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Serving Harris, Galveston, Brazoria, Fort Bend Counties and Montgomery County

HOUSTON

April Issue 2018

Inside This Issue

Dr. Stephen Spann Named Founding Dean of UH College of Medicine

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Halting the Progression of Alzheimer’s Disease See pg. 12

INDEX Mental Health...................... pg.3 Legal Matters........................ pg.4 Oncology Research......... pg.5 Healthy Heart....................... pg.8

he University of Houston has named Dr. Stephen J. Spann founding dean of the UH College of Medicine. A seasoned physician, health care administrator and medical educator who holds both an M.D. and M.B.A., Spann was appointed planning dean for the college in fall 2015. Since then, he has shaped an academically desirable and financially feasible plan for the new college that will complement the current medical landscape in Houston and Texas. Spann’s vision for the College of Medicine focuses on preparing primary care doctors to practice in underserved urban and rural communities to ultimately improve health outcomes in Houston and across Texas. “Dr. Spann’s many years of training physicians and practicing in areas with health disparities uniquely positions us to accommodate the needs of Houston’s most underserved communities,” said Renu Khator, president of the University of Houston. “He is as passionate about closing the health care gap as our

university is about supporting our city’s most critical needs. I cannot think of a person with clinical and business expertise more qualified to lead.” “This is an important project to the Houston area and Dr. Spann is

the person we want creating the model and building it. Too many people don’t have access to proper care and that’s not just a health problem, it puts a strain on our economy and makes this a less see Dr. Spann... page 17

Rise in Coffee Consumption Might Help in Fight Against Colon Cancer By Cathy Frisinger Discovering a Plant Based Diet See pg. 15

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report that Americans are drinking a lot of coffee might be good news in the battle against colon cancer, scientists with the Simmons Cancer Center at UT Southwestern Medical Center say. A recent industry survey found that coffee consumption is steadily increasing, with 64 percent of adults reporting having had at least one cup of coffee the previous day. Prior studies have found that coffee drinking is associated with a lower risk of getting colon cancer, as well as reduced risk of recurring tumors and death from colon cancer. “We don’t quite know how coffee

exerts its health benefit because there are many different compounds in coffee. But researchers have shown that both caffeinated and decaf can be helpful,” says Dr. Muhammad Beg, a GI cancer specialist at the Harold C. Simmons Comprehensive Cancer Center, one of just 49 National Cancer Institute Comprehensive Cancer Centers in the nation. “Studies suggest that people who drink coffee may decrease the risk of colon cancer. “ T hat’s impor ta nt because colorectal cancer is the second-leading causes of cancer deaths in Texas,

according to the Cancer Prevention and Research Institute of Texas (CPRIT). CPRIT estimates that about 10,000 Texans will be newly diagnosed with invasive colorectal cancer each year and approximately 3,500 will die see Coffee... page 17

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Mental Health Texas A&M Tackles Opioid Epidemic with Multidisciplinary Task Force By Lindsey Hendrix

Texas A&M Health Science Center Opioid Task Force to serve as focal point for research, education and practice issues critical to addressing the opioid epidemic

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ith the federal government declaring a public health emergency, the growing opioid epidemic in America has become more visible with more than 1,000 people treated daily in emergency rooms for misusing prescription opioids. Closer to home, Texas has experienced a significant increase in opioid overdose death in recent years, with fentanyl now on the streets in many Texas communities. Texas A&M University Health Science Center has responded by forming a multidisciplinary opioid task force to reduce the burdens of opioid addiction, misuse and overdose on individuals, families, communities and the health care system. The Texas A&M Health Science Center Opioid Task Force is made up of representatives from all five Health

Science Center components (dentistry, medicine, nursing, public health and pharmacy) as well as the Coastal Bend Health Education Center. It will serve as a focal point for research, education and practice issues critical to addressing the opioid epidemic and its impact on Texas. “I established the task force in recognition that many of our health science faculty were individually already engaging in research, education and practice activities relevant to addressing the opioid epidemic,” said Carrie L. Byington, MD, dean of the Texas A&M College of Medicine, senior vice president of the Texas A&M University Health Science Center and vice chancellor for health services at The Texas A&M University System. “By working together, we can create an even greater impact in preventing and managing the devastating consequences faced by Texans and others around the country.” Work has already begun to gauge the implications of the opioid epidemic in current medical practices. In an

initial task force survey of Texas primary care physicians conducted by chairperson Marcia G. Ory, PhD, MPH, more than 70 percent reported that they received too little or no training during medical school or residency on patient education of pain management or opioid prescriptions. Additionally, while 73 percent reported that being knowledgeable in safe opioid prescribing is very important in their clinical practice, only 29 percent indicated that they felt very confident in their ability to prescribe opioids

safely. “There is an urgent need for continuing medical education—such as the recent conference in Corpus Christi hosted by task force member Starr Flores. The conference was attended by nearly 150 health care professionals coming from across the state. To share the valuable information with a broader audience, key talks will be available on our online learning management system to see Mental Health...page 17

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Legal Matters HHS HIPAA Guidance on Cloud Computing Systems By Charles Dunham and Francesca Ozinal Epstein Becker Green

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ealth care providers are increasingly adopting and utilizing cloud-based solutions, such as electronic medical record (EMR) systems, patient portals and virtual consults, in the delivery of treatment and care to their patients in the community. The U.S. Department of Health and Human Services (“HHS”) recently issued HIPAA related guidance on contractual and regulatory obligations specific to utilizing cloud services providers (“CSP”). Important takeaways from the HHS guidance: • CSP is a Business Associate. The CSP is a business associate when it creates, receives, maintains or transmits electronic protected health information (“ePHI”) on behalf of a covered entity, as well as when doing so as a subcontractor of a business associate. The guidance confirms this is true even if the CSP only processes and stores encrypted ePHI and cannot view the ePHI, but not

if the CSP receives and stores only de-identified information as defined by the HIPAA Rules. Also, the guidance clarifies that a CSP will most likely not fit within the “conduit” exception because the exception is limited to “transmission-only services” of ePHI and the CSP will generally maintain ePHI for the purpose of storage. This is true even in cases where the CSP provides view-only services. • Risk Analysis. The guidance states that the health care provider is responsible for having a sufficient understanding of the cloud computing systems and configurations offered by a CSP and the particular risks in order to appropriately conduct an internal risk analysis and establish risk management policies to ensure the confidentiality, integrity and availability of its ePHI. For example, the provider should know what security and encryption protections are in place by the CSP; how does the CSP back-up and recover ePHI; and how will the ePHI be returned and destroyed after the service contract is terminated. • CSP Security Practices. The

HIPAA Rules do not require a covered entity or business associate customer to audit the security practices of the CSP or that the CSP must provide documentation of its security practices as confirmation. However, that does not preclude a health care provider from requiring certain assurances from the CSP through the service contract or BAA of its security protections for the ePHI, such as documentation of a risk analysis and safeguard protocols. • Foreign Vendors Storing ePHI. The HIPAA Rules do not prohibit a health care provider to use a CSP that stores ePHI on servers outside of the U.S., but the guidance notes that the risks may vary dramatically depending on its geographic location; especially with respect to enforceability of HIPAA privacy and security protections over

the data. This line of inquiry should be part of the risk analysis performed by a covered entity and business associate customer prior to entering into a contract with a CSP. • Privacy Rule Compliance. The guidance suggests that the service contract or BAA clarify the obligations of the CSP to allow the covered entity or business associate customer to make available or make amendments to any ePHI stored on the cloud computing system. • Security Rule Compliance. In cases where a CSP is providing only no-view services, certain access and use controls, such as authentication or unique user identification, may only see Legal Matters...page 17

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Houston Medical Times

Oncology Research Beyond Drugs: The Other Breakthroughs in Cancer Research By Raghad Abdul-Karim, M.D., Texas Oncology Houston Memorial City

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e usually associate cancer research and clinical trials with new cancer medicine. But evidencebased cancer care goes far beyond providing drug therapies to patients. Exciting research developments that are unrelated to cancer medicines are improving patients’ outcomes and quality of life. Breakthroughs include technology to improve cancer screening, ways to minimize the side effects of cancer treatment, and tools to determine best approaches for treatment. We’re increasingly able to use and analyze data to customize cancer care for specific patients. Clinical research drives each of these non-medicine advancements. 1. Better Prevention and Screening

Research that helps identify causes and risk factors leads to better cancer prevention. Better screening and earlier detection enables physicians to treat cancer sooner with greater success. Research is underway to find better screening tools for a variety of cancers. One example of such research is already making a difference. Mammograms traditionally are the most reliable way to discover breast abnormalities. Traditional mammograms, however, are sometimes unable to identify concerning areas in women with dense breast tissue. Researchers developed a newer technology called 3-D mammography, which takes many low-dose X-rays to create a three-dimensional picture of the breast. Also called digital tomosynthesis, the procedure helps doctors locate and better examine suspicious areas in dense breast tissue beyond traditional mammograms. 2. Reduced Side Effects from Cancer Treatment Chemotherapy is the most

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common form of cancer treatment. Unfortunately, the treatment sometimes has negative side effects, including nausea and hair loss. Reducing side effects can improve patients’ quality of life. Many years ago, research that developed better nausea medications now has helped thousands of patients relieve symptoms of this side effect and spurred transferring most delivery of chemotherapy from a hospital to an outpatient setting, enabling patients to be more comfortable at home with their families. More recently, researchers developed a “cooling cap” to combat chemo-induced hair loss. The cooling cap reduces scalp temperature to reduce the blood flow to hair follicles before, during, and after chemo treatment, which helps prevent hair loss. Although currently FDA-approved for

limited cancer types, research indicates that about half of patients who use a cooling cap will successfully retain their hair through chemo treatments. 3. More Precise Radiation Treatment Most people know that radiation therapy often accompanies drug treatments such as chemotherapy, but many don’t realize that radiation therapy has ongoing clinical trials too. Such research has improved the precision of radiation beams to more see Oncology...page 17

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Houston Medical Times

A New Hope for Becoming AFib Free and Stopping Blood Thinners for AFib By Randall K Wolf MD Professor, University of Texas McGovern Medical School Director, Surgical AFib Program Memorial Hermann Hospitals

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n my experience over the last 18 years as a physician who specializes in the treatment of atrial fibrillation (AFib), I have learned AFib sufferers want two things: Hope and a chance to feel better. The treatment of AFib usually starts with medications to regulate the heart rate and rhythm. Often times these medications are not effective. Additional treatments include catheter ablation or nodal ablation and a pacemaker. As an AFib researcher, device and procedure developer the most common

question I am asked in the office is: “Why haven’t I heard about the newer treatments for AFib?” Because this question is asked so often, I do spend time helping patients understand what the latest AFib treatments are, including the procedure I developed to stop AFib and to prevent strokes. Last year, 2017, AFib sufferers traveled to Houston from 30 states and were helped with the Wolf minimaze. These are patients who traveled long distances in order to become AFib free and to be able to stop blood thinners. The procedure these people traveled to Houston to receive, the Wolf minimaze, has been shown to be twice as effective in maintaining a normal rhythm compared to catheter ablation. The minimaze also dramatically decreases the chance of stroke, and allows most patients to stop blood thinners. The minimaze is a minimally

April 2018

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Randall K Wolf MD

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triggers around the pulmonary veins that initiate AFib, 2 closes the ear called the left atrial appendage (which allows patients to stop blood thinners) and 3 tests and treats the tiny nerves on the back of the heart that can also initiate AFib.


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Healthy Heart Sodium and Heart Health Please Don’t Pass the Salt By Nicole Dixon Director of Communications Houston/Gulf Coast American Heart Association

H

eart disease is the No. 1 killer of all Americans, and something as simple as reducing the sodium in your diet can significantly reduce your risk. Your goal? The American Heart Association recommends no more than 2,300 milligrams of sodium a day and an ideal limit of no more than 1,500 mg per day for most adults. Right now, the average American consumes more than twice the ideal amount daily. Why does my body need sodium? Sodium is a mineral that’s essential for life. It’s regulated in the body by your kidneys, and it helps control your body’s fluid balance. It also helps send nerve impulses and affects muscle function. How does sodium affect my heart health? When there’s extra sodium in your bloodstream, it pulls water into your blood vessels, increasing the total

amount (volume) of blood inside your blood vessels. With more blood flowing through your blood vessels, blood pressure increases. It’s like turning up the water supply to a garden hose — the pressure in the hose increases as more water is blasted through it. Over time, high blood pressure may overstretch or injure the blood vessel walls and speed the build-up of gunky plaque that can block blood flow. The added pressure also tires out the heart by forcing it to work harder to pump blood through the body. Even if you don’t have high blood pressure, eating less sodium can help blunt the rise in blood pressure that occurs with age, and reduce your risk of heart attack, heart failure, stroke, kidney disease, osteoporosis, stomach cancer and even headaches. The extra water in your body can also lead to bloating and weight gain. How much sodium is in salt? Table salt is a combination of two minerals – sodium and chloride. By

weight, table salt is approximately 40% sodium and 60% chloride. About 90% of Americans’ sodium intake comes from sodium chloride. More than 75 percent of the sodium Americans eat comes from some processed, prepackaged and restaurant foods – not from the salt shaker.

What are common sources of sodium? Nearly three quarters of the sodium we consume comes from packaged, prepared and restaurant foods. The rest of the sodium in our diets occurs naturally in food or is added by us when we’re cooking food or sitting down to eat. The latter only makes up only about 10 percent of our total sodium intake. So, even if you never use the

Here is a guide to how much sodium in table salt: •1/4 teaspoon salt = 575 mg sodium •1/2 teaspoon salt = 1,150 mg sodium •3/4 teaspoon salt = 1,725 mg sodium •1 teaspoon salt = 2,300 mg sodium

see Healthy Heart...page 18

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Renowned Cardiologist Says New Blood Pressure Guidelines Not Good for All

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ne of the nation’s leading cardiologists is challenging the new hypertension guidelines, perhaps sparing up to 10 million people from unnecessarily aggressive blood pressure treatments. Robert A Phillips, M.D., Ph.D., Houston Methodist’s chief medical officer, and his colleagues investigated the impact of new guidelines issued in November that redefine high blood pressure. Phillips, who is an expert in hypertension and cardiovascular disease, says while patients at higher risk for cardiovascular disease benefited from the stricter guidelines, those with lower risk had more harm than benefit from the intensive treatment recommendations. The findings are described in a paper titled “Impact of cardiovascular risk on the relative benefit and harm of intensive treatment of hypertension,” appearing online March 7 and in print April 17 in the Journal of the American College of Cardiology, a

leading medical journal in the field of cardiovascular disease. “While it’s estimated that 107,500 deaths could be averted annually in the U.S. by implementing more aggressive treatments, it may be accompanied by other serious, adverse events,” Phillips said. “This presents clinicians and patients with a dilemma, potentially trading one clinically significant condition for another.” The new rules were written by a panel of 21 scientists and health experts who reviewed more than 900 published studies. Issued by the American Heart Association, American College of Cardiology and nine other professional health organizations, the new guidelines classify hypertension as a reading of 130 over 80, rather than 140 over 90. Under these new tightened rules, 46 percent of U.S. adults are now

considered hypertensive, up from 32 percent. This call for more aggressive treatment is based largely on data from the Systolic Blood Pressure Intervention Trial, or SPRINT, which was a large-scale study of more than 9,000 people, sponsored by the NIH’s National Heart, Lung and Blood Institute. “Classifying patients by degree of future risk might be the best way to identify who could benefit most from intensive treatment,” Phillips said. “We

developed a model using the 10-year cardiovascular disease risk and found that aggressive treatment of patients with a risk greater than or equal to 18.2 percent would result in more benefit than harm, while those with a risk of less than that would fare better under a standard blood pressure management approach.” These numbers are at odds with the new guidelines, which suggest treating patients with a greater than 10 percent risk.

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San José Clinic President and CEO Named National Thought Leader by New England Journal of Medicine – Catalyst

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aule Anne Lewis, president and CEO of San José Clinic, has been named to the Care Redesign group of Thought Leaders by the distinguished New England Journal of Medicine – Catalyst. Ms. Lewis is one of only three Texan Thought Leaders and the only Houstonian. Thought Leaders are appointed to serve as national, dynamic, engaging experts who will ‘share their knowledge on innovations in health care delivery and how to spark change in organizations of all sizes.’ “It is an honor to join this prestigious group of health care executives and leaders,” shared Ms. Lewis. “I am pleased that NEJMCatalyst recognized the need to include the perspective of the only safety-net clinic in the world’s largest medical center to this national discussion.” Ms. Lewis has been appointed a Thought Leader as she begins her eighth year of leadership at San José

Clinic, Houston’s oldest and premier safety-net clinic. This accolade follows her recent participation in NEJM-Catalyst’s “Expanding the Bounds of Care Delivery: Integrating Mental, Social, and Physical Health” symposium, moderating a panel investigating health system solutions. Ms. Lewis is a native Houstonian with twenty-five years of healthcare administration experience in the local market. As president and CEO of San José Clinic, she has driven the addition of the Clinic as a Texas Medical Center Member institution, the Clinic’s first national publication in the NEJM-Catalyst, and the successful implementation of a nationallyrecognized quality assurance program. “I am pleased for this opportunity to represent the vulnerable populations served by San José Clinic and other safety-net clinics throughout the country,” elaborated Ms. Lewis. “Since 1922, the Clinic has empowered

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Houston Medical Times

Shining New Light on Halting the Progression of Alzheimer’s Disease

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light that is barely visible to the human eye could be the key to stopping the terrible effects of Alzheimer’s. A new study from The University of Texas Medical Branch at Galveston shows that using near infrared light on the heads of mice can effectively reduce vulnerability to the damaging effects of a toxic chemical in the brain known to be involved with the onset of Alzheimer’s. This data is detailed in Scientific Reports. UTMB researchers have previously found evidence that amyloid beta protein pieces may underlie the early stages of Alzheimer’s. These proteins disrupt the communication between brain cells, driving the first noticeable cognitive deficits. So, preventing this dysfunction within the brain would be an effective therapeutic strategy for the disease. “Our findings provide evidence that near infrared light can make the brain more resistant to the damaging effects

April 2018

of amyloid beta,” said senior author Giulio Taglialatela, neurology professor and director of the Mitchell Center for Neurodegenerative Diseases at UTMB. “Near infrared light therapy increases the health of the points of connection between brain cells, thus decreasing the susceptibility to the toxic proteins.” In this study, the researchers shined a near infrared LED light for up to 90 seconds a day, five days per week for a month on the heads of regular mice and a separate group of mice that were genetically engineered to have brain abnormalities seen in Alzheimer’s. They found that the toxic proteins wreaked less havoc on all of the light-treated mice compared with the genetically engineered Alzheimer’s-like mice. “We looked closely at the ability of the near infrared light to mitigate the toxic binding of amyloid beta to the points of communication between brain cells,” said Michele Comerota, doctoral candidate in neuroscience. “Preventing the toxic chemical

from taking hold in the brain may serve as a new means of protecting against Alzheimer’s,” said Balaji Krishnan,

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assistant professor in the department of neurology.


Houston Medical Times

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Bonded by Love: Sister Donates Kidney to Brother

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ennifer and Richard Ramirez are the oldest and youngest siblings in a family of six. They grew up in a tight-knit household and have always been close. Now the Navy Veteran and his sister have something that bonds them even more – he has her kidney. Richard joined the Navy in 1989 and after his discharge made his home in San Antonio, Texas. Jennifer settled in New York. Separated by 1,800 miles, the brother and sister kept in close touch with each other and the rest of their family. Last month, they came together at the Michael E. DeBakey VA Medical Center in Houston so Jennifer, 37, could donate her kidney to her brother.

to be able to tell her she does not have the PKD gene,” said Dr. Venkat Ramanathan, director of the Houston VA’s Transplant Program. “This eased her mind for the future and allowed us to match her as a donor for her brother.” After being cleared as a donor, Jennifer traveled to Houston in February. The surgery took place February 13. A few days later, brother and sister were discharged and even able to tour Minute Maid Park, home of the World Series Champions Astros, with their sister Jackie McGarr, who also came to Houston to support her siblings during the surgery. Both Jennifer and Richard are now back home and doing great. “The doctors at the Houston were incredible from start to finish,”

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Navy Veteran Richard Ramirez and his sisters Jackie McGarr and Jennifer Ramirez visiting Minute Maid Park, home of the World Series Champions Houston Astros, days after Jennifer donated her kidney to him.

“It wasn’t a hard decision for me,” Jennifer said. “His best friend initially matched as a donor, but when he couldn’t donate due to medical issues, I knew I had to step up even though he never asked me to. I couldn’t not help my brother if I was physically able.” Polycystic kidney disease is an inherited disorder that causes kidneys to lose function over time. It runs in the Ramirez family. Richard was already on dialysis three times a week and faced more of the same in the future. Although Jennifer showed no signs of PKD, doctors at the Houston VA Medical Center had to rule out that she could develop it later in life. “We performed extensive genetic testing on Jennifer and were happy

said Richard. “It was a strange feeling knowing my sister was having surgery in an operating room right down the hall, but everything went perfectly. I can’t say enough about the amazing care I got at VA and about the outcome of the surgery.” Jennifer agreed. “I would encourage everyone to get tested to see if they are a match for someone who needs a kidney,” she said. “The wonderful feeling of helping someone far outweighs any discomfort that exists in this surgery. If I had more kidneys, I would donate again in a heartbeat.”

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How One Houstonian Tackles the Challenges of Type 1 Diabetes

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indsey Fridge was diagnosed with type 1 diabetes (T1D) in 1988. At just 9-years-old, she was told that she would never be able to eat sweets again and would have to learn to live an entirely new kind of life. Known as the silent disease, most people don’t fully understand T1D until they live it or care for someone who has it. Every day proposes different challenges for Lindsey; she has to test her blood sugar levels multiple times a day since everything from food, exercise and stress can affect her levels. “I could equate it to preparing for a hurricane every day of your life, not knowing if the worst will come,” Lindsey said. Lindsey graduated from the University of Houston with a degree in communications and started her career in public relations. Lindsey Fridge Soon after she experienced a wake-up call. She was diagnosed glucose tabs, alcohol swabs and small with diabetic retinopathy, a diabetic- snacks like protein bars to help regulate related eye disease where, overtime, her blood sugar on a daily basis. Even high blood sugar levels cause damage as an avid exerciser, Lindsey is unable to blood vessels in the retina, and to make impromptu trips to the gym or can lead to blindness. As a result, she pop in on a whim to her favorite fitness began to take even more control of her class, as workouts require preparation personal health, which ultimately led hours in advance to make sure she’s her to a career change in the healthcare in a safe blood sugar range to exercise. When her blood sugar levels are high, industry. In 2008, Lindsey began working Lindsey feels lethargic as if she is for Medtronic and was introduced to moving in slow motion and when her the artificial pancreas (AP) technology levels are low she feels irritable, dizzy and the Medtronic 670G. An AP and shaky. It’s a balancing act; staying relieves some of the cognitive burden on the “high” side creates long-term of T1D by automatically controlling effects that can slowly kill your body a person’s blood sugar levels. Lindsey over time while lingering on the “low” quickly began using the Medtronic side results in faster moving fatalities 670G, and has since been able to be including death. Lindsey found the JDRF more “proactive” versus “reactive” in her diabetes management. She has community through her work at more energy and sleeps better at night. Medtronic. JDRF has become a When she was younger, her insulin second family for type 1 diabetics and levels weren’t as regulated and she their family members to seek support, would experience seizures when her guidance and financial aid. “I realized blood sugar dropped too low. With the how different everyone handles their AP, Lindsey doesn’t have as many blood diabetes and how each person has sugar swings, which over time can lead different requirements in order to stay T1D patients to have heart attacks, healthy. This isn’t a one-size-fits-all strokes, amputations, blindness, and disease and treatment plan,” Lindsey said. She now serves on the JDRF kidney failure. Regardless of wearing the Houston Gulf Coast Chapter Board of Medtronic 670G, Lindsey still has to carry around necessary supplies such as her insulin pump, glucose sensor, see Diabetes..page 18

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Plant Based Diet Eat food. Not too much. Mostly plants. –Michael Pollan By Denise Hernandez, MS, RD, LD Houston Medical Times

May be lower in calories Higher in fiber Helps lower cholesterol levels Helps in heart disease prevention. Higher in potassium Lower in sodium

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his mantra is a good one to live by and is one that I, as a dietitian, highly recommend. What exactly is a plant-based diet, why do I recommend it to clients, and how can you implement it into your diet? These are the questions that you may be asking yourself.

The latest science in support of plant-based diets demonstrates that plant-based diets reduce the risk of ischemia, hypertension, and type 2 diabetes. These diets also lower LDL and blood pressure, reduce body mass, and reduce overall cancer rate. These lowered risks can be attributed to

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The Dietary Guidelines Advisory Committee refers to the plant-based diet as one “that emphasizes vegetables, cooked dry beans and peas, fruits, whole grains, nuts, and seeds.” It allows you to replace animal food sources to more plant food sources. Following a plant-based diet can be a gradual process where you include more plant foods and slowly shift away from the traditional Western diet, a diet that is high in meat, fat, saturated fat, and sodium and low in fiber. It’s a simple idea that doesn’t require complicated instructions to promote good health—people just eat more whole, unprocessed foods that come directly from plants. The health advantages of a plant-based diet are plentiful. The general benefits of eating a plant-based diet include: Lower in cholesterol

the decreased intake of saturated fat and cholesterol and increased intake of vegetables (with more fiber and phytochemicals), nuts, and soy. MAKE THE SHIFT 1. Start slow – you can’t make the change overnight. I usually recommend starting off by eating vegetarian one night per week and then slowly increasing it to making an entire day vegetarian.

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2. Find a good vegetarian cookbook – take the guesswork out of it and use vegetarian cookbooks as an inspiration to transform your meals. 3. Convert some of your favorite meals to vegetarian meals – If your favorite meal is lasagna, swap the meat portion with vegetables. Or try spiralizing vegetables to replace the noodles in spaghetti. 

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Men’s Health A Unique Look Inside the Training and Nutrition Regimen of a Local UFC Fighter By Ricky Rivas Special to Houston Medical Times

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eet Roberto Sanchez: full time father, actuarial analyst, UFC fighter. The thought of working two jobs is something that is becoming more and more common, however; Sanchez’s second job is not one you hear of every day. Sanchez works for an insurance company where he calculates the cost of certain incidents, he also competes in the sport of MMA at the highest level in the world. In the following interview I ask Sanchez about the balance between

between being a father and working as an actuary? “It’s definitely tough, balancing actuarial and MMA is normally very difficult because they are counterproductive. One involves a lot of sitting and studying while the other demands a lot of body movement and sweating. Luckily my work is very flexible. We have a fitness center here, so I can do cardio exercises during lunch. If I have an upcoming actuarial exam my work provides paid study hours. With this flexibility I can do part of my training and studying at

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the two lines of work, as well as his nutrition. What does your office job think of your UFC career? “I had Professional Mixed Martial Arts Fighter on my resume when I applied so it was never a secret. They are supportive and flexible with my training schedules.” What is your training schedule like? “My training is always focused on improving my technique in striking wrestling, and jiu-jitsu. Once a fight camp starts the focus shifts. I start to study my opponent and build up my fight cardio. I must train my body to be ready for a full three (or five) round war. Because I work a desk job, this isn’t something I can say my body is ready for every day.” How do you find time to train medicaltimesnews.com

work and focus a big portion of my time after work with my wife and kids. Naturally if I have a scheduled exam or fight, my time outside of work starts going more towards that. I try my best not to schedule fights and exams close together but sometimes they do overlap. That’s when you’ll see me sprinting on a treadmill wearing a sweat suit while reading a statistics book.” Does the pressure of competition ever affect you? “I never planned on earning a living from MMA. That’s why I have always worked instead of looking for sponsors, so I had a guaranteed income. I am aware MMA is a temporary profession. I can’t keep fighting into my 50’s and 60’s. see Men’s Health..page 18


Houston Medical Times

Dr. Spann

Continued from page 1 attractive place to create jobs,” said Tilman Fertitta, chairman of the UH System Board of Regents. Spann graduated from Baylor College of Medicine and completed a residency in family medicine at Duke University Medical Center. He began his career as a family physician in rural Arkansas and North Carolina, embracing the challenge of providing quality care in communities with a shortage of physicians and poor access to health care. There is still a shortage of primary care doctors in America, and Texas ranks 47th out of 50 states in primary

Coffee

Continued from page 1 of the disease. Colorectal cancer is the third most common cancer that is diagnosed in both men and women in the United States, with nearly 5 percent of men and just over 4 percent of women developing the disease over

Mental Health Continued from page 3

be widely distributed in Texas as well as throughout the nation,” said Ory. To further close the identified gaps in knowledge of opioid pain management safety, the task force is developing continuing education materials for physicians, dentists and pharmacists that will also be widely shared. Two studies by task force members have been selected for funding in the first year of the ten-year, $100 million President’s Excellence Fund, T3: Texas A&M Triads for Transformation.

Oncology

Continued from page 4 exactly target tumors and minimize damage to surrounding tissues. Organizations such as the Radiation Therapy Oncology Group give patients access to many promising radiation

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care physician-to-population ratio. Spann envisions a distinctive medical school that addresses the health and health care needs of communities with significant health disparities. The college will be centered on transforming the way high-quality care is delivered, taking a more cost-effective, patient-centric and team-based approach to care. Among his many goals, Spann hopes to attract and train more physicians from underrepresented minorities in medicine to better mirror the ethnic composition of the population. “Being named founding dean is a great honor and privilege, and it’s a great opportunity to do something significant that will ultimately have a major impact on health and health care of the population of this great city, our state and beyond,” said Spann. “I really

love taking care of people and teaching young physicians how to take care of people, and then discovering new ways to provide better health and health care. Spann has spent most of his nearly four-decade career in medical education. He’s been on faculty and held leadership positions at the University of Oklahoma College of Medicine, served as chair of the Department of Family Medicine at the University of Texas Medical Branch at Galveston, and chaired the Department of Family and Community Medicine at Baylor College of Medicine. While at Baylor College of Medicine, Spann also served as senior vice president and dean of clinical affairs, overseeing a major part of that large medical enterprise. More recently, he served as chief medical officer at Tawam Hospital in the United Arab Emirates,

which is a tertiary care teaching hospital managed by Johns Hopkins Medicine International. In addition, he was senior advisor to the Abu Dhabi health system. “Building a medical school from the ground up is a heavy lift and that’s why Dr. Spann is leading it. He knows medicine and he understands the business model,” said Fertitta. Last November, the UH System Board of Regents approved establishment of a College of Medicine at the University of Houston. UH is seeking medical degree approval from the Texas Higher Education Coordinating Board and has initiated the process for accreditation by the Liaison Committee on Medical Education. The UH College of Medicine would admit its first class in 2020.

their lifetime. The American Cancer Society estimates that in the United States, over 97,000 new cases of colon cancer and 43,000 new cases of rectal cancer will be diagnosed in this year alone. Scientists also have found a s so ciation s b et ween cof fee consumption and a lowered risk of several other cancers, including prostate, endometrial, skin, and liver

cancers. In addition, studies have found coffee drinkers have a lower risk of death from vascular causes such as heart attack or stroke, and coffee-drinking has been associated with lowered risk of cirrhosis, gallstones, gout, and type 2 diabetes, as well as some potential cardiovascular benefits. But nutritionist Lona Sandon, Assistant Professor in the School

of Health Professions at UT Southwestern, which is recognizing its 75th anniversary this year, notes that coffee-drinking can backfire if you add too many extras added to your coffee. “Hold the extra cream and sugar. Excess calories that lead to excess body weight increase heart disease, diabetes, and cancer risk.”

Ory and colleagues will examine the opioid epidemic’s impact on older adults and Ranjana Mehta, PhD, MS, assistant professor at the Texas A&M School of Public Health, along with colleagues, aims to develop a Smart Sensing System for Opiate-withdrawal Symptoms (Smart Sensing SOS). “I am delighted that two of our task force members successfully competed in the T3: Texas A&M Triads for Transformation,” Byington said. “I look forward to seeing the results of these two studies and the positive impacts they will have on combatting the opioid epidemic in Texas and beyond.” Opioid overdose has certainly taken a toll on American society. The Centers for Disease Control and Prevention reported that 116 people died every

day in 2016 from opioid-related drug overdoses. These deaths were caused by legally available pain relievers such as oxycodone, hydrocodone, codeine and morphine, as well as the illegal drug, heroin and illicitly produced fentanyl. The economic toll that year added up to $504 billion. In early February, Ory led a brainstorming session in Corpus Christi with health care professionals on the frontlines of the opioid crisis. The group was made up of representatives from primary care, anesthesiology, Veterans Affairs, oncology, dentistry, pharmacy, public health and addiction recovery. Their charge was to begin a frank and open discussion about how the opioid epidemic is affecting older adults and their families, and to identify

intervention strategies for reducing the prevalence and consequences of opioid misuse among older populations. They identified six major contributing factors and potential solutions for addressing them. The group plans to prepare a consensus statement to be presented to key stakeholders in the near future. “We need to understand patient experiences and how the epidemic is impacting persons with pain, those addicted, their families, the health care system and community at large,” Ory said. “Through collaborative action across the health sciences, this task force will improve clinical practice and, ultimately, the health and well-being of all Texans.”

trials. 4. Improved Patient Outcomes and Experiences Researchers comb mountains of data to discern the most effective treatments and patient experiences for specific types of cancer. That research, in turn, benefits many future patients. Texas Oncology participates in evidence-based pathways, which uses research and data to inform doctors

which therapeutic interventions are most appropriate for each individual patient’s case. For example, we now can customize some treatments for breast cancer patients based on how patients with similar molecular profiling have responded to certain approaches. By treating patients with the right treatment at the right time, we can improve outcomes. Drug therapies will always be

a vital part of cancer care. But thanks to new research and technology, cancer care continues to expand beyond drugs to improve outcomes and patient experiences.

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Raghad Abdul-Karim, M.D. is a medical oncologist at Texas Oncology— Houston Memorial City in Houston, Texas. April 2018


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Houston Medical Times

Legal Matters

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Continued from page 4 be the responsibility of the covered entity or business associate customer. The guidance emphasizes that, if the service contract states that the covered entity or business associate customer will control and implement certain security features of the cloud service, HHS will not hold the CSP responsible for the compliance failures that are attributable solely to the actions or inactions of the customer. • Use of Mobile Devices to Access

Cloud System. The guidance confirms that health care providers are allowed to use mobile devices to access ePHI stored in a cloud-based solution; provided that there are appropriate physical, administrative, and technical safeguards are in place to protect ePHI. To be clear, no specific types of technology are required under HIPAA rules and HHS does not recommend specific technology or products. HHS has issued guidance in the past on

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Continued from page 8 be of lowering sodium consumption to less than 1,500 mg per day for most Americans? One estimate suggested that if the U.S. population moved to an average intake of 1,500 mg/day sodium from its current level, it could result in a 25.6% overall decrease in blood pressure and an estimated $26.2 billion in health-care savings. Another estimate projected that achieving this goal would reduce deaths from cardia

vascular disease by anywhere from 500,000 to nearly 1.2 million over the next 10 years. You can join American Heart Association’s sodium reduction campaign, where consumers can write to food companies and restaurants, asking them to keep sodium reduction a priority. Learn more at www.heart. org/sodium. 

Diabetes

to contribute to the overall effort of spreading awareness and funding new initiatives. Lindsey looks forward to advances in encapsulated beta cell replacement therapy, which involves wrapping insulin-producing islet cells in a protective barrier before implanting them into the body and protects the

cells from being destroyed by the body, and the use of smart insulin, a glucoseresponsive insulin that circulates throughout the bloodstream and turns on and off when it’s needed to regulate blood sugar drops. Both technologies are funded by JDRF.

to lose weekly and I follow that daily till fight week. For this last match I was roughly at a 1750 daily calorie deficit for 45 days. So, I would have to burn +3000 calories every day, so I could eat around 1250-1500. This sounds like it would wreak havoc on my body, but it put me in the best shape of my life. It’s amazing how eating clean and working out daily makes you feel ten years younger.” When you indulge, what foods do you typically like to eat?

“Ice cream, pecan pie, pizza, burgers… and they taste so much better after eating raw broccoli and spinach for months.” As any one can see, Sanchez has his life organized and well thought out. This allows him to have a great home life, a secure job in the future, and a chance to live out his dream as a UFC fighter.

Men’s Health

Continued from page 16 That’s why I always stayed in school and kept progressing my education. I never wanted to feel like I had to fight to earn money. I fight because it’s a hobby I love to do.” What is your diet like? “Dieting is always tough. I love to eat just like everyone else. I develop my own diet plans and track my weight daily compared to previous diets I’ve done for my fights. I set a daily calorie deficit based on how much weight I need April 2018

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Continued from page 14 Directors, is a part of the JDRF Fund A Cure Gala committee, helps out at the annual JDRF golf tournament and participates in the JDRF Walk. Lindsey encourages others to give back and support JDRF in any way they are able by volunteering at events or donating what they can

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Healthy Heart

salt shaker, you’re probably getting too much sodium. Because most of the sodium we eat is in our food before we buy it, it makes it hard for people to limit how much sodium they eat. Americans deserve the opportunity to choose how much sodium they consume. An AHA survey found that 75% of adults in the U.S. preferred less sodium in processed and restaurant foods. What would the health impact

Editor Sharon Pennington

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Houston Go Red For Women Luncheon The Post Oak Hotel at Uptown Houston May 18, 2018

Please join us at the 14th Annual Go Red For Women Luncheon United, we can improve the health of all women! Heart diseases and stroke cause 1 in 3 deaths among women each year, killing approximately one woman every 80 seconds. Fortunately, 80% of cardiac and stroke events may be prevented with education and lifestyle changes.

Roberta Schwartz

Executive Vice President, Houston Methodist Hospital Campaign Co-Chair

Rachel Clingman

American Heart Association Board Member Campaign Co-Chair Go Red For Women is nationally sponsored by

Houston Goes Red Sponsor

Alison Levine Keynote Speaker

Heartbeat Sponsors

First American Women’s Everest Expedition Team Captain & Author of The New York Times Best-seller “On the Edge: Leadership Lessons from Everest and Other Extreme Environments”

Heartfelt Sponsors

For more information, please visit HoustonGoRed.heart.org or contact Jessica.Ansel@heart.org or 832-918-4010.

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