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Serving Harris, Brazoria, Fort Bend and Montgomery Counties

HOUSTON

Volume 10 | Issue 2

Inside This Issue

February Edition 2020

Changes Coming for Prescribers to The Texas Prescription Drug Monitoring Program By Mark S. Armstrong, JD Polsinelli, PC

Memorial Hermann Appoints Erin Asprec as Executive Vice President, Chief Operating Officer See pg. 10

INDEX Oncology Research......... pg.3 Mental Health...................... pg.5 Healthy Heart....................... pg.7 Financial Forecast.............. pg.8

5 Food Groups to Avoid If You Want to Lower Your Cancer Risk See pg. 11

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n response to the opioid epidemic, many states, including Texas, created prescription drug monitoring programs to monitor high-risk patients and provider behaviors. The Texas Prescription Drug Monitoring Program (“PMP”) is managed by the Texas State Board of Pharmacy and is the only statewide electronic database that currently collects, manages, and stores outpatient prescription data for all Schedule II through Schedule V controlled substances dispensed by a Texas pharmacy. PMP helps inform prescribing practices and addresses prescription drug misuse, diversion, and overdose. In addition, PMP assists prescribers and pharmacists to avoid potentially life-threatening drug interactions, decide when to make referrals to specialty treatment providers, and identify individuals obtaining controlled substances from multiple health care providers and pharmacies. PMP can also be used to verify a practitioner’s

own records and prescribing history, as well as to inquire about patients.

required to access PMP, with respect to a patient, before prescribing or dispensing opioids, benzodiazepines, barbiturates or carisoprodol; provided, however, that neither a prescriber nor a pharmacist is required to access PMP if the patient has been diagnosed with cancer or if the patient is receiving hospice care. Prescribers or pharmacists may access PMP with respect to a patient before prescribing or dispensing any controlled substance. After the effective date, a prescriber or pharmacist in Texas who fails to access PMP with respect to the patient prior to prescribing or dispensing opioids, benzodiazepines, barbiturates or carisoprodol may be subject to disciplinary action by the regulatory agency that issued a license, certification or registration to the individual who committed the violation (i.e. Texas Medical Board, Texas State Board of Dental Examiners, Texas Board of Nursing, Texas State Board of Pharmacy).

Effective March 1, 2020, prescribers and pharmacists will be required to access the Texas Prescription Drug Monitoring Program (PMP)...before prescribing or dispensing opioids... Texas-licensed pharmacies are presently required to report all dispensed controlled substances records to PMP no later than the next business day after the prescription is filled. If the pharmacy does not dispense a controlled substance prescription during a period of seven consecutive days, then the pharmacy must submit a zero report indicating that the pharmacy did not dispense any controlled substances during that period. Effective March 1, 2020, prescribers and pharmacists will be

see Monitoring Program... page 13

PRSRT STD US POSTAGE PAID PERMIT NO 1 HOUSTON TX


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Houston Medical Times

Setting the pace for cardiovascular care in Greater Houston. At Memorial Hermann, our team of world-renowned, affiliated heart physicians provides innovative cardiovascular care – from revolutionary new medications, to minimally invasive procedures for correcting atrial fibrillation or repairing heart valves to innovations in heart and lung transplants. These cutting-edge solutions are less traumatic and aim to reduce a patient’s pain and recovery time. Our innovations are putting Memorial Hermann at the forefront of advancing heart health in Greater Houston and helping our patients lead a better quality of life.

Learn more about heart care at heart.memorialhermann.org

February 2020

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Oncology Research Coping with Cancer: How Finding Your Motivation Can Shape Your Journey of the hardest challenges you’ll ever experience. According to the National Institutes of Health, a hopeful outlook can help the body deal with cancer, and scientists are studying whether a positive attitude helps people feel better. Maintaining a positive, hat’s your motivation? That’s a motivated attitude is easier said than question you might expect to done, but there are steps you can take come up in an acting class. But not an to help shift your perspective. Embrace change. Whether it’s oncologist’s office. After all, motivation – being reducing a busy schedule of activities motivated – sparks a sense of due to lack of energy while undergoing inspiration and action. What spurs you treatment, or a more significant on to tackle the challenges you face? In restriction in your physical capabilities, this sense, finding motivation in the cancer brings change. For some midst of a cancer diagnosis is especially patients, planning their days ahead and going about business as usual is a viable important for many patients. Your emotional health can impact option, but it’s different for everyone. how you address the physical health Embracing the changes cancer brings challenges associated with fighting can help make your days feel more cancer. Once the initial shock of manageable. Taking time to focus on diagnosis wears off, you may feel a what motivates you can help you cope wide range of emotions, including with cancer. No doubt it takes a lot of fear, anger, sadness, anxiety, or guilt. energy, strength, and perseverance – understanding your limitations doesn’t Finding aHou_Med_times_ad_11_2019.pdf sense of motivation and hope 1 11/20/19 3:44 PM mean they have to define you. can help you face what is perhaps one By Jamie E. Terry, M.D., FACS, Texas Breast Specialists– Houston Medical Center

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Evaluate what motivates you. We are all motivated by something – a hobby or passion, time with loved ones, learning new skills, achieving goals, playing sports, or simply spending time in nature. The things that motivate us push us toward new heights and inspire us to keep going during challenging times. For many patients, a cancer diagnosis is time to reflect on what they value most in life and to focus time and energy on what motivates them to look toward the future. Lean on others. Unhealthy thinking often accompanies cancer – fear of the unknown and questioning whether something you did or did not do caused your illness are examples. When these thoughts move from the back to the front of mind, it’s time to draw strength from others who care about you. Many patients find a sense of motivation from those close to them. The American Cancer Society recommends three types of activities

for patients to help stay positive: • Don’t go it alone. Involve other people. Have lunch or coffee with a friend. • Check the ‘to-do list.’ Activities that give you a sense of accomplishment, like going for a walk or finishing a project are ultimately positive. • Cool it. Do things that make you feel relaxed, such as watching a funny movie with family. A serious health diagnosis, like cancer, is deeply personal. While some are vocal, others wish to keep quiet. No matter the approach, embracing change, leaning on those around you for support, and focusing on what motivates you can transform your cancer journey. Texas Oncology is proud to help patients navigate their cancer experience and serve as a source of support and motivation in their fight.

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Three Texas Siblings with Rare Form of Congenital Blindness Received First-of-Its-Kind Genetic Treatment at Baylor St. Luke’s Baylor St. Luke’s is one of ten institutions in the United States offering the first FDA-approved gene therapy for a genetic disease.

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nherited retinal disease specialists at Baylor College of Medicine’s Alkek Eye Center, an outpatient surgery center at Baylor St. Luke’s Medical Center, successfully treated three young siblings with a rare form of hereditary blindness that begins in infancy and typically worsens over time. The treatment developed by Spark Therapeutics is the first FDA-approved gene therapy to ever exist for a genetic disease. The novel therapy known as

February 2020

LUXTURNA treats patients with RPE65-associated Leber Congenital Amaurosis (LCA), an eye disorder caused by mutations in both copies of the REP65 gene, which alter a key vision-enabling protein. The newly FDA-approved therapy option, also known as gene replacement therapy, reverses the effects of this condition by replacing the mutated gene that causes the disease with a healthy copy of the gene. “Spark put a normal copy of

the human RPE65 gene into a virus that is designed to infect the right cells in order to make the right protein,” said Dr. Timothy Stout, retina surgeon at Baylor St. Luke’s and chair of ophthalmology and director of the Cullen Eye Institute at Baylor College of Medicine. “We then inject the virus underneath the retina in patients that have this condition and that’s how we can arrest the progression of the disease. The technology is remarkable because we can use a harmless-engineered virus to correct a blinding defect.” The FDA approved LUXTURNA in December 2017 after a phase three clinical trial in which patients Dr. Tim Stout and Dr. Roomasa Channa, retina surgeons at who received the drug could Baylor St. Luke’s Medical Center, during surgery. navigate an obstacle course at night significantly better than those wide of an area people can see, and who received a placebo injection. sight in dark conditions. RPE65-associated LCA patients who The most recent treatment have been treated with this novel in Houston was performed by gene therapy have seen improvements Baylor St. Luke’s retina surgeon Dr. in light sensitivity, visual field or how

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see Blindness...page 14


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Mental Health Drug Shows Promise for Treating Cognitive Problems and Inflammation In Gulf War Illness By Mary Leigh Meyer

T he compou nd, monosod iu m l u m i n o l , s h ow n t o i m p r o ve cognitive and mood function and reduce inflammation in a Gulf War illness model

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ulf War illness, or GWI, previously called Gulf War syndrome, is a collection of medically unexplained chronic symptoms that one-third of veterans who served in the first Gulf War experience even now, nearly 30 years later. This condition is characterized by central nervous system impairments—including cognitive and memory problems, mood dysfunction, sleep disorders and chronic fatigue—and systemic symptoms such as gastrointestinal problems and hypersensitive skin. With such a wide variety of symptoms, historically, experts have been unable to find a treatment for the illness. However, Ashok Shetty, PhD, professor with the Department of Molecular and Cellular Medicine at the Texas A&M College of

Medicine and associate director of the Institute for Regenerative Medicine, and his research team took a significant step forward with regard to treating this mysterious illness. Their findings, a result of a study funded by the Department of Defense, were recently published in Redox Biology. Modeling Gulf War illness During the war, veterans were exposed to multiple chemicals. Although the exact cause of Gulf War illness is unknown, it is generally understood that the combination of pyridostigmine bromide (an anti-nerve agent used as a pretreatment to protect troops from an attack with nerve gas agent), DEET (a mosquito repellant) and permethrin (a pesticide sprayed on clothes to keep rodents and insects away) played a significant role. “In our study, after administering the chemicals, the models presented Gulf War illness symptoms that closely resembled the symptoms veterans experience every day,” Shetty said. “They have memory problems,

concentration issues and depressive-like behavior. Furthermore, the models experienced similar systemic problems and the blood samples showed elevated levels of proinflammatory cytokines.” A previous study by Shetty showed proinflammatory cytokines— which, when in too great of a quantity can eventually deteriorate brain tissue and cause cognitive and mood problems—can be used as a reliable biomarker to determine the progression of the brain inflammation. Oxidative stress, free radicals and Gulf War illness Another previous study by Shetty

showed that the brain experiences increased oxidative stress and inflammation when suffering from Gulf War illness. Oxidative stress, or an accumulation of free radicals, can happen for a number of reasons. “Most GWI-related chemicals are acetylcholinesterase inhibitors, which are known to induce hyperexcitability in neurons and cause inflammation,” Shetty explained. “These hyperexcited neurons are caused by an excess of free radicals.” see Mental Health...page 13

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Traumatic Brain Injury Impairs Hormone Production, Disrupting Sleep, Cognition, Memory

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ore than 2.5 million people in the United States alone experience a traumatic brain injury, or TBI, each year. Some of these people are plagued by a seemingly unrelated cascade of health issues for years after their head injury, including fatigue, depression, anxiety, memory issues, and sleep disturbances. A collaborative team, led by Dr. Randall Urban, The University of Texas Medical Branch at Galveston’s Chief Research Officer and Professor of Endocrinology, has spent the past 20 years investigating this post-TBI syndrome. The team has learned more about how a TBI triggers a reduction in growth hormone secretion and why most TBI patients improve after growth hormone replacement treatment. The studies led to the

definition of the syndrome as brain injury associated fatigue and altered cognition, or BIAFAC, as recently described in a commentary published by Drs Urban and Brent Masel, UTMB Professor of Neurology, in the Journal of Neurotrauma. Detailed information on the team’s two most recent advances also in the Journal of Neurotrauma. The team’s work on brain injuries began in the late 1990’s when Galveston philanthropist Robert Moody asked the team whether TBI caused dysfunction of the hormones made by the brain’s pituitary gland and funded research for the study. His son, Russell, had suffered a serious TBI during a car accident and was seeking ways to improve the life of his son and others living with brain injuries.

The team has been building on the discovery that TBI triggers a long-term reduction in growth hormone, or GH, secretion that is linked with BIAFAC. Most TBI patients experience dramatic symptom relief with GH replacement therapy, but the symptoms return if the treatment stops. The researchers are trying to better understand BIAFAC and exactly how and why GH replacement works so well in order to develop new interventions. “We already knew that even mild TBI triggers both short-and

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long-term changes to functional connections in the brain,” said Urban. “GH administration has been extensively linked with both protection and repair of the brain following damage or disease, however we didn’t know much about the particular mechanisms and pathways involved.” They examined 18 people with a history of mild TBI and inadequate GH secretion. The subjects received GH replacement see Brain Injury ...page 13

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Healthy Heart Join American Heart Association’s Go Red for Women movement and Wear Red and Give during American Heart Month this February By American Heart Association

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hile 80 percent of cardiac events may be prevented, cardiovascular disease continues to be the leading cause of death in women, claiming the lives of one in three. It’s time to change this fact. This February – American Heart Month – the American Heart Association (AHA) and its Go Red for Women® movement, sponsored nationally by CVS Health and by Premier Local Sponsor BP America, is calling on women, and those they love, to support its efforts to improve the overall health of all women. BP America is also the sponsor of Houston Goes Red and has made a multi-year commitment to the organization, aiming to improve heart health in the Greater Houston area. Houstonians can celebrate National Wear Red Day on Friday, February 7, by wearing red to support heart health awareness and by giving to the AHA’s lifesaving mission throughout February.

The Go Red for Women movement is the trusted, passionate, relevant force for change to end heart disease and stroke in women. For 16 years, Go Red for Women has provided a platform for women to come together and improve the lives of all women everywhere. “It is an honor and real pleasure to serve this lifesaving mission in Houston,” said Melanie Gray, Go Red for Women leader. “I’ve seen firsthand how Go Red for Women has brought together volunteers and supporters from all walks of life to champion women’s health equity. I encourage all businesses to get involved in some way, by donating to the cause, encouraging employees to wear red and spread awareness, and encouraging healthy lifestyles.” In Houston, there are a variety of ways to support the American Heart Association’s Go Red for Women movement throughout February: Wear Red and Give

Celebrating

• Wear red on Friday, Feb. 7. If we can turn the city red, we can change the future. Purchase the iconic Red Dress Pin at ShopHeart.org. • Donate anytime during February at heart.org/HoustonWearRedDay Nearly 80 cents of every dollar donated is spent on research, education, and community outreach helping to save the lives of women and all the women we can’t live without. • Use #WearRedAndGive on social media. Go Red with CVS Health As part of CVS Health’s commitment to building healthier communities, the company has made

a three-year $15 million pledge to Go Red for Women. Customers can also help in the fight against heart disease and stroke by donating at the register or online at cvshealth.com/GoRed. Shop at Gordmans Gordmans (formerly Stage Stores) will donate 10 percent of their sales on Friday, February 7, to Go Red for Women, in honor of National Wear Red Day. Shop at one of their dozens of stores around Houston and show your support. Go to https://stores.stage.com/ to find a store near you. Chances are we all know someone affected by heart disease and stroke. Show your support this February – Wear Red and Give. 

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Financial Forecast Could the SECURE Act Make Your Retirement Savings More Vulnerable to Taxes? By Grace S. Yung, CFP Managing Director Midtown Financial Group, LLC

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ith the passage of the SECURE Act (Setting Every Community Up for Retirement Enhancement), investors and business owners now have some additional incentives that pertain to saving for the future. But even with a long list of advantages, one of the key “tradeoffs” with this legislation could result in a significant amount of your savings and investments going to taxes. There are, however, some actions you can take now to help. Pros and Cons of the SECURE Act In an effort to boost retirement savings in the U.S. and to help avoid a potential retirement crisis, the SECURE Act went into effect on January 1, 2020. Some of the highlights of this new legislation include:

WHAT WE OFFER:

• Continued contributions to traditional IRAs and retirement plans, even after age 70 ½ • Increased age for taking required minimum distributions (RMDs) from traditional plans from 70 ½ to 72 (but because the year you turn age 70 ½ can make a difference, it’s important to know when RMDs are required for you) • Allowance of qualified part-time employees to participate in employer-sponsored retirement plans • Penalty-free withdrawals from retirement plans for the birth or adoption of a child, and from 529 plans for paying off student loans • Deduction of unreimbursed healthcare costs that exceed 7.5% of adjusted gross income (in 2019 and 2020), and withdrawing funds from IRAs and qualified retirement plans to cover costs that exceed this threshold • More attractive provisions for small business owners to set up “safe harbor” retirement plans like 401(k)s

Even with all of the plusses that the SECURE Act provides, there is another provision that could benefit Uncle Sam far more than it does investors and their survivors. This is the elimination of the “stretch” IRA. Previously, when traditional IRA funds were inherited by a non-spouse beneficiary, the recipient was allowed to take withdrawals over a long period of time. This helped to ease the tax burden, and was especially beneficial to younger beneficiaries, because withdrawals could be based on the beneficiary’s life expectancy. This was referred to as a “stretch IRA”. Now with the passage of the SECURE Act, other than just a few exceptions, non-spouse beneficiaries must liquidate the account within just ten years of the account holder’s passing. Because of this, non-married couples who are each other’s

• Integrating the Montessori method into the public school curriculum • Currently offering Pre-K thru 4th • Open enrollment until positions fill

beneficiaries may want to reconsider tying the knot or update their estate plan to account for this new law. Ideas to Help Ease the Tax Burden One possible solution is to reconsider the structure of your estate plan. In some cases, it could make sense to enact changes to your beneficiary designation. Another option is to convert traditional IRA funds to a Roth IRA for tax-free inheritance. While taxes may be incurred on the conversion, this could result in significant tax savings later. Conversions do not always carry a heavy tax bill. One can make a Traditional IRA contribution and then immediately convert it to a Roth before there is any gain. That is one way to potentially reduce taxes. Another tax-advantaged strategy is life insurance. Proceeds of a life see Financial Forecast...page 14

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There is no wrong way to take a CME ethics course. FEATURED COURSES

CULTURALLY EFFECTIVE HEALTH CARE: Get tips and tools for increasing cultural effectiveness in your practice. This course is an essential guide for pediatric health-care providers in Texas. Earn ethics CME.

MOTIVATIONAL INTERVIEWING: Gain communication skills that can be used in the primary care setting to motivate children, adolescents, and families to make positive health changes, improve self-care for chronic conditions, and avoid highrisk behaviors. Earn ethics CME.

Join more than 100,000 medical professionals who get free CME with Texas Health Steps Online Provider Education. Choose from a wide range of courses relevant to your practice, including short tutorials and podcasts on topics like Medicaid guidelines, ethics and mental health — all available 24/7. Learn more at TXHealthSteps.com.

TRANSITION SERVICES FOR SPECIAL HEALTH-CARE NEEDS: Learn to develop and implement transition plans for patients with chronic health conditions or disabilities as they approach school age or adulthood. Earn ethics CME.

Content on the Texas Health Steps Online Provider Education website has been accredited by the Texas Medical Association, American Nurses Credentialing Center, National Commission for Health Education Credentialing, Texas State Board of Social Worker Examiners, Accreditation Council for Pharmacy Education, UTHSCSA Dental School Office of Continuing Dental Education, Texas Academy of Nutrition and Dietetics, Texas Academy of Audiology, and the International Board of Lactation Consultant Examiners. Continuing Education for multiple disciplines will be provided for some online content.

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Memorial Hermann Appoints Erin Asprec as Executive Vice President, Chief Operating Officer

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emorial Hermann Health System has named Erin Asprec as its new Executive Vice President and Chief Operating Officer (COO). Asprec will lead the organization’s operations, service lines, clinical transformation and consumer experience, providing executive oversight for all of its 17* hospitals and more than 300 outpatient clinics. Asprec’s promotion comes as part of an evolved organizational structure and service line operating model driven by Memorial Hermann’s new vision: To create healthier communities, now and for generations to come. “The future of health care is creating value for consumers, and Memorial Hermann is making intentional and strategic steps in that direction,” said Memorial Hermann President & CEO David Callender,

Houston Methodist Clear Lake Opens New Cardiac Catherherization Lab

MD. “Adapting to a service line operating model will enable us to create exceptional experiences while delivering s a f e , h i g hquality, costeffective care that is Erin Asprec coordinated and seamless across the care continuum. I can’t think of a better person to direct this effort than Erin, a talented and trusted leader who is known for her ability to partner with clinical leaders under a common vision and bring innovative consumer-

see Memorial Hermann...page 13

Houston Methodist Clear Lake Hospital cath lab team

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he new cath lab has doubled in size and incorporates the latest and most sophisticated technology. This includes a biplane interventional imaging system, which uses two rotating digital X-ray cameras to provide the most detailed, three-dimensional blood vessel and soft tissue images available – while drastically reducing patient exposure; all configurable to the performing physician’s preferences. The cardiac cath lab’s newest feature is its expanded

electrophysiology capabilities to test and treat the heart’s electrical activity. Cath labs are used for a wide range of cardiac procedures, including coronary angiography, a ngiopla st y, percuta neou s co ro n a r y i nter ve nt io n, a nd specialized treatment for dangerous pulmonary emboli, or blood clots that rob the lungs of circulation. In addition, cardiologists use the lab for performance of endovascular see Methodist...page 14

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5 Food Groups to Avoid If You Want To Lower Your Cancer Risk By Heather Alexander

Let’s face it, it can be hard to stick to a healthy diet. If you do fall off the wagon, be sure to avoid these foods if you are concerned about your cancer risk.

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deally we would all follow a diet that’s best for cancer prevention. A plant-based diet is proven to reduce your risk for this and other diseases. But it’s rare to find anyone who can always stick to only vegetables, whole grains and fruits with lean proteins like chicken, fish and beans. We talked to our MD Anderson Employee Wellness Dietitian Lindsey Wohlford to find out which foods you should be sure to avoid. Wohlford says

components,” says Wohlford. “A lot of them also contain quite a bit of sodium. And eating too much sodium is linked to stomach cancer.” Alcohol When your body processes alcohol, it releases a chemical called acetaldehyde. This chemical damages your DNA, which can cause your cells to start growing out of control. This is what creates tumors. “Alcohol is linked to esophageal, liver, breast, colorectal and other cancers. So it’s a lot of them,” says Wohlford. For cancer prevention, it’s best to not drink any alcohol. Charred meat

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Call us today! choose the foods for your cheat days carefully, and stay away from these five worst foods for cancer risk. 5 worst food groups for cancer Processed meats Processed meats are meats that have been preserved by salting, smoking or curing. They include bacon, hot dogs, beef jerky and deli meats like ham and pepperoni. Deli turkey slices are also off-limits. If you eat even small amounts of these meats, it increases your cancer risk. Research shows that if you eat two slices of ham daily, your risk for colorectal cancer increases by at least 16%. Processed meats are risky because they contain preservatives like nitrates and nitrites. Both are linked to cancer. Nitrate-free meats are available, but they are not necessarily any better. “The other issue with a lot of these processed meats is that they’re heated to high temperatures, which can produce other cancer causing

Meat that is cooked at high heat, burnt or charred has been linked to cancer. That’s because the high temperature creates chemicals called HCAs and PAHs, which are carcinogens. When you’re cooking animal protein, use low-heat methods like baking. You also can try moist heat methods like braising or stewing. “These cooking methods do not raise the temperature high enough to char the meat and create those cancer-causing compounds,” Wohlford says. Sugar-sweetened beverages Evidence suggests that drinking sugary drinks, like soda and fruit juice, leads to weight gain. And being overweight or obese increases your risk for several cancers. “The issue here is that these drinks are so easily consumed and they are a lot of calories,” says Wohlford. If your drinks are high in see Cancer Risk...page 14

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CVS Health Debuts HealthHUB Locations to Serve Greater Houston Community

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ndividuals and families in Greater Houston can now experience health care that is simple, convenient and affordable with the debut of HealthHUB, CVS Health’s new store design in 15 CVS Pharmacy locations across the community. During a ribbon-cutting event at the company’s HealthHUB location at 5402 Westheimer Road in Houston, the community celebrated the new, innovative store format that features a broader range of health care services to help patients better manage chronic conditions; more products and services focused on overall health and wellness; and trusted advice and personalized care, all with the ease of walking into a local CVS Pharmacy. “Helping people get well and stay well is at the heart of everything we do, and that is the focus of our new HealthHUB stores here in Houston,” said Jeffrey Schmidt, Senior Vice President, CVS Pharmacy. “Customers tell us they want local access to convenient, personalized and integrated health care. Our HealthHUB locations do just that helping to elevate the store into a community-based health care destination where consumers can engage people they trust, who are accessible and knowledgeable, to help bring everything together in a better health experience at a lower cost.” CVS Health began piloting HealthHUB locations last year to overwhelming customer satisfaction. The introduction of 15 HealthHUBs in Houston is part of the company’s strategy to scale the program nationally with plans to have up to 1,500 locations operating throughout the U.S. by the end of 2021.

“Patients deserve the coordinated care and tools necessary to manage their chronic conditions and easily determine what is best for their health,” said State Representative Jim Murphy, who helped to dedicate the new stores. “I applaud CVS Health for creating a new front door to health care, and see a significant upside for the people of Houston seeking access to quality, affordable care under one roof.” For many Americans, health care can be difficult to navigate. At a time when chronic disease continues to grow in prevalence and impact in the U.S., patients are also facing complexities and fragmentation when seeking the right care. Today, one in two Americans has at least one chronic illness, with data showing that close to $500 billion of the costs associated with chronic disease are avoidable. What’s more, nine out of 10 (91%) patients say they need more help with chronic disease management. The HealthHUB store format was developed to help people manage chronic conditions more conveniently and affordably by improving the overall patient experience and featuring a wide array of health and wellness products, clinical services and expertise. “We are delivering real change to the health care system,” said Alan Lotvin, M.D., Chief Transformation Officer for CVS Health. “Through HealthHUBs, consumers are at the center of an unmatched retail health experience. The HealthHUB products and services are designed specifically with the consumer’s health needs, challenges, and goals in mind, so that they can easily receive coordinated, personalized care in a familiar, neighborhood location.”

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Monitoring Program

barbiturates or carisoprodol include, Prescribers and pharmacists but are not limited to: are further permitted to designate an unlimited number of delegates to • Physicians access patient prescription data and • Dentists generate reports on their behalf. Every Continued from • Podiatrists individual is required to register with page 1 PMP as a separate user, however all • Optometrists delegate queries are attributed to the Individuals who are provided • Advance Practice Nurses prescriber or pharmacist for whom they access to PMP and who are subject • Physician Assistants generate the report. Eligible prescriber to the new requirements regarding delegates include nurses, medical accessing PMP prior to prescribing or • Pharmacists residents, administrative staff, etc. dispensing opioids, benzodiazepines,

Mental Health

Continued from page 5 Free radicals are uncharged molecules with an unpaired electron. Therefore, Shetty looked toward an existing drug known to balance out the free radicals by bringing the body back to normal levels as a solution. Although not FDA-approved in the United States, monosodium luminol has been tested for use with cancer patients in Europe and Russia. “The drug is a redox balancing drug, as it can donate and receive electrons. In other words, it maintains redox homeostasis, or an equilibrium of free radicals,” Shetty said. “When a shift in the balance of free radicals occurs, oxidative stress happens.” Measuring the cognitive function During the study, the research team administered the drug at

Brain Injury

Continued from page 6 in a year-long, double-blind, placebo-controlled study and were assessed for changes in physical performance, resting metabolic rate, fatigue, sleep quality, and mood. Functional magnetic resonance imaging was also used throughout the year to assess changes in brain structure and functional connections. The study showed that GH replacement was linked with increased lean body mass and decreased fat mass as well as reduced fatigue, anxiety,

Pharmacists may only delegate this responsibility to pharmacy technicians. Prescribers, and their delegates, who are not currently registered with PMP, should do so prior to March 1, 2020, so that they are positioned to access PMP, with respect to a patient, before prescribing opioids, benzodiazepines, barbiturates or carisoprodol.

different doses for several weeks. They measured the levels of oxidative stress, inflammation and cognitive function. Oxidative stress and inflammation can be quantitatively assessed through various markers in the body. However, cognitive function cannot. To decrease the subjectivity of measuring cognitive function, the team used three tests. First, they tested the hippocampus via the object location test. This test investigates the ability to discern minor changes in the environment. The second test, called the pattern separation test, measures ability to distinguish similar, but not identical experiences. For the third test, the researchers conducted a depression test to measure the amount of depressive-like behavior in the models. Monosodium luminol’s impact All three of these tests measured common cognitive issues veterans with

Gulf War illness experience: problems with working memory, memory recall and depression. As expected, the models had difficulty with all three tests. However, the models that received the drug tested close to normal levels of cognitive function with all of these tests. Similarly, the monosodium luminol brought the elevated oxidative stress and inflammation levels back within normal range. “We measured the oxidative stress markers in the blood and they were normalized,” Shetty said. The drug helped both the cognitive and systemic symptoms in the models of Gulf War illness. “When you have inflamed conditions in the hippocampus, neurogenesis—the production of new neurons—goes down,” Shetty said. “We know people with depression and Gulf War illness have very low levels of neurogenesis. Low levels of

neurogenesis are related to depression, problems in making new memory and cognition.” Shetty said neurogenesis actually increased in the models after taking this drug. The next step Presently, the drug is not approved by the U.S. Food and Drug Administration (FDA), but there is a pharmaceutical company conducting the required tests to get approval for monosodium luminol to be administered in the United States. Furthermore, the Department of Defense is backing several studies with this drug. “From what we can tell right now, this drug does not seem to have any side effects,” Shetty said. “Theoretically, if this drug gets approved for use in the United States, this drug would need to be taken every day to maintain that redox homeostasis and, hopefully, be a solution for many of our veterans suffering from this illness.”

depression and sleep disturbance. It was also found, for the first time, that these improvements were associated with better communications among brain networks that have been previously associated with GH deficiency. They also noted increases in both grey and white matter in frontal brain regions, the “core communications center of the brain,” that could be related to cognitive improvements. “We noticed that TBI patients had altered amino acid and hormonal profiles suggesting chronic intestinal inflammation, so we recently completed a trial to investigate the role of the gut-brain axis in the long-lasting

effects of TBI,” said Urban. “We compared the fecal microbes of 22 moderate/severe TBI patients residing in a long-term care facility with 18 healthy age-matched control subjects, identifying disruptions of intestinal metabolism and changes in nutrient utilization in TBI patients that could explain the reduced growth hormone function.” The results suggest that the people with TBI-related fatigue and altered cognition also have different fecal bacterial communities than the control group. Urban said that the findings suggest that supplementing or replacing the dysbiotic intestinal

communities may help to ease the symptoms experienced after TBI. “These two studies further characterize BIAFAC and act as a springboard for new treatment options,” said Urban. “We hope that the publications will focus the collective wisdom of the research community to better understand and treat this syndrome, providing hope for many. Because these symptoms can manifest months to years after the initial injury and as this cluster of symptoms hasn’t been previously grouped together, it often goes unidentified in the medical community.” 

Hermann has always been at the forefront of industry changes, and this transition to expand value-based care in Houston exemplifies our continued commitment to improving the health of the communities we serve. I look forward to helping Memorial Hermann fulfill its vision for the future and set new standards for health care here and beyond.” Asprec has been recognized by the Houston Business Journal as

one of Houston’s “Women Who Mean Business” and selected among the “Most Powerful and Influential Women in Texas” by the National Diversity Council, among other honors. She is a member of the Executive Committee and Board of Directors of the Texas Hospital Association, and has served in several healthcare and community board capacities. She holds a master’s degree in Healthcare Administration from St. Louis University.

Memorial Hermann Continued from page 10

focused solutions to the organization.” For more than 15 years, Asprec has held integral roles within the Memorial Hermann Health System, including key leadership positions— most recently as Chief of Acute Care Services and Chief Transformation Officer, guiding the strategic,

Page 13

operational and financial management of Memorial Hermann’s extensive network of care delivery sites. “I am profoundly touched by this appointment and proud to help shepherd this significant and essential transformation for our System,” said Asprec. “Memorial

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February 2020


Page 14

Blindness

Continued from page 4 Roomasa Channa on three siblings from Georgetown, Texas, who were all born with the same condition caused by mutations in the REP65 gene. “These kids have grown up not seeing things we take for granted, such as stars in the night sky or their parents’ faces,” said Channa, who also is an assistant professor of ophthalmology at Baylor College of Medicine. “It’s great to hear their stories and the additional things they can slowly start to see after the procedure. Importantly, the therapy corrects the genetic defect and prevents further damage and loss of vision.” “The team of doctors at Baylor St. Luke’s and Baylor College of Medicine

Financial Forecast

Continued from page 8 insurance policy are tax-free. One can use funds earmarked for an IRA contribution or RMDs to fund life insurance if one’s goal is to have their beneficiary inherit tax-free funds. Moving and changing retirement funds is not a do-it-yourself project, as there could be taxes and/or penalties involved. So, before moving forward with any strategies, it is recommended

Methodist

Continued from page 10 thrombectomies, removing deadly coronary obstructions. “The expansion of our cath

Cancer Risk

Continued from page 11 calories, it makes it much harder for you to achieve energy balance. That is when you take in the same amount of calories as you burn off in physical activity or exercise. When you take in more calories than you burn off, it leads to weight gain. Processed foods Almost all diets will tell you to avoid processed foods and there is a good reason for that. People who eat processed foods tend to eat as much as 500 more February 2020

Houston Medical Times

has been incredible; especially Dr. Channa and Dr. Stout,” said Esther Owofade, the children’s mother. “They have been very kind and supportive throughout the process. We have started seeing differences in their vision, and for that, I’ll be forever grateful.” LUXTURNA is the first directly administered gene therapy approved in the United States that targets a disease caused by mutations in a specific gene. This latest advancement signals the potential of gene therapy to successfully treat additional retinal genetic diseases for which there are no other treatments. “There are millions of people who have problems with the other 300 genes that function as moving parts of the retina,” said Stout, who also was

a co-investigator in the 2017 clinical trials that led to the FDA approval of LUXTURNA. “We should treat genetic diseases for which we have no other treatments with gene replacement therapy. It might not cure this disease, but it seems to work well in reverting or stopping the progression.” Channa and Stout along with Dr. Christina Weng and Dr. Tahira Scholle, who both also are with Baylor College of Medicine, are the only retina surgeons in Texas specialized and trained to treat patients with RPE65 deficiencies with this latest gene therapy advancement. They have treated approximately a dozen of patients from around the world since LUXTURNA gained FDA approval in 2017.

that you discuss your options with a CERTIFIED FINANCIAL PLANNER who is well-versed in both the financial and tax aspects. Traditional IRA account owners should consider the tax ramifications, age and income restrictions in regards to executing a conversion from a Traditional IRA to a Roth IRA. The converted amount is generally subject to income taxation. The Roth IRA offers tax deferral on any earnings in the account. Withdrawals from the account may be tax free, as long as they are considered qualified. Limitations

and restrictions may apply. Withdrawals prior to age 59 ½ or prior to the account being opened for 5 years, whichever is later, may result in a 10% IRS penalty tax. Future tax laws can change at any time and may impact the benefits of Roth IRAs. Their tax treatment may change. This information is not intended to be a substitute for specific individualized tax advice. We suggest that you discuss your specific tax issues with a qualified tax advisor. Securities offered through LPL Financial, Member FINRA/SIPC 

lab is a major step forward in the growth of our cardiovascular care at Houston Methodist Clear Lake,” said CEO Dan Newman. “The additional space enables us to respond quickly to patient needs for cardiac studies

and interventional procedures, our advanced technology gives physicians the in-lab imaging diagnostic capabilities needed today’s complex treatments.”

calories a day than people who eat freshly prepared meals. This can be because these foods are high in calories. Or the foods are low in nutrients and not very satisfying, which means you eat more of them. Any food that comes in a bag or box is generally processed. That includes chips and other snacks, frozen French fries or nuggets and fast food burgers. It also includes foods that can seem healthy like breakfast cereal and pasta sauce. “Processed foods typically lead to weight gain, obesity and then there is that cancer link,” says Wohlford.

As well as the extra calories, processed foods often include more sugar and salt. Maintain a healthy weight Two out of every 10 cases of cancer are linked to excess body weight, alcohol use, poor diet or physical inactivity. That is almost as much as cigarette smoking. If you want to reduce your risk for cancer, it is essential to maintain a healthy weight through diet and exercise. Aim for 150 minutes of moderate or 75 minutes of vigorous exercise each week and eat a plant-based diet.

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