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Medical Observer H E A LT H N E W S & I N F O R M AT I O N THE RIO GR AND E VAL L EY ED I TI ON

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HIGH COURT UPHOLDS OBAMACARE The Affordable Care Act

5-YEAR TIMELINE

Now that Obamacare has been upheld by the Supreme Court, will the States be forced to expand their Medicaid program to abide by the conditions of the federal government?

Affordable Care Act Hearings End

In a landmark decision, the Supreme Court ruled to uphold the sweeping federal health care law, known as the 2010 Affordable Care Act and commonly referred to as Obamacare. This decision poses a great challenge to the Republicans as they now have to work hard to repeal the law that the court did not. They plan to initiate a

More Voluntary Blood Donations Essential

“AIDS of the Americas”

CHAGAS DISEASE

Every year, millions of people rely on the generosity of another person to donate blood.

Yet, blood donation rates vary considerably and the demands for blood and blood products are increasing worldwide. To meet these needs, more people must come forward to give blood voluntarily, and regularly, says the WHO on World Blood Donor Day. “With increasing life expectancy and the subsequent increase in the number of age-related, chronic diseases, including cancers, that require blood and blood products for treatment, demand outstrips supply,” says Dr Neelam Dhingra, Coordinator for Blood Transfusion Safety at WHO. Blood Donations

AIDS of the North American Continent, Chagas Disease is Insect-Borne Experts have labeled Chagas Disease, a parasitic illness as the ‘new AIDS of the Americas.’ Chagas is a life-threatening disease with symptoms that take years to emerge. New York Times reported that more than 10 million people are estimated to be infected with Chagas worldwide with about 30,000 sufferers in the United States and the rest in Latin American countries, Columbia, Bolivia and Mexico. In 2008, it is said that more than 10,000 people died because of Chagas disease. The Public Library of Science’s recent editorial on neglected tropical diseases said that there are more than 20,000 people a year that die from the disease.

Both Chagas and HIV/AIDS are chronic diseases which are difficult to detect in its early stages and can take years to show its symptoms. In addition to the insects, Chagas can also be spread through blood transfusion and organ transplants just like AIDS and can also be passed on to the babies of infected mothers.

Continue page 2

IN THIS ISSUE

Scary New Problem: Distracted Doctoring / PAGE 2

Surrogacy In India: Explosive Growth reported potential

CHAGAS BUG OCCURRENCE BY STATE

Chagas Disease Continue page 6

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House vote on July 9 and then proceed to try to remove President Obama from office come November. It all boils down to numbers. A full repeal of the law would require the Republicans to muster 60 votes. Another avenue is to choke off the implementation budget with a 5-year Timeline Continue page 6 majority vote of 51.

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ERMC & Edinburg Children’s Hospital Welcome Jason Chang To Administrative Team

South Texas Health System welcomes Jason Chang as its new Chief Operating Officer at Edinburg Regional Medical Center and Edinburg Children’s Hospital. Mr. Chang, whose professional background includes a progressive career in healthcare administration, comes to South Texas from Visalia, California, where he served as the Associate Administrator & Director of Business Development for Tenet Health Corporation at Twin Cities Community Hospital in Templeton, California.

Chang has extensive experience with project management, cost saving initiatives and strategic development.

These skills will be an asset to the South Texas Health System team in Edinburg as the campus is set to make several upgrades, including implementing the Cerner electronic medical record (EMR) system to more effectively share patient medical records among authorized us-

ers to enhance patient safety, streamline administration, and cut costs. The leadership team at Edinburg Regional Medical Center and Edinburg Children’s Hospital is moving forward on other initiatives aimed at recruiting specialty physicians, developing new service lines, and enhancing patient satisfaction, too. The hospital COO, who is charged with managing the day-to-day operations of the facilities, is an integral part of this team.

Mr. Chang earned a Master’s Degree in Business Administration from the University of Massachusetts in Amherst,

Mass., and a Bachelor of Science, Pre-Medicine from Northern Arizona University in Flagstaff, Arizona. Outside of his career, Mr. Chang holds the position of National Vice President of the Japanese American Citizens League and served on many appointed councils to promote economic development within the Central California region.

Mr. Chang looks forward to the opportunity to continue his history of community service here in the Rio Grande Valley.

“My family and I are very excited to join the South Texas Health System family and integrate ourselves in our new community. The opportunity to work in a beautiful hospital and improve health care for the people of Edinburg is outstanding.” Mr. Chang said.

Please help South Texas Health System welcome Mr. Chang and his wife, Losa, and their daughter, Amari, to our lovely community.

How New Social Security Changes Affect Baby Boomers

Scary New Problem: Distracted Doctoring 'NYT' reports on terrifying trend

It’s one thing to be distracted by your smartphone at the dinner table; it’s another thing entirely when you’re performing surgery. The New York Times reports on a disturbing trend it calls "distracted doctoring," explaining that thanks to the increased use of devices including smartphones and computers in medicine, an increasing number of doctors and nurses are not focused on the patient at critical moments. Says a doctor who recently published a journal article on the problem, "My gut feeling is lives are in danger."

Sophisticated devices have certainly helped to prevent medical error and can provide doctors with instant access to important information, like patient files and

Blood Donations Continued from page 1

“In addition, some blood products used to treat cancer patients, like platelets, have a shelf-life of only five days.

This means we increasingly need more blood donors to meet these demands.”

Need for Blood and Blood Products is Rising

As the Baby Boomer generation creeps closer and closer to the age where they can start collecting Social Security many wonder if this will finally be the tipping point that pushes the social Security system over the edge. The United States government is already facing a record deficit, and providing Social Security to the estimated 80 million Baby boomers is only going to exacerbate that problem. Many politicians are already starting to take aim on social Security in word and deed. With the Social Security system poised to pay out more than it takes in by 2017 there is definitely a need for some changes to be implemented in order for the system to survive. What recent changes have been made, and how will they affect the Baby Boomer generation?

The basic choices to solve the problem boil down to increased taxes or reduced spending. Republicans are opposed to tax increases and Democrats seem averse to spending cuts. The only way for the Social Security system to survive is for both parties

to reach a compromise. Even though current Social Security recipients are seeing a Cost of Living Adjustment (COLA) for the first time in three years, the three year gap with no increase was put into place to try and stem the tide and save some money.

In terms of increasing taxes 2012 marks an increase on the amount of money that is subject to Social Security tax, with those who make over $107,000 having to pay higher taxes.

A Social Security tax holiday that began in 2011 was extended for 2 months into 2012 saving the average worker 2% on what they would they normally have to put into the Social Security trust fund.

Higher income earners had a recapture tax placed on their earning over a certain amount, and all workers will see a return to the normal 6.2% rate for Social Security taxes removed from their earnings starting in March 2012. Another change in 2012 regards how much early retirees who work and draw Social Security will have temporarily withheld from their Social

Security check. This change is more likely to affect more Baby Boomers, many of whom were able to retire early because of wise business decisions when the economy was in a better place.

The maximum amount for Social Security benefit checks also increased in 2012 to $2,513 a month. As Baby Boomers get closer to the age for drawing their Social Security there are some tough questions that must be decided on if Social Security is going to be around for the next generation. Even though the current surplus in the Social Security fund is expected to last until 2035 at current rates of consumption, that does not bode very well for the current generation of young workers who are likely paying into something that may not exist when they need it. The president and the Congress do well to use the current situation as a turning point in how the Social Security system is administered so that the system will not simply run out of money in the process of taking care of the Baby Boomers.

The need for blood and blood products is rising in all parts of the world. In highand middle-income countries, with advancements in healthcare systems and improved health coverage, this need is being driven by increasingly sophisticated medical and surgical procedures such as cardiovascular and transplant surgery, trauma care and therapy for cancer and blood disorders. All major surgeries need blood to be available on standby.

In addition, severe bleeding during delivery or after childbirth is the leading cause of maternal mortality worldwide. When severe bleeding occurs, urgent and timely treatment is required for management of these patients, including transfusion of blood and blood products, as women may die within one hour.

drug data. Even so, the Times article is filled with terrifying examples of the side effects: A patient who was partially paralyzed while his neurosurgeon used a wireless headset to make at least 10 personal calls on his cell phone. A nurse checking airfares during a spinal operation. Doctors and

nurses sending emails while intubating a patient. A study that found 50% of technicians texted while operating bypass machines. "Amazon, Gmail, I’ve seen all sorts of shopping, I’ve seen eBay," says one doctor. "You name it, I’ve seen it."

Every year, road traffic accidents cause 1.3 million deaths globally and, in addition, injure or disable between 20 million and 50 million people; 90% of deaths from road traffic accidents occur in developing countries. Uncontrolled bleeding accounts for more than 468 000 deaths per year.

“Each blood donation is only 450 millilitres and by having more repeat voluntary donors, we can better assure the reliability of blood supply and safety of blood and blood products.”

In low-income countries where diagnostic facilities and treatment options are limited, the majority of transfusions are prescribed for the treatment of complications during pregnancy and childbirth, the management of severe childhood anaemia, trauma and congenital blood disorders. In many situations, current systems are unable to meet the needs, while expansion of health coverage and improved access to health services further increases these demands.

More Repeat Donors are Essential There are 92 million blood donations per year globally, most of these by voluntary, unpaid donors. But of these voluntary donors, 30 million give blood once, and then do not return.

“We need to encourage these donors to come back and become repeat, regular donors,” says Dr Dhingra.

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M E D ICA L OB S E RV E R

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Country Successes Yet, there are some noteworthy examples of countries who are able to meet the transfusion needs of their healthcare systems, and WHO is highlighting these successes on this World Blood Donor Day. Today, 62 countries meet their transfusion needs and many more are making rapid progress. For example, Viet Nam has increased voluntary blood donation from just one third of total supplies to almost 90% in just 10 years. It has also increased total annual blood collection from 268 394 units to 776 420 units in the same period.

In the Cook Islands, education campaigns targeting health workers and the community have resulted in a complete change in the source of blood donations: from 2002 to 2007, the proportion of blood collected from voluntary, unpaid donors increased from 30% to 100%. It also increased the number of regular donors from just 70 to more than 400 donors from its pop-

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Healthy Schedules Make Wellness a Reality ing the internet, committing to bursts of fitness adds up! Make it a game for your kids—every commercial, agree that a family member gets to pick an exercise that everyone does until the show resumes. Whoever wins the video game gets to lead the push-ups for the whole family.

Praise consistency with fun rewards: Post a star chart on the fridge that shows who has tallied 150 minutes of fitness activities each week.

The one who has the most minutes gets to pick the movie on MovieNight. For older families, try rewarding the winner by re-allocating house chores for the day/week. This shows that fitness is a family priority.

Suzanne Parker, H-E-B Corporate Wellness Coach

How many times have you heard “I just don’t have time to exercise and healthy food takes too long to prepare. Besides, if my family doesn’t like it then I have to start over!”

When school is in session, parents and families are working double duty. When we choose our schedules, we are building priorities and perhaps sending the wrong message to our kids as to what is important for health’s sake. Here are three ideas that might help you find time for healthy choices in your busy schedule because making wellness a reality might be easier than you think!

Menu Planning and Shopping Can Include the Kids/Family Members Get the family involved: We are all less likely to resist change if we can be part of the process. Making a family decision to add more veggies to the grocery cart or less sugary and processed foods to the snack list can be tough if all palettes are not acknowledged. Perhaps each family member can pick a new recipe or food to try.

Adding in, not just taking away: Keeping some family favorites is important too such as pizza night;

Keep Bedtime and Wake-up Time Non-Negotiable

just adding in a salad and some grilled chicken can pump up the volume of nutrition and still enjoy our treat foods. When putting together new menu ideas, think around the three basics: where is the protein, carbohydrate and healthy fat? Protein comes in many forms; just find the leanest choices so you can add in the healthy fats for flavor. Carbohydrates are plentiful in the plant kingdom—fruits, veggies and even dairy offer great carbohydrates with a good fiber punch.

Make trying new foods an adventure: As long as the environment

can remain positive, meal time can be a chance for families and friends to enjoy food in a new way. We can come together and share new ideas and tastes without the pressure of ‘have to eat’. Trying new foods can be an experiment and maybe even learn about other cultures and cuisines in the process. Keep it simple and uncomplicated.

Exercise As A Family For Fun Team sports can be played with as few as two: Kicking a soccer ball, shooting hoops or throwing a football or Frisbee, not only can count

as part of our needed 150-minutes of activity a week but it teaches skill building. Schedule in 2 nights a week or one weekend afternoon where all screens are off and movement is ON—outside or in-pick a sport that requires arms and legs in action. If your kids are already doing a team practice after school, take that time to exercise yourself—this will be a powerful message to your kids that everyone needs to work in exercise—not just kids.

Be an active observer: Whether you are watching your favorite TV show, playing a video game or surf-

For children and adults it is clear that a regular sleep schedule is one of the most important parts of a healthy lifestyle: Frequent bouts of staying up late, sleeping in excessively late only disrupts the body’s sleep rhythm and makes getting good quality sleep more difficult.

Without seven hours of good quality sleep, we miss the time it takes to reset hormone levels that govern mood, metabolism, mental clarity and memory. Create a routine around the evening so that your body prepares for sleep: very little food within 3 hours before bed, light activity, warm bath and a cool sleeping quarters can be excellent strategies for creating a good night’s sleep. Most importantly though, your head needs to hit the pillow on a regular schedule every night - for your best quality health.

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Do You Know Your Water Type?

Getting the proper amount of water in your body everyday is absolutely essential to a healthy lifestyle.

Knowing what kind of water you have in your home can help you decide if you need to buy some accessories to improve the water quality in your home. Let's take a look at the three major water types and how each water type affects your family's health.

When it comes to water types the type that most people are familiar with is hard water. Hard water has a very high concentration of mineral content, and even though hard water is not generally as dangerous as most people believe it is, it is still not the most desirable type of water to drink on a regular basis. Hard water can do serious damage to the equipment that moves water from one place to the other, and the corrosion that it causes can eventually lead to more serious problems.

While there are some studies that have shown weak correlations between hard water and certain diseases, most of the issues associated with hard water can quickly be fixed with the addition of a water softener in the home.

That leads us into the next major water type, soft water.

Soft water is basically free of any dissolved calcium or magnesium deposits. Soft water can help to eliminate any signs of soap scum, which is normally caused

Chagas Disease

Continued from page 1

Researchers have seen the striking similarities between the people living with HIV virus and those infected with Chagas, especially the epidemic-like spread of the infection among the poor. If sexual orientation had been the barrier to care of HIV infected individuals, immigration status may prove to be the Chagas’ victims care and prevention deterrent.

Like the early years of AIDS, there is little understanding of the Chagas disease or its effective treatment.

Chagas is a disease which can cause the death of about one-fourth of the total number of infected people.

Chagas disease has been discovered in 1909 by Brazilian doctor Carlos Ribeiro Justiniano Chagas. Bloodsucking insects have been found to cause the spread of the disease including the insect Triatomids or the ‘kissing bugs” that release the Trypanosoma cruzi parasite through their feces. The trypanosoma parasite in the feces enters the bloodstream of their victims. This is why the Chagas disease is also called

by hard water. Soft water is much better for your hair and your skin since it allows both to “breathe” more readily. Unlike hard water, which can leave your skin feeling dry and scratchy, soft water tends to leave skin feeling more moisturized. The makers of water softeners claim that there are even more health benefits that result from using soft water, but most of these claims have not been fully proven.

Filtered water can come from many different sources. One of the first things that most people notice about filtered water is the taste. Depending on the type of water that was common where you grow up you may find that filtered water has a sweeter taste. A few things to keep in mind when choosing a water filter are to remember that you

American trypanosomiasis.

Triatomids are black beetles without wings that are about 20mm in size. They are related to the Tsetse fly, which is responsible for the swelling of victims’ brains called Sleeping Sickness common in Africa.

There are two phases of the disease, the acute phase and severe phase. During the acute phase, the symptoms of fever, malaise and swelling in one eye may not alert the victim that he has a potentially deadly disease. The disease then goes into remission after the acute phase, taking as long as 10-15 years for symptoms like constipation, digestive problems and abdominal pain to emerge and develop into the severe phase. Eventually, the parasite may travel to the heart,

probably want to buy a filter that targets a specific contaminant that is in your water. Pitcher water filters are the most inexpensive kind of water filter, and the filter just needs to be replaced as per the manufacturer's instructions. Faucet-mounted filters and under the sink filters are also available for those who want more high volume filtering.

A simple but important fact to keep in mind is that the United States has some of the safest tap water in the world. Having said that if you notice that the water in your area has an odor or a funny taste you may want to consider investing in a water softener or a filter in order to improve the quality of your water. It will at least make it easier for you to drink the proper amount of water every day, which is definitely a health benefit.

living there and multiplying resulting in an enlarged heart.

Those infected with Chagas can suddenly die from a swollen intestine, damaged esophagus or develop a fatal heart disease like arrhythmia or cardiomyopathy.

Chagas is now one of the five parasitic diseases on the list of the Center for Disease Control (CDC) targeted for public health action and considered as a Neglected Parasitic Infection. The disease is commonly diagnosed affecting people in depressed and poverty-stricken communities in Latin America. In the United States, those found affected are mostly immigrants and people residing in Texas and the Gulf coast.

Early diagnosis can prevent the onset of the fullblown disease employing a

Hospitals Celebrate Decision, But Threats Remain Everybody agreed hospitals would be the biggest business losers if the Supreme Court overthrew the health act.

But the Thursday ruling that preserved most of the law — along with the promise of billions in extra hospital revenue — raises new problems for the industry.

Hospital bosses applauded and hospital stocks soared as investors bet that coverage for as many as 30 million extra Americans would reduce unpaid bills and boost profits.

“It’s kind of like your kid being in a ballgame and having a critical play,” said Wright L. Lassiter, III, CEO of Alameda County Medical Center in California. “You cringe right when they’re going to do it and hope they’re successful.” Thursday morning, he said, “I was that way and kind of cringed, hoping it was upheld. It was, and I cheered.”

Even so, attention switched almost immediately to the November election, unsustainable deficits, looming fiscal deadlines and the court’s decision to let states opt out of the Medicaid expansion — a critical part of the law.

After the justices announced their decision, presumptive Republican presidential nominee Mitt Romney repeated his pledge to get rid of the law.

“If Romney is elected and the Senate becomes Republican and the House remains Republican, they could well repeal it, even though we know that they don’t have a clue as to what they’d replace it with,” said Paul Ginsburg, president of the Center for Studying Health System Change. “I take that risk very seriously.”

Even if President Barack Obama is re-elected, the ruling letting states refuse the act’s Medicaid expansion puts at risk billions of dollars in potential federal funding of medical care.

“We have a lot of questions about that,” said Richard Umbdenstock, CEO of the American Hospital Association. “It wasn’t an area that people focused on.”

That’s a financial risk for all hospitals in those states that opt out but especially

3-month intense treatment using the drug Benznidazole or Nifurtimox, although this treatment will only work at the early stages of the disease. These drugs have been used to treat Chagas for 40 years without extensive studies to support a full understanding of their working mechanisms.

Many cases of Chagas remain undetected and untreated because of its length of incubation time. Before it gets properly diagnosed, the disease can already be in its severe stage. Many of those affected also find it hard to afford the costly medication

for “safety net” hospitals that serve the uninsured poor. Not only would the hospitals miss out on the expansion of Medicaid coverage; over time the health act reduces the Medicare and Medicaid surpluses they collect for handling a disproportionate share of low-income patients.

“If a state chose not to participate in the expansion, the poorest of the poor would be impacted,” said John M. Haupert, CEO of Grady Health System, an Atlanta public hospital where a third of the patients are uninsured.

Georgia Gov. Nathan Deal said Thursday that he would wait until after the election to decide about the Medicaid expansion, but he hinted that the state would be likely to accept the funding. “The taxpayers of the state of Georgia will be paying as federal taxpayers to support the expansions of other states,” Deal said. “And if ours are excluded, that’s certainly a question we would have to ask if that is prudent.”

Under the Affordable Care Act, Grady Health’s annual $60 million in extra federal funds to take care of the uninsured will be substantially reduced. That shortfall was supposed to be filled by expanded coverage in Medicaid and the private market, Haupert said. But if Georgia opts out of the Medicaid expansion and Congress doesn’t change the rules, the hospital will be forced to turn for funding to the counties it serves, he said, “and they are not in a position to make up that difference right now.”

Most states are expected to embrace the Medicaid expansion, which was estimated to bring coverage to an additional 17 million people nationwide. But Republican lawmakers in Idaho, Missouri, Nebraska and Mississippi have already raised doubts about going along with it, claiming it would be too expensive even though Washington would pay almost the entire bill.

“The vast majority of states will move forward and implement the expansion, but it may take longer than anticipated,” said Dan Hawkins, senior vice president at the National

Association of Community Health Centers, a trade group of federally funded clinics serving the poor.

Analysts predicted that hospitals and health centers — which provide jobs for their communities as well as care and healing — would heavily lobby Republican lawmakers in their states to accept bigger Medicaid programs.

“Whether you look at it from the position of states, whether you look at it from the position of consumers or whether you look at it from the position of providers, there’s tremendous pressure to expand coverage,” said Deborah Bachrach, a health lawyer and former New York Medicaid director.

The bigger threat to hospitals comes from Washington.

Even if the health act isn’t repealed after the election in November, there could be delays in implementing it, and the means to pay for it could be undermined by a post-election deal to address expiring tax cuts and looming budget reductions, analysts said.

“It’s a short-term victory for hospitals to have the whole law upheld,” said Arthur Henderson, who covers hospital stocks for Jefferies, an investment bank. “What I’m focused on, now that that’s behind us, is the election… We know there’s going to be deficit reduction, and it’s going to be very hard for hospitals not to chip in something.”

On Thursday, investors buying stock in HCA Holdings, which operates more than 150 hospitals, seemed more focused on the shortterm. HCA stock zoomed up by $2 a share immediately after the court’s announcement and closed the day up $2.86, or 11 percent.

Phil Galewitz of KHN and Jim Burress of WABE in Atlanta contributed to this report.

Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.

during the long months it takes to treat the disease.

Although the drugs prescribed for Chagas are still less costly than the medicines for AIDS, drug shortages exist in poorer countries and not enough money is spent on research and finding new treatments. In the United States, studies are being done by a W. David Nes, a Texas Tech University Center expert in Chemical Biology in cooperation with researchers from the Vanderbilt University School of Medicine and Meharry Medical College.

Screening is done for traces of Chagas in all blood

banks in the United States and in Latin America. The American Red Cross and US blood banks have been universally testing for Chagas since 2007. The infection is rapidly spreading globally, so there should be a campaign for awareness of the existence of the deadly disease and Chagas should be included in the screening list of blood banks all over the world. With country borders easily breached with the advances in transportation, the number of infected people crossing country borders and continents increase progressively.

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Exercise Good Judgment While Enjoying The Outdoors With Baby

From biking and hiking to walking and jogging, today's parents are keeping fit and bonding with their babies in the process. With an array of products unheard of a generation ago - like baby carriers, joggers and trailers - even the tiniest among us are enjoying the great outdoors. But while these items can make life easier and more enjoyable for both parent and child, they can be the cause of pain and injury if not used properly. The American Chiropractic Association (ACA) urges you to exercise caution and good judgment while exercising with your baby.

Biking When biking with a child on board, use a trailer, a rolling ride-along that hitches to the back end of a bike. It is a much safer option than a carrier, a "passenger" seat that sits directly on the bike, according to Dr. Scott Bautch, a member of ACA's Council on Occupational Health. Dr. Bautch prefers trailers because of their added stability. He cautions that carriers can decrease a bike's stability, possibly causing it to topple and injure both the parent and child.

To further ensure the child's safety while biking, keep the following tips in mind: • The trailer must be equipped with a harness that can be

placed over the child's body.

The harness should be complicated enough that the child cannot unhook it or wiggle out of it.

• A screen that covers the front of the trailer will add an extra line of protection against stray pebbles and other flying objects.

• Be sure to select a trailer that has large, bicycle-style tires, which will add stability and ease to your ride.

• Protect your child's head with a sturdy, adjustable helmet that can be sized to fit properly. If the helmet rests too high, it will expose part of the child's head, leaving it susceptible to injury.

• Bike only on smooth surfaces for optimal control.

• Only an experienced rider should attempt to bike with a child on board at all. And even then, the rider should practice with a ride-along trailer for two weeks before riding with a real child - in an effort to get a feel for the strength and coordination necessary to maneuver the bike.

Jogging If you wish to go for a jog and bring your child along for the ride, the baby jogger is your best option. A baby jogger is a rolling pushcart that a parent can jog behind, using

handlebars to maneuver. Here are some rules of thumb to consider: • Make sure the handlebars of the jogger are both large and adjustable, so that they fit comfortably into your hands for complete control. The handlebars should be kept as upright as possible.

• Handbrakes and a locking mechanism are a necessity.

• Look for a jogger with a good shoulder harness to keep the child secure.

• Large, bicycle-style tires offer more control and stability.

• A screen over the front of the jogger adds to its safety by deflecting stray flying objects.

• Jog only on smooth surfaces.

Backpack-Style and FrontSide Baby Carriers For parents who prefer walking or hiking with their little ones, a backpack-style or front-side baby carrier could be for you. Dr. Bautch cautions, however, that there are risks involved with carrying an infant on your back in a backpack-style carrier. "The cervical spine of a child less than one year old is not fully developed. It is important at that age that the head does not bob around. The backpacktype carrier is not ideal be-

cause the parent cannot watch to make sure the child's head is stable. A front-side carrier is better for a very young child," explains Dr. Bautch.

Dr. Bautch also urges you to think about the following: • A backpack-style or frontside carrier decreases a parent's stability when walking or hiking. It is critical that a parent gets into shape before attempting to use one of these products.

• Since these carriers will change the feel of walking or hiking quite a bit, they should not be used by beginning walkers or hikers.

• If using a backpack-style or front-side baby carrier, make sure to select one with wide straps for your shoulders and waist. This will help distribute the carrier's weight evenly. The shoulder straps should fit comfortably over the center of your collarbone.

• The carrier should include a harness to keep the child stable.

• Once you place the child in the carrier, check to make sure there is no bunching of material against the child's body, particularly on the back, buttocks and spine.

Isolated, uneven pressure like this can produce pain.

Baby Slings

The "baby sling" is becoming more and more popular for its versatility of positions and comfort. But if you wish to use a baby sling, keep in mind that it is intended only for very young infants and follows these tips: • A baby can become very hot inside the sling, so be mindful of the temperature around you. Also, make certain the baby's breathing is clear and unobstructed by the sling's material.

• Never run or jog while carrying a baby in any backpackstyle carrier, front-side carrier or baby sling. A baby's body is not adjusted to the cyclic pattern that is a part of running and jogging. This motion can do damage to the baby's neck, spine and/ or brain.

Take Care of Yourself Finally, don't forget about your own health and comfort.

When lifting a child to place him or her into a trailer or jogger, exercise caution. Don't bend from the waist, but begin in a 3-point squat and implement a two-stage lift that consists of a) pulling the child up to your chest and then b) lifting straight up with your leg muscles. Stay as close to the car seat or trailer as possible and place the child into it without reaching, stretching or twisting. The further the

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child is from your body, the more strain you will place on your spine and musculoskeletal system.

Chiropractic Care Can Help If you or your child experiences any pain or discomfort resulting from these or other outdoor activities, call your doctor of chiropractic. Doctors of chiropractic are licensed and trained to diagnose and treat patients of all ages, and can provide health tips for you and your children that will make enjoying outdoor activities safer and more enjoyable.

For more information contact Drs. Blaine and Jana Hendrick at 956-6302255 or visit their website at www.

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6

CDC Ad Campaign Reveals Harsh 5-year Reality of Smoking-Related Diseases Timeline “Tips from Former Smokers” shows real lives and bodies damaged by tobacco

A hard-hitting national ad campaign that depicts the harsh reality of illness and damage suffered as a result of smoking and exposure to secondhand smoke was launched today by the Centers for Disease Control and Prevention.

Beginning Monday, March 19, ads will run for at least 12 weeks on television, radio, and billboards, online, and in theaters, magazines, and newspapers nationwide.

The “Tips from Former Smokers” campaign features compelling stories of former smokers living with smoking-related diseases and disabilities, and the toll smoking-related illnesses take on smokers and their loved ones.

The ads focus on smoking-related lung and throat cancer, heart attack, stroke, Buerger’s disease, and asthma. The campaign features suggestions from former smokers on how to get dressed when you have a stoma (a surgical opening in the neck) or artificial limbs, what scars from heart surgery look like and reasons why people have quit. The ads will be tagged with 1-800-QUIT-NOW, a toll-free number to access quit support across the country, or the www.smokefree.

gov web site, which provides free quitting information.

web and mobile based interventions.

“Hundreds of thousands of lives are lost each year due to smoking, and for every person who dies, 20 more Americans live with an illness caused by smoking,” said Health and Human Services Secretary Kathleen Sebelius. “We cannot afford to continue watching the human and economic toll from tobacco rob our communities of parents and grandparents, aunts and uncles, friends and co-workers. We are committed to doing everything we can to help smokers quit and prevent young people from starting in the first place.”

Smoking remains the leading cause of preventable death and disease in the United States, killing more than 443,000 Americans each year. Cigarette smoking costs the nation $96 billion in direct medical costs and $97 billion in lost productivity each year. More than 8 million Americans are living with a smoking-related disease, and every day over 1,000 youth under 18 become daily smokers. Still, nearly 70 percent of smokers say they want to quit, and half make a serious quit attempt each year. The “Tips from Former SmokThe “Tips from Former ers” campaign will provide Smokers” campaign is anoth- motivation, information, and er bold step in the administra- resources to help. tion’s commitment to prevent “Although they may be young people from starting tough to watch, the ads show to use tobacco and helping real people living with real, those that smoke quit. Recent painful consequences from milestones include the pas- smoking,” said CDC Direcsage of the Family Smoking tor Thomas R. Frieden, M.D., Prevention and Tobacco Con- M.P.H. “There is sound evitrol Act which gives the Food dence that supports the use and Drug Administration au- of these types of hard-hitting thority to regulate tobacco images and messages to enproducts to prevent use by courage smokers to quit, minors. Additional support to to keep children from ever help smokers quit is provided beginning to smoke, and to through state toll-free quit drastically reduce the harm lines and implementation of caused by tobacco.”

Continued from page 1

Ironically, Chief Justice John Roberts delivered the deciding vote in favor of the bill, even though he got a negative vote from President Obama for the confirmation of his appointment. It is the court’s opinion that the purchase of insurance and payment of a fine is considered a tax, so it falls within the authority of Congress.

This is a dramatic victory for President Obama and his landmark legislative achievement which he signed into law on March 23, 2010.

The decision Roberts wrote stated that: “The Affordable Care Act is constitutional in part and unconstitutional in part.” The law requires individuals who are non-exempt to have health insurance or be liable for a tax penalty. The written decision also states that the justices including Roberts do not posses the expertise or the right to make judgments about policies. It is the court’s opinion that those decisions are made by leaders elected by the people. The people then can vote them out of office during elections if they so choose.

The opposition to the Health Care Law claimed that the U.S. Constitution does not grant authority to the federal government to meddle with health care. It is for this reason that 26 States representing more than half of all the US States and private groups and organizations have challenged the health care law’s constitutionality and brought it before the Supreme Court. They also attested that Congress does not have the mandate to force its citizens to purchase products like insurance or regulate the health care industry. Before the law’s constitutionality was brought to the Supreme Court, there were a series of appellate court rulings which did not resolve the question of whether Obamacare is enforceable.

The Affordable Health Care Law also expands Medicaid coverage. The decision is being viewed by oppositionists

as an expansion of the powers of the federal government.

Many think that health care control and policies should be done at the state levels.

Now that the decision has been handed down, the Obama administration can start implementing the timelines according to the provisions of the health care law.

The law’s provisions have been broken down into timetables according to its important features from 2010 to 2015. It includes comprehensive and sweeping reforms in health insurance with many of the changes scheduled to take place by 2014.

• The Act protects consumers, making it illegal for insurance companies to deny payment due to errors or technical mistakes in the insured’s application form.

• The Affordable Care Act provides citizens with more coverage options, lower coverage costs and stronger protection for consumers.

• It expands the options of families for health coverage, making health care more affordable as well as provides consumers with assistance programs for stronger protection for insurance claims.

• Options have also been made available for coverage of pregnant women and their child and for Medicaid eligibility for pre-existing conditions.

• Seniors are afforded new preventive benefits under the law, and they enjoy discounts for prescription drugs with more long-term care options.

• Tax credits are made available for small businesses so that they can offset the additional costs of health insurance that they should provide to their workers.

• Federal matching funds will

be made available to States so that low-income families and individuals can get Medicaid coverage.

• Children and young adult’s eligibility for coverage under their parent’s plan has also been expanded up to age 26.

• The new law also provides for funding of community health center services across the United States.

• Physicians are also encouraged through incentives to form “Accountable Care Organizations” for improving the quality of patient care through better coordination thereby reducing hospital admissions.

An easy-to-use website, HealthCare.gov has been made available to consumers, so that health insurance options can be easily compared and people can choose the coverage that they find most beneficial and cost-effective.

Effective 2014, Affordable Insurance Exchanges shall have been established and they will offer health plans that comply with certain benefit requirements at affordable costs. It will also be the individual responsibility of people to obtain their basic health insurance coverage by 2014 and those who can afford to but fail to do so shall be made to pay a fee which will be used to fund the care of uninsured Americans.

The health reforms outlined in the Affordable Care Act are expected to improve patient access to better health care by 2015 through incentives and regulations resulting in quality care for all Americans.

But with Republicans determined to remove President Barack Obama from office by November, will Americans get to see the 5-year Affordable Care Act timeline through?

Health Care Law Saves Consumers Over $1 Billion Health Care Law Provides Rebates To More Than 12 Million Consumers

Today, Health and Human Services (HHS) Secretary Kathleen Sebelius announced that 12.8 million Americans will benefit from $1.1 billion in rebates from insurance companies this summer, because of the Affordable Care Act’s 80/20 rule. These rebates will be an average of $151 for each family covered by a policy.

and advertising. Beginning this year, insurers must notify customers how much of their premiums have been actually spent on medical care and quality improvement.

Insurance companies that do not meet the 80/20 standard must provide their policyholders a rebate for the difference no later than Aug. 1, 2012. The 80/20 rule is also The health care law general- known as the Medical Loss ly requires insurance compa- Ratio (MLR) standard. nies to spend at least 80 per"The 80/20 rule helps encent of consumers’ premium dollars on medical care and sure consumers get fair value quality improvement. Insur- for their health care dollar," in one of the following ways: ers can spend the remaining Secretary Sebelius said.

• A rebate check in the mail 20 percent on administrative Consumers owed a rebate costs, such as salaries, sales, will see their value reflected • A lump-sum reimburse-

• A reduction in their future premiums; or • Their employer providing one of the above, or applying the rebate in a manner that benefits its employees.

ment to the same account that they used to pay the premium if by credit card or debit card;

Insurance companies that do not meet the 80/20 standard will send their policyholders a rebate for the difference no later than Aug. 1, 2012. Consumers in every state will also receive a notice from their insurance company informing them of the 80/20 rule, whether their company met the standard, and, if not, how much of difference between what the in-

surer did or did not spend on medical care and quality improvement will be returned to them.

For the first time, all of this information will be publicly posted on HealthCare.gov this summer, allowing consumers to learn what value they are getting for their premium dollars in their health plan.

For many consumers, the 80/20 rule motivated their plans to lower prices or improve their coverage to meet the standard. This is one of the ways the 80/20 rule is bringing value to consumers for their health care dollars.

7

US Citizen, Born In India "Surrogacy In India" Explosive Growth Industry Surrogacy-Born Global Babies Can End Up Stateless The modern world and the advances in transportation and communications now make it possible to have breakfast in Asia and enjoy dinner in another continent. For residents of many developing and underdeveloped countries around the world, a citizen status in a G8 country is equivalent to a dream come true. The Group of Eight largest economies created in France in 1975 remains the recognized premier countries that meet to discuss matters pertaining to food security, environment, energy, health, terrorism and other global issues. The original members were six: France, the United States, the United Kingdom, Italy, Germany and Japan with Canada joining in 1976 and Russia in 1997.

Recently, representatives of five other countries have been participating as guests in the meetings namely: Brazil, South Africa, Mexico, India and the People’s Republic of China.

sure of looking after the welfare of a child. While it is true that living alone or with another adult is more convenient and physically non-taxing, it is human nature to desire the warm embrace of one’s own family – of which a child needing care and attention is a vital component.

While many developing countries offer advantages like an advantageous exchange rate, cheap food, availability of household help, comfortable living and other services, the world’s largest economies offer the best benefits in terms of health, job opportunities and overall financial security and safety for its citizens. Studies also show that while the population growth of the underdeveloped countries have been exploding, many developed countries find themselves faced with an aging population with progressively diminishing number of babies being born.

Adoption is increasingly becoming difficult legally in the United States and in many other developed countries. There are many issues that have to be taken into consideration, including the welfare and the protection of the rights of the child, those of the biological parents and those of the persons who desire to adopt a child. A large segment of the population of the world resides in countries where common law systems or mixed systems of common law and civil law are recognized, further complicating adoption matters. This system of common law originated in England in the Middle Ages and is practiced in countries tracing their legal heritage as former colonies of the British Empire which includes the United States, Australia, India, Malaysia, New Zealand, Israel and many South African countries. Common law is also known as the law of precedent or case law where weight is given to a body of precedents binding future court decisions.

These systems of combined common law and civil law and the worldwide concern about children and human trafficking have made adopting a child and acquiring citizenship extremely difficult in many developed countries.

Many childless couples and same-sex couples or partners wake up to the fact that they have accumulated a sufficient nest egg and at middle age can now afford the time and plea-

Surrogacy is now becoming the more popular option for couples and individuals who wish to have children they can raise, clothe, feed, educate, call their own and share

their life. Surrogacy in India caught the attention of many people when the subject was featured in the Oprah show in 2007. According to records, the first surrogate baby delivered in India was on June 23, 1994 although it was not until 2004 when the practice gained international attention when an Indian grandmother delivered a surrogate child for her daughter who was then living in the U.K. Since then, the practice of surrogacy has become widespread in India where there are now many clinics specializing in surrogacy. This means that the clinic have facilities for In Vitro Fertilization (IVF)-egg transfer and provide various services related to surrogacy like identifying surrogates and assisting in the agreement/ contract process as well as the legal requirements for bringing the child into the United States or other countries. The popularity of surrogacy in India stems from the fact that European and U.S. clinics are generally focused only on in vitro fertilization of the intended mother. Surrogacy in India which includes the IVF procedure and the care and monitoring of the surrogate costs considerably less.

Through all these years, several questions have arisen about surrogacy in India. Babies born by surrogates are considered stateless unless a country agrees to grant it a passport and citizenship. Local consulates in India can issue the passport for a child depending on the destination country’s laws and regulations. As of March 2010, new laws to regulate the practice of surrogacy and to determine the rights of the surrogates and the child to be born are still under discussion in India.

In the United States, the Overseas Citizens Services of the Bureau of Consular Affairs considers cases of surrogacy as Assisted Reproductive Technology (ART) and has published important information for United States citizens wanting to pursue this option.

The US Citizenship of a child born in another country falls under Sections 301 and 309 of the US Immigration and Nationality Act (INA) where a child born through ART has to be biologically connected to a US citizen parent to gain entry as a US citizen. US citizenship can be denied to a child if there is no biological connection to the parent-claimant even if the surrogacy agreement has been recognized by local laws. In most cases, DNA testing is required to prove the biological connection to the US residentparent and the DNA material can only be acquired after the child has been born.

A U.S. citizen parent of a child born of surrogacy in India should file a Consular Report of Birth Abroad of an American Citizen (CRBA) and apply for a U.S. passport at the United States Embassy

in India. The CRBA is issued as a birth certification of U.S. citizens born abroad. The U.S. passport is the proof of the child’s U.S. citizenship. In cases of Assisted Reproductive Technology, the evidence of the child’s conception and birth will be required and the evidence of the identity and citizenship of the parents. The parents will also be required to execute an Affidavit of Presence in the U.S. before the birth of the child.

This situation can occur because of the practice of some clinics that have been known to replace donor eggs and sperm of non-viable genetic materials, resulting DNA test failures and stateless children.

The DNA link will also be non-existent even if an infertile woman goes through ART in another country using noncitizen donor egg and sperm cells. This poses a dilemma for US citizens who deliver their IVF baby in another If a child has been proven to country from donated genetic have no biological relation to a materials of non-US citizens.

US citizen parent, the parents In spite of all these possible can encounter trouble bring- problems, surrogacy in India ing the child into the United is a thriving, growing indusStates. United States citizen- try. There have been some isship is not acquired automati- sues about exploitation of locally at birth for children born cal women and claims against through Assisted Reproduc- agents and unscrupulous inditive Technology abroad. This viduals who take advantage of also poses a problem because Indian women’s poverty and in some countries surrogate need for the money that childmothers are not considered less couples are willing to pay parents of a child born out of to pass on their genes and hold surrogacy agreement. The the little bundle in their arms child therefore cannot get a without the rigors of carrying passport from the country of the baby for nine months and the birth mother nor get a US leaving their jobs or whatevpassport if the biological con- er it is that keeps them in the nection with the US resident United States. parent is not established.

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8

What Is Behind the Resurgence of the Measles?

At one time it looked as if measles could be beaten. Cases worldwide were on a serious decline, but all of the sudden it seems that the measles are back with a vengeance.

The most recent records indicate that 2011 had the highest reported incidence of measles cases in 15 years. What is the cause behind this sudden resurgence in the measles?

One of the main reasons for the latest resurgence seems to be more travel to foreign countries that are dealing with a measles crisis. 200 of the 222 reported measles cases last year were directly connected with travel to foreign countries. Of those cases over 60% of the individuals had never been vaccinated against the measles, and over 20% of the individuals did not know whether they had been vaccinated make sure that their children are against the disease or not. properly vaccinated. By choosing If the tide is going to be turned not to be vaccinated a person is not when it comes to new cases of the only putting themselves at risk but measles it is important that parents putting others at risk as well. Since

If an infant has their immune system compromised by the measles before they are vaccinated they will not longer be able to receive the measles-mumps-rubella (MMR) vaccine, thus exposing them to being infected by other diseases.

infants cannot be vaccinated until they reach a certain age, they are put in an especially harmful position if they are exposed to the measles before they can be vaccinated.

The travels concerns are heightened this year because many Americans will be heading to Europe for the 2012 Summer Olympics. Even though Europe is not considered to be a high-risk measles area, 72 of the 222 reported cases last year originated from Europe. The best way to protect yourself if you are planning to travel abroad is to make sure that you receive a measles vaccination at least two weeks before you plan to travel. The Center for Disease Control Advisory Committee on Immunization Practices (ACIP), the American Academy of Pediatrics (AAP), and the American Academy of Family Physicians all provide recommendations about

when children should receive the measles-mumps-rubella (MMR) vaccine that protects against the measles.

Unlike other vaccines, which have been adjusted over the years, the MMR vaccine has remained the same for over 20 years. Even though many adults over the age of 40 simply assume that they have been vaccinated for the measles, it is always a good idea to actually verify this fact with your doctor, especially if you are planning to ravel overseas. If this new increase in measles cases is going to be kept under control it is very important that doctors all over the world work hard to make sure that MMR vaccines are given to all children at an early age. There will be no need to put limitations on travel as long as the general population is made to realize the importance of being vaccinated against the measles.

Childhood Obesity and Summer Weight Gain As summer nears many parents are beginning to start planning the activities that will keep their children busy while they are out of school. One thing that parents need to seriously consider is what their children will be eating during the summer months. Recent studies have linked the summer months with more weight gain in children, up to three times as much when compared with the rest of the year.

The chronic problem of childhood obesity that is currently plaguing the United States should give parents cause for concern about what they will be allowing their children to consume this summer. What can you do as a parent to make sure that your children do not fall victim to excess weight gain during the summer months?

weight in the summer months will help you to be more proactive about helping your children to have a healthy diet during the summer. One of the main causes for extra weight gain during the summer months is that most young people have a lot of extra time on their hands and many children find that eating is a good pastime when there is nothing else to do. During the summer months many children eat meals that are often over-processed and full of fat and calories. In addition to this with no external motivation to get out and be active, many young people are content to stay at home and play video games or sit on the computer all day long.

Adding more structure to the summer months is an excellent way to keep children active and reduce Looking at some of the reasons their chances of succumbing to why children tend to gain more childhood obesity. Parents can start

by setting a good example through healthy eating and regular exercise. Research related to the obesity study showed that children who saw their parents exercise regularly were over 40% more likely to exercise or engage in physical activity even during the summer months.

Summer camps are also designed to help keep children physically active while many schools have information about summer programs that can help children to stay on the move. Check with your local boys and girls club, who has many different summer programs planned to entertain and motivate children in the community both mentally and dips, bite-size vegetable platters, physically. and small assorted sandwich platMake it a point to prepare healthy ters. These can all be prepared in meals for your family during the advance and kept in the refrigerator summer and then eat those meals so that they are ready and waiting together as a family. Healthy snacks when it is time for a snack. There include things like fruit and yogurt are tons of healthy, kid-friendly rec-

ipes online and if you really want to get your kids involved you should consider allowing them to help you pick out the recipes that you are going to try. Summer time may mean less homework, but it should never mean less healthy living.

What Do Infants Remember When They Forget?

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Six-month-old babies are severely limited in what they can remember about the objects they see in the world; if you hide several objects from an infant, they will only remember one of those objects with any detail. But a new study, which will be published in an upcoming issue of Psychological Science , a journal of the Association for Psychological Science , finds that when babies “forget” about an object, not all is lost.

Researchers used to think that babies less than two years old did not understand that an object continues to exist when it is not currently in the baby’s view. But in the mid-1980s, new ways of doing experiments with babies found that they do, in fact, know that objects don’t disappear when you’re not looking at them—a concept known as object permanence. But it was still unknown what babies needed to remember about objects in order to remember their existence.

Leslie, of Rutgers University, are working to figure out exactly what it is that babies remember about objects. For the new study, they showed six-month-old babies two objects, a disk and a triangle. Then they hid the objects behind small screens, first one shape, then the other. Earlier research has shown that young babies can remember what was hidden most recently, but have more trouble remembering the first object that was hidden.

Once the shapes were hidden, they lifted the screen in front of the first object. Sometimes they showed infants the shape that was hidden there originally, but sometimes it was the other shape, and sometimes the object had vanished completely.

Psychologists measure how long babies look at something to see how surprised they are. In Kibbe and Leslie’s study, babies weren’t particularly surprised to see that the shape hidden behind the screen had changed, for example, from a Now Melissa Kibbe, of Johns triangle to a disk. But if the object Hopkins University, and Alan

was gone altogether, the babies looked significantly longer, indicating surprise at an unexpected outcome. “This shows that even though infants don’t remember the shape of the object, they know that it should continue to exist,” Kibbe says. “They remember the object without remembering the features that identify that object.”

This helps explain how the young brain processes information about objects, Leslie says. He suspects the brain has a mechanism that acts like a kind of pointer, a mental finger that points at an object. Each finger can only point to one object.

“Just like a finger that points to something, you can’t tell from the finger itself what the shape of the thing being pointed at is,” Leslie says. “You can’t tell from looking at my finger whether I’m pointing at a cat or a dog.” This study shows that the mechanism in the baby’s brain that remembers the object doesn’t have to remember much about it.

9

Cancer Patients Participating in Healthcare Decisions Have Better Outlooks

In the United States, most people spend more time researching the type of car they want to buy than they do learning about their own healthcare options. Though the information is available, some patients opt to be a bystander instead of a proactive, engaged participant in their own healthcare decisions.

However, when faced with a major health crisis like a cancer diagnosis, it’s important for patients to consider the major role they play in the overall success of their treatment.

Time and time again, I’ve witnessed that those patients who make an effort to understand their cancer type and treatment plan benefit from a better attitude and outlook during

their cancer fight. Consider the following tips for becoming a more proactive patient: Upon Diagnosis, Learn about Your Type and Stage of Cancer

When a patient is diagnosed with cancer for the first time, he or she typically knows very little about the disease. As a first step, ask your doctor to provide you with an overview of your specific type and stage of cancer, and typical treatment options. If needed, don’t be afraid to ask your doctor to repeat things in “layman’s terms,” to ensure that you really understand. Make sure you leave the doctor’s office with additional information you can take home and read or with recommended resources

to find more information.

Then, spend some time learning on your own, before your next doctor’s appointment. When using the Internet, be sure to stick to reviewing reliable cancer websites from major organizations like the American Cancer Society (Cancer.org), National Cancer Institute (Cancer.gov), American Society of Clinical Oncology (Cancer.net), National Comprehensive Cancer Network (NCCN.org), and Texas Oncology (TexasOncology. com).

Have a Voice in the Decisions about Your Treatment Prior to meeting with your doctor to begin outlining your treatment plan, compile a short

list of questions, including:

• What successes have you had with different treatments for my type of cancer?

• What are the benefits and risks of each type of treatment?

• What option would you recommend to one of your friends or family members if they were in my shoes?

In addition, ask your doctor whether your particular cancer case may benefit from a clinical trial. This is a research study that examines how patients respond to new medical approaches for various types of cancers. Texas Oncology patients have the opportunity

to take part in some of the most promising clinical trials in the nation.

It Never Hurts to Have a Second Set of Ears Invite a friend or family member to attend your appointments to help listen and take notes. With so much medical information to take in, a second set of eyes and ears is helpful. However, it’s still up to you to prepare for appointments in advance, including compiling questions, and sharing your current list of medications and any new symptoms you’re experiencing with your doctor.

Throughout the cancer fight, every patient receives advice – from healthcare providers,

Billie Marek, M.D. Texas Oncology–McAllen

other cancer survivors, family, and friends. Consider each of these perspectives and weigh them carefully to help you make educated decisions about your health and treatment options, so that you feel confident that the path you take for your treatment therapy is the right one for you.

For more information about cancer types and treatment, visit www.

TexasOncology.com.

What is Diabetic Peripheral Neuropathy?

Sandra Y. Blanco, DPM Podiatrist

D i ab e t i c n e u r o p a t h y i s nerve damage caused by diabetes. When it affects the arms, hands, legs and feet it is known as diabetic peripheral neuropathy. Diabetic peripheral neuropathy is different from peripheral arterial disease (poor circulation), which affects the blood vessels rather than the nerves.

Three different groups of nerves can be affected by diabetic neuropathy: • Sensory nerves, which enable people to feel pain, temperature and other sensations • Motor nerves, which con-

trol the muscles and give them their strength and tone.

• Autonomic nerves, which allow the body to perform certain involuntary functions, such as sweating.

Diabetic peripheral neuropathy doesn’t emerge overnight. Instead, it usually develops slowly and worsens over time. Some patients have this condition long before they are diagnosed with diabetes. Having diabetes for several years may increase the likelihood of having diabetic neuropathy.

The loss of sensation and other problems associated with nerve damage make a patient prone to developing skin ulcers (open sores) that can become infected and may not heal.

This serious complication of diabetes can lead to leg amputation or even loss of life.

Causes Nerve damage that characterizes diabetic peripheral neuropathy is more common

in patients with poorly managed diabetes. However, even diabetic patients who have excellent blood sugar control can develop diabetic neuropathy.

There are several theories as to why this occurs, including the possibilities that high blood sugar or constricted blood vessels cause damage to the nerves.

As diabetic peripheral neuropathy progresses, various nerves are affected. These damaged nerves can cause problems that encourage development of ulcers. For example: Deformities (such as bunions or hammertoes) resulting from motor neuropathy may cause shoes to rub against toes, creating a wound. The numbness caused by sensory neuropathy can make the patient unaware that this is happening.

Because of numbness, a patient may not realize that he or she has stepped on a small ob-

ject and cut the skin.

Severely dry, cracked skin caused by autonomic neuropathy, combined with sensory neuropathy’s numbness and problems associated with motor neuropathy can lead to developing a wound.

Symptoms Depending on the type(s) of nerves involved, one or more symptoms may be present in diabetic peripheral neuropathy Sensory neuropathy

• Numbness or tingling in the feet

can lead to areas of increased pressure

• Pain or discomfort in the feet or legs, including prickly, sharp pain or burning feet

Autonomic neuropathy

Motor neuropathy •Muscle weakness and loss of muscle tone in the feet and lower legs • Loss of balance • Changes in foot shape that

• Dry feet • Cracked skin Diagnosis Diagnosis of diabetic peripheral neuropathy, is obtained by the patient’s history of symptoms and by performing simple in-office tests on the feet and Neuropathy legs.

Continue page 10

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Diabetes is the seventh leading cause of death in the United States.

Now more than ever, it is crucial to continue looking for ways to prevent, manage and treat diabetes, as well as all of its complications.

10

Safety First When It Come to Amusement Rides: Ten Tips From Ryerson University Many families may be thinking about heading to an amusement park or summer festival for a fun day riding stomach-dropping roller coasters, Ferris wheels and spinning swings. Rides can be thrilling, and even a little scary, but most of the sensation of danger is a clever illusion, says Kathryn Woodcock, an amusement ride expert at Ryerson University.

Professor Woodcock, director of the Ryerson’s THRILL lab (Tools for Holistic Ride Inspection Learning and Leadership), says before buckling in, parents and their young ones should remember a few things to make their day safe and fun: Tips for parents: 1. Don't get a false sense of security from height limits if your child is tall for her age. The height requirement is aimed to filter out children too young for the intensity of the ride or who don't have the muscle strength for its forces. Try to see the ride through your child's eyes. To your child, it may seem fast, noisy, and shaky, or full of fascinating distractions and confusing illusions that can cause impulsive behaviour. Make sure the lap bars secure the child if he/she is slender as well as tall for his/her age.

2. When the rules require that your child ride with a supervising companion, make sure that individual is paying attention to the child, not simply enjoying the ride from the next seat.

Companions are required when there is some concern that smaller children may react to the ride out of fear or excitement with dangerous actions. The companion is part of the safety restraint system of the ride. If you're not riding with your child, choose a companion mature enough that you would trust them to babysit your child.

3. Don't undermine the operator's responsibility to keep your children safe. If the operator says your child is too small to ride, explain to your child he isn’t ready and he can try again next year. Likewise, don’t give

Neuropathy

into your child’s demands to go on a ride that you think is too mature for him. He or she may not realize how fast the roller coaster will seem or how high the Ferris wheel goes.

Children can panic and attempt to exit the moving ride or suffer through the ride feeling traumatized.

This can spoil the day for everyone and may have repercussions on future trips to the fair.

4. If something seems wrong with the ride, such as a lap bar not latching properly or brakes not holding well, inform the operator immediately, and as soon as possible, tell guest relations at the carnival or main park entrance in case the operator did not understand you.

If you are still concerned, contact the regulator.

5. Be especially careful of "bouncy castles" and inflatable slides. There have been many sprains and fractures, and even fatal injuries when these devices are not properly installed and secured to the ground or not adequately supervised. Constant supervision by staff and parents is critical to prevent children injuring themselves or other smaller children. Many inflatable rides are rented and can be staffed by event hosts who are not properly qualified or attentive. If you are the event host, make sure the rental company shows you a current registration document for every device you are renting. Check to ensure they secure every

combination of different medications is used.

Continued from page 9 In some cases, the patient This evaluation may in- may also undergo physiclude assessment of the pa- cal therapy to help reduce tient’s reflexes, ability to feel balance problems or other light touch and ability to feel symptoms. vibration. In some cases, adPrevention ditional neurologic tests may The patient plays a vital be ordered. role in minimizing the risk Treatment of developing diabetic peFor the treatment of dia- ripheral neuropathy and in betic peripheral neuropa- preventing its possible conthy, control of the patient’ sequences. Some imporblood sugar level is impera- tant preventive measures tive. include: Medications are avail• Keep blood sugar levels able to help relieve specific under control. symptoms, such as tingling • Wear well-fitting shoes to or burning. Sometimes a avoid getting sores.

tether attachment to the ground and provide training for staff or volunteers who will supervise the children.

Tips for children: 1. Follow the rules, not the other kids. The rules are to help you have fun, not spoil it.

2. Watch out when the rules say things like “hang on to the handles”, “slide only feet first”, “stay seated”, “don't rock the seat”, “get rid of gum before you ride”, or “no flipping”.

When they post those rules, it is because they know those actions can cause kids to get hurt.

3. Choose rides that are fun for you. Don't go on a boring ride and try to make it exciting by doing it upside down and backwards.

Chances are you can be hurt or may even be sent home and not allowed to come back.

4. Watch out for the little kids. If you see a little kid that is doing something dangerous, warn the ride operator or another adult so someone can help. If you see older kids pushing, shoving and spoiling the fun for others on the ride, tell the ride operator.

The operator can direct the older kids to a ride that is more suited to their age group.

Skipping Breakfast Can Lead to Unhealthy Habits All Day Long Compared to breakfast-eaters, breakfast-skippers tend to weigh more and have other unhealthy habits, such as consuming too many sugary drinks or high-calorie snacks, according to a panel discussion during a symposium at the Institute of Food Technologists (IFT) 2012 Annual Meeting & Food Expo.

Research shows about 18 percent of Americans older than age 2 regularly skip breakfast, said Nancy Auestad, PhD, vice president of regulatory affairs at the Dairy Research Institute.

They are missing out on key nutrients, she said, pointing to statistics that show breakfasteaters get about 17 percent of their daily calories from breakfast as well as a significant portion of their daily recommend intake of several key nutrients, such as Vitamin D (58 percent), Vitamin B12 (42 percent) and Vitamin A (41 percent).

In addition, studies of young

people found that breakfastskippers consume 40 percent more sweets, 55 percent more soft drinks, 45 percent fewer vegetables and 30 percent less fruit than people who eat breakfast.

“Most of these negative factors were abbreviated when breakfast was consumed, compared with breakfast-skippers,” said Heather Leidy, PhD, assistant professor in the department of nutrition and exercise physiology at the University of Missouri.

“Targeting that behavior could lead to a reduction in obesity.”

Leidy conducted research focusing on the role of protein in breakfast, and she found that the effects of breakfastskipping were felt throughout the day. She assembled a group of 10 breakfast-skipping teenagers and split them into groups that consumed no breakfast, a normal-protein breakfast and a high-protein breakfast. By measuring their

IFT

Mayo Clinic Expert Discusses Safe Swimming Practices to Reduce Water-Related Illnesses

5. Read the signs and teach your parents some safety rules. Even adults get hurt when they put their hands in the air or don't ride properly.

• Inspect your feet every day. If you notice any cuts, redness, blisters or swelling, see your foot and ankle surgeon right away. This can prevent problems from becoming worse.

• Visit your foot and ankle surgeon on a regular basis for an examination to help prevent the foot complications of diabetes.

• Have periodic visits with your primary care physician or endocrinologist. The foot and ankle surgeon works together with these and other providers to prevent and treat complications from diabetes.

hunger levels and several other indicators, she found that eating a healthy breakfast of any kind lead to more satiety and less overeating throughout the day, but these benefits were especially prominent among the teens who ate the high-protein breakfast. They consumed about 200 calories less in evening snacking, she said.

Her study also used magnetic resonance imaging to determine that a protein-rich breakfast reduces the brain signals controlling food desires, even many hours after breakfast.

Despite the benefits of consistently eating breakfast, all the participants in Leidy’s study went back to being breakfast-skippers within six months, citing the lack of available healthy, highprotein foods. This means the food industry has to work to create more of these options to fit into the lifestyle of busy kids and adults.

With the hot, muggy summer season arriving, kids will be heading to the pool to cool off. While swimming is refreshing, fun and good exercise, even chlorinated pools contain many germs that can make them ill. Mayo Clinic pediatric experts warn that many swimmers may not be aware of the water illnesses associated with pools due to the germs that can linger.

"A swimming pool is basically a community bathtub without the shampoo," says Thomas Boyce, M.D. , pediatric infectious diseases specialist, Mayo Clinic Children's Center. "Children can still get sick in a properly chlorinated pool. Chlorine does not kill germs instantly and, in fact, does not kill cryptosporidium at all, which is a common germ that causes

water-associated gastrointestinal illness."

Recreational water illness outbreaks peak in summer.

According to the Centers for Disease Control and Prevention, 21.6 percent of Americans don't know that swimming while they have diarrhea puts other swimmers at risk for water-associated illnesses. To help keep germs from entering the water, Dr. Boyce advises parents to take young children on bathroom breaks often; change their diapers in the bathroom, not poolside; and wash a toddler's bottom with soap and water before entering the water.

Swimming is a great way for kids to cool off and get exercise in the summer, however, Dr. Boyce cautions that children who swallow water while they swim can be at risk for diarrhea, viral meningitis and other illnesses. Parents can keep children safe by having their children rinse off before entering the pool, not allowing children with diarrhea to swim and teaching children not to swallow the pool water that they swim in, he says.

- Mayo Clinic

11

Protect Your Eyes to Reduce Nostalgic Thoughts Of Happier Computer Vision Syndrome Times Can Help Overcome Loneliness How many of us are old enough to remember the day when there was NOT a computer in every household, let alone one for each member of the family. Today, with e-readers and computer notepads, even our books are being delivered electronically.

Most people today spend an increasing number of hours using computers, tablets and smart phones to read increasingly small type. For many of us, the result of all this screen time is eye strain.

According to national statis-

Breakfast From the grill • Steak and Eggs

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•Pork Chops and Eggs

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Extra filling ($0.50) • Taco de Machacado, Barbacoa, or Fajita $2.00 • Super Taco $6.00 More Breakfast and Omelettes • Country Breakfast $5.50 Two pancakes, two eggs, diced potatoes and choice of bacon, ham, or sausage.

• Kitchen Style Breakfast

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• Tex-Mex Omelette

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Two Texas toast, two eggs, diced potatoes and choice of bacon, ham or sausage.

Three eggs, bell peppers, tomato, onions and cheese. Served with hash-browns, beans and Texas toast.

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Three eggs, mushrooms, onions, Monterrey cheese, served with hash-browns and Texas toast.

• Ham and Cheese Omelette

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Crunchy corn chips layered with beans and cheese. Served with raw onion, tomato, jalepeno, and avocado.

Chicken $1.00 Sausage $1.00 Shrimp $2.00 Beef $2.00

• Crispy Fish Fillet Strips/Chicharron de Pescado $7.00 Served with salad and avocado.

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Served with Mozzarella cheese, mushrooms, onions, hash-browns, and Texas toast.

Lite Start Meals • Oatmeal Bowl $3.50 Cereal and Milk • French Toast $3.50 Two Texas toast, at the core of this sweet, classic pastry. Served with butter and syrup.

• Two Gravy Biscuits & Sausage $4.00 Breakfast Selections All selections served with beans, home potatoes and tortillas.

• Huevos a la Mexicana $4.00 • Huevos Rancheros $4.00 • Chicharron Plate $4.50 • Chicharron Plate with two eggs $5.50 • Migas Plate $4.00 • Migas Rancheras con Queso $5.00 • Machacado Plate $5.00 • Machacado a la Mexicana $6.00 • Chorizo Plate $4.50 • Chorizo a la Mexicana $5.00 • Chilaquiles Regulares $4.50 • Chilaquiles con pollo $5.50 • Colungas Breafast $6.00 • Chilaquiles with two eggs, any style. $3.00 • Homestyle Two Eggs Any style eggs. (1 bacon, 1 sausage, or 1 ham)

Monday – Friday 7am – 11am Full Breakfast $5.00

Any style two eggs (bacon, sausage, or ham) and hash-brown with toast or biscuit, and coffee.

Cheese

Nostalgia, a sentimental longing for the past, has a crucial part to play in combating feelings of isolation and loneliness, claim researchers in a new study.

Their findings suggest that for lonely people, drawing on nostalgic memories of happier times could provide a coping mechanism for their feelings, magnifying perceptions of social support and restoring an individual's feelings of social connectedness.

Loneliness is connected to a perceived lack of social support networks, such as close friends and family, and is usually eased by actively seeking support and company from those networks.

However, many lonely people find it difficult to deal with their loneliness directly, either by forming new social support networks or expanding existing ones. This may be because they are shy or have poor social skills, or because relocating to a new job or home has taken them away from friends and family.

Psychologists, from the Universities of Southampton and Sun Yat-Sen University, in Guangzhou, China, conducted four diverse studies to test whether nostalgia could combat the effects of loneliness in people from different walks of life, including

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Breaded breast, lettuce with diced American cheese, tomato, onion, bell peppers, and ranch dressing.

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• Tex-Mex

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• Edinburg Plate

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Three crispy corn tortillas with beans, cheese, lettuce, tomato, and avocado; served with Spanish rice.

One cheese enchilada, one fajita taco, one carne guisada taco, Spanish rice, beans, and avocado salad.

Ripe avocados & your choice of its classic ingredients: Lime juice, garlic, salt, diced onion, jalapeno, cilantro & tomato.

One cheese enchilada, one fajita taco, one chicken flauta, Spanish rice, beans, and avocado salad.

• Carne Guisada/Mexican Beef Stew $7.50

Diced sirloin in a flavorful meat sauce; served with Spanish rice, beans, avocado salad, and tortillas.

Soups/Sopas • Shrimp Soup (caldo de camarones)

• Chile Relleno/Stuffed Poblano Pepper$7.50

Bowl: $7.50

Jumbo: $9.50 • Caldo de Res (Rich beef soup with vegetables, rice and tortillas) Bowl: $6.50 • Seafood Soup (caldo de mariscos) Fish and Shrimp Bowl: $7.50 Jumbo: $8.50 • Fish Soup (caldo de pescado) Bowl: $6.00 Jumbo: $8.00 • House Soup (shrimp, fish, octopus and oysters) Jumbo: $13.00

Choose cheese or beef filling with melted cheese on top. Served with Spanish rice, beans, avocado salad, and tortillas.

• Milanesa/Breaded Sirloin Steak $8.00 Served with French fries, avocado salad, and Spanish rice.

• Bistec Ranchero/Mexican Ranch Steak $8.00

Diced sirloin served with Spanish rice, avocado salad, and tortillas. $7.50 • Enchiladas Americanas Your choice of filling: Cheese, chicken, or beef; all served with Spanish rice and beans.

• Enchiladas Suizas

Tacos

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• Entomatadas/Tomato Enchiladas $7.00

Mild enchiladas on tomato sauce, covered with cheese.

Served with Spanish rice and beans.

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Foot-long flour tortilla filled with beans, bacon, beef fajita, American cheese, and vegetables.

Burgers • Half-Pounder $5.50 Ground been on a bun, served with French fries and salad.

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• Chicken Burger

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Breaded chicken breast, real ham, and cheese on a bun. Served with French fries and salad.

• Fish Burger $5.50 Breaded Fish Fillet on a bun, served with french fries and salad

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Chicken filling, with green tomatillo sauce and sour cream. Served with rice and beans.

Order is served with rice, beans and salad.

• Super Taco

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Meat grilled to perfections, with lettuce, American cheese, tomato, onion, bell peppers, and ranch dressing.

Three crispy corn tortillas filled with beef or chicken, topped with beans, cheese, lettuce, tomato, and avocado; served with Spanish rice.

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Garnish these tacos with: “Toreado Seasoning” (chile, tomato, and onion) Cheese Guacamole

• Chicken or Beef Fajita Salad

Mexican Favorites/Especialidades de la Casa • Chalupas $7.50

Large flour tortilla filled with Mozzarella cheese; served with guacamole and sour cream. For the local experience, taste the “Toreado Seasoning” ADD: Chile, tomato, and option $1.00 Beef fajitas $2.00 Chicken Fajitas $1.00 Gulf shrimp $3.00 Mushrooms & Spinach $2.00

• Chicken Fajita • Beef Fajita • Shrimp • Fish

All vegetables found in our parcela, including ham, cheese, and ranch dressing.

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Shredded chicken inside crispy rolled corn tortillas, served with guacamole and sour cream on a lettuce bed.

• Guacamole

Low Calorie Dishes: Salads • Chef Salad $4.50

We will cheerfully prepare your seafood as requested!

• Shrimp/Camarones (6, #21/25) $9.00 • Either ready to eat, or “on the rocks” (9, #21/25) $14.00 • Pollock Fish Fillet $9.00 • Pollock Fish with shrimp filling $12.00 • Fish & Shrimp Combo $10.00 8 oz. Fish & Three shrimps

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schoolchildren, college students and factory workers.

One study involved a group of migrant children between nine and 15 years of age who had moved with their parents from rural areas to the city of Guangzhou. The psychologists assessed how lonely they felt, how nostalgic they were for the past, and how strong they felt their own support networks to be.

The results showed that, while the loneliest children felt there was a lack of social support, they were also the most nostalgic for the past.

This in turn increased their perceptions of social support, making them feel less lonely.

Psychologist Dr. Tim Wildschut of the University of Southampton explains: "Our findings show that loneliness affects perceived social support in two distinct ways.

First, the direct effect of loneliness is to reduce perceived social support, so that the lonelier a person feels, the less social support they perceive for themselves.

"But paradoxically, loneliness may also have an indirect effect by increasing perceived social support via nostalgia: the lonelier someone feels, the more nostalgic they become, and the more social support they may then perceive they have."

Grilled or boiled shrimp, lettuce, diced American cheese, tomato, onion, bell peppers, and ranch dressing.

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near work is that people tend to blink less and that causes eyes to become dry.”

You can help reduce CVS by following these tips: Sit back far enough from your computer, 25 inches away is recommended, and tilt the screen in order to look down as you work.

Every 20 minutes or so, look at least 20 feet across the room for 20 seconds to activate your distance vision and take a break from near work. It also helps if you can get away from your desk or close your eyes.

Blink often and remember that deep breathing relaxes eye muscles.

Keep some artificial tears – eye drops – on hand, or look into a desktop humidifier to put some moisture back into dry offices with central air conditioning.

Check your eye glass prescription to make sure you have the correct refraction for your eyes.

“It’s important to be sure you have the right prescription because that will help make near tasks easier for you to do without your eyes straining because your glasses are too strong,” Seidel said.

It’s also important to have anti-reflecting coating, which creates no-glare lenses that result in fewer headaches and less eye fatigue caused by computer screens and overhead lights, she said.

Restaurant Available for Banquets 50 - 120 People

Shrimp Cocktail Medium $7.50 Large $10.00

Choose two fillings out of bacon, chorizo, ham, and eggs.

• Colunga's Omelette

tics, approximately 70 percent of Americans have what’s called computer vision syndrome or CVS. Symptoms include blurry vision, headaches and strained, dry or just plain tired eyes.

“The reason that people get CVS is because electronic devices require you to do too much ‘near work’, which strains the muscles in your eyes that focus on near objects and makes them tired,” explained Christy Seidel, ophthalmic technician and team leader, Marshfield Clinic Minocqua Center Optical Department. “The other problem with

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Served with Spanish rice and beans. $8.00 • Mexican Plate Two cheese enchiladas, one chalupa and one crispy beef taco. Served with Spanish rice and beans. $10.00 • Tampiquena Plate Grilled sirloin fajita with one American enchilada; served with Spanish rice, avocado salad, and tortillas. $16.00 • Tamaulipas Steak Choice of Ribeye or T-bone, with one American enchilada; served with Spanish rice, avocado salad, and tortillas. $10.00 • Rio Bravo Plate Stuffed poblano pepper, one American enchilada; served with Spanish rice, beans, avocado salad, and tortillas. $7.50 • Chicken Fried Steak Old fashioned standard; served with choice of baked potato or French fries, white gravy, salad, and Texas toast.

Tim continues: "Our findings show that nostalgia is a psychological resource that protects and fosters mental health. It strengthens feelings of social connectedness and belongingness, partially improving the harmful repercussions of loneliness. Our research is an initial step towards establishing nostalgia as a potent coping mechanism in situations of self-threat and social threat. The past, when appropriately harnessed, can strengthen psychological resistance to the vicissitudes of life."

Further, the researchers found a connection between nostalgia and emotional resilience, with the restorative function of nostalgia being particularly marked among highly resilient individuals who are able to withstand or recover quickly from difficult conditions. When lonely, these people report high levels of nostalgia.

The researchers say their findings have implications in a number of areas, including for clinical psychology, where nostalgia could be used as a tool in cognitive therapy, training individuals to benefit from the restorative function of nostalgia when actual social support is lacking or perceived as lacking.

From the Grill/De la Parrilla

• Steak and Shrimp $16.00 Your choice of T-Bone or Ribeye; and three shrimps prepared as requested. Served with baked potato or French fries, salad, and Texas toast. $12.00 • T-Bone Platter Served with baked potato or French fries, salad, and Texas toast. $12.00 • Rib-Eye Platter Served with baked potato or French fries, salad, and Texas toast. $8.50 • Agujas al Carbon Served with Spanish rice, beans, avocado salad, and tortillas.

• Pork Chops/Chuletas de Cerdo $8.00 Served with Spanish rice, beans, avocado salad, and tortillas. $7.50 • Hamburger Steak Grilled hamburger patter and onions. Served with choice of baked potato or French fries, brown gravy, salad, and Texas toast. $12.00 • Fajita & Shrimp Plate Grilled sirloin fajita, shrimp and vegetables, served with Spanish rice, beans, avocado salad, and tortillas. $8.50 • Fajita Plate Grilled sirloin fajita with vegetables; served with Spanish rice, beans, avocado salad, and tortillas.

Chicken/Aves • Pechuga Santa Fe

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Grilled chicken breast marinated in house sauce with melted cheese on top. Served with Spanish rice, beans, avocado salad, and tortillas.

Grilled chicken fajita and vegetables; served with Spanish rice, beans, avocado salad, and tortillas.

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Delicious house cilantro cream sauce, served with Spanish rice, avocado salad, and tortillas. $8.00 •Jalapeno Chicken/Pechuga Toreada Grilled chicken breast, jalapeno pepper, tomato and onions. Served with rice, avocado salad, and tortillas.

Family Platters • Mar, Tierra y Sol

Grilled chicken, beef, and vegetables over a bed of corn chips, beans and cheese. Also, breaded fish and shrimps over a bed of French fries.

Served with Spanish rice, beans, avocado salad and tortilla.

For (2) $20.00 For (3) $29.00 For (4) $38.00 • Sombrero Grilled chicken/Beef Fajitas and vegetables; topped with melted Monterrey cheese. Served with Spanish rice, beans, avocado salad, and tortillas.

For (2) $16.00 For (3) $22.00 For (4) $28.00 • Botana Grilled chicken/Beef fajitas and vegetables over chips, beans, and cheese. Served with Spanish rice, beans, avocado salad, and tortillas.

For (2) $17.00 For (3) $25.00 For (4) $32.00 • Mariscada/Seafood Delight Fish, shrimp, fish fillet, and crab. Served with French fries, Spanish rice, soup and Texas toast.

For (2): 4 shrimp, 4 fish fillet, 2 crabs $20.00 For (3): 6 shrimp, 6 fish fillet, 3 crabs $29.00 For (4): 8 shrimp, 8 fish fillet, 4 crabs $38.00

Catering Available!!! Call: (956) 458-7311 (956) 386-9356

Dr. Jose A. Cobos is pleased to announce that Dr. Donald Vargas has joined OrthoCare.

Dr. Vargas has been a Board Certified Orthopedic Surgeon serving the Harlingen community for over 30 years.

For an appointment call OrthoCare at: Jose A Cobos, MD

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