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September Issue 2017

Inside This Issue

More Than Pink By Suzanne Stone Executive Director Susan G. Komen Austin

D Dell Medical School Creates Department of Oncology See pg. 14

INDEX Mental Health...................... pg.3 Legal Matters........................ pg.4 Oncology Research......... pg.6 Geriatric Medicine............ pg.8 Healthy Heart..................... pg.10 The Framework.................. pg.16

Music Therapy: Can it Help ? See pg. 15

uring the month of October, the country bears witness to a phenomenon called pink. There is a sudden onset of athletes and policemen, celebrities and socialites, bus drivers and construction workers, everyone wearing pink. Lights on buildings change color and decals appear on cars, windows and the cheeks of children. It all began because one woman promised her sister, who was dying from breast cancer, that she would do everything she could to make sure that one day, no one died from this disease. That was 35 years ago. Today Susan G. Komen is renewing that promise with a new, big bold goal: to reduce the number of breast-cancer deaths by 50 percent by 2026. For all the progress that has been made on this disease, 40,000 women will die this year from it. In Travis County, it’s the second-leading cause of death. If you are an African-American woman, your chance of dying from the disease is 40 percent higher. Once a woman is diagnosed with breast cancer, one in five will see it return in the form of metastatic disease, having spread somewhere else in the body and resulting in a chronic condition for which there is no cure. There are about 150,000 women living with that diagnosis today. Just because you are yonder than 40 doesn’t mean this disease can’t find you. More than

13,000 women younger than 30 will be diagnosed this year alone. Breast cancer doesn’t discriminate or play favorites. The biggest risk factors for getting breast cancer are being a woman and getting older.

This battle is about more than just moving numbers; it’s about saving lives. It’s not all doom and gloom, though. We do see hope on the horizon and there are ways to move those numbers. The first way is screening. If a diagnosis is made early, a breast cancer patient’s five-year survival rate is 99 percent. When the cancer goes undetected and diagnosed at Stage 3 or later, survival rates drop to 60 percent or lower. Its sounds like an easy fix, but while many women have access to care and insurance to pay for it, overwhelmingly, in Texas, many do not. With more than 4.3 million Texans without insurance, getting those women screened is a challenge. Komen Austin is funding thousands of mammograms in our five-county impact area for women who can’t pay for them. Last year, 31 women were diagnosed with breast cancer from those screenings. That’s truly impactful dollars at work. Once a diagnosis has been made,

there are biopsies, tests and treatments that can cost a patient without insurances thousands and thousands of dollars. Jenny Peterson is a great example of how close many live to the edge. A self-employed landscape designer, Jenny chose to put her kids through school instead of paying for insurance for herself. When the diagnosis of breast cancer came, it came with a $15,000 price tag just for the diagnostic work she needed before treatment could begin. Komen funding paid that bill. Today, she’s five-year cancer free, written a book and has just gotten married. This battle is about more than just moving numbers; it’s about saving lives. Everyone can have a role in doing it. Allison was 3 when she lost her mother to breast cancer. She and her family have been participating in Race for the Cure and raising money every year since. Jordan knits and sells drink holders to raise money to donate to Komen’s efforts. And these women make these commitments all because no one deserves to grow up without a mother, a daughter, sister or best friend. They are all more than pink. You wouldn’t think a color could change everything, that a simple shade of light would be able to inspire action, enlighten the mind, even save a life. But it does, every day. The pink “running ribbon” isn’t just a logo. It’s a symbol of strength, perseverance, survival and the see More Than Pink... page 18

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Mental Health Living With/out Fear: The Power of Being a Rational Optimist By Jason Powers, MD Chief Medical Officer Promises Austin

love if you just put fear aside — at least that’s what you’ll find in the self-help section and in blogs — but here is a little different view on fear and passion and life.

Living a Passionate Life, Devoid of Fear uch has been written on the Truth be told, I started out subject of fear and how it impedes intending to write a similar blog success. Go to the self-help section of post. I interviewed CEOs and COOs, any bookstore and you’ll find thousands executive vice presidents, regional vice of pages dedicated to the idea that if you presidents and professional athletes. “throw your fears aside you will shine I talked with two clients I coach on like a burning star and achieve your personal development, a practice that goals.” According to popular literature, focuses largely on escaping the clutches fear tells us “wait a minute you can’t do of fear and entering “the zone,” where that, it’s never been done” or “you’re one can achieve optimal performance. not good enough” or “you don’t have I also interviewed a close friend who to the resources” or “now is not the time.” me is an exemplar of living a passionate Author Samuel Johnson said, life, seemingly devoid of fear. “Nothing will ever be attempted if When I was younger, I was all possible objections must first be fortunate enough to be part of a tightly overcome.” Fear will drown your passion knit group of best friends. There were and halt your momentum before any five of us and we would dream about dream has a chance to become reality.   what our futures would be like. All but Even love is letting go of fear (there’s one of us wanted to change the world a book by that title). You can achieve in our own way, to make it better than power, success, a financial windfall and the way we found it, to help people

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and not least of all to be wealthy and successful professionally. But my friend Stan didn’t participate in that type of future planning. He said he hoped he had a modest house and had “enough,” and we would laugh at him. So I asked Stan recently what he is passionate about and how he handles fear and stress. Although he appears to be devoid of the types of fear-induced neuroses, let’s call them, that afflict so

many of us, he says he does feel stress related to the things that are important to him. It’s just that his passion isn’t about attaining great wealth and prestige and the accoutrements of success. To him, achievement is measured differently. “I don’t want to be successful the way other people are professionally and I am not jealous of see Mental Health page 17

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Legal Matters Congressional Task Force Issues Report on Cybersecurity in the Health Care Industry By Zuzana S. Ikels, J.D. Polsinelli

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ecently, the Health Care Industry Cybersecurity Task Force (the “Task Force”) issued its Report on Improving Cybersecurity in the Health Care Industry (the “Report”). The Task Force, which was created by Congress as part of the Cybersecurity Act of 2015, is comprised of subject matter experts from the public and private sector who evaluated the cybersecurity threats to health care industry, the current state of the IT systems for health care industry stakeholders, and the related health care laws and regulations. The Task Force observed that the health care sector has only invested in cybersecurity in the last five years, while rapidly expanding the use of the Internet of Things (internet-connected, medical devices) and the transition to EHR data, the combination of which

magnifies the risk of breaches and data theft. The Report discusses the acute threat of cyber-incidents related to the rise and sophistication of ransomware attacks that hold data hostage involving critical patient information and monitoring devices. The Report offers a laundry list of recommendations, guidelines and practices aimed to streamline the compliance process and reduce risk, while encouraging technological innovation, research and development, and sharing information. Highlights of the Task Force’s observations and recommendations include: • There should be a national, uniform set of standards, which follow the National Institute of Standards and Technology (NIST) Cybersecurity Framework, but customized to reflect the complexity of patient and health care data. • A single cybersecurity leader should be appointed to govern the privacy concerns for medical information

within HHS. The Report criticizes the dizzying number of federal agencies, noting that the Federal Trade Commission (FTC) regulates some aspects, coupled with six, different agencies within the HHS jockeying for control: the Office for Civil Rights (OCR), CMS, the Food and Drug Administration (FDA), the Office of the National Coordinator (ONC), and the Office of the Assistant Secretary for Preparedness and Response (ASPR). • The need for a federal, uniform standard is evident by the burden on healthcare entities to comply with the panoply of state laws that vary in definitions, scope,

standards, and expectations. The Report highlighted the variation in state laws governing: (1) Unauthorized access, malware, and viruses (all 50 states), (2) Denial of service attack laws (25 states); (3) ansomware laws in two states, with another four states currently under consideration; (4) Spyware laws (20 states); and (5) Phishing laws (in 23 states). • Implement scalable best practices that impose different expectations, obligations and standards depending on the size of the health care entity. • Congress should create an see Legal Matters page 18

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One Year In, Dell Med Students Are In The Community, Helping People Who Need It — and It’s Making Them Better Doctors By Stephen Scheibal

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arryl Brandenburg has experienced homelessness since his wife died in 2009. For him, the C.D. Doyle Clinic is a haven of healthy normalcy. “Some people, this is the only place they can go to get treatment,” says Brandenburg, 62, who receives treatment at the clinic and has become a member of its board of directors as well. At C.D. Doyle, people “don’t need any ID or payment — all you have to do is show up..’

America vets, won an $8,000 grant to teach science and pre-health professions at Travis High School. • Students interested in psychiatry are frequent volunteers at Austin Clubhouse, which provides a community center and resources to people with severe and persistent mental illness. There are more. All told, since Dell Med’s first 50 students started classes in July 2016, they have volunteered 3,500-plus hours across

Darryl Brandenburg (left) talks to a care provider at the C.D. Doyle Clinic.

Leonard Edwards is a member of the inaugural class at Dell Medical School at The University of Texas at Austin, and he has the Tetris-screen calendar to prove it. But he still makes time to work at the C.D. Doyle clinic. For him, it’s a place of healing for people who desperately need it. “The safety net has so many holes,” says Edwards, who serves as a medical student director at C.D. Doyle. “There aren’t enough services to keep these people healthy.” C.D. Doyle is an eight-year-old free health clinic run by students that offers a medical home for people who live on Austin’s streets. It connects those who need help with others who are training — and craving — to provide it. In this, it’s one of several places where Dell Med students are promoting health and providing care in Austin and Travis County, especially among the community’s most vulnerable populations: • One group of students is working in a program that encourages creative artistic expression at an alternative high school in Austin. • Another group, all Teach for

the community, including more than 1,300 hours in health care settings, according to the school’s student affairs office. Those annual numbers will likely double this year with the arrival of the next class, and then double again by 2020, when the third and fourth classes will be admitted and the inaugural students will be readying to graduate. “ Quote “ Wherever we possibly can, Dell Med stresses community and collaboration. We’re not really pursuing students who are inclined to spend four years with their nose in a book. -Stephen Smith “Wherever we possibly can, Dell Med stresses community and collaboration,” says Stephen Smith, Dell Med’s associate dean for student affairs. “We’re not really pursuing students who are inclined to spend four years with their nose in a book.” Medical students often seek volunteer work that allows them to bring healing to people who need it, and a number of studies have demonstrated that such work makes students better doctors. 

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September 2017


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Thinking of a New Home in Austin?

Oncology Research CAR-T Cells: Pursuing and Hunting Cancer Cells By Jorge Augusto Borin Scutti, PhD Austin Medical Times

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he Oncologic Drugs Advisory Committee (ODAC) responsible for reviewing and evaluating data concerning the safety and effectiveness of human drugs products for use in the treatment of cancer patients has been recommended, unanimously for approval by FDA, the investigational CAR T cell therapy (CTL019 or CART19) sponsored by Novartis® to treat pediatric and young adult relapsed or refractory patients with B-cell acute lymphoblastic leukemia (ALL). B- cell acute lymphoblastic leukemia or also called B-ALL is a fast-growing cancer comprising approximately 25% of cancer diagnoses in children under 15 years in which bone marrow makes a plenty of B immature lymphocyte cells (a type of white blood cells). In physiologic patterns normal B-lymphocytes helps our body to fight against infections by destroying infected cells or producing antibodies in which stimulate the immune system to enhance the cellular (T cells) response against cancer cells. In B-cell ALL context the lymphocytes don’t fight infections because they are so immature to realize their functions - they are considered cancerous cells (leukemic blasts). The cause of ALL is unknown but the following factors may play a role in the development of ALL such genetic translocations (in which some genes on a chromosome may be shuffled or swapped between a pair of chromosomes). The most common genetic translocation in ALL is called Philadelphia (Ph) chromosome, where the nucleotides are swapped between chromosomes 9 and 22. Another common translocation in ALL is referred to TEL-AML1 occurring in about 20% of patients with ALL. Past treatment with chemotherapy drugs, receiving a bone marrow transplant, exposure to radiation, including X-rays before birth, some viral infections and toxins such benzene may contribute for the development of ALL. Thus, these cells grow quickly and crowd out the bone marrow preventing it from making the normal red blood cells, white blood cells, and platelets that our body needs. Classically, there are 3 strategies used for ALL treatment: Chemotherapy, radiation (not

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usually) and bone marrow transplant. Extensive progress has been made in the treatment of acute lymphoblastic leukemia, but recurrent disease remains a leading cause of death in children. T cells (most involved against cancer immune response) can be genetically engineered to create customized receptors on their surfaces – called as Chimeric Antigen Receptors (CARs), a personalized treatment that involves genetically modifying T cells to make them target. CAR-T differs from those biologic therapies such monoclonal antibodies or targeted therapy using small molecules because it is produced for each individual (personalized treatment). The T cells are selected from patient’s blood and reprogrammed in laboratory to create T cells that are genetically programmed to express a chimeric antigen receptor to recognize and fight against cancer cells expressing that particular antigen. In this case, CTL019 is driven against the expression of CD19 in bone marrow or peripheral blood, the major antigen expressed by B cells in B-ALL. The NCT 02435849 “Determine Efficacy and Safety of CTL019 in Pediatric Patients with Relapsed and Refractory B-cell ALL (ELIANA)” conducted by Novartis® is the first pediatric global CAR-T cell therapy registration trial. “The panel’s unanimous recommendation in favor of CTL019 moves us closer to potentially delivering the first-ever commercially approved

CAR-T cell therapy to patients in need. We’re very proud to be expanding new frontiers in cancer treatment by advancing immunocellular therapy for children and young adults with r/r B-cell ALL and other critically ill patients who have limited options. We look forward to working with the FDA as they complete their review” said Bruno Strigini, CEO, Novartis Oncology. Despite several encouraging results it is time to balance the risks and prizes regarding CART-T cells therapy.


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Geriatric Medicine Managing Your Diabetes By Deborah Y. Liggan, MD

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iabetes is a disease that makes it difficult for the body to turn food into energy. Some of the food we eat (sugar, starch, and other carbohydrates) is broken down in the digestion process into a simple sugar called glucose. Then glucose is absorbed into the bloodstream from your stomach, causing the level of blood glucose to rise. For the cells of your body to use the glucose as fuel, it needs the help of insulin, which a hormone produced by the pancreas, a small gland located below and behind the stomach.  Insulin helps the blood glucose get from the bloodstream into the cells. Once inside the cells, the glucose is burned to give your body energy. Diabetes in the elderly is most commonly associated with a stable elevation of blood glucose levels both after an overnight fast and after eating a meal. Diabetics have an accentuated glucose rise in response  to meals and often fail to return to normal baseline glucose levels between meals. When the body has difficulty properly controlling

sugar levels within the blood, a person is said to have diabetes mellitus . Symptoms noted by those suffering from this disorder include fatigue, weight loss, increased urination, and pronounced thirst. Cultural Factors How do we examine which factors explain ethnic differences in prevalence of diabetes? Let us start with hygiene because it is essential to control. This is especially important to the maintenance of foot care; because vascular insufficiency and neuropathy, diabetics have unique foot care problems. Careful attention to foot care is vital in prevention of limb loss. It has been estimated that up to 80% of amputations required in diabetics are attributable to poor foot care. Feet need to be inspected daily, especially when there is coexisting peripheral neuropathy that limits protective sensation. Disproportionately affecting African Americans such that foot care prevents infected cells, low bone mass, and amputation. Therapy Available

Diet regulation is the foundation for all diabetic control programs. Avoiding sugars in the diet and emphasizing low-fat high-fiber foods further improves control. Consequently, weight reduction can yield complete control in many elderly diabetics. Although it is not possible to predict the exact improvement in glucose control from each pound lost, a reduction of only seven to ten pounds often improves glucose tolerance. All food affects blood sugar. However, carbohydrates (carbs) are the nutrients that do the most to determine blood sugar levels. Your job

is to monitor your carbs, which you can do by learning about the carbohydrate content in different foods, eating healthy foods with fewer carbs watching your portion size, and knowing the number of carbs in a portion, consider also diet choices for vegetables fruits, and whole grains. Consider these foods give you good nutrients, energy, and fiber, fewer calories, and less fat. Exercise has beneficial effects on glucose control in diabetes. In the well controlled diabetic,  exercise increases glucose consumption and improves glucose tolerance by see Geriatric Medicine page 18

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September 2017


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Healthy Heart Atrial Fibrillation: What You Need to Know By Vivek Goswami, MD Board President of the American Heart Association – Austin Chapter

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eptember is National Atrial Fibrillation Awareness Month and the American Heart Association wants you to be aware of the symptoms and the risks associated with it. Normally, the heart has an even and regular beat driven by its natural pacemaker, the sinus node. The sinus node produces electrical signals that trigger the heart to contract and pump blood. In atrial fibrillation (also call AFib), random electrical activity disturbs this normal rhythm. As a result, the heart’s left atrium (upper chamber) does not contract the way it should. This can lead to a decrease in cardiac output. It can also place patients at risk of stroke and weakened heart muscle. Symptoms of atrial fibrillation can include palpitations (irregular and rapid heartbeat), shortness of breath, chest discomfort, fatigue and exercise intolerance. Anyone can develop atrial fibrillation, however risk factors include: advanced age, high blood pressure, valve disorders, sleep apnea, heavy consumption of alcohol, stimulant use, hyperthyroidism, lung disease and others. As mentioned, uncontrolled atrial fibrillation can lead to stroke and heart failure. In fact, the risk of stroke is five times higher in individuals with atrial fibrillation because this condition can lead to blood clotting in the left atrium. If these clots dislodge,

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they have the potential of traveling downstream to the brain resulting in a stroke. For this reason, one of the main treatment options for atrial fibrillation includes blood thinners. Additionally, medicines such as beta blockers, antiarrhythmics and others can be used. Other treatment options include electrical cardioversion (an electrical shock to reset the heart rhythm), ablation and occasional pacemaker placement. As Americans are now living longer than ever, the incidence of atrial fibrillation and its complications have skyrocketed. This affects both the patients’ health and our healthcare system overall. More than 2.7 million Americans currently suffer from atrial fibrillation and that number is expected to double by 2050. Atrial fibrillation patients have twice the number of hospitalizations when compared to patients in normal rhythm and they are 3 times more likely to undergo multiple hospital admissions. As a result, atrial fibrillation costs the U.S. $26 billion annually and that number is on the rise. The best news is that with our latest medical advances we can effectively treat atrial fibrillation decreasing the morbidity, mortality and the cost associated with this rapidly progressing disease. For patients and caregivers interested in learning more about atrial fibrillation, visit MyAFibExperience. org. For hospital administrators interested in the American Heart Association’s guideline-based care programs for atrial fibrillation, contact Austin-based Quality and Systems Improvement Director Sarah Duzinski at Sarah.Duzinski@heart.org.


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What’s the Difference Between Alzheimer’s and Dementia? By Dominic Hernandez

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ot all dementia is Alzheimer’s— but it can be just as devastating when it affects loved ones While often used interchangeably, dementia and Alzheimer’s disease are not the same. Dementia is a general term for a decline in mental ability severe enough to interfere with daily life. Alzheimer’s disease is a specific type of dementia that causes memory loss and impairment of other important mental functions. An expert from the Texas A&M School of Public Health describes how these conditions can impact the lives of both patients and those around them, and provides insights into ways of minimizing risks.

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Dementia (and Alzheimer’s) “Dementia is an umbrella term for a serious decline in mental ability that impacts one’s overall health and functioning,” said Marcia Ory, PhD, MPH, head of the Center for Population Health and Aging and Regents and Distinguished Professor at the Texas A&M School of Public Health. “There are different types of dementia, and the most common type of dementia is Alzheimer’s.” Alzheimer’s disease makes up between 60 to 80 percent of dementia cases. It is a progressive disease, which means that the symptoms gradually worsen over a number of years. Alzheimer’s is also the sixth-leading cause of death in the United States, and those with Alzheimer’s live an average of eight years after their symptoms became noticeable to others. Other specific types of dementia include vascular dementia and mixed dementia. Vascular dementia is considered the second-most common form of dementia after Alzheimer’s disease and is usually the result from injuries to the vessels supplying blood to the brain—often after a stroke or

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series of strokes. Other less-common types of dementia come from frontotemporal disorders and Lewy body dementia. Frontotemporal disorders are a form of dementia caused by a family of brain diseases known as frontotemporal lobar degeneration (FTLD), and Lewy body dementia is caused by abnormal deposits of a protein—called alpha-synuclein—in the brain. Mixed dementia is a term that describes having multiple types of dementia, such as both Alzheimer’s disease and vascular dementia. In a person with mixed dementia, it may not be clear which symptoms are attributed to one type of dementia over the other. Researchers are still working to understand how the disease processes influence one another in mixed dementia patients. In some cases, it’s not known what type of dementia someone has or if it’s not a specific, named type at all. The causes of dementia are not always known, and some older people may develop age-associated memory impairment—which is different than dementia and Alzheimer’s disease. Risk factors for dementia Two of the most common risk factors for Alzheimer’s and dementia are age and genetics. Most individuals with Alzheimer’s are 65 or older, and those who have a parent or sibling with Alzheimer’s are more likely to develop the disease. However, there is evidence to suggest that there are other factors that people can influence. According to research from the University of Cambridge, one-third of Alzheimer’s disease cases were attributed to preventable risk factors. The seven main risk factors for Alzheimer’s disease are diabetes, see Alzheimer’s and Dementia page 17


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Dell Medical School Creates Department of Oncology

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September 2017

READY TO USE. DO NOT DILUTE. LISTO PARA USAR. NO DILUIR.

ith a focus on advancing the full spectrum of cancer education, research and care in Austin and Travis County — where cancer is the leading cause of death — the Dell Medical School at The University of Texas at Austin is creating a Department of Oncology. The new department, the medical school’s ninth, is chaired by S. Gail Eckhardt, MD, who joined Dell Med in September 2016 to become the inaugural executive director of the LIVESTRONG Cancer Institutes. She is also the school’s associate dean of cancer programs. Every year in Texas, nearly 120,000 people are diagnosed with cancer, and 44,000 people — 120 a day — die from the disease. According to the Austin Public Health Department, 1,131 cancer-related deaths were reported in Travis County in 2014. “Our team at Dell Med is looking to streamline administrative support, improve efficiency and develop an enterprise strategy to advance cancer care — and improve health outcomes — for the people of Travis County and Central Texas,” Eckhardt said. “This effort is inherently collaborative, and we are working with a wide array of community partners on disease-focused, multidisciplinary care.” Eckhardt’s “enterprise strategy” also involves ramping up cancer research locally to improve both access to care and patient quality of life, she said. That includes expanding, enhancing and connecting cancer research underway at UT Austin. Working with partners, the department will translate basic science research into tools and treatments to improve patient health outcomes, offer more high-quality clinical trials locally, and focus on precision medicine that personalizes cancer treatments based on the latest developments in molecular diagnostics. “When Travis Country voters gave their support to create a new medical school in 2012, increasing access to high-quality cancer care was

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a major part of the discussion,” said Clay Johnston, MD, PhD, dean of the medical school. “This gets us another step closer to realizing the community’s vision for better health, particularly for those who are most vulnerable, making Austin a model healthy city.” Faculty members of the department will work within the LIVESTRONG Cancer Institutes on a patient-centered framework to improve cancer care in collaboration with the LIVESTRONG Foundation, Ascension’s Seton Healthcare Family and the Central Texas cancer care community. “A strong Department of Oncology at Dell Medical School will help to differentiate programs like the LIVESTRONG Cancer Institutes even more,” said Greg Lee, president of the LIVESTRONG Foundation. “Under Gail’s leadership, we have an incredible opportunity to support and enhance the work that’s already happening around cancer care in our community and hold that up as a model.” The department’s creation is a significant step toward making Austin a major center for cancer care that serves Texas, said Greg Hartman, Seton’s chief of external and academic affairs. “Not only does it mean better treatments, but it allows Seton, Dell Med and the medical community to work together on leading-edge care and research,” Hartman said. Progress around a patient-centered framework for care in Austin is already being made on multiple fronts, including: • Expanding patient support resources in partnership with the UT Austin School of Social Work to include multidisciplinary support teams that will soon be helping local cancer patients and their families navigate care; • Working with Dell Med’s

see Dell Oncology page 18


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Seton Trauma Expert Tackles Pot’s Effects on Driving Deaths

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ontrary to what you might expect, states with legalized recreational marijuana don’t have a greater increased rate of car accident deaths than states that prohibit the drug, according to a new study published in the American Journal of Public Health. Seton Healthcare Family trauma experts looked at auto crash fatalities in Colorado and Washington—states where recreational marijuana use is legal. They compared data to states where the drug is illegal and found no significant difference in fatality rates between the two groups. “This is the first time researchers have actually looked at the real-life effects to see if there have been any major population changes in injuries on the road after marijuana was legalized in these states,” said Jayson Aydelotte, MD, lead study author and trauma surgeon at Dell Seton Medical Center at The University of Texas. “No one has looked to see if actual crashes and deaths happened more frequently yet,” he said. Previous studies were mostly conducted under controlled conditions, such as the effect of marijuana smoking

on drivers’ ability to manage driving on a closed course – not on the open road, said Aydelotte. Study compares data in other states including Texas Aydelotte and the adult Level I Trauma team used data from the U.S. Fatality Analysis Reporting System for Colorado and Washington states between 2009 and 2015 and compared traffic accident fatality statistics with similar data in those same states before recreational marijuana was legalized. They also analyzed traffic accident trends compared to eight other states, including Texas, without legalized recreational marijuana during the same period. “I’m not surprised by these results, simply based on the types of cases I see in my everyday job as a trauma surgeon,” said Aydelotte, who is an associate professor of surgery and perioperative care at Dell Medical School at The University of Texas at Austin. “It’s rare to see someone in a serious accident who is just high from pot; usually there’s alcohol involved, from my experience,” he said. One possible explanation for why

recreational marijuana has not had a significant effect on accident rates may be that marijuana smokers are less inclined to drive when high. Or, smoking pot and driving in everyday life may just not have the same effect on driving as it does on controlled courses, Aydelotte said . Focusing on the big picture

“Whenever there’s been a big legal change, it’s important to see if that change has made and overall impact on population health,” Aydelotte said. States debating marijuana legalization should take studies like this into consideration, and that we need more research in this area to draw even stronger conclusions, he said. 

moms’ singing. Music therapy can benefit people of all ages, for a wide range of conditions—such as Alzheimer’s disease and chronic pain—and has even found its place in palliative care.

have shown to decrease pain and anxiety and improve quality of life. Some studies looking at the use of music therapy in hospice and palliative care have use standardized scales for quality of life assessment and demonstrated benefit.” However, music intervention is so much more than just popping in any old CD and expecting benefits. For the best results, working in conjunction with a licensed music therapist (with hundreds of hours of training) can help tailor-make an approach for the patient. In palliative care, music therapists work with patients and their families to help find particular genres or styles that can help reduce stress and anxiety, which can help improve their

Music Therapy: Can It Help? Music has a number of benefits, but does it have a place in health care? By Dominic Hernandez

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here is not enough time in a day to talk about all of the goodness that music can bring. In fact, Ludwig van Beethoven may have said it best when he wrote, “Music is indeed the mediator between the spiritual and sensual life.” However, what many people consider a hobby or an art may be going further, and is now also being used in a medical setting. An expert from the Texas A&M College of Medicine explains why music is part of delivering the best care. Health benefits of music Music has a universal range and is one of the rare things that makes people feel good AND has a beneficial effect on the body—unlike sugary desserts or salty snacks. Music has been linked to reducing stress and anxiety—especially before stressful situations. In fact, one study done by researchers at the Texas A&M College of Nursing showed that students who listened to music before patient care simulations had higher self-efficacy and lower anxiety.

“Music has a lot of beneficial effects in day-to-day life,” said Laurel Kilpatrick, MD, clinical assistant professor of medicine at the Texas A&M College of Medicine. “It can trigger comforting memories or just have a natural calming effect that relieves some of the stresses or anxieties that are happening.” Also, music has been linked to decreasing pain. A 2013 study investigated the effects of music on pain and depression for people with fibromyalgia, a chronic pain syndrome. The treatment group reported a significant reduction in pain and depression compared to the control group, who reported no differences in pain. Another study showed that music can benefit even the smallest patients. A study in 2016 showed that babies born prematurely gained more weight listening to music therapists sing “Twinkle, Twinkle” than their own mothers singing the song. In that same study, the babies would begin quietly sleeping by the song’s end with the music therapist, but not with their

Music and palliative care “We use music and music therapy in palliative care,” said Kilpatrick, who is also an expert in palliative and hospice care. “Music can affect your mood, and that’s part of the caregiving experience in palliative care.” It’s hard to measure the quantitative effects that music has in health care, but there is qualitative evidence to support the practice, at least in hospice and palliative care. “We look at the patient reports and testimonials from the families,” Kilpatrick said. “Music interventions

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see Music Therapy page 18 September 2017


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Austin Medical Times

The Framework St. David’s HealthCare Breaks Ground in Leander For New Healthcare Facility

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t. David’s HealthCare, which provides care for more Central Texans than any other healthcare system, today announced the groundbreaking of 52 acres of land in Leander for a healthcare facility, to be constructed in phases. Construction is beginning with a freestanding emergency center, which is expected to open in the fall of 2017. The remaining plans for the site include a full-service hospital with 80 beds. “We’re initiating this project in response to rapid growth in the area, and we’ll develop it in phases as the area continues to grow,” David Huffstutler, president and CEO of St. David’s HealthCare, said. “We look forward to partnering with the Leander community to ultimately bring them a full-service hospital.” St. David’s HealthCare celebrated the groundbreaking for its new facility with community leaders including Leander Mayor Chris Fielder, who read a proclamation declaring May 11, 2017, “St. David’s HealthCare Day” in Leander, and Leander Chamber of Commerce President Bridget Brandt.   “As Leander continues to grow, there is an increased need for access to healthcare in our city,” Mayor Fielder said. “St. David’s is one of the largest health systems in Texas with a wonderful reputation for quality care; we are grateful for the investment St. David’s is making in our community and are pleased to welcome them to Leander.” The first phase of construction

September 2017

will include an 11,200-square-foot emergency center with 10 to 12 rooms, and advanced testing capabilities including radiological testing and a medical lab. It will be staffed by board-certified emergency medicine physicians affiliated with St. David’s HealthCare and nurses trained in emergency care. During the emergency center’s first year of operation, it is expected to hire 25 employees, including nurses, imaging personnel, laboratory personnel, registration staff and support personnel. With future construction of the 80-bed hospital, more than 200 jobs will be created. The emergency center and hospital will serve as an extension of St. David’s Round Rock Medical Center, a Level II Trauma Center. St. David’s HealthCare is a unique partnership between a hospital management company and two local non-profits—St. David’s Foundation and Georgetown Health Foundation. The proceeds from the operations of the hospitals fund the foundations, which, in turn, invest those dollars back into the community. Since the inception of St. David’s HealthCare in 1996, more than $379 million have been given back to the community to improve the health and healthcare of people in Central Texas.

Texas Children’s Hospital Extends Expert Pediatric and Maternal Care to Austin

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exas Children’s Hospital announced plans to expand their expert pediatric and maternal care services into Austin, Texas. The organization plans to open an initial pediatric urgent care clinic. This will mark the first Texas Children’s location in the Austin area, with plans to open three additional pediatric urgent care clinics, as well as 18 primary care pediatric practices, three pediatric specialty care locations and two maternal-fetal medicine practices across the city over the next five years. “We are constantly evaluating new opportunities, and working to advance our mission to provide all children and women with the specialized care Texas Children’s delivers,” said Mark A. Wallace, president and CEO of Texas Children’s. “We see this as an extension of our mission, to expand care and access to even more children and women in Texas. We are dedicated to providing families with the right care, in the right place, at the right time. Adding pediatric-focused urgent care, primary care and specialty care, as well as maternal-fetal medicine options in Austin will help us to serve the state of Texas even more successfully.” Texas Children’s aspires to collaborate with the many established pediatric and OB/GYN providers in the region to help support the growing Austin market. Texas Children’s Pediatrics will build on its 20 plus years of experience

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working with community pediatricians and will partner with existing pediatric primary care practices in the region. “We are being thoughtful in our approach to the services we plan to bring to the Austin community,” said Michelle Riley-Brown, executive vice president at Texas Children’s. “Our goal is to elevate the level of care provided to children and women throughout the state by supplementing and adding value to the great health care options already available to Austin-area families.” Children are not simply tiny adults. Their medical care, as well as the tools and equipment used, should be designed specifically to meet their needs. This is why it is important children are seen and treated by the experts trained to care for them. Slated to open in 2018, the first Texas Children’s Urgent Care location will provide high quality, efficient and affordable pediatric-focused care after hours and on weekends in a convenient location. “We believe this will be a great benefit for the entire community. We plan to work with local pediatricians to give them a place to send their patients when their offices are closed and provide them with timely communication so they have the relevant information they need when their patients return to their office. We are creating a place pediatricians and caregivers can feel confident sending their children knowing they will be well cared for by experts specially trained in pediatrics,” said Kay Tittle, president of Texas Children’s Pediatrics and Urgent Care.


Austin Medical Times

Mental Health

Continued from page 3 them in any way,” he tells me. “I worry about the people I love being healthy and happy.” That is his passion — achieving happiness, not striving for the next promotion, because that just brings with it the stress of climbing up the next rung on the ladder, or the fear of falling off, because the higher you climb the more painful the tumble. I asked, so what exactly do you do with fear — do you just push it aside? “Absolutely not,” he replied. “I put everything in a box and I look at it. I can’t push it aside or it’s going to take on a life of its own. I decide I’m going to do something about it rather than give it more energy than I’m giving myself.” In short, what he talked about was not an unrealistic and overwhelming delusion about the harsh realities in the world, but rather a realistic, rational optimism.  Mindless Optimism vs. Rational Optimism

other smokers and even nonsmokers. Most of us believe we are less likely than other people to have a heart attack or be involved in a car accident. Such irrational optimism, or what psychologists call the “optimism bias,” can also be found in the problem gambler who is irrationally optimistic about winning. Buoyed by mindless optimism, the smoker forgoes medical research and never tries to quit. The career-changer gets his real estate license at the top of the bubble (home prices will never fall!) without doing his homework on market indicators. These people hope for the best and close their eyes to potential threats. And therein lies the danger. Just believing things will get better will not cause them to get better and can prevent us from taking preventive action that might curb the inherent risks.  Martin Seligman, one of the foremost experts on optimism and the father of positive psychology, implores the need for optimism to be checked by reality testing in these words: “What we want is not blind optimism but flexible optimism — optimism with its eyes open. We must be able to use pessimism’s keen sense of reality when we need it, but without having to dwell in its dark shadows.  Flexible optimism accounts for risk, rather than a Pollyannaish belief that everything will turn out just fine.”

On the flip side of rational optimism is irrational or mindless optimism. Irrational optimists see the world through rose-tinted glasses, believing that negative experiences are what happen to other people. For example, research has shown that people are irrationally optimistic Becoming a Rational Optimist about an array of health concerns. Smokers underestimate their risk of Being realistic and at the same developing lung cancer compared to time positive helps us move forward.

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We shouldn’t worry about or fear the future, but rather have a plan to deal with things should they not turn out like we hope. And if Plan A doesn’t work, we’ll have Plan B and Plan C at the ready. In short, rather than being paralyzed by fear or, on the other end of the spectrum, unwisely pushing  forward while ignoring danger signs, channel my friend Stan, the rational optimist. Combine a positive attitude with an honest appraisal of risk. Don’t simply put fear aside. Look at it, consider its validity, then put it in a box. Think of two or three actions you can take to make things better. Plans A, B and C. In the words of William Arthur Ward: “The pessimist complains about the wind; the optimist expects it to change; the realist adjusts the sails.”

I think Stan is dealing with fear optimally, the way we all should no matter what we are striving to achieve. I also believe that Stan stresses about the right things. Health and happiness are what he is passionate about and what he’s focusing on. And, by the way, others might come to the same conclusion that Stan reached at such an early age about what to concern ourselves with if they knew what Aristotle said about happiness — that it is an end in itself, that all virtue and action aim to happiness: “Honor, pleasure, reason, and all other virtues, though chosen partly for themselves are chosen for the sake of the happiness that they will bring us. Happiness, on the other hand, is never chosen for the sake of these, nor indeed as a means to anything else at all.” 

care provider about your concerns can be very beneficial. They can provide you with information and resources to help ease your concerns or improve your quality of life if you have any of these conditions. “There are simple screening tests that health care professionals can perform during routine medical visits,” Ory said. “Knowing the signs and symptomatology of dementia is important as there are medications that can reduce your symptomatology, and, along with being more active and engaging in other healthy lifestyles, can improve your quality of life.” Although there are no medications or treatment that can cure dementia or Alzheimer’s, medications and a healthy lifestyle will help you process your condition as well as possible. Ask your physician about safety and limitations. There is nothing

shameful about having dementia. “Before people talked about dementia in medical terms, they’d say that the patient was ‘crazy’ or ‘senile,’” Ory said. “People don’t use those terms now because they recognize it’s a medical condition and not about personality or willpower. Alzheimer’s and dementia are far too common and are not something we can ignore.” Ory also recommended that caregivers of someone with dementia look into programs or support groups. “Don’t ignore your own care when you are caring for someone with dementia,” she said. “It takes a group effort sometimes, and joining a program or being able to discuss the difficulties with others or experts, can help immensely.”

Alzheimer’s and Dementia Continued from page 12 hypertension, obesity, physical inactivity, depression, smoking and low educational attainment. “Minimizing the risk of these factors can potentially minimize the onset of dementia, but to an unknown degree,” Ory said. “We know that physical activity, a healthy diet and healthy lifestyle can help reduce the symptomology of many major diseases, and similarly these can affect the onset and progression of dementia symptomatology.” If you’re looking for a start to reducing the risk for dementia or Alzheimer’s, a healthy diet and getting enough exercise is a good start. Exercise has been shown to increase blood flow and help connections between neurons, which is important with cognitive functioning. “Systematic review of all the studies of physical activity conclude

that it’s a modifiable risk factor,” Ory said. “We don’t know what type, how much or how often we should exercise. Further, the newest frontier is to go beyond a single risk factor approach and identify all the good behaviors— such as diet, exercise and cognitive exercises—and examine how the combination can lower the risk or symptomology of dementia.” Overall, because there are multiple risk factors, the solutions should be multi-pronged intervention programs. “Similar to how there are a lot of risk factors for falls, there are a lot of risk factors that increase likelihood of dementia,” Ory said. “It’s complicated to minimize the risk, but you’ll do best with multi-dimensional approach.” Talking with your health care provider Aging is a difficult process for many people, and talking to your health

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Geriatric Medicine Continued from page 8 increasing the number and affinity of insulin receptors. Exercise increases the concentration of insulin receptors, and a sedentary lifestyle is associated with glucose intolerance. There are several precautions regarding exercise n diabetic patients. In the patient with claudication, exercise is probably best achieved by daily walking. Elders

Music Therapy

Continued from page 15 health. “It’s not a one-size-fits-all approach,” Kilpatrick said. “What is comforting and relaxing to one patient may not be as beneficial to another. It’s really about working with the patient to develop a structured therapeutic approach.”

More Than Pink Continued from page 1

vision of a world without breast cancer. I hope everyone will join me, Jenny, Allison, Jordan and thousands of others at Race for the Cure. Go grab those running shoes, walking shoes, hiking shoes, river shoes or high-heeled shoes and let’s get to work to make the color pink a color of celebrations and a reminder of a time when breast cancer was something we still had to fight. Put aside a dollar for every mile you run, every step you take or hill you climb, donate it to Komen Austin and watch lives change – all because of a color.

Legal Matters

Continued from page 4 exception, under the Stark Law and Anti-Kickback Statutes, to encourage hospitals to share resources and provide financial assistance to doctors and clinics related to cybersecurity systems. • Health care entities should focus on increasing the security of medical devices, health IT, and legacy EHR systems. The Task Force suggests either imposing requirements or financial incentives to share software and systems to ensure a more robust and secure system September 2017

are advised to walk to the point of discomfort, stop briefly, and then resume walking. Prevention. Living well with diabetes requires both good medical care and effective self-management. Teaching the diabetic person to watch for skin, eye, nerve disorders and cardiovascular changes is  an

Music therapy going forward While music therapy may sound like some new age sugar pill to medical traditionalists, the use of it in conjunction with traditional medicine is being researched. “There is ongoing investigation into using music therapy approaches to reduce anxiety or pain in addition to traditional medicine,” Kilpatrick said. “This can be beneficial because there is

important part of the monitoring effort. High blood pressure, high fat levels and obesity should be corrected, and smoking should be discontinued. And most important, certain cognitive disorders, such as essential energy levels, quality of life, and memory have been shown to improve with glucose control. 

the potential to reduce the medication burden for some patients.”.” Music likely won’t ever replace the benefits of traditional medicine or cure your illnesses, but when it comes to improving quality of life—it has found its rhythm.

Editor Sharon Pennington Director of Media Sales Richard W DeLaRosa Senior Designer Jamie Farquhar-Rizzo Web Development Lorenzo Morales Distribution Robert Cox Guillermo Mendez Accounting Liz Thachar Writers Jorge Augusto Borin Scutti, PhD Denise Hernandez MS,RD,LD

Dell Oncology

Continued from page 14 Department of Internal Medicine on cancer prevention and support for patients in navigating decision-making; • Developing a plan for a program that meets the outpatient clinical care needs of young adults (ages 18-30), which Eckhardt describes as a vulnerable population with nationally recognized inferior outcomes; and, • Working with local stakeholders to develop a new framework for improved access

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Office: 512-203-3987 to exceptional cancer care.a

“I’m excited about the collaborative approach to cancer care that Dell Medical School is bringing to Central Texas,” said Shannon D. Cox, MD, a cancer specialist at Austin Cancer Center. “By unifying the local oncology community in novel ways, the department and institutes will help foster an environment where residents can get even more supportive, excellent cancer care close to home.” 

overall for safe transmissions of patient data. • Implement a multi-step authentication process and training requirements for clinicians accessing the systems. • The Report also discusses a series of specific recommendations regarding appointing a lead IT representative, conducting annual audits and sharing information related to better security measures, Big Data Analytics, and research and development.

enhanced responsibility to secure their systems, IoT medical devices, and patient data. Stakeholders are advised to reduce the use of less defensible legacy and unsupported products and focus on reducing risk through robust development and support strategies. The Report is a sincere and ambitious offering of practical and clear solutions that balance the tension between cybersecurity threats, patient privacy concerns, and technological innovation. The more difficult question is whether Congress will consider the The Report makes clear report and pass federal legislation in that now more than ever, health response.  care delivery organizations have an austinmedtimes.com

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FACE OF HEROISM DR. PATT

Oncologist, Austin

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