the important features of services provided by ECI are planned, individualized, family centered services by professional providers in familiar setting. They also provide directions for continuing services and case management. Family income does not affect the eligibility. Some of the services provided by ECI are speech and language therapy, occupational therapy, physical therapy, play therapy, assistive technology, audiology, family education and counselling, nursing, nutrition, psychological, social and vision care.
The eligibility is depending on the professional evaluation of a team of at least two professionals from different disciplines. ECI serve children with medical diagnoses found in the DARS ECI list at https://dmzweb.dars.state.tx.us/prd/ qdiag/. For children with auditory or visual impairment this determination is usually made by certified staff from local independent school district. This provision is defined by Texas Education Agency rule at 19 TAC Section 89.1040. Child with at least 25% developmental delay which affects functioning in one or more areas including communication, cognition, gross or fine motor skills, social- emotional and self-help or adaptive skills. A comprehensive evaluation will be done to look at all areas of development as per federal law.These evaluation and assessments are provided at no cost to family from federal and state resources under Individuals with Disabilities Education Act (IDEA). It is very important to find the local ECI program in the child’s home location. Parents can contact the Department of Assistive and Rehabilitative services (DARS) at 1-800-628-5115 or search for program at www.dars.state. tx.us/ecis/searchprogram.asp. This web site provide ECI program that serves the specific area in which one can search by city, county or Zip code. This list services in every Texas count. ECI parent hand book will help to understand the law protection for family and child as well as guide families through the steps to ECI. This handbook can be found at http://www.dars.state. tx.us/ecis/publications/EnglishHandbook.shtml
SOBHA GEORGE, MSN, CEN. Sobha George MSN, CEN, is a registered nurse who currently lives in Houston. She works in the Clinical Operations Informatics Department at MD Anderson Cancer Center. Apart from her job obligations, she is also involved with various activities for special needs children and adult. She serves as a voluntary resource specialist for school districts, and different organizations such as Texas Parent to Parent and National Autism Association (NAA). Mrs. George is actively involved with operations of Heavens Own Precious Eyes (HOPE), an organization that consists of differently abled persons and their families.
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The silent scourge of juvenile arthritis Most people have never heard of juvenile idiopathic arthritis, defined as joint swelling, or limited range of motion of a joint, that strike children under the age of 16. Many wrongly assume that arthritis is an old person’s disease, but it really can affect all age ranges. In the United States alone, nearly 300,000 children have been diagnosed with juvenile idiopathic arthritis. And while most of these kids are able to live a fulfilling life, including continuing to play competitive sports, they do so with a fairly intense treatment regimen. Many have to take infusions, shots and medications every day, just to be able to move. It’s not a rare disease. In fact, juvenile idiopathic arthritis is one of the
most common chronic conditions affecting pediatric patients. But parents and primary care doctors don’t often recognize the early signs and symptoms, writing off their child’s achy joints as nothing more than “growing pains” instead of noticing them as warning signs of a more serious inflammatory rheumatic disease. Some children go months without a diagnosis. Others go years.
However, a child who is limping on a regular basis, or suffering from pain and swelling of any joint, should be evaluated by a doctor. There is no known cure for juvenile idiopathic arthritis but early intervention is key. Children who receive medical treatment early can avoid serious, permanent damage to their young joints, and continue to enjoy an active lifestyle.
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It’s often a misunderstood and misdiagnosed illness, but every year, tens of thousands of children struggle with the aches and pains of juvenile idiopathic arthritis, and they often do so in silence.
ANKUR KAMDAR, FAAP, FACR. Dr. Ankur Kamdar, FAAP, FACR, is a UTHealth McGovern Medical School pediatric rheumatologist affiliated with Children’s Memorial Hermann Hospital. He is an assistant professor of pediatrics, the associate program director of the general pediatrics residency program at McGovern Medical School and an active board member of the Arthritis Foundation, Houston chapter. He understands the importance of raising awareness about the little-known condition, and has been working diligently to bolster interest in an underrepresented specialty. HEALTHLINEMAG.COM
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OBESITY AND RISKS
OF COMORBIDITIES A National Health Crisis and a Threat to Safe Patient Care
Obesity and Risks of Comorbidities A National Health Crisis and a Threat to Safe Patient Care by David B. Troxel, MD, Medical Director, The Doctors Company Obesity continues to be a national crisis: Current research has found that 35 percent of men and 40.4 percent of women in the United States are obese.1 The obesity crisis not only contributes to growing health costs but also raises serious patient safety risks. Patients who have experienced an adverse medical event leading to a medical malpractice claim are frequently noted to be obese (based on documented height and weight). A review of 7,065 claims from 2011 to 2013 by The Doctors Company, the nation’s largest physician-owned medical malpractice insurer, revealed that 28 percent were identified as having one or more comorbidities, and obesity was the most common (8.3 percent of total claims and 19.2 percent of total claims with a comorbidity). When closed claims were analyzed, 26 percent of claims that resulted in indemnity payments listed obesity as a comorbidity. Photo Credit: Fotolia
Increased Risks: Complications and Access Issues Obese patients commonly have a variety of comorbidities. Many are associated with a metabolic syndrome, such as hypertension, dyslipidemia, and hyperglycemia, which increases the risk of stroke, ischemic heart disease, and diabetes mellitus. These patients also have increased risk of obstructive sleep apnea (which often contributes to opioid-induced respiratory depression), susceptibility to nosocomial and postoperative infections, and weight-associated wear and tear on joints that can lead to osteoarthritis. Additionally, bariatric surgery can be associated with both surgical and metabolic complications. In addition to the risks of comorbidities, healthcare facilities also face risks if they are unprepared to accommodate obese patients. An inability to fit a morbidly obese patient into a conventional MRI machine or CT scanner is a unique problem
necessitating use of an open MRI or CT. Healthcare facilities that are unable to accommodate morbidly obese patients in their MRI machine or CT scanner or if their MRI or CT isn’t available at night or on weekends should have transfer agreements with open facilities in place so there are no delays in urgent MRIs or CT scans. The failure to transfer an obese patient to a facility with an open MRI machine or CT scanner in a timely fashion may result in a delay of diagnosis and/or surgical treatment—and, ultimately, in a malpractice claim. Practices should have appropriately sized furniture in the waiting areas and exam rooms to meet the needs of obese patients. They should also have equipment—such as blood pressure cuffs, needles, and wheelchairs—designed for obese patients. It’s key to understand the importance of talking about weight with patients— the conversation should take place early for better prevention and treatment. Many factors can arise that inhibit a practitioner from speaking frankly about weight with a patient. As obesity rates continue to increase, it is worthwhile for doctors and other healthcare professionals to recognize that they might have their own barriers to such communications. Sensitive treatment of obese patients involves attending to their needs for comfort, safety, and respect. Obesity can be viewed as one of the many chronic health conditions afflicting patients. The person, not the obesity, should be the focus of treatment. As with any patient with a chronic health condition, a relationship with respectful caring forms the bedrock of medical care. Reference 1Trends in obesity among adults in the United States, 2005 to 2014. JAMA. 2016;315(21):2284-2291. doi:10.1001/ jama.2016.6458. http://jama.jamanetwork.com/article. aspx?articleid=2526639. Accessed June 9, 2016.
Reprinted with permission. ©2016 The Doctors Company (www.thedoctors.com).
DAVID B. TROXEL, MD David B. Troxel, MD,is secretary of the Board of Governors and medical director of The Doctors Company, the nation’s largest physician-owned medical malpractice insurer. Dr. Troxel is clinical professor emeritus, School of Public Health at the University of California at Berkeley. He serves as chairman of The Doctors Company Foundation and as a member of the Patient Safety and Technology Committees at The Doctors Company.
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Eating Well with Scleroderma Systemic sclerosis is a condition in which the immune system overstimulates the collagen-producing cells of the body causing inflammation and an excessive buildup of collagen. This leads to hardened skin and fibrosis of internal organs such as the lungs, digestive tract and blood vessels. While there are no specific foods or nutrients capable of reducing collagen production, the foods you eat can have a positive impact on your disease condition by fighting fatigue, inflammation and digestive dysfunction. Malnutrition in scleroderma may occur either by inadequate intake of nutritious foods or from poor absorption of nutrients from the digestive tract. Individuals who eat small amounts of food because they have difficulty chewing, swallowing, and/or preparing meals may lose weight and be unable to meet their nutrient needs.. Or, individuals who have extensive digestive dysfunction may eat enough food, but are unable to absorb the nutrients properly. Either situation may result in specific vitamin or mineral deficiencies, with or without obvious symptoms of malnutrition. Therefore, it is important for everyone with scleroderma to have his or her nutritional status monitored regularly and to eat healthy foods daily from all the different food groups. An unintentional 10-20 pound weight loss over a three-to-six-month period could indicate inadequate nutrient and calorie intake. Measuring your weight at home at regular intervals is a simple step toward monitoring your malnutrition risk. Managing Specific Scleroderma-Related Issues lReflux or heartburn: Eat small, frequent meals to avoid overfilling your stomach. Avoid eating two
to three hours before bedtime. Avoid foods that may aggravate symptoms such as citrus fruits, tomato products, greasy fried foods, coffee, garlic, onions, peppermint, gas-producing foods, spicy foods, carbonated beverages and alcohol. If you carry extra weight around your midsection, weight loss also may improve your symptoms. lDecreased GI motility and constipation: Exercise, such as walking, helps move food through the digestive tract. Eat a high fiber diet including 100 percent whole grains, fruits and vegetables. Take a daily probiotic supplement and/or eat yogurt with active cultures regularly. Remember to increase your fluid intake. lInflammation: Choose deeply colored fruits and vegetables to increase antioxidant intake, especially dark green, deep yellow, orange, red, purple and blue. Eat fatty fish, ground flaxseeds and walnuts for Omega-3 fatty acids. Consider taking a 1000 IU vitamin D3 tablet with your fattiest meal. lFatigue: Eat small, frequent meals to provide continuous energy and keep blood sugar from dipping too low. Increase fluid intake. Participate in 30 to 60 minutes of moderate daily exercise. Sleep for seven to eight hours each night. If iron levels are low, which is typical of someone with chronic disease, discuss additional iron supplementation with your doctor. lPoor circulation/Raynaud Phenomenon: Exercise will increase circulation to areas suffering from limited blood flow. If you have finger ulcers, eat animal sources of protein with zinc and iron (such as beef and pork) to accelerate wound healing. • Tight, thickened skin: Eat foods rich in vitamin E such as nuts, seeds, wheat germ, Olive and peanut oils; consider taking 5 mg biotin supplement, which may help skin and nails.
LINDA KAMINSKI, MS, RD, CDE. Linda Kaminski, MS, RD, CDE is a nutrition and lifestyle counselor, speaker, and author specializing in the prevention and management of chronic disease. Linda has lived with limited systemic sclerosis for 14 years and enjoys using her professional knowledge and experience to help others live well and feel well.
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S:6.5”
Dear Sam, I thought we were in this together, but apparently I was wrong. You’ve been ignoring me for a while. We don’t go for walks as often as we used to. You barely eat anything green anymore. And you don’t realize the daily pressure you put me under. It’s just too much.
Don’t let your heart quit on you. If you are living with high blood pressure, just knowing and doing the minimum isn’t enough. Uncontrolled high blood pressure could lead to stroke, heart attack or death. Get yours to a healthy range before it’s too late. Find out how at heart.org/BloodPressure
Check. Change. Control.™
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Your Heart
B:10.25”
Sincerely,
S:9.5”
I QUIT!
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