Recognizing National Breast Cancer Awareness Month
Volume 16 | Issue 10
Inside This Issue
October Edition 2026
Breast Cancer Awareness Month: Houston Has a Message for Every Family By Houston Medical Times Staff
E What Untreated Sleep Apnea Means for Alzheimer’s Risk See pg. 9
INDEX Legal Matters........................ pg.3 Oncology Research......... pg.5 Healthy Heart....................... pg.8 Financial Forecast............ pg.12
Could Man’s Best Friend Help Patients Get Back on their Feet? See pg. 11
very October, pink ribbons appear across Houston — in hospitals, physician offices, businesses, schools and community events. But behind the color is a message that goes far beyond a month-long awareness campaign: breast cancer affects individuals and families, and finding the disease early can improve the chances of successful treatment. For Houston, that message is especially meaningful. The city is home to a remarkable concentration of cancer specialists, researchers and medical institutions, including the Texas Medical Center. Patients throughout the Houston area have access to specialized breast cancer care, diagnostic imaging, genetic counseling, clinical trials and survivorship services. Yet one of the most important tools in detecting breast cancer remains regular screening. Know When to Get Screened Screening recommendations depend on age, personal health and individual risk factors. According to the American Cancer Society, women at average risk ages 40 to 44 have the option of beginning annual mammograms. Women ages 45 to 54 should have a mammogram every year. Beginning at age 55, women can transition to mammograms every other year or continue with annual screening, as long as they remain in good health and have a life expectancy of at least 10 years. Women who are at higher risk because of factors such as a strong family history, certain inherited genetic mutations or previous medical conditions may need to begin screening earlier or receive additional testing. A healthcare professional can help determine the appropriate
screening plan. UT MD Anderson Cancer Center similarly emphasizes that breast cancer screening recommendations depend on a woman’s age and level of risk. Its High Risk Screening and Genetics Clinic provides individualized risk assessment, genetic counseling and screening recommendations for people with certain personal or family histories. Know Your Risk—and Know Your Body Family history is an important part of understanding breast cancer risk. People with a significant family history of breast or ovarian cancer, certain inherited genetic changes or other risk factors may benefit from genetic counseling and a personalized cancer risk assessment. MD Anderson’s genetic counseling services help individuals and families understand inherited cancer risk and determine whether genetic testing or specialized screening may be appropriate. Being familiar with how your breasts normally look and feel is also important. A new lump or thickening, a change in breast size or shape, changes in the skin, a nipple that changes direction or becomes retracted, or unexpected nipple
discharge should be discussed with a healthcare professional. Changes do not necessarily mean cancer, but they should not be ignored. Houston’s Medical Community Makes a Difference Houston offers a broad range of resources for people at different stages of the breast cancer journey. UT MD Anderson’s Nellie B. Connally Breast Center provides personalized breast cancer care, including screening, diagnosis, treatment and survivorship services, with locations throughout the Houston area. MD Anderson also provides access to clinical trials and specialized programs for patients with increased breast cancer risk. For individuals and families facing a diagnosis, Houston’s medical community also includes organizations that can help patients navigate the practical and emotional challenges that can accompany cancer treatment. More Than a Pink Ribbon Breast Cancer Awareness Month is also an opportunity to remember that every diagnosis represents a person— not a statistic. It may be a mother, wife, daughter, see Breast Cancer ...page 14
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Legal Matters CMS Makes Telehealth Enrollment Flexibilities Permanent: What Providers Need to Know
By Mary Buckley Tobin, J.D. Kathy L. Schaeffer, J.D. Polsinelli, PC
T
he Centers for Medicare and Medicaid Services (CMS) recently announced that certain Medicare telehealth enrollment flexibilities first adopted during the COVID-19 public health emergency are now permanent. These flexibilities allow practitioners who furnish telehealth from home to avoid reporting their home addresses on Medicare enrollment and claim forms when they are associated with an enrolled physical practice location. The policy addresses privacy, safety and administrative concerns and
gives practitioners and group practices greater certainty when using remote clinicians. What Is Medicare “Telehealth” for Enrollment Purposes? The permanent flexibility applies only to Medicare telehealth services—covered services ordinarily furnished in person, such as office visits, psychotherapy and consultations, when delivered through two-way telecommunications technology. Services not ordinarily furnished in person, including care management, remote monitoring and remote interpretation of diagnostic tests, are not considered Medicare telehealth for this purpose. That distinction is especially important for remote radiologists and other practitioners whose services fall outside Medicare’s telehealth definition. Practitioners Providing Telehealth From Home A practitioner who furnishes telehealth from home but has another physical practice location associated with a Medicare Part B group practice
generally does not need to report the home address as a Medicare practice location. Instead, the practitioner may enroll and bill from the group’s physical practice location as though the service had been furnished there in person. The same principle applies when a remote practitioner reassigns Medicare billing rights to a Part B group practice, including across state lines. The practitioner identifies the telehealth arrangement to the applicable Medicare Administrative Contractor, while the group reports its physical practice locations rather than the practitioner’s home. Claims are processed as though the services were furnished at the group’s physical location. Virtual-Only Practitioners and
Groups The policy does not eliminate the need for a physical practice location altogether. If a practitioner furnishes telehealth virtually and the practitioner’s only physical practice location is the practitioner’s home, the home address must be reported as a Medicare practice location. Likewise, a virtual-only group with no physical practice location must report the practitioner’s home as its practice location. CMS permits providers to designate such locations as a “Business Office for Administrative/Telehealth Use Only” or “Home Office for Administrative/Telehealth Use Only,” see Legal Matters. ...page 14
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Houston Medical Times
New Houston Methodist Study Shows Growing Breast Cancer Risk for Younger Women, Improved Outcomes for Older Women Age, Race and Tumor Subtype Together Unlock Hidden High-Risk Breast Cancer Patterns Among Asian and Hispanic Populations By Nathaniel Godwin
A
national study analyzing U.S. breast cancer data spanning nearly 50 years has uncovered a major shift in outcomes and risk of developing the disease, highlighting urgent gaps in prevention and treatment for specific groups of women. Analyzing Surveillance, Epidemiology and End Results (SEER) data from 1975 - 2022, researchers from Houston Methodist found that breast cancer deaths, once concentrated mostly among older women, are increasingly affecting younger women, signaling a major change in the nation’s breast cancer risk landscape. While the data showed that survival improved substantially among older women over
time, younger women did not experience the same improvement. women alongside improved survival in older women shows how breast cancer risk is shifting,” Wong said. “Importantly, Rising mortality among we found that Asian women under younger women alongside 50 experience poorer outcomes and improved survival in older face elevated risk of mortality than women shows how breast previously recorded.” Young Black women with triple cancer risk is shifting. negative breast cancer remained the —Stephen Wong, Ph.D. highest risk group. However, the study also found elevated mortality risks The research was led by Stephen Wong, among Hispanic and Asian women Ph.D., the John S. Dunn Presidential under 50 in specific molecular subtypes, Distinguished Chair in Biomedical particularly those with triple negative Engineering at Houston Methodist and breast cancer, a more aggressive type of director of T. T. & W. F. Chao Center the disease. for BRAIN. The study appears in npj According to the American Breast Cancer, published by Nature. Cancer Society, aside from skin cancers, “Rising mortality among younger breast cancer is the most common
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Oncology Research Texas Men Are Falling Behind on Prostate Cancer Screening Know When to Get Checked By Vipal Pratin Durkal, M.D. Texas Oncology
F
or many men, prostate cancer doesn’t announce itself. There may be no pain, no warning and no obvious reason to see a doctor. But Texas men are getting screened at lower rates than men nationally. According to the American Cancer Society, just 28% of Texas men age 50 and older are current with prostate cancer screening, compared with 31% nationwide. That gap matters because prostate cancer is often highly treatable when it is found before it spreads. The five-year relative survival rate is greater than 99% for prostate cancer that remains
localized or has spread only to nearby areas. When the cancer has spread to distant parts of the body, that rate falls to 38%. These numbers don’t predict what will happen to any individual patient, but they illustrate why having a conversation about screening before symptoms appear can be so important. What men should know about screening Do I need a PSA test? Not necessarily. Prostate cancer screening is a personal decision that should be made after discussing the potential benefits, risks and uncertainties with your physician. The PSA blood test is the primary screening tool. The American Cancer Society recommends that men at average risk begin discussing screening with their doctor at age 50. Men at higher risk, including Black men and those with a father or brother diagnosed with
prostate cancer before age 65, should begin that conversation at age 45. Men with multiple first-degree relatives diagnosed at an early age should discuss screening beginning at age 40. I don’t have any symptoms. Why should I be screened? That’s precisely why screening can be valuable. Early prostate cancer often causes no symptoms. Waiting until something feels wrong can mean waiting until the disease is more advanced. Does an elevated PSA mean I have cancer? No. PSA can be elevated for several reasons, including an enlarged prostate
or inflammation. An elevated result may lead to additional testing or monitoring, but it is not by itself a cancer diagnosis. What if prostate cancer runs in my family? Tell your doctor. A family history, particularly in a father or brother, can increase your risk and may mean you should begin discussing screening earlier. Start the conversation There is no single screening schedule that is right for every man. see Oncology. ...page 14
Changing the future of healthcare Nursing Nutrition & Food Science Occupational Therapy Physical Therapy Health Care Administration
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Mental Health Study Explores How Ketamine Reshapes Brain Activity in Older Adults
By Emma Lawson
The Findings Could Help Researchers Better Understand Treatment Response in Depression
K
etamine is increasingly used for treatment-resistant depression, but its use in older adults has been limited due to safety and efficacy concerns. (Adobe Stock) Researchers at the Texas A&M University Naresh K. Vashisht College of Medicine have identified time-specific patterns of brain activity following ketamine treatment in older adults with treatment-resistant depression. The findings, published in Translational Psychiatry, could help researchers identify potential biological markers associated with ketamine’s antidepressant effects and better understand why patients
respond differently to treatment. Ketamine is increasingly used as a rapid-acting treatment for treatment-resistant depression, but its use in older adults has not been widely adopted due to concerns of safety and efficacy associated with aging pathology. To address these questions, the Experimental Psychopharmacology of Mood and Anxiety Disorders Lab (EPMAD Lab) at Texas A&M, led by Sanjay Mathew, MD, professor and head of the Department of Psychiatry and Behavioral Sciences, has been studying how the brain responds to ketamine in U.S. veterans over 55 years old. Nicholas Murphy, PhD, research associate professor in the Department of Psychiatry and Behavioral Sciences at Texas A&M, coordinates the neuroscience-informed treatments wing of the EPMAD Lab. He compares ketamine’s effects to opening a floodgate: the
drug allows communication to flow through the brain, leading to enhanced flexibility. Murphy suggested patients’ clinical response to ketamine is tied more closely to the malleability of the brain than how large of an initial response it has. “Let’s say you had a map of rivers in the desert,” he said. “You release the dam, and now all the tributaries are being flooded with water. We now have these connections between places, and that’s what ketamine does; it helps to create a more flexible and densely connected environment. But
this isn’t the end of the story. For it to be useful, we need to understand how that water is flowing, and that’s where our current analysis comes in. It tells us how the surging of glutamate released by ketamine needs to flow to get a clinical response.” The new study focused on the next questions: how is information organized across the brain after ketamine use in older adults, and how does that organization change over time? see Mental Health. ...page 13
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Healthy Heart Hispanic Heritage Month: Representation Matters for Heart Health
By Dion Bart The American Heart Association
A
new report from the American Heart Association reveals a troubling milestone: cardiovascular disease has surpassed cancer as the leading cause of death among Hispanic adults in the United States. Although Hispanic people represent nearly 1 in 5 U.S. residents, they remain underrepresented in the research that shapes prevention and treatment strategies for cardiovascular care. Additionally, they face many unique health challenges influenced by language, culture, access to care and social conditions. Despite the growing need for culturally relevant cardiovascular care to overcome these challenges, according to the new report, only about 6% of cardiologists identify as Hispanic. The American Heart Association
established the National Hispanic Latino Cardiovascular Collaborative (NHLCC), which is helping guide the next generation of healthcare leaders through mentorships and resources for Hispanic college students pursuing medical careers. Founding member of the NHLCC, Johanna Contreras, M.D., M.Sc.FAHA, was the chair of the volunteer writing group for the new report, which provides a comprehensive overview of the current state of heart disease and stroke among Hispanic adults in the U.S. She stressed it is imperative to have Hispanic representation in the healthcare workforce at all levels — from the person who opens the door of the hospital, to the nursing staff, to the general practitioner and at all levels of medical specialists. “We need to be able to understand the unique experiences of these individuals, where they are
coming from, what their environment is like and what resources they have access to. As a Hispanic woman, I understand my community a little bit better, because I grew up in this community, so I know how people sometimes react to certain situations. And I am also able to educate my colleagues that may not have had those experiences,” said Contreras who is the director of the Division of Heart Failure and medical director of the Hispanic Heart Center within the Mount Sinai Health System in New York. “I am very excited about our Hispanic scholars’ program, because these students are so eager to make a difference. I think we’re going to be able
to have a true international impact in how we are better able to take care of all people.” The American Heart Association is working to advance culturally responsive care, support bilingual health education, expand Hispanic representation in research and foster trusted community partnerships. Spanish-language resources and culturally tailored programs designed to help people better understand risk factors, navigate the healthcare system and improve health outcomes are see Healthy Heart. ...page 14
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By Hans Schleicher, DDS, D-IAOS | Founder, Sleep Houston PLLC
A
lzheimer’s disease has no cure, which is exactly why modifiable risk factors deserve so much clinical attention. Sleep is turning out to be one of the more actionable ones. A growing body of research over the past decade links untreated obstructive sleep apnea (OSA) — one of the most common, and most underdiagnosed, conditions in older adults — to earlier onset of mild cognitive impairment (MCI) and Alzheimer’s disease, and to a meaningfully elevated long-term dementia risk. For physicians managing an aging patient population, that makes OSA screening a legitimate part of cognitive risk assessment, not just a sleep-quality conversation. The biological case starts with how the brain cleans itself. In
a landmark 2013 study published in Science, researchers demonstrated that the brain’s glymphatic system — the channel through which cerebrospinal fluid flushes metabolic waste, including amyloid-beta, out of brain tissue — becomes dramatically more active during sleep, with interstitial space expanding and waste clearance accelerating compared to the waking state. OSA disrupts exactly the kind of sleep this clearance depends on: repeated apneas fragment sleep architecture and suppress slow-wave sleep, the deep-sleep stage in which glymphatic flow is believed to peak. Intermittent hypoxia compounds the problem, triggering oxidative stress, mitochondrial dysfunction, and microglial activation that can injure
neurons independent of amyloid accumulation. The clinical data bears this out. A widely cited 2015 Neurology study followed 2,470 adults ages 55 to 90 and found that those with sleep-disordered breathing developed MCI roughly a decade earlier, and Alzheimer’s disease about five years earlier, than those without breathing problems during sleep. Critically, the same study found that patients who were treated for their sleep-disordered breathing had an age of MCI onset nearly identical to patients who never had breathing problems at all. “Patients who were treated for their sleep-disordered breathing had an age of MCI onset nearly identical to patients who never had breathing problems at all.” That finding held up at scale. A 2022 systematic review and meta-analysis pooling 11 cohort studies
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The Sleep-Brain Connection: What Untreated Sleep Apnea Means for Alzheimer’s Risk
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and more than 1.3 million patients found sleep apnea associated with a 43% higher risk of any neurocognitive disorder and a 28% higher risk of Alzheimer’s disease. The same analysis found no significant association with vascular dementia, but a notably stronger association with Parkinson’s disease and Lewy body dementia — a pattern that points toward disease-specific biological pathways rather than a generic PET studies have repeatedly found elevated amyloid-beta and tau burden in cognitively normal older adults with untreated moderate-to-severe OSA. A 2022 randomized crossover
see Sleep ...page 13
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What Parents and the Public Should Know About the Degenerative Brain Disease, CTE, This Football Season By Staff
A
s football season kicks off, attention is once again turning to chronic traumatic encephalopathy, a neurodegenerative disease associated with repeated head impacts. Kenneth Podell, Ph.D., a clinical neuropsychologist and director of the Houston Methodist Concussion Center, is available to discuss what scientists currently know about CTE, who may be at risk and how exposure to repetitive head impacts may be reduced. A recent study estimated that at least one in four former NFL players had CTE. The researchers also suggested that its prevalence may be higher than estimates derived from earlier brain-bank studies. “The evidence is clear that CTE is a real disease and occurs at elevated
rates among former professional, NFL players,” Podell said. “Long-term exposure to repetitive head impacts appears to increase that risk. Although we are getting closer to understanding the factors that contribute to CTE and its prevalence among professional football players, current estimates remain imprecise because much of the research has relied on selected samples of donated brains.” Podell said findings involving former professional football players should not automatically be applied to younger athletes. The risk of CTE among individuals who play football only through high school is substantially lower and the rate has not been determined yet, he said, noting that current evidence has not established that participation in football or another contact sport through high
school increases the risk of developing CTE-related dementia later in life. While some retired professional football players who experience personality changes or progressive cognitive difficulties may fear that they have CTE, Podell said, CTE currently can only be definitively diagnosed through examination of brain tissue after death. “CTE is a neuropathologic diagnosis and is not synonymous with dementia,” Podell said. “Not everyone with CTE pathology develops severe cognitive impairment. Researchers are continuing to examine the biological,
medical and lifestyle factors that may influence long-term outcomes.” Podell also said the risk of concussions and exposure to repetitive head impacts may be reduced by: • Following age-appropriate contact guidelines • Limiting full-contact drills and practices at the youth, high school and collegiate levels • Teaching and reinforcing proper tackling and blocking techniques • Continuing to evaluate helmet improvements and other protective equipment
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Could Man’s Best Friend Help Patients Get Back on Their Feet? New Study Says Maybe By Staff
C
ould a dog be more than a patient’s best friend during rehabilitation? New research suggests a trained facility dog may also be a meaningful part of the recovery process. Tara Haas, MS, OTR, TIRR Memorial Hermann’s Facility Dog Program Coordinator and handler of Annie, is an author of a newly published study examining the association between canine-assisted intervention and functional independence among patients receiving inpatient rehabilitation. The study examined 1,619 adult inpatient rehabilitation patients,
intervention causes better recovery. At TIRR Memorial Hermann, Haas sees firsthand how specially trained facility dogs can become part of a patient’s rehabilitation experience. For example, Annie can participate in therapy sessions and respond to task-specific cues designed to help patients work toward individualized goals. “We see such wonderful responses when the dogs are present. Folks might go from standing maybe thirty seconds to then all of a sudden they’re standing at the mat working on playing a game
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Tara Haas, seen here with Annie
including 269 who participated in at least one therapy session involving a trained facility dog. Researchers found that patients exposed to canine-assisted intervention experienced greater improvement in overall functional independence from admission to discharge compared with those who did not participate in canine-assisted intervention. Patients who received canine-assisted intervention had an average 2.4 point greater improvement in their composite functional independence score. The study also found that among patients who participated in canine-assisted intervention, greater cumulative exposure to the facility dog was associated with progressively greater improvement in functional independence. While the findings are encouraging, researchers emphasize that the study demonstrates an association, not proof that ca nine-assisted
with our dogs or brushing them and the next thing you know they’ve broken standing records,” Haas said. TIRR Memorial Hermann is also home to Pilot, another specially trained facility dog who works with handler Renee Lee. The dogs work alongside physical, occupational, speech and other rehabilitation professionals, helping patients stay engaged and motivated as they work toward functional goals. For patients, that can mean turning a challenging therapy exercise into something a little more engaging, whether that involves reaching, moving, walking or completing another task necessary for greater independence. The new research offers a scientific look at something rehabilitation teams like Haas have seen in practice: the connection between a patient, a specially trained dog and the rehabilitation team may be about more than comfort, it may also help support functional recovery. medicaltimesnews.com
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Financial Forecast Your Financial Life Deserves a Checkup: 10 Things to Review This October By Grace S. Yung, CFP Midtown Financial Group, LLC
O
ctober is Financial Planning Month, making it a great time to review where you are financially, where you want to go, and whether your current decisions are helping you get there. Financial planning is about much more than investments. A comprehensive plan can include cash flow, retirement, taxes, insurance, estate planning, debt management, and preparing for life’s unexpected events. And because life changes, your financial plan should evolve with you. You don’t have to tackle everything at once. Here are several areas to consider this month. Revisit Your Goals Start with a simple question:
What am I working toward? Perhaps retirement is getting closer, you’re considering a career change, helping an aging parent, paying for college, buying a home, or hoping to travel more. Your priorities today may be very different from what they were five years ago. Try putting a dollar amount and time frame around your goals. The clearer the destination, the easier it becomes to determine what steps may be needed to get there. Review Your Cash Flow and Emergency Savings Take a look at several months of bank and credit card statements. You may discover unused subscriptions, expenses that have gradually increased, or opportunities to redirect money toward savings and other goals. This doesn’t mean eliminating everything you enjoy. Good financial planning should allow you to spend money on things that are important to you while still preparing for the future. Also review your emergency
reserves. Unexpected home repairs, medical expenses, job changes, or family needs can arise at any time. Having accessible savings may help you avoid relying on high-interest debt or selling investments at an inconvenient time. Check Your Retirement Strategy Review your workplace retirement plan, IRA, and other investment accounts. Are you taking full advantage of available employer contributions? If you’re eligible for catch-up contributions, are you using them? Also consider whether your investment allocation still reflects your goals, time horizon, and comfort with market fluctuations. If retirement is approaching, begin thinking beyond simply accumulating money. Consider how Social Security, pensions, retirement accounts, taxable investments, and other resources may
eventually work together to provide income. Look for Tax-Planning Opportunities Tax planning shouldn’t begin in April. Before year-end, consider whether increasing retirement contributions, realizing investment losses to offset certain gains, charitable giving, or a Roth conversion might make sense. Retirees should also review required minimum distributions and, if eligible, Qualified Charitable Distributions from IRAs. Because tax decisions can affect more than the current year’s tax bill, consider coordinating strategies with your tax and financial professionals. Review Insurance, Beneficiaries, and Estate Documents see Financial ...page 13
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Mental Health Continued from page 6 The Texas A&M team collaborated with researchers at Baylor College of Medicine and the University of the Balearic Islands to examine brain activity over the hours and days following a single ketamine infusion. Krisha Shah, research associate in the Department of Psychiatry and Behavioral Sciences, said the team’s goal was to understand how ketamine reorganizes communication across the brain over time and how those changes could impact patients’ clinical responses. “Often, EEG research looks at individual brain signals or communication between pairs of signals, but the brain doesn’t operate in pairs. It’s a highly interconnected system,” she said. “Ketamine is unusual because the drug exposure is brief, but antidepressant effects have the potential to extend well beyond that
Sleep Continued from page 9 study found that just three nights off CPAP therapy was enough to produce measurable overnight shifts in plasma neurofilament light — a marker of active neurodegeneration — with loss of deep (N3) sleep identified as the strongest predictor of the change. The brain, in other words, doesn’t need years of untreated OSA to register the insult; a biomarker signal can show up within days of interrupted treatment. The treatment side of the literature is where this becomes clinically actionable rather than just concerning. Beyond the Neurology finding on delayed MCI onset, a 2021 analysis of roughly 53,000 Medicare
Financial Continued from page12 Your financial plan also needs protection. Review your life, disability, health, homeowners, auto, liability, and long-term care coverage. Marriage, divorce, retirement, a new child, caregiving responsibilities, or significant changes in assets can all affect your insurance needs. Next, review beneficiary designations on retirement accounts, IRAs, annuities, and life insurance
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experience.” To capture that complexity, the researchers used high-order interactions, an information-theory approach that examines how information is organized across multiple EEG signals at once rather than only looking at signals individually or in pairs. The researchers found that ketamine did not produce a single, stable pattern of brain activity. Instead, the organization of information changed substantially over time, with different patterns emerging one hour, 24 hours and seven days after treatment. Greater increases in one measure of brain-wide information sharing at 24 hours were also associated with greater improvement in depressive symptoms at Day 7. The research builds on two previous publications by the group, which found that intravenous ketamine is both feasible and effective in older adults. By mapping out patterns of brain connectivity over time after a
ketamine infusion, the researchers identified brain-signal changes that could serve as potential biomarkers of ketamine’s antidepressant effects in late-life demographics. The new study also replicates and extends earlier higher-order interaction research in healthy volunteers. “Most drug studies end at age 65, leaving relatively little research on how ketamine affects the aging brain,” Murphy said. “Although older adults make up more than one-third of the nation’s population, they remain underrepresented in clinical research. The results also addressed a question co-author Rubén Herzog, distinguished professor in the Department of Psychology of the University of the Balearic Islands in Spain, had about whether depression itself might affect how the brain responds to ketamine. “I was originally worried the brains of people with depression could be highly different, and maybe they will
react differently compared to a healthy population,” Herzog said. “I was very impressed to see that the acute effects of ketamine that we found in the healthy population was more or less the same compared to the population with depression.” The findings add to the team’s ongoing work examining how ketamine affects the brain. “Ketamine has come a long way from its humble beginnings as an anesthetic,” Murphy said. “However, it still has a strong abuse potential. The goal of the work that my team has been doing is to identify these key points in that physiological roadmap so it can be acted upon via another mechanism that doesn’t have the psychedelic or medical side effects of ketamine.” Other collaborators in the study were Rahul Balakrishnan, Baylor College of Medicine professors Dr. Alan C. Swann and Dr. Brittany O’Brien.
beneficiaries with an OSA diagnosis found that those who used PAP therapy had 22% lower odds of an Alzheimer’s diagnosis and 31% lower odds of dementia, compared to those who did not use it. Adherence to treatment , not just having a prescription, is what separates the protective association from the risk — a therapy that goes unused protects no one’s brain. Sleep-disordered breathing is also far more common in older adults than most non-sleep specialists appreciate, affecting an estimated 52% of men and 26% of women in this population. A 2020 review integrating three decades of research on this topic found that hypoxia-driven cognitive risk was significantly greater in black and Hispanic patients, while sleepfragmentation-driven risk was greater
in women — a pattern pointing to real disparities in who bears the cognitive cost of undiagnosed OSA. For physicians, the practical takeaway is straightforward. A patient with new memory complaints, a family history of Alzheimer’s, or the classic OSA risk profile — snoring, witnessed apneas, excessive daytime fatigue, treatment-resistant hypertension — deserves a sleep evaluation as part of that cognitive workup, not after it. And because treatment adherence is what determines whether treatment actually protects the brain, it’s worth remembering that oral appliance therapy exists as a well-tolerated alternative for older patients who can’t or won’t tolerate CPAP, with efficacy confirmed by follow-up testing rather than assumed.
If you have patients whose cognitive risk profile intersects with suspected or diagnosed OSA, we are glad to be part of that conversation — whether that means facilitating testing, fitting a custom oral appliance for a CPAP- intolerant patient, or simply comparing notes on a specific case. Reach Sleep Houston at 713-828-8587 or fax at 866-420-8578.
policies. Make sure they still reflect your wishes and coordinate with your overall estate plan. Estate documents deserve attention as well. Consider whether your will, financial power of attorney, medical power of attorney, healthcare directives, and any trusts still reflect your current circumstances. Consult an estate-planning attorney regarding your individual needs. Get Organized—and Talk Create a secure inventory of your financial accounts, insurance policies, debts, important documents,
and professional contacts. Make sure an appropriate trusted person knows how to locate essential information if an emergency occurs. Finally, have the conversations you’ve been postponing. Talk with your spouse or partner about retirement. Ask aging parents about long-term care and estate plans. Business owners should consider what happens to the company if they retire, become disabled, or die unexpectedly. Financial planning isn’t something you do once and put on a shelf. It’s an ongoing process of reviewing,
adjusting, and making decisions as life changes. This October, choose two or three areas that deserve your attention and start there. Small steps today can help you become better prepared for tomorrow. If you’re unsure where to begin, consider working with a Certified Financial Planner professional who can help you evaluate the different pieces of your financial life and develop a strategy based on your goals, circumstances, and priorities.
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October 2026
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Breast Cancer Continued from page 1 sister, grandmother, friend, coworker or neighbor. It may also be a man. Breast cancer is much less common in men, but men can develop the disease as well. Fewer than 1% of breast cancers in the United States occur in men. For survivors, October can be a celebration of strength. For families currently facing treatment, it can be
Legal Matters Continued from page 3 which prevents the home address from appearing on Medicare’s Care Compare website. Practitioners may update the practice-location type through PECOS or the applicable CMS-855 enrollment application. Patient Location and State Licensure Practitioners are not required to enroll in Medicare in every state where telehealth patients are located. That rule is separate from state professional licensure requirements. CMS continues to defer to state law, so practitioners and organizations remain responsible for determining whether additional licensure is required based on patient location. CMS also confirms that providers may continue using the existing interjurisdictional reassignment policy and need not convert existing enrollments solely to conform to the permanent telehealth policy. Teleradiology and Other Remote
Oncology Continued from page 5 Age, family history, race, overall health and other risk factors all matter. What every man can do is talk with his primary care physician about his individual risk and whether prostate
Healthy Heart Continued from page 8 among the many ways to reach people where they are in a relevant way. “Improving heart health in Hispanic communities requires more
October 2026
Houston Medical Times a reminder that they are not alone. And for those who have lost someone to breast cancer, the month can bring memories and an opportunity to honor that person’s life. Houston’s medical community continues to advance breast cancer research, diagnosis and treatment. But awareness begins with individuals taking action. Know your family history. Know your risk. Follow your healthcare provider’s screening recommendations.
And don’t ignore changes that concern you. This October, Houston Medical Times encourages our readers to look beyond the pink ribbons and have the conversation that could matter most: When was your last mammogram, and have you talked with your healthcare provider about your breast cancer risk? Sometimes, awareness begins with simply making the appointment.
Services Organizations should not apply the telehealth enrollment rules to every remotely furnished service. CMS distinguishes teleradiology from Medicare telehealth because remote interpretation of radiological images is not a service ordinarily furnished in person. A teleradiologist therefore cannot use the telehealth enrollment flexibility. Instead, a teleradiologist must enroll in Medicare in the state where the interpretation is performed and report the location from which the service is furnished, including a home address when studies are routinely interpreted from home. An enrolled physical office cannot be substituted merely because it is already on file. Organizations with both telehealth practitioners and remote diagnostic professionals should therefore evaluate the two populations separately. What Providers Should Do Organizations with remote practitioners should review their enrollment structures and confirm which services qualify as Medicare
telehealth. They should also review work-from-home arrangements, identify virtual-only practitioners or groups that must report home addresses, use the appropriate home-office designation when necessary, assess interstate arrangements for state licensure requirements and separately review remote radiology and other non-telehealth services for location-specific enrollment and billing rules. For organizations that expanded their remote workforce during and after the COVID-19 public health emergency, CMS’s permanent policy provides greater certainty and preserves much of the enrollment flexibility that supported telehealth growth. At the same time, the distinction between Medicare telehealth and other remotely furnished services remains critical. Providers should review remote practitioner arrangements, enrollment records, reassignment structures and claims-submission practices to use the permanent flexibility where available while continuing to comply with state-specific licensure requirements.
cancer screening makes sense. That conversation is particularly important in Texas, where we have an opportunity to improve screening rates and find more cancers before they spread. Screening doesn’t mean assuming you have cancer. It means giving yourself the opportunity to find out sooner if something is wrong, when
there may be more treatment options available. Men, if you haven’t talked with your doctor about prostate cancer screening, make it part of your next appointment.
than raising awareness,” said Eduardo Sanchez, M.D., M.P.H., FAHA, the Association’s chief medical officer for prevention. “We must ensure every person has access to heart and brain health information and care that reflects their culture, language and unique needs.”
During Hispanic Heritage Month, the Association encourages individuals and families to explore its bilingual heart and brain health resources and take steps toward improving cardiovascular health. Learn more at heart.org/heart.org/es and stroke.org/derramecerebral.org
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