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

HOUSTON

Volume 9 | Issue 9

Inside This Issue

September Edition 2019

Study Finds Lead in Drinking Water in Some Eastern Houston Homes

Older Homes with Lead Pipes, In Conjunction with the Chemicals Used During the Water Purification Process, Underlie Problem By Rae Lynn Mitchell

A MEDVAMC earned the “LGBTQ Health Care Equality Leader” designation from the Human Rights Campaign See pg. 11

INDEX Legal Matters........................ pg.3 Mental Health...................... pg.5 Oncology Research......... pg.6 Healthy Heart..................... pg.10

Age Well Live Well See pg. 12

ccording to a study conducted by the World Health Organization, lead exposure over time affects multiple body systems and is extremely harmful to children. Lead exposure is the cause behind the Flint Water Crisis in Michigan, but practices that led to the water contamination in Flint are also happening in communities in Houston, Texas. While much attention is given to Flint, researchers at the Texas A&M School of Public Health, College of Architecture and College of Geosciences discovered lead contaminated water in residential areas through a pilot study along the Houston Ship Channel. In work published in the International Journal of Environmental Research and Public Health, Garret Sansom, PhD, research assistant professor in the Department of Environmental and Occupational Health at the School of Public Health, led a study in Manchester, a low-income neighborhood along the Houston Ship Channel plagued with numerous issues including flooding, air pollution and health concerns. Natural disasters, such as Hurricane Harvey, increase the risk of exposure to lead in this area. Previous research has shown low-income minority communities have an increased risk of lead exposure, but few studies have examined the environmental justice factors of these communities. Manchester is located in eastern Houston and considered an industrial site, known for generating and storing hazardous waste and discharging large amounts of air pollution. Manchester is one of several communities along

the Houston Ship Channel, with 98 percent of this population being minority. Only 6 percent of residents have obtained bachelor degrees, and the median income is one-third lower than the city of Houston overall, according

indicated having concerns about their water. 75 percent of the residents who had concerns actually had lead in their water. Overall, 30 percent of the homes sampled had lead in the water, with 25 percent of these homes having children. Older homes with lead pipes, in conjunction with the chemicals used during the water purification process, are the underlying cause of lead contaminated water in Manchester. “The water purification process in Houston uses chlorine and chloramines to purify tap water,” Sansom said. “However, these chemicals change the composition of the water, so that when it flows through old piping, it causes the pipes to leech lead into the drinking water.” According to Sansom, replacing pipes in homes with older infrastructures is very costly for citizens and is beyond the means of most living in low-socioeconomic communities. The best long term solution is a lead abatement program,

Researchers at the Texas A&M School of Public Health, College of Architecture and College of Geosciences discovered lead contaminated water in residential areas through a pilot study along the Houston Ship Channel. to the City of Houston Planning and Development Department. Researchers collected surveys from 13 randomly selected residents and collected tap water samples from 22 households. Researchers found that 30.8 percent of respondents

see Drinking Water... page 14

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Houston Medical Times

Legal Matters 340b Payment Reductions and Remedies for Urban Hospitals According to the 2020 OPPS proposed rule, CMS’s payment policies for 340B drugs and biosimilars would remain unchanged: 1. Continue to pay average sales price (ASP) minus 22.5% for all separately payable, non-pass-through 340B By Kyle Vasquez, J.D. drugs and nonpass-through Lidia M. Niecko-Najjum, J.D. biosimilar biological products JD Polsinelli, PC (biosimilars); and ecently, the Centers for Medicare 2. Continue to make all biosimilars and Medicaid Services (CMS) eligible to apply for temporary released several highly-anticipated pass-through payment at ASP plus proposed Medicare payment rules: the 6% of the reference product’s ASP. CY 2020 Medicare Hospital Outpatient CMS’s Average Sales Price Prospective Payment System (OPPS) (ASP) minus 22.5% payment rate is Proposed Rule, the Medicare Physician a continuation of a reduced payment Fee Schedule (PFS) CY 2020 Proposed rate CMS established in its CY 2018 Rule, and the End Stage Renal OPPS Final Rule and expanded in its Disease (ESRD) and Durable Medical CY 2019 OPPS Final Rule. Following Equipment Prosthetics, Orthotics and a challenge from a group of hospital Supplies (DMEPOS) CY 2020 Proposed associations and nonprofit hospitals, Rule. While the rules contain a variety the D.C. District Court ultimately held of proposed payment changes for CY that the reimbursement cuts to Part B 2020, below are key updates affecting 340B drugs in 2018 and 2019 were both 340B Program covered entities. unlawful. Although the Court granted Hou_Med_times_ad_7_2019.pdf 1 7/22/19 3:16 PM Part B 340B Drug Payment Rates an injunction, it refused to vacate the

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rules and remanded the issue back to CMS to take the first crack at crafting appropriate remedial measures. The case is now on appeal before the D.C. Circuit Court of Appeals. In the meantime, CMS continues to reimburse applicable covered entities at ASP minus 22.5% and require reporting of applicable modifiers. The Good News and Potential Comment Areas While CMS continues to propose the same reimbursement methodology for 340B drugs that was previously held unlawful by a D.C. District Court on two occasions, the 2020 OPPS Proposed Rule indicates that CMS is actively considering its options should CMS ultimately lose on appeal: 1. Appropriate payment rate. CMS is soliciting comments on whether a rate of ASP plus 3% could be an appropriate remedy for underpaid CY 2018 and 2019 claims, and an alternative to the proposes CY 2020 payment rate of ASP minus 22.5%.. Notably, CMS cited to the District Court’s December

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27, 2018 opinion supporting the proposition that a payment reduction of between 0.2-2.9% is “not significant enough” to fall outside the Secretary’s authority to “adjust” ASP. 2. Structuring the remedy. CMS is requesting comments on (i) whether such a remedy should be retrospective in nature (e.g., made on a claim-by-claim basis), (ii) whether such a remedy could be prospective in nature (e.g., an upward adjustment to 340B claims in the future to account for past underpayments) or (iii) whether there is a different mechanism that could produce equitable results while respecting budget neutrality. see Legal Matters...page 14

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Houston Medical Times

Women at Higher Risk For Brain Aneurysms By Hannah F. Pietsch

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aneurysms are most common between the ages of 35 and 60, they can still exist at any age. A woman with any of these risk factors should reduce her risk by quitting smoking, reducing alcohol consumption, working with her doctor to safely manage blood pressure and talking with her doctor about her family history of aneurysms. “Even if a woman has none of these risk factors, she’s still at risk for a brain aneurysm due to her gender,” said Britz, chairman of the Houston Methodist Hospital department of neurosurgery. “Lindsay is the perfect

example of this. She had none of the known risk factors. That’s why all women should be familiar with the warning signs – a sudden severe headache or head pain, a very stiff neck, sudden vision changes, hearing or feeling a loud ‘snap’ in their head, or any of these symptoms coupled with nausea or vomiting.” After feeling the snap in her head, Bowerman managed to call her father who happened to be close by. When he arrived five minutes later, he found see Aneurysm...page 14

RELAX

indsay Bowerman was sitting at her kitchen table preparing to take her sons to their swim lessons when she felt a “snap” in her head that was immediately followed by intense pressure and the worst pain she had ever experienced. The healthy 36-year-old woman had just suffered a ruptured brain aneurysm. Lindsay Bowerman had none of the known risk factors for a ruptured brain aneurysm when she suffered one in June 2018. Women are one and one half times more likely than men to suffer a ruptured brain aneurysm. Bowerman says she’s thankful she survived and gets to see her six and four-year-old sons grow up. A brain aneurysm is a when a weak spot on an artery balloons out and fills with blood. It is estimated that more than 6 million people in

the United States have an unruptured brain aneurysm, with approximately 30,000 rupturing each year. Forty percent of ruptured brain aneurysms lead to death, and women are one and one half times more likely to have brain aneurysms than men. “While we don’t know the reasons why, women are more likely to have brain aneurysms than men,” said Gavin Britz, M.D., a Houston Methodist neurosurgeon and director of the Houston Methodist Neurological Institute. “So it’s really important for women to know the risk factors and take steps to reduce their risk.” Smoking, high blood pressure, and heavy alcohol consumption can increase a woman’s risk of suffering a ruptured brain aneurysm. Having an immediate family member with an aneurysm could also indicate that a woman is at higher risk. While

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Houston Medical Times

Mental Health Adults Who Mix Cannabis with Opioids for Pain Report Higher Anxiety, Depression They Have More Mental Health Issues Than Those Who Use Opioids Alone

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researcher from the University of Houston has found that adults who take prescription opioids for severe pain are more likely to have increased anxiety, depression and substance abuse issues if they also use marijuana. “Given the fact that cannabis potentially has analgesic properties, some people are turning to it to potentially manage their pain,� Andrew Rogers, said in describing the work published in the Journal of Addiction Medicine. Rogers focuses on the intersection of chronic pain and opioid use, and identifying the underlying psychological mechanisms, such as anxiety sensitivity, emotion regulation, pain-related anxiety, of these relationships. Rogers is a doctoral student in clinical psychology who works in the UH Anxiety and Health Research Laboratory and its Substance Use Treatment Clinic. Under the guidance of advisor Michael Zvolensky, Hugh Roy and

Lillie Cranz Cullen Distinguished University Professor of psychology and director of the lab and clinic, Rogers surveyed 450 adults throughout the United States who had experienced moderate to severe pain for more than three months. The study revealed not only elevated anxiety and depression symptoms, but also tobacco, alcohol, cocaine and sedative use among those who added the cannabis, compared with those who used opioids alone. No increased pain reduction was reported. Importantly, said Rogers, while the co-use of substances generally is associated with poorer outcomes than single substance use, little work has examined the impact of mixing opioids and cannabis. Opioid misuse constitutes a significant public health problem and is associated with a host of negative outcomes. Despite efforts to curb this increasing epidemic, opioids remain the most widely prescribed class of

Celebrating

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medications. Prescription opioids are often used to treat chronic pain, despite the risks, and chronic pain remains an important factor in understanding this epidemic. Cannabis is another substance that has recently garnered attention in the chronic pain literature, as increasing numbers of people see Mental Health...page 14

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Oncology Research Fresh, Seasonal, and Local: Three Ways Eating with the Harvest Improves Your Health By Leslie Gutierrez, AGACNP-BC, APRN, MSN Texas Oncology– Houston Memorial City

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omatoes, peppers, peaches, and strawberries. It wouldn’t be summer in Texas without our popular fresh fruits and vegetables. But the joy – and the results – of gardening, along with major nutritional benefits can be experienced in all seasons. Think butternut squash and pumpkins in the fall. Lettuce, spinach, and broccoli in colder weather. Eating with the seasons means different things to different people. Locally fresh and available produce can vary based on whether you reside in a rural area or a city, and the region in which you live. Your local climate will also impact the types of produce available to you.

But whether you’re hitting up your local farmer’s market, scanning the aisles of the grocery store, or growing a garden in your backyard, choosing fresh, in-season produce offers health benefits at any age and stage of life. Here are three things you should know about eating with the seasonal harvest. Fresh produce contributes to lower cancer risk as part of a plant-forward diet. The connection between diet and cancer risk is an important topic we often hear about in the news and from our physicians. What and how much we eat matters. The World Cancer Research Fund has estimated that roughly 20 percent of all cancers diagnosed in the United States are related to poor nutrition, excess body weight, and physical inactivity. Nutritionists recommend eating more cruciferous vegetables such as cauliflower, broccoli, and Brussels sprouts, along with berries, and leafy green vegetables, all of which rate high

in essential vitamins and nutrients. A diet rich in seasonal produce can transform the way we think about food. A well-balanced diet full of nutrients that lower the risk of disease is important to overall well-being and critical to preventing and fighting cancer. “Eating the rainbow” refers to eating a colorful diet rich in fruits and vegetables. Guidelines from the American Institute for Cancer Research (AICR) help make it easy to remember. Its recommendation includes the “two-thirds” rule, meaning two-thirds or more of your plate should comprise vegetables, fruits, beans, or

whole grains, and one-third or less of the plate can be a small portion of protein. Eating fruits and vegetables may help you regain strength after cancer treatment. Our dietary needs change at different stages in life, and this is also true for those with cancer. During cancer treatment, the cancerous cells are killed but sometimes healthy cells are damaged too. This can cause side effects that lead to eating problems, according to the National Institutes of Health (NIH). While going through see Oncology Research...page 14

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Houston Medical Times

Study Proves Hepatitis C Drugs Reduce Liver-Related Deaths by Nearly Half By Patrick McGee

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new study from the UT Southwestern Simmons Comprehensive Cancer Center demonstrates that antiviral drugs for hepatitis C reduce liver-related deaths by nearly 50% in patients with a history of liver cancer. The finding builds on a December 2018 study by the same researchers who found that antiviral drugs do not increase the risk of liver cancer recurrence, as was previously feared. Dr. Amit Singal’s study was published in the journal Gastroenterology on July 30. Dr. Singal is an Associate Professor of Internal Medicine, Medical Director of the UT Southwestern Liver Tumor Program, and Clinical Chief of Hepatology. He collaborated on these studies with Dr. Caitlin Murphy, Assistant Professor of Population and Data Sciences and Internal Medicine. They are both members of the Harold C. Simmons Comprehensive Cancer Center at UT Southwestern.

Their studies overturn prior misconceptions that made doctors reluctant to prescribe direct-acting antivirals to treat hepatitis C in patients with a history of liver cancer. Many doctors previously believed that hepatitis C, for all its harmfulness, activates the immune system when it infects the liver, and the immune system kept liver cancer recurrence at bay. But this notion appears to be false. Drs. Singal and Murphy studied nearly 800 patients from 31 medical centers across the country and found that the drugs are not only safe, they decrease death from cirrhosis and liver cancer by 46%. “Not only are these drugs safe in this patient population, but we have now demonstrated that they are helpful,” Dr. Singal said. “Our study changes the paradigm from you could treat a patient’s hepatitis C to you should treat it.” Dr. Carlos L. Arteaga, Director of the Simmons Cancer Center, said the study’s scope and impact are something that can only be produced by a National

Cancer Institute-designated Comprehensive Cancer Center. “Dr. Singal had more patients involved in the study than any other participating site. As an epidemiologist, Dr. Murphy brought rigor to the data that removes prior doubt on this issue,” he said. Dr. Murphy said previous studies compounded the misunderstandings of direct-acting antiviral therapy because they, among other things, failed to account for the timing of therapy relative to liver cancer diagnosis, did not include a comparison group, or did not properly consider clinical differences among patients. The new study is a significant contribution because it clears the path to beneficial drug treatment. “Hepatitis C therapy is so important because it provides a cure,” Dr. Singal said. “You take oral medications for two or three months, with minimal to no side effects, and you’re done. You’re cured of hepatitis C. There’s less than a 1% chance of relapse if you’re cured of hepatitis C.” Defeating hepatitis C is an important step because infection can otherwise lead to cirrhosis – scarring of the liver – which can be deadly.

Cirrhosis can increase the risk for liver cancer, which also may be fatal. Curing hepatitis C with antivirals breaks the first link in a deadly chain of events and can lead to improvement in liver function among those who have previously developed cirrhosis. The disease can lie dormant for 25 to 30 years and resurface as a lifethreatening specter years after someone has stopped using drugs and turned to a healthy lifestyle. Hepatologists saw an alarming spike in cirrhosis as baby boomers aged. By 2017, The New York Times called hepatitis C “an enormous public health problem.” In 2018, the Centers for Disease Control and Prevention announced there were nearly 2.4 million people living with hepatitis C in the U.S. “Dr. Singal’s and Dr. Murphy’s study reports a welcome, fact-based way to oppose the adverse effects of hepatitis see Hepatitis C...page 13

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Healthy Heart High-Intensity Step Training Boosts Stroke Survivors’ Walking Skills By American Heart Association

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igh-intensity step training that mimics real-world conditions may better improve walking ability in stroke survivors compared to traditional, lowimpact training, according to new research published in the American Heart Association’s journal Stroke. The recent research is vital for residents of Houston, a city that is part of the Stroke Belt, a medical nickname given to describe an 8-state region with high stroke mortality across the southeastern United States. The suggestion of the research is that stroke patients can perform higher intensity walking exercises and more difficult tasks than previously thought possible. The idea is for patients to move beyond traditional, lowintensity rehabilitation to challenge the nervous and cardiovascular systems so patients can improve function and perform better in the real world. “People who suffer strokes often have difficulty walking and impaired

balance. Rehabilitation after a stroke traditionally focuses on patients practicing low-intensity walking, usually only in a forward direction, which does not provide enough of a challenge to the nervous system to enable patients to negotiate real-world situations, such as uneven surfaces, stairs or changing direction,” said study author T. George Hornby, Ph.D., professor of physical medicine and rehabilitation at Indiana University School of Medicine in Indianapolis. Participants received training of either high-intensity stepping performing variable, difficult tasks; high-intensity stepping performing only forward walking; or low-intensity stepping of variable tasks. Variable tasks included walking on uneven surfaces, up inclines and stairs, over randomly placed obstacles on a treadmill and across a balance beam. Researchers evaluated 90 people, 18- to 85-years-old with weakness on one side of the body who had survived a stroke at least six

months prior. The study was small compared to larger, multicenter clinical trials. Hornby said the next step would be to test high-intensity, variable step training in larger patient populations in a large, multicenter clinical trial. This is what the researchers found: • Survivors in both the highintensity, variable training and high-intensity, forward walking groups walked faster and farther than the low-intensity, variable training group. • For all walking outcomes, 57% to

80% of participants in the highintensity groups had important clinical gains, while only 9% to 31% of participants did so following low-intensity training. • High-intensity variable training also resulted in improved dynamic balance while walking and improved balance confidence. Ultimately, the goal is to incorporate high-intensity variable step training into regular clinical rehabilitation protocols.

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Financial Forecast Will More Flexibility in Your Retirement Plan End Up Costing You? It Could with the Passage of the Secure Act By Grace S. Yung, CFP Managing Director & Wealth Advisor Midtown Financial Group, LLC

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hen it comes to your retirement savings, there are a number of risks that could impact the amount of money you will have available to spend in the future. These can include things like market volatility, inflation, taxes, etc. Now, there is another potential lurking around the corner that can negatively impact your retirement plan as well, the pending legislation referred to as the Secure Act. Why the Secure Act May Not Be as Beneficial as Investors Think The Setting Every Consumer Up for Retirement Enhancement, or SECURE, Act is a bipartisan bill designed for aiding Americans’ ability

to save for retirement. This legislation could help investors to ultimately save more for the future, while at the same time reducing IRS penalties for making early withdrawals from tax-advantaged accounts. Some of the highlights of the Secure Act include: • Tax credits for small businesses that offer 401(k) plans to their employees; • Eligibility for retirement benefits for certain part-time employees; • Approval to continue making contributions into certain retirement plans beyond age 70 ½; • Raising the age to start taking required minimum distributions from certain retirement plans from age 70 ½ to 72; • Penalty-free withdrawals – up to a maximum dollar amount – when a retirement plan participant has or adopts a child and / or when a 529 plan holder uses the funds for repaying various types of student

loans; • Relaxed rules for businesses that offer annuities in their sponsored retirement plans; and • Revision of some areas of the Tax Cuts and Jobs Act where benefits received by students, heirs of deceased veterans, and some Native Americans were subject to increased taxes. While the Secure Act can provide some flexibility in terms of what may be done with retirement savings, investors aren’t the only ones “benefitting” from this legislation. In fact, in some cases, Uncle Sam could still come out to be the big winner. For instance, under the current law, even though money in traditional IRAs and many employer-sponsored retirement plans is allowed to grow taxdeferred, withdrawals from these types of accounts are oftentimes fully taxable (if contributions were made pre-taxed). Further, if an IRA owner dies before he or she has spent all of the money in the account, the

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beneficiary who inherits this money must begin taking withdrawals within a certain time frame and include these withdrawals in their taxable income. There is some relief in that today, IRA beneficiaries are allowed to “stretch out” the mandatory distributions throughout their life expectancy. This, in turn, can provide at least some amount of reprieve taxwise. If passed, though, the Secure Act would require IRA accounts that have a balance of $400,000 or more when inherited by a beneficiary to be distributed within ten years of the passing of the original IRA owner.2 Given this shorter period of see Financial Forecast...page 13

MEDVAMC earned the “LGBTQ Health Care Equality Leader” designation from the Human Rights Campaign

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he Michael E. DeBakey VA Medical Center (MEDVAMC) earned a perfect score on the Human Rights Campaign Foundation (HRC) Health Care Equality Index, earning the “LGBTQ Health Care Equality Leader” designation. The HRC Foundation is education arm of America’s largest civil rights organization working to achieve equality for lesbian, gay, bisexual, transgender, and queer people. The designation was awarded in the 12th edition of HRC’s Healthcare Equality Index (HEI). A record 680 health care facilities actively participated in the HEI 2019 survey, with HRC Foundation proactively researching key policies at 1000 additional non-participating hospitals. Of those included in the

HEI, MEDVAMC was one of 406 who earned a “LGBTQ health care Equality Leader” designation. “MEDVAMC aspires to provide LGBT Veterans with state-of-the-art patient centered services in an inclusive and welcoming environment,” said Dr. Hiram Rivera-Mercado, LGBT Veteran Care Coordinator. “Receiving the Leadership status from HEI means we are continually progressing toward giving our LGBT Veteran population what they look for in healthcare institutions.” The 12th edition of the HEI assesses participants on four criteria: Non-Discrimination and Staff Training, Patient Services and Support, Employee Benefits and Policies, and Patient and Community Engagement.

“It is more important than ever that health care institutions stand with the LGBTQ community,” said HRC President Alphonso David. “The health care facilities that participate in HRC’s Healthcare Equality Index are making clear that they stand on the side of fairness and are committed to providing inclusive care to their LGBTQ patients. Going beyond inclusive non-discrimination policies, these health care facilities are adopting best practices in the areas of LGBTQ patient care and support, employee policies and benefits, and LGBTQ patient and community engagement. We commend all of the

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HEI participants for their commitment to providing inclusive care for all.” “We are so proud to have this designation,” said Elizabeth Steen, LGBT Veteran Care Coordinator. “We strive to be leaders in LGBT healthcare, and as the only hospital in the Texas Medical Center to receive the HEI Leadership designation, we feel honored to be recognized.” For more information about LGBT services at the MEDVAMC, visit https://www.houston.va.gov/ services/LGBT_Program.asp. For more information about the VA LGBT Program, visit https://www.patientcare. va.gov/LGBT/ 

September 2019


Houston Medical Times

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fficer Nestor Garcia’s dream of being a police officer was tragically put on hold when he was struck by a vehicle traveling at a high rate of speed during a routine traffic stop in 2017. Garcia underwent lifesaving surgery at the Red Duke Trauma Institute at Memorial Hermann-Texas Medical Center, where they repaired multiple injuries he sustained in the accident. Once discharged from the hospital, Garcia was transferred to TIRR Memorial Hermann for inpatient rehabilitation where he worked with physical and occupational therapists to regain movement and strength. Nearly two years later, Garcia has returned to his dream job of being police officer. “I was out of work for a little over a year, so I’ve really been working to get back into the groove of things and I’ve spent a lot of time very focused on getting back to doing what I love,” Garcia said. While Garcia’s experience going from a first responder to a trauma patient was trying, he now feels as if he has a second chance to make an impact.

“ M y experience r e a l l y motivates me to push even harder in my career,” G a r c i a Nestor Garcia added. D u e to the nature and extent of his injuries, Garcia still experiences some physical and cognitive complications but he has learned to adjust. “One thing my therapists at TIRR Memorial Hermann, both inpatient and outpatient, really taught me was how to compensate for things I may struggle with,” Garcia said. His advice to anyone experiencing life-changing injuries is to never give up because there is a finish line. “My entire family and I really want to thank my doctors at Memorial Hermann and my doctors and therapists at TIRR Memorial Hermann,” Garcia said. “We’ve said it many times but I know I wouldn’t be where I am today without them.”

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exploitation. “Adult Protective Services investigates all suspected victims of abuse, neglect or financial exploitation of the elderly population or adults with disabilities throughout the state of Texas, and our goal is to alleviate or prevent future maltreatment,” said Dirk Sheridan, community see Live Well...page 13


Houston Medical Times

Hepatitis C

Continued from page 8 C infection in various demographic

Financial Forecast Continued from page 11

withdrawal time, it is likely that the

Live Well

Continued from page 12 engagement lead for APS. APS received approximately 116,000 reports of allegations of abuse, neglect or exploitation from across the state last year. APS uses the following definitions to define abuse, neglect and exploitation. Abuse: The negligent or willful inflictionof injury, unreasonable confinement, intimidation, or cruel punishment with resulting physical or emotional harm or pain by a caretaker, family member, or other individual who has an ongoing relationship with the person. Abuse includes sexual assault, verbal, psychological and physical abuse. Obvious symptoms

Page 13

groups,” Dr. Arteaga said. “Their findings will have a global, lifesaving impact on how hepatitis C is treated. It is particularly important to Texas because

the liver cancer incidence rate in Texas is the highest in the nation.” Dr. Arteaga said the study is also important because liver cancer is highest

among the Hispanic population in Texas, and research-based advances in reducing cancer in underserved groups are a Simmons Cancer Center priority.

IRA beneficiary’s income tax liability would increase significantly. Keeping More of Your Retirement Income in Your Pocket

In order to take more control over your retirement savings and inherited funds – as well as the taxes you incur though distributions - it can

help if you take an active role in how and where the money is invested by working with an experienced financial professional.

are scratches, cuts, bruises, burns and broken bones. Neglect: The failure to provide for one’s self the goods or services, including medical services, which are necessary to avoid physical or emotional harm or pain, or the failure of a caretaker to provide such goods or services. Neglect can result in starvation, dehydration, over or under-medication, unsanitary living conditions, or lack of heat, running water, electricity, medical care or personal hygiene. Exploitation: The misuse of resources of an elderly or disabled person for personal or monetary benefit. This includes taking Social Security or Supplemental Security Income checks, abusing a joint checking

account, and taking property or other resources that doesn’t belong to them. “Adult Protective Services clients have the right to refuse certain services if they have capacity and they are not in harm’s way,” Sheridan said. “Adult Protective Services can only investigate suspected victims of abuse, neglect or financial exploitation of individuals who have an ongoing relationship with our clients. We do not investigate telephone scams, home improvement frauds, mail scams, etc. … The alleged perpetrator must have an ongoing relationship with our clients for APS to get involved or investigate.” Sheridan urges people to call and make a report with the Texas Abuse Hotline if they suspect

anything. The APS campaign, It’s Everyone’s Business, urges all Texans to pay attention and help older neighbors and people with disabilities who might be a victim of abuse, neglect or exploitation. “Always pick up the telephone and call 800-252-5400 if you suspect anyone who may be a victim of abuse, neglect or financial exploitation,” Sheridan said. “We have trained staff answering the telephones 24/7 to assist all callers in reaching the correct services for the suspected or possible victim.” To report abuse, neglect or exploitation, call 800-252-5400. To learn more about APS and how you can get involved, visit dfps. state.tx.us/Everyones_Business. 

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Drinking Water

Continued from page 1 an initiative in which the state or local government will cover the cost of replacing lead pipes in older homes. Currently, the only solutions to the contaminated water in Manchester is to provide filters for people to use in

Legal Matters

Continued from page 3 3. Beneficiary cost-sharing responsibilities. CMS is also interested in public comments on the most appropriate way to address the issue of Medicare beneficiary cost-sharing responsibilities (20% of the total Medicare payment rate) under any proposed remedy. CMS’s continuation of its current payment methodology is disappointing to covered entities, but its proposal of ASP plus 3% may be a sign of things to come. If the D.C. Circuit Court of Appeals affirms the lower court’s

Aneurysm

Continued from page 4 her on the floor screaming in pain. When Bowerman arrived at Houston Methodist Hospital, Britz treated her with a coil embolization, which involves placing soft metal coils in the artery at the site of the rupture to stop the bleeding. He told Bowerman’s family that she had a 30% chance of survival if she woke up within 72 hours. “My sister was the first person to

Mental Health

Continued from page 5 use it to manage chronic pain. “There’s been a lot of buzz that maybe cannabis is the new or

Oncology Research

Continued from page 6 cancer treatment, some patients will experience loss of appetite, nausea, a sore throat, or trouble swallowing, among other side effects. Others will

September 2019

Houston Medical Times

their homes or change water use habits, such as letting water run freely before drinking it. Further research is needed at a larger scale to clearly determine the long-term effects of lead-contaminated water in communities along the Houston Ship Channel. In addition to this, Sansom said more research is needed to address environmental

decision in favor of covered entities, CMS may will likely push to reimburse applicable 340B drugs at ASP plus 3% barely meeting the range laid out by the D.C. Circuit Court. Covered entities should submit comments to CMS and quantify the impact of CMS’s ASP plus 3% proposal versus the statutory requirement of ASP plus 6%. Unless stakeholders suggest alternatives to CMS and offer support for those alternatives, CMS would likely finalize its ASP plus 3% proposal, or even a lower payment amount. Key takeaways for 340B Program covered entities:

justice inequities in additional communities across the country. “Flint, Michigan, is not the only municipality suffering from contaminated drinking water,” Sansom said. “This study highlights that contaminated water is an issue in our backyard and should be taken just as seriously.”

• Submit comments on the proposed rule regarding an appropriate 340B drug payment rate and remedy structure. Comments must be submitted by 5 p.m. EST on September 27, 2019. • Continue to report JG/TB 340B drug modifiers and expect ASP minus 22.5% for CY 2020 until the Court of Appeals rules on HHS’s appeal. • Continue to preserve rights on underpayments of individual Part B 340B drug claims by filing appeals with your Medicare Administrative Contractors (MACs).

arrive back at the hospital the morning after surgery after my family was sent home with those numbers,” Bowerman said. “She said she heard my voice as soon as she got off the elevator and later told me it was the first tears of joy and hope she cried since the rupture. Days later, I knew who I was and could understand I was in the hospital, but I kept thinking it was 1999. I couldn’t wrap my head around the fact that it was 2018.” Bowerman was in the ICU for 15

days, but suffered no permanent damage from the aneurysm. “I never expected that I would go from being a perfectly healthy 36-year-old woman to nearly dying in front of my six and four-year-old sons,” Bowerman said. “They still refer to it as the day of mommy’s bad headache. I think of it as the day I could have died, and every single day I think about how lucky I am that instead I get to be here and see my boys grow up.”

safer alternative to opioid, so that’s something we wanted to investigate,” said Rogers, who said the idea for the study evolved from a conversation with Zvolensky. Rogers was studying opioid use and pain management when they began discussing the role of cannabis

in managing pain. “The findings highlight a vulnerable population of polysubstance users with chronic pain and indicates the need for more comprehensive assessment and treatment of chronic pain,” said Rogers.

be instructed by their oncologist to maintain a low-fiber diet instead of high-fiber fruits and vegetables. The NIH also reports that cancer patients may need extra protein and calories. Treatment can affect the body’s ability to absorb nutrients. When treatment ends, boosting the immune system is important – and adding seasonal produce back into the diet can help. Another benefit of eating

seasonally? Teaching our communities and families where our food comes from can help form healthy habits early, preparing younger generations to make healthier decisions. From cancer prevention to nutrition counseling before, during, or after cancer treatment, Texas Oncology is proud to support a healthier lifestyle that reduces disease risk and improves overall wellbeing. 

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