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Volume 3, Issue 2

UNT HEALTH SCIENCE CENTER OCTOBER 2018

The science of sleep:

10

tips for better rest

OUR PETS

Pets light up our lives, chase away the blues and keep us entertained. UNTHSC teammates talk about the pets they love.

AFTERMATH

For one family, the death of a loved one 34 years ago still brings home the sad and bitter legacy of domestic violence.

CARE TEAM

The life of a student can be stressful. That’s where the Care Team comes in, a unit uniquely equipped to offer a hand.


I NV E S T I N A HE A LT H I ER FU TURE

Investing in our students pays dividends now and long into the future. Your scholarship donation will support a medical student, a future pharmacist, an aspiring physical therapist or physician assistant, a research student pursuing the world’s next major discovery or a future leader in the field

Contact Institutional Advancement at

of public health.

817-735-2018

We’re transforming lives in order to improve

unthsc .edu/sc holarships

the lives of others . . . and that starts with you. Help make a difference by supporting scholarships for our providers of the future.

or visit


OCTOBER 2018, VOLUME 3, ISSUE 2

FROM PRESIDENT MICHAEL R. WILLIAMS

A

t UNT Health Science Center, our purpose is to transform lives in order to improve the lives of others. In the pages of this Solutions, you’ll see many examples of how UNTHSC’s people and programs live out this purpose. Research: Imagine going for your annual checkup and getting a simple blood test that can tell whether you’re at risk for Alzheimer’s disease. Brain scientist Sid O’Bryant, PhD, is working to make this a reality. Education: Half of Texas medical graduates leave the state to find work. We’re making sure more of them stay at home by sponsoring more than 500 new residency positions across the region. Patient care: Cancer patients between ages 15 and 39 frequently are overlooked in cancer care, despite often having a worse prognosis than pediatric and older adult patients. We’re working to change that. We have extraordinary teams creating remarkable work at UNTHSC on a daily basis. That means innovative science in our laboratories, collaborative learning in our classrooms and compassionate care in our clinics. Over the long term, that adds up to a health sciences university that’s transforming and improving lives while creating new solutions to many complex problems across North Texas.

SOLUTIONS Solutions is a publication of the Office of Brand and Communication at UNT Health Science Center. Editor Kerry Gunnels Assistant Editor Jeff Carlton Art Director Marco Rosales  •  Designer Guillermo Gómez Writers Alex Branch, Jeff Carlton, Sally Crocker and Jan Jarvis Photographer Jill Johnson Senior Director, Brand Studio Amy Buresh Senior Vice President, Innovation & Brand Monty Mohon For more information about UNT Health Science Center and its educational, research and health care efforts, go to www.unthsc.edu. To find out how you can support Fort Worth’s Health Science Center, contact the Office of Institutional Advancement, 817-735- 2254 or unthsc.edu/giving

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contents 03

Short Takes UNTHSC news in brief

32 18

More women doctors In 2017, more women than men entered med school

FEATURES 10

A painful legacy

24

The ultimate gift

32

People and pets

40

The Care Team

Correction In a story in the April issue of Solutions, a photo on page 34 misidentified a Medical Sciences Program student as Sohail Siraj. The student in the photo is Med-Sci student Kevin Benny.

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46

Cancer and the young

54

Alzheimer’s gift

Care for adolescents and young adults

Protecting the next generation

56

The science of sleep 10 things you should know before bed

64

Why I do it Accident’s impact on a career


short takes A quick look at how UNTHSC is creating solutions for healthier communities

A blood test that IDs Alzheimer’s earlier, easier and cheaper T

he first study of a blood test to detect Alzheimer’s disease within a primary care setting soon will be conducted at UNT Health Science Center. The simple test, conducted in your doctor’s office, could be a game-changer in the diagnosis of early Alzheimer’s. If successful, it would be possible to identify patients earlier, easier and at a lower cost than any method that exists today, said Sid O’Bryant, PhD, Professor of Pharmacology and Neuroscience.

“Using this simple blood test, primary care doctors will be able to tell if someone has early Alzheimer’s,” he said. “Nobody anywhere on the globe has a test that can do that now.” The three-year study, funded by a $6.5 million grant from the National Institute on Aging, will look at accuracy and effectiveness of the test in screening older adults. The test looks for biomarker proteins in the blood to detect Alzheimer’s disease. In previous studies, it was shown to be 96 percent accurate.

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Meet Charles Taylor, PharmD, who was appointed to the position of Provost and Executive Vice President of Academic Affairs on Aug. 1.

1

What does a provost do?

I view my role as a “compass” to ensure our financial resources, time and initiatives are oriented toward our academic mission, and we stay on course to achieve our goals and objectives through extraordinary teamwork. I am excited about the ability to focus on the success of our students and faculty and consider myself very fortunate to have this outstanding opportunity.

2

What are UNTHSC’s academic strengths?

Our students are amazing, and I am in awe every time I have an opportunity to spend time with them. Couple that with our incredible faculty, and we are positioned to accomplish great things at the Health Science Center. And while the concept of “interprofessional education” isn’t necessarily new, I think we have the ability to take it to the next level with the caliber of programs we have on our campus.

3

What excites you about your new role?

I literally lose all track of time when people come together to brainstorm and collaborate on areas that influence our students and their experience at UNTHSC. To me, that’s fun and exciting and not anything I would label as “work.” Now my “Team” is going to be the entire campus – can you believe it? I’m ready to roll up my sleeves and make great things happen for our students and faculty.

4

What was your hometown like?

I grew up in a small town in northwest Alabama called Phil Campbell, population 1,100. We have a stop sign, a little country grocery store and a post office. That’s what we call “livin’ in the country.” My graduating high school class was huge – 65 students. It’s the same high school my parents went to.

5

This is not really a question, but you have cooler dress socks than anyone on campus.

I have so many pairs of socks these days that I’ve lost count. Some are fun and whimsical while others are more subdued and professional. But I enjoy the variety as they’re reflective of me and my mood on any particular day. And I love that people are noticing and having more fun with their socks. Now I find myself telling others on campus, “Hey, cool socks!”

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short takes


short takes

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Artifact: Tavener bowling pins

F

or almost 50 years, UNT Health Science Center has preserved two scuffed bowling pins. They hold a significant – and quirky – place in the history of Fort Worth’s oldest medical school. The story starts with the opening of the Texas College of Osteopathic Medicine (TCOM) in 1970. Classes for the first 20 students were held among hastily arranged partitions on the fifth floor of the old Fort Worth Osteopathic Hospital at Camp Bowie Boulevard and Montgomery Street. A nearby garage apartment was the anatomy lab. For the fledging medical school to succeed, its founders knew they needed more space — badly. Then the Tavener Playdium Bowling Alley came on the market. Near the hospital along Camp Bowie, the Tavener alley was owned by Jackie Tavener, a former pro baseball player. The bowling alley was large enough for classrooms, laboratory space and offices. Faculty and students rounded up 30 gallons of paint and spent a weekend turning the bowling alley into a medical school. Bowling lanes became classrooms and laboratories. The alley’s bar? It became the President’s Office, red carpeting still covering the walls.

Child care that’s low cost and on campus U

NTHSC took another giant step on its journey to becoming a Best Place for All with the opening of a Lena Pope Early Learning Center child care facility on campus. The center will expand access to high-quality early learning experiences for families and children in Fort Worth. The initial enrollment process reserved up to 70 percent of program spots for children of UNTHSC students and employees; the remaining spots were open to the community. To ensure that more children have access to high-quality early learning, subsidized tuition is available for those who qualify. “Lena Pope will make a great difference in mine and my son’s life,” said Ian Tanner, who works in UNTHSC Facilities Management. “It will save me money, while still being more convenient than the place he’s currently in. Plus, their curriculum will better prepare him for school.” The UNTHSC Best Place for All initiative creates programs, policies and a work environment that increase team member satisfaction and engagement. Lena Pope was the perfect partner for UNTHSC because the organization is dedicated to creating conscientious members of the community. The center provides all-day care and learning and integrates evidence-based practices in the daily instruction.


short takes

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Hepatitis C clinic shows future of pharmacy T

Student devotes spare time to ensuring kids are safe in cars

U

NTHSC public health student Elizabeth Velarde – a busy mom juggling graduate school, a job and volunteer work – understands the challenges parents face when time is at a premium and it’s important to get things right.

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Dr. Jennifer Fix

he medications cost close to $100,000, but they cure hepatitis C in 12 weeks or less. And yet, some patients leave this costly prescription unused in their medicine cabinet. A phone call from pharmacist Jennifer Fix, PharmD, can turn things around and get patients on a path toward a cure for this deadly disease. “But non-adherence can prevent or delay a cure,” said Dr. Fix, Associate Professor of Pharmacotherapy at UNT Health Science Center. “Programs like ours improve adherence by close to 100 percent.” The Hepatitis C Clinic at the UNTHSC Health Pavilion is unique because the person managing every patient’s care, in collaboration with the health care team, is a pharmacist. In this new model, pharmacists are part of the health care team and are no longer limited to working behind the counter. Having a pharmacist-led hepatitis C service in the UNT Health Clinical Practice Group is groundbreaking, said Dr. Charles Taylor, UNTHSC Provost.

So she’s devoting part of her time to provide 1-on-1 instruction to parents on how to properly use a child car seat. While working at Family Compass, a nonprofit organization that helps parents raise healthy families, Velarde and a coworker created a child car seat program. She’s now a volunteer. “We distribute and help install free car seats at community events and teach parents about important safety issues. Statistics show that many parents are not using their child car restraints as intended and need help in getting it right. That’s where we come in.”


SOLUTIONS

short takes

Ask an expert: Dr. Michael Coble How accurate are DNA tests that identify your heritage? “Y

ou may find interesting things you didn’t know about your ancestors going back several generations,” said Dr. Michael Coble, Associate Professor, UNT Center for Human Identification. “And then again, you may not.” The tests deliver two results: ancestry and kinship. For ancestry, the results are only as good as the reference populations used to come up with the information. If someone’s DNA sequence matches a certain sequence in one of the many databases in use today, then they will get information about others who share the same ancestry. “If the data is incomplete, you may get close, but not as close or as accurate as you’d like,” Dr. Coble said. “For example, the results may suggest your ancestors came from the Iberian Peninsula rather than Central Europe.”

While DNA can help trace lineage, the kits have opened up a Pandora’s box for some families. Such was the case for one woman who grew up believing she was of Irish ancestry on both sides of her family tree, only to learn that 50 percent of her DNA was of Eastern European ancestry. Some detective work revealed the truth: Her father had been switched at birth with another baby at a New York City hospital.

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short takes

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Residency partnership to help keep doctors here

H

CA Healthcare, Medical City Healthcare, and UNT Health Science Center are teaming up to create hundreds of new residency positions in North Texas, a move that helps address the state’s growing

physician shortage and improves health care across the region. The partnership is a result of HCA’s continued investment in building the nation’s physician supply by providing much needed residency and fellowship positions within its top-performing facilities. It also reflects a commitment shared by UNTHSC and Texas Christian University to train health care providers of the future for North Texas and beyond. Medical City has pledged over the next seven years to develop approximately 500 resident positions in its 14 hospitals

across the Dallas-Fort Worth area. The academic sponsor of those residencies will be UNTHSC, which has two medical schools: the Texas College of Osteopathic Medicine and the planned TCU and UNTHSC School of Medicine, established by the two universities, which is scheduled to open in 2019, pending accreditation. “Studies show that physicians often remain in the communities where they complete their residencies,” said Erol Akdamar, president of Medical City Healthcare.

Helping military pilots stay alert on long missions C

ompounds that could make it easier for sleep-deprived pilots to stay alert during long missions are being studied by researchers at UNT Health Science Center and Savannah State University. Researchers are also looking at how the same compound could also be used to relieve cognitive impairment associated with Gulf War Illness. Meharvan Singh, PhD, Professor of Pharmacology and Neuroscience, is teaming up with Kai Shen, PhD, from Savannah State, to address health issues that can affect those who served in the military. The two projects total $1.3 million in grants and are funded by the Department of Defense. The researchers want to show that the compounds can help Air Force pilots stay alert, even when their circadian rhythms are thrown off by time changes, long flights and sleep disturbances inherent to their constant state of readiness. The compounds also hold promise as a way to relieve the cognitive impairment associated with Gulf War Illness, a unique chronic health disorder with multiple symptoms associated with fatigue, muscular pain and gastrointestinal problems.

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short takes

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A better cold-case database

A

UNT Health Science Center team has upgraded and enhanced a national database for cold cases involving missing people and unidentified remains to offer more powerful investigative tools for criminal justice agencies and families searching for their loved ones. NamUs, or the National Missing and Unidentified Persons System, is a clearinghouse and resource center for missing person cases, unidentified bodies, unidentified living individuals and unclaimed bodies. Based at UNTHSC since 2011, it is managed by the UNT Center for Human Identification through a cooperative agreement with the National Institute of Justice. The upgraded database, named NamUs 2.0, replaces the existing NamUs databases, which were launched in 2007 and 2008. Since then, NamUs has received more than 15,000 unidentified person cases and over 32,000 missing person cases. More than 3,000 of those unidentified person cases and more than 14,000 missing person cases have been resolved.

SOLVED

+3,000

Unidentified person cases

+14,000

Missing person cases

Research probes inflammation drug’s link to glaucoma

G

lucocorticoids are often used to reduce inflammation, reduce pain and treat many conditions such as allergies and rashes. But for some people, the very drugs that treats one condition can cause another – specifically, glaucoma. The condition, which affects more than 64.3 million people, is the second-leading cause of irreversible blindness in the world. Still, little is known about why glucocorticoid therapy elevates intraocular pressure and raises the risk of developing this disease, said Gulab Zode, PhD, Assistant Professor in Pharmacology & Neuroscience. “We know that when people are treated with glucocorticoids, one of the possible side effects is increased intraocular pressure,” he said. “About 30 percent to 40 percent of patients develop this and if they don’t get treated, they experience vision loss.” In a paper recently published in the Journal of Biological Chemistry, a team of scientists led by Dr. Zode discovered how glucocorticoids elevate intraocular pressure in the eye. “I want to know what causes the damage so that a targeted treatment can be developed,” he said.

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Domestic ’ e violenc s painful legacy By Sally Crocker

Maria Guadalupe Almaguer’s 1984 death has lingering impact on her family

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Maria Guadalupe Almaguer was a strong and independent woman. She believed she could handle her estranged husband’s violent temper.

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I

n the fall of 1984 Maria Guadalupe Almaguer was murdered by her estranged husband, David Gonzales. The couple had been separated for two years following a rocky, abusive relationship, and Maria had been saving for a divorce. She had just been promoted at work, and things were slowly starting to go her way. She was feeling upbeat, thinking she might finally be ready to start dating again, in hopes of connecting with someone new who would treat her right. Maria’s second chance at happiness was cut brutally short the September afternoon

she and a male friend were ambushed inside a California restaurant by Gonzales, who had been following them and slashed her tires on the way in. Tensions exploded onto the parking lot, and as they attempted to flee, the beautiful young girl with so much life was viciously, fatally stabbed in the heart and back, and her companion left bleeding and wounded. Her last act before she died was to step in front of her friend in an attempt to shield him. Maria was less than two months away from her 28th birthday. Across miles and decades, her tragedy had a profound impact on the life and career of UNT Health Science Center researcher Emily Spence-Almaguer, PhD. In 2005, Dr. Spence-Almaguer, Associate Dean for Community Engagement and Health Equity at the UNTHSC School of Public Health, began dating the man she would eventually marry. His name was Paul Almaguer, and he was Maria’s younger brother. One evening early in their relationship, over dinner, Paul asked about her day. That afternoon, Dr. Spence-Almaguer, who had spent the prior 14 years addressing domestic violence as a social worker and researcher, had given a presentation on the topic to Dallas law enforcement officers. Paul listened, and then quietly said, “I understand. I have some personal experience with that.” Staggering statistics According to the National Coalition Against Domestic Violence (NCADV), an average of 20 people per minute across the U.S. are physically abused by an intimate partner, equal to more than 10 million men and women each year. On any given day, more than 20,000 phone calls are placed to domestic violence hotlines nationwide. The CDC uses the term “intimate partner violence” to describe physical or sexual violence, stalking and psychological aggression, including coercive acts, by a


domestic violence

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› promising career. “My sister was a very confident, independent and strong person, not easily intimidated, and she thought she could handle it. It just wasn’t in her to want to run and hide,” Paul said. The turning point that may have brought Gonzales’ rage to a boiling point, Paul and his older brother Arnold believe, was when he finally recognized that Maria had moved on and that getting back together would never happen.

Maria Almaguer’s stalwart defenders. From left, brother Paul; his wife, Dr. Emily Spence-Almaguer; and brother Arnold.

current or former intimate partner. Leaving does not guarantee safety. A 2016 study by the Texas Council on Family Violence showed that 40 percent of women killed across the state had made attempts, like Maria, to end their relationships or were in the process of leaving when they were murdered. “After they separated, David broke into Maria’s house several times, threatened and stalked her, frightening her friends and others who witnessed his behavior,” Paul said. “He attempted to strangle her at one point, until her roommates were able to intervene.” Maria’s mother tried convincing her to move back home to Texas, but she liked California, where she had moved during the marriage, and she wanted to stay. She had friends there and was building a

Families speak out The pain for the families of domestic violence victims is terrible and lasting. For Dr. Spence-Almaguer, the lingering trauma felt by her new husband and his family over Maria’s death prompted her to reroute her own career and to step back temporarily

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“It was hard to talk about my work and have it trigger the worst trauma of my husband’s life.” — Dr. Emily Spence-Almaguer

Dr. Emily Spence-Almaguer speaks at an annual victim’s dedication ceremony for Maria in California’s Monterey County.

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from domestic violence research. “It was hard to talk about my work and have it trigger the worst trauma of my husband’s life,” she said. Legislation like the California Victims’ Bill of Rights Act of 2008 has helped to expand opportunities for grieving families to advocate and represent their loved ones through the criminal justice system. “Laws today are different from the early 1980s when Maria was killed,” Dr.

Spence-Almaguer said. “Families now are considered victims too in many states, and have a voice with regard to court proceedings, parole hearings and restitution.” In 2009, Arnold received a letter informing the family of their rights on behalf of Maria, explaining that Gonzales was going up for parole and they had an opportunity to participate in the process. “Until then, the only person representing


domestic violence

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much,” Dr. Spence-Almaguer said. “We came to see it as a way to raise awareness, which eventually helped me return to my domestic violence work.” She has since led victim advocate trainings and spoken at the Monterey

Arnold and Paul Almaguer say their sister would be proud of her younger brothers’ efforts to keep her murderer behind bars.

my sister at hearings was Monterey County Deputy District Attorney Cynthia Jewett,” Arnold said. “She had been doing it all on her own, with a belief that David should stay incarcerated. He had been pretty much a model prisoner and had a strong case for parole, but he still expressed intense hostility and showed no remorse for Maria’s murder. He seemed to be that same man who had said at trial that he felt ‘relieved’ when he learned my sister was dead.” Jewett, now retired, remembers her decision to find Maria’s family. There wasn’t much to go on. Maria was listed by her married name in the sheriff’s report, Mary Gonzales. There was no mention of Almaguer and no family contact information, no note of her Texas ties. “Laws were changing, and more effort was required to show that a prisoner would be dangerous if released. So I began having victims’ families contacted whenever they could be located,” Jewett said. “My examination of this case and Gonzales’ one disciplinary infraction in prison, a power struggle with a woman who taught a class, led me to believe that he was unrepentant and would be a danger in any future relationship. There was concern he could be a stalker.” With help from a DA investigator, evidence records were reopened, and an old address book was found. Faded entries, written in pencil and barely legible, were recreated and eventually led to the Almaguer family. Since then, Paul and Arnold have led the family’s effort in attending parole meetings and advocating for victims’ rights. Traveling to San Quentin State Prison and reliving the traumatic loss isn’t easy. But being able to confront Maria’s murderer and help keep him in prison gives comfort that they are honoring their sister’s memory and hopefully helping others. “Through the hearings, it became less painful because we had to talk about it so

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“It’s not always the police that people go to for help when they’ve been victimized; it could be health care providers,” she said. “Certain effects of abuse can be seen years later, as the result of living with stress and strain or health problems exacerbated by trauma.” The rates of domestic violence homicides in Texas reached their highest point in 10 years between 2015 and 2016. That makes it critical, Dr. SpenceAlmaguer said, “for programs like TESSA and a network of Tarrant County health providers and agencies to work together to promote victims’ safety and well-being.” “There is still much work to do,” she said. “Relationships are complicated. In domestic violence situations, people feel trapped and some, like Maria, feel they can handle it. For others, it might not be the right time to leave. Children, finances and other reasons come into play. As has been demonstrated recently through the national #MeToo Movement, sometimes victims don’t feel like they’ll be believed or that they have the power to speak out. That’s why we stay committed to helping.”

Paul Almaguer holds his only remaining possession of his sister, a carved wooden Labrador retriever. “Maria loved labs,” he says.

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County Silent Witness Exhibit, where life-sized, red wooden silhouettes stand tall in representation of all the women lost through domestic violence. Back home, Dr. Spence-Almaguer has taken teams to the streets to study interpersonal violence and victimization of the homeless in Tarrant County, helping to bring about real changes in safety, shelters and community services. With federal funding, she also developed a Technology Enhanced Screening and Supportive Assistance (TESSA) program linking local health clinics, emergency medical services and victim safe centers to help those at risk and suffering from mental, physical and other stresses of abuse to get back on their feet.

Finding closure On Facebook, loved ones, friends and supporters connect through a tribute page to Maria filled with loving photographs and notes in her memory. “This site has been created,” it says, “to honor her memory, organize support to keep her abuser in prison, and raise awareness of the dangers of domestic violence and the horrific impact that it has on surviving friends and family.” Last June, Paul and Arnold traveled back to San Quentin for Gonzales’ latest parole hearing. Their testimony helped secure another three years of incarceration for Maria’s murderer. “Being active in this way brings a little bit of peace to our family,” Paul said. “I’ll bet my sister is proud of her little brothers, who are still looking out for her. I miss her.”


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Domestic violence statistics Individuals who have been stalked by an intimate partner during their lifetime to the point in which they felt very fearful or believed that they or someone close to them would be harmed or killed.

Individuals who have been victims of some form of physical violence by an intimate partner within their lifetime.

Percentage of stalking victims who reported being stalked by a current or former intimate partner.

Individuals in the United States who have been stalked in their lifetime.

1 in 7

1 in 18

1 in 3

1 in 4

60.8

43.5

19.3M

5.1M

19

Percentage of domestic violence that involves a weapon

15

Percentage of all violent crimes that involve an intimate partner

18-24 Age of women who are most commonly abused by an intimate partner 33

Percentage of women who have been in a relationship and report they have experienced some form of physical and/or sexual violence by their intimate partner in their lifetime

38

Percentage of murders of women that are committed by a male intimate partner

Sources: National Coalition Against Domestic Violence, World Health Organization

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The future 2017 was the first time more women

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is female

By Jan Jarvis

entered medical school than men

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medical education

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W

TCOM student Mary Ann Reed performs a physical exam on fellow student Lisa Nguyen as part of a skills lab exercise.

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hen Mary Ann Reed was considering a career in medicine, she kept getting a question she never expected: “So… you’re going to be a nurse?” Although surprised, the second-year Texas College of Osteopathic Medicine (TCOM) student did not let the remarks deter her. Reed is part of a record-setting class of female students who entered medical school in 2017, when for the first time, more women enrolled as first-year medical students than men. Nationwide, about 12,800 women, representing 50.7 percent of new enrollees, began medical school in 2017-18, according to the Association of American Medical Colleges. UNT Health Science Center is part of that trend. This year, 54.3 percent of first-year students entering TCOM were women, slightly higher than the 2017-2018 enrollment of 54.1 percent females. The

highest ratio was in 2011, when 57 percent of TCOM first-year students were women. Since 2015, the number of female enrollees has grown by 9.6 percent, while the number of male enrollees has declined by 2.3 percent. Overall, medical school classes continue to diversify. New enrollment among African-Americans rose by 12.6 percent and among Hispanics by 15.4 percent from 2015 to 2017. Along with a change in numbers comes a shift in culture for female medical students and physicians. While challenges such as wage gaps and patient discrimination have not gone away, women are finding strength in numbers. Through mentoring, online groups and professional organization support services, female physicians are turning to each other for help navigating the challenges. “I've seen a lot of women mentoring and supporting other women,” said


medical education

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Kendi Hensel, DO, PhD, Associate Professor in Family and Osteopathic Manipulative Medicine. Dr. Hensel is herself a trailblazer and leader. In 2014, she became the first woman to serve as an associate editor of The Journal of the American Osteopathic Association, the oldest journal of her profession. Earlier this year, she was named President-elect of the American Academy of Osteopathy (AAO), a national organization of about 9,000 physicians and students. Today, many more women are leading and mentoring young female medical students and physicians, said Yein Lee, DO, Assistant Professor in Family and Osteopathic Manipulative Medicine. That’s something previous generations lacked. “I am thankful that I am able to learn from their experiences and seek their wisdom and advice when needed,” Dr. Lee said. “As we produce more female physicians, I am optimistic that we will create more of such opportunities for medical students and female physicians in their early careers.” Women now account for more than 60 percent of pediatricians and more than 51 percent of OB-GYNs practicing in the United States. More than 60 percent of dermatology residents are women. But only 38 percent of general surgery residents are female. “There just aren’t that many women who are orthopedic or cardiothoracic surgeons,” Dr. Lee said. “That leaves women with fewer mentors they can look up to.” When Dr. Lee was a resident, she said she was required to wear a color-coded nametag that identified her as a physician. Still some patients assumed she was a nurse. “I dealt with this a lot,” Dr. Lee said. “Even though I was wearing the white coat and I had the name tag, I would still be called the nurse on a daily basis.” It is a common problem among the 72,000 members of Facebook’s Physician

Dr. Yein Lee says as more women become physicians, they will serve as mentors and role models, something previous generations of women medical students lacked.

Unique challenges As a first-year TCOM student, Reed faced a challenge that her male classmates never would: She was pregnant. During the six-week break that comes at the end of the first year of medical school, she expected to have her baby – and recover in time to start her second year and finish on schedule. “I plan to finish just like anyone else does,” she said. “It may be a little harder emotionally and physically, but I feel like I will be able to do it.” Deciding on a specialty can be fraught with challenges. Second-year TCOM student Melissa Schullek, for example, said she is thinking about family medicine or pediatrics, both rewarding fields that she said would leave her more time for parenthood.

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As a first-year TCOM student, Mary Ann Reed faced a challenge her

SOLUTIONS male counterparts never did. She was pregnant.

discovery


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Wage gap At a roundtable discussion with the Tarrant County Medical Society, TCOM students learned some hard truths about the gender wage gap. A 2016 study found male primary care physicians made 16 percent more than females. For specialists, the gap was 37 percent. Overall, female physicians earned 90 cents for every dollar that male physicians made, according to one study. The experience made many of the group realize how much they have to learn. Several studies have found that female physicians have better outcomes and fewer readmissions than male doctors do. A 2017 study, for example, found that elderly hospitalized patients treated by female internists had lower mortality rates than those treated by male physicians. “Why is that not translating into career advancement?” Dr. Lee asked. “Change is coming, but at a snail’s pace.” The gap is notable in academia. Nationwide, female physicians constitute 38 percent of faculty but only 21 percent of full professors, 15 percent of department chairs and 16 percent of deans. “Years ago when I came here, I was the only female faculty member in OMM,” Dr. Hensel said. “Now we have four.”

then, but stay close to 50 percent. “Osteopathy has a history of being a lot more accepting of women in medicine,” Dr. Hensel said. “I think that is because the founder believed in being more inclusive, so they became a part of the culture and the profession.” As time goes by, certain specialties will likely become female-dominated while others remain more male-dominated, Dr. Hensel said. “The diversity should strengthen the specialties,” she said. Women in medicine today have more opportunities to excel – no matter which path they choose. “We just want to be given a shot,” Dr. Hensel said. “We want the chance to do the work, not because of our gender, but because of our ability.”

Dr. Kendi Hensel is a trailblazer. Earlier this year, she was elected President-elect of the American Academy of Osteopathy.

Moms Group. “I bet once a month somebody posts that they’re in an examining room with a male nurse or male residents and the patient always directs their questions to the guys,” said Dr. Hensel, who is a member.

Past and future Through the late 19th century, women were largely excluded from allopathic medical schools. But it was a different story at the American School of Osteopathy, when in 1892, the first class included six women. By 1923, half of all osteopathic medical students in the United States were female. The numbers have gone up and down since

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bodies of knowledge

Medical students never forget anatomy lab — or the people who entrust their remains to them. By Alex Branch

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At a glance THE NUMBERS Each year, about 150 people donate their bodies to UNTHSC’s Willed Body Program. Some are planned gifts, others are referred to the university by families or hospices. THE IMPACT No other medical school experience impacts students more than Human Gross Anatomy. It is here that future doctors learn to visualize and understand a body’s organs and functions.

MORE INFO To learn more about the Willed Body Program, call 817-304-3763.

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First-year TCOM student Matthew Owens, right, prepares to make his first incision in Anatomy Lab.

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irst-year medical student Matthew Owens approached the first “patient” of his medical education with a conflicted sense of anticipation and apprehension. She was 71, a small woman who smoked much of her life and weighed just 82 pounds. Owens furrowed his brow and lowered a shiny silver scalpel to her back, slicing the skin near her shoulder. His intention was not to save the woman but to understand her. The woman was dead. Owens would dissect and learn from her body in the Anatomy Laboratory at UNT Health Science Center. “This is our first real person,” Owens said. “For those of us interested in surgery, our first cut. It doesn’t feel like something we will ever forget.” Perhaps no other medical school experience impacts students more than Human Gross Anatomy. It is here that future doctors learn to visualize and understand a body’s organs, complex functions and variabilities that make each person unique. The donor, in a sense, becomes the student’s first patient. “The afternoons I spent in anatomy lab are among my most vivid,” said Mary

Rosegrant, DO, a 2018 graduate of the Texas College of Osteopathic Medicine. “My body donor simultaneously taught me reverence for human life, respect for the doctor-patient relationship and the intricacies of human anatomy.” That experience would not be possible without the selfless donors who make the ultimate contribution to the future of health care. They give themselves. A broad impact Each year, about 150 people donate their bodies to UNTHSC’s Willed Body Program. Some are planned gifts specified in wills and testaments. Others are unexpected, referred to the university by families or hospices. Willed Body Program officials handle everything — they file the death certificate, notify Social Security and transport the donated body at no cost to the donor or family. “It is such a generous gift to entrust with the Health Science Center. We want to make it as stress free as possible for the donor’s family,” said Claudia L. Yellott, Willed Body Program Manager. “Our donors enable the program to be on the forefront of medical research and education.” Donors remain in the program for approximately 12 to 24 months. Afterward, they are cremated and returned to family members if they wish. Donors impact a broad range of current and future health care providers. Every year, about 600 UNTHSC medical, graduate, physician assistant, physical therapy and medical science students train in the Anatomy Lab. After the Texas Christian University and UNTHSC School of Medicine opens in 2019, 60 more students will join them. Nurse anesthetists, paramedics, firefighters, resident doctors, surgeons and many other health care professionals in


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Tarrant County and beyond also reserve time in the UNTHSC Anatomy Lab for training. “I think it’s still fairly unknown on this campus the number of professionals who save people’s lives and perfect their craft in the Health Science Center’s Anatomy Lab,” said Rustin Reeves, PhD, Director of the UNTHSC Center for Anatomical Sciences.

Dr. Rustin Reeves, Director of the Center for Anatomical Sciences, addresses students on the first day of Anatomy Lab.

First-year TCOM students get their first glimpse of the body they will work on and learn from all year.

better physicians, surgeons or family practitioners.” That admiration for willed-body donors remains. Mia Eriksson, a third-year medical student, visited the UNTHSC Anatomy Lab while an undergraduate at Texas Christian University. “I never forgot the respect that was

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Past, present and future Sam Buchanan, a 1975 TCOM graduate, never forgot what Dr. Joel Alter told him and his classmates on the first day of anatomy class. He shared his memory in a book published in 2011 to celebrate the history of the Health Science Center. “Beyond those doors, cadavers await you,” Dr. Alter said. “These people had a past, which is their own. They have a present, which is yours. They also have a future, and that future depends on how much you learn from them now and carry forward in your practice of medicine. “Because of these people, you will be

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have grown quite attached to their donors,” Dr. Reeves said. “The donor has given the student so much. It’s hard to say goodbye.”

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The honor guard folds a U.S. flag at a burial ceremony at DFW National Cemetery for military veterans who participated in the Willed Body Program.

Billie Stambulic, left, shows TCOM student Mary Rosegrant, then a first-year, an album showing photos of her daughter, a body donor. Dr. Rosegrant is a 2018 TCOM graduate.

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shown to the donors even as we were given a tour of the laboratory,” Eriksson said. “The donors’ dignity is paramount. They are what brings everything students read about in textbooks to life. It becomes real.” Dissections in anatomy lab can initially be upsetting for some students, Dr. Reeves said. Students step outside if they need a break. Faculty members are always available to counsel those students. “By the end of the year, many students

Honoring donors’ families Students honor donors every spring at the Legacy of Life Ceremony on campus. Families of donors hear personal testimonies from students who learned from their loved ones’ bodies. As a first-year student, Dr. Rosegrant met Billie Stambulic, who had brought a photo album showing pictures of her daughter, Patricia Williams, a body donor. Together, they looked through the photo album showing Williams as a child, a high school graduate, a new mother, and ultimately, sick from cervical cancer. Donors’ families are encouraged to share stories, pictures and personal items of their loved ones. One woman cried as she showed students her father’s old workshop tools. At first, Stambulic had “cold feet” about Williams’ participation in the Willed Body Program, but the students’ sincerity reassured her. “These kids studying to become doctors have an incredible level of respect and reverence for the people who participate and help them learn,” Stambulic said. “I am so glad Patricia did this.” In June, 17 U.S. military veterans who participated in the Willed Body Program, but whose families did not collect their cremated remains, received full military honors at DFW National Cemetery. In the absence of family members, the UNTHSC Willed Body team were treated as honorary next-of-kin. They received folded American flags for the veterans honored. “These veterans gave themselves during life to their county and, in death, they continued to give themselves by advancing medical education,” Yellott said, “It’s a priceless gift for our students.”


short takes

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“These veterans gave themselves during life to their county and, in death, they continued to give themselves by advancing medical education. It’s a priceless gift for our students.” — Claudia L. Yellott

Yellott, Willed Body Program Manager, accepts a flag at a ceremony at DFW National Cemetery for body donors who were military veterans.

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INTERDISCIPLINARY RESEARCH AND EDUCATION BUILDING

‘The most successful public construction project in Texas’

“This building makes a statement. It’s designed to be a true center for research and education,” says Janna Morgan, Associate Director of Design for the UNT System.

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ON TIME, UNDER BUDGET

New building is worthy addition to Fort Worth’s Cultural District The new Interdisciplinary Research and Education Building (IREB) is scheduled to open in October, making it the first new research facility at UNTHSC in 14 years. With an exterior of limestone and glass panels, and outdoor plazas and seating overlooking the Kimbell Art Museum, it’s a worthy addition to Fort Worth’s Cultural District. It’s also open to the public. Inside the two-story lobby atrium are a full-service café and the Health Care Innovations Lab, featuring a demonstration kitchen for healthy cooking and interactive kiosks for visitors with health questions.

facts about the ireb 3 Tenants North Texas Eye Research Institute, TCU and UNTHSC School of Medicine and UNT System College of Pharmacy.

Easy conversion It was originally designed primarily as a research building, but plans changed with the development of the School of Medicine. The infrastructure for laboratories remains in place.

Public Works

A two-story, glass-paneled atrium, top photo, is accented by wooden ceiling slats. Outdoor seating and a medicinal garden, bottom, bolster the building’s connection to Fort Worth’s Cultural District.

It’s ahead of schedule and under budget, with $80 million from the Texas Legislature, thanks to Sen. Jane Nelson and Rep. Charlie Geren. “Right now I think it’s the most successful public construction project in the state of Texas,” said Jason Hartley, Vice President of Operations.

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FROM FAINTING GOATS TO RUSSIAN TORTOISES -OUR TEAM MEMBERS’ UNIQUE ANIMAL FRIENDS

By Jan Jarvis

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J.D. the bull takes a treat out of owner Dr. Egeenee Daniels’ mouth.

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hether it’s a feline friend or a gregarious goat, pets play a unique role in people’s lives – including those who work at UNT Health Science Center. Here we feature people from across campus, and the pets that light up their lives. J.D. the bull; Egeenee Daniels, DVM Most bulls become aggressive when they get to be a year old, said Egeenee Daniels, Director of Lab Animal Medicine. “They try to run over you and, well, they act like a bull,” he said. “Not this guy. He thinks he’s a dog.” At 6, Dr. Daniels wanted to be a veterinarian. At 15, he started working as a

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ranch hand to support his family following his father’s death and his mother’s cancer diagnosis. He told his mother that his dream was to live on a farm and hang out with cows and horses all day. After graduating from veterinarian school, he did his residency in biomedical research and took a job at UNT Health Science Center. Nearly three decades later, he divides his time between his job and his home, Shiloh Ranch, in Benbrook. He also owns the Louisiana ranch where he worked as a teen. “My father was a science teacher and my grandfather was a cowboy,” he said. “I have the best of both worlds.”


people and pets

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In college, she studied to be a researcher and planned to be a vet tech, but she never stopped loving barrel racing. “The first big paycheck I got I went out and bought a horse,” she said. Tatum will be away at college this fall, but that doesn’t mean Nelson’s favorite horse is ready to be put out to pasture. “She may be faded out and fat,” Nelson said. “But we’ll never have another horse like Sister.” Murphy the cat; Rebecca Cunningham, PhD Three years ago, radioactive iodine treatment for thyroid cancer forced Rebecca Cunningham to spend a week in isolation. No one in her family could come within six feet of the Associate Professor of Physiology and Anatomy. For Murphy, a ginger tabby who slept

Sister the horse, with owner Tito Nelson, started her life as a racehorse. Now, she’s a barrel racer.

Sister the horse; Tito Nelson, veterinary technician Little Miss High Society could whip around a racetrack at record speeds. But the racing life was not for this girl, and Little Miss High Society soon traded the glitz of the track for a more relaxed lifestyle in Alvarado. Tito Nelson changed her name to Sister and trained the horse to be a barrel racer. “Saddles, buckles, boots, gift certificates, money – I won a lot on her,” Nelson said. When daughter Tatum or Tito saddle up Sister to practice barrel racing, they have an attentive audience that includes dogs Max, Quincy and Pickle, cats George, Jim and Melvin, and a pig, Henry. For Nelson, caring for animals at work and at home is a dream come true. She got hooked on the rodeo life in high school.

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Murphy the cat hated being separated from owner Dr. Rebecca Cunningham during her treatment for cancer three years ago. He’s now back where he belongs.

curled up in the crook of Dr. Cunningham’s arm every night for 13 years, the experience was devastating. “He’d just slam himself against the bedroom door,” she said. “Then I’d see his little paw poking out from under the door.” Eventually Murphy and Dr. Cunningham were reunited, and he returned to his rightful spot in the bed, where he has slept every night since her recovery from cancer. Murphy is happy at last but still suffers from separation anxiety. “He hates closed doors,” Dr. Cunningham said. “Closed doors mean something bad to him.” Kansas City the goat; Jerry Simecka, PhD Kansas City loves to climb on everything, but his favorite place is Jerry Simecka’s lap. The longhaired miniature fainting goat was just six weeks old when he arrived at

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the Weatherford home that Dr. Simecka shares with his wife, Leslie. “I could hear him making goat noises and the next thing I knew he had crawled up in my lap,” said Dr. Simecka, Professor of Pharmaceutical Sciences. “He just wanted to be held.” Today K.C. is grown and weighs about 60 pounds, but this big baby still likes to be held. Dr. Simecka, who grew up in Southern California, never imagined that one day he would be living in the country with a bunch of animals: 14 chickens, four cats, three tarantulas, three lizards, two dogs, two goats, two miniature donkeys and a Welch pony. “They’ve all gotten used to each other, but when the goats want to play, they’ll head-butt the dog,” he said. “Even that doesn’t really bother him.”


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“I could hear him making goat noises and the next thing I knew he had crawled up in my lap. He just wanted to be held.” — Jerry Simecka

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Ty the dog, with owner Lynley Dungan, loves attention. He’s training to be a therapy dog.

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Ty the dog; Lynley Dungan, Chief Information Officer With his Farrah Fawcett mane and perennial grin, 85-pound Ty can definitely stop traffic. And that’s exactly how this fluffy 4-yearold golden doodle likes it. “He just loves all the attention,” said Lynley Dungan. “If we go to Lowe’s and people don’t pay enough attention to him, he gets this big attitude and starts giving people his puppy eyes.” Ty recently earned the highest marks possible on his test to become a registered therapy dog. The family started his training early by exposing him to all kinds

of environments. “We go all over DFW with him, up escalators, in the Apple store and downtown around horses, so he’s exposed to different noises and situations,” Dungan said. He’ll continue his training by shadowing a dog-training team during visits to hospitals, schools and nursing homes. Then he and Dungan will work on their own. “He loves to make people happy.” Dungan said. “I think that’s why he’ll make a good therapy dog.” Butter and Bentley the bunnies; Mary Schaaf, social worker When Butter’s sister Bobbie passed away


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unexpectedly, Mary Schaaf felt as if she had to adopt another bunny within a few days. “Our veterinarian told us bunnies can become very depressed when their partner dies,” she said. Bentley, a very sweet and very lazy bunny from a rescue organization, soon joined the family. The bunnies spend their days in the living room of the family’s Azle home. “They love to ‘bunny-lax’ together by laying side by side on the floor,” Schaaf said. “Their favorite treats are bananas and cranberries, but they mainly eat Timothy hay and have a salad once a day with kale.” Schaaf, who works as a social worker in the Seminary Clinic, said she thinks the bunnies are therapeutic. “As soon as I pick one up at the end of the day, I feel instantly better,” she said.

Mary Schaaf holds Butter the bunny. Along with buddy bunny Bentley, the two spend lazy days in the family’s living room.

Austin and Casandra Luna show off Cheezers and Cheddars, a pair of Russian tortoises who get along great despite their differences.

Cheezers and Cheddars the tortoises; Casandra Luna, Recruitment Admissions Associate, and Austin Luna, Academic Program Coordinator When Austin and Casandra Luna brought Cheezers home, the Russian tortoise was small enough to hold in one hand. Seven years later? Not so much. The tortoise lives in a luxurious, custom terrarium and dines on kale. When the family goes on vacation, Cheezers goes too. On her first trip, she went camping in Abilene State Park. “We didn’t want to leave her alone,” Austin said. “The first night it got very cold and I kept waking up every hour to turn on the car’s heater to make sure she was warm enough.” When the couple moved from San Antonio to Fort Worth, Cheddars joined the family. The two girls get along great despite their differences. “Cheezers is more outgoing.” Austin said. “She’s bigger than Cheddars and she knows it. Cheddars is not comfortable peaking her head out of her shell. If you pick her up, after a while she’ll relax and come out.”

people and pets

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mental

health in grad school By Jan Jarvis

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a helping hand

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Dr. Emily Mire, Chair of the Care Team, says it can be very stressful for students when they are separated from their families.

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he thoughts whispering at Anna Black never took a rest – ever. They followed her through junior high, then into college. “I believed I had to be perfect in everything I did,” she said. “Getting a 95 was unacceptable.” For a while, she was able to manage her thoughts. Then she started her first year at Texas College of Osteopathic Medicine and felt overwhelmed. “I was not sleeping or eating at all,” Black said. “I was trying to keep up with everything, but I just couldn’t. It got to the point where all I did was think about how I needed to be perfect if I was going to be taking care of patients one day.” Her weight plunged. She became withdrawn. No matter how hard she

tried, Black could not outrun the thoughts churning in her brain. When thoughts of killing herself crowded out the voices telling her to be perfect, Black fell into a deep despair. The Care Team was ready to catch her. Pressure cooker More than 25 percent of medical students nationwide report symptoms of depression, according to a study in the Journal of the American Medical Association. About 10 percent of all medical school students report having thoughts of suicide. In 2012, the Care Team was established at UNT Health Science Center following a student’s suicide. The interdisciplinary Care Team supports students and connects them with the appropriate resources.


a helping hand

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face and started crying,” she said. “All of a sudden, I realized I wasn’t just looking at a body. I was looking at a man with blue eyes.” Seeing the donor body as someone’s husband, son or father was enough to rattle Jackson’s confidence as a first-year TCOM student. What jarred her even more was the realization that she might be jeopardizing a future she had been working for since high school. “I was doing exactly what I always wanted to do,” she said. “But now all of a sudden, I’m wondering if I even belonged in medical school.” The first and third years of medical school are peak times for referrals to the Care Team. Both are transitional years when students must adjust to big changes, Dr. Mire said. Although students can refer classmates

Asst. Director of Welfare Services Chris Klein, accompanied by Sgt. Kevin Saunders and Lt. Timothy Payovich of the UNTHSC Police Department, conducts a student welfare check.

“That’s why this job exists,” said Emily Mire, PhD, Director for Wellness Services and Chair of the Care Team. “What I am doing professionally is because of a tragedy.” Students are referred or seek help on their own for all kinds of reasons. For some, it is depression brought on by financial worries, loneliness and stress. For others, a life crisis – such as the death of a parent, a divorce, or illness – leads to despair. Some students struggle to meet basic needs, like finding a place to live and food to eat. The Food Pantry, for example, was launched in 2016 after some students lost everything in an apartment fire. In addition, the Care Team works with International Services to address the unique needs of students from foreign countries. “We keep up with what’s happening in other countries and how our international students are affected by travel bans, elections and other issues,” Dr. Mire said. “When students are separated from members of their family, it be can very stressful.” For many, it’s an unrelenting pressure to succeed that triggers the greatest despair. After cruising through college, they find themselves facing a blast furnace of facts that must be memorized. Competition, criticism and confusion combine with sleep deprivation, poor diet and isolation. It’s a recipe for hopelessness. Black said she was close to suicide when the Care Team stepped in to guide her to a better place. That meant taking leave, entering inpatient treatment and spending the next year getting strong enough to start medical school again. “Nobody quits med school,” she said. “But I also felt like that was the only option. I knew I’d come back stronger and be better for having done it.” Challenging years Mary Jackson’s breaking point came a few weeks into Anatomy Lab. “I was peeling off the skin from a man’s

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“I was a wreck. In the back of my mind, I kept thinking about the test, but also my dad and baby.” — Chris Douglas

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health issue


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school, Jackson’s mother was diagnosed with ovarian cancer. Between studying for the boards and taking her mother to chemotherapy, Jackson felt as if she would not be able to finish school. “I didn’t want to quit, but I needed a breather,” she said. “The Care Team never stopped checking on me. Without them, I probably would have failed my first year or I would have quit and had to start over. “I credit Emily and the Care Team for being the reason why I am going to graduate.”

Chris Douglas, holding son George as his father Gary and wife Emilie gaze with approval, says the Care Team helped him balance family stress and school demands.

anonymously, many hesitate to do so. More often, a faculty member observes that a student is missing classes or appears withdrawn. The team meets weekly to discuss students who have been referred for help. When students fail to respond to phone calls, welfare checks are performed by the team with help from the UNTHSC Police, said Chris Klein, Assistant Director of Wellness Services. Officers respond quickly, whether it is during the day, night or weekends. “Because of them, we’re going to come right away and make sure a student is okay,” said Klein, a former Dallas police officer. Chris Douglas turned to the Care Team when he faced a major test along with a double dose of family stress: His father was diagnosed with cancer and Douglas’ wife was expecting a baby. The Care Team provided emotional support and got the test moved up a day so he could be there for the birth of his son. “I was a wreck,” Douglas said. “In the back of my mind, I kept thinking about the test, but also my dad and baby.” Marie MacDonald knew that as a single mother with two boys, going to school would be tough. “But I thrive under challenges,” she said. “I felt like there was never a good time to go to school – I just had to make it happen.” When her nanny quit and her son stopped talking, MacDonald thought she would have to leave the physical therapy program in UNTHSC’s School of Health Professions. Although she was reluctant to ask for help, MacDonald finally contacted the Care Team. “They listened to me for almost two hours and just let me vent it all out,” she said. The team delivered emotional support and helped MacDonald find ways to juggle childcare and school. In Jackson’s case, she says the Care Team kept her going through her first year. Then, in her second year of medical

* For privacy reasons, the names of some students have been changed at their request.

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Courtney Parker is one of 70,000 adolescents and young adults who are diagnosed with cancer each year in the U.S.

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Lives interrupted The least studied and most isolated cancer patients are adolescents and young adults. UNTHSC is helping change that. By Alex Branch

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cancer registry

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“I dropped my daughter off, drove to school, sat in the hallway and cried on my friend’s shoulder until my husband got there.” — Courtney Parker

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ourtney Parker, a 32-year-old high school teacher, was breastfeeding her infant daughter when she felt a pea-sized lump. Her mind instantly lurched to cancer, but a visit to her doctor calmed her. Breast feeding often causes changes in breast tissue. The doctor performed a mammogram and ultrasound and suggested they observe the lump for a couple of months. Two months later, the lump was so large that Parker could see it in the mirror. She underwent a biopsy. While driving her daughter to daycare one morning, the doctor called. Parker had an aggressive form of Stage 3 breast cancer. “I dropped my daughter off, drove to school, sat in the hallway and cried on my friend’s shoulder until my husband got there,” said Parker, who teaches social studies in Eagle Mountain Saginaw School District. Parker is one of an estimated 70,000 adolescents and young adults between the

ages of 15 to 39 who are diagnosed with cancer in the U.S. each year. While that accounts for only 6 percent of all cancer diagnoses, this age group is diagnosed eight times more often than pediatric cancer, according to the National Cancer Institute. Because they are younger than the typical adult cancer patient and older than the typical pediatric cancer patient, adolescents and young adults can fall into a medical gray area. Their treatment plans must consider unique factors, such as biological differences, fertility and parenting, as well as social, educational and professional challenges. Providing better care and support to patients like Parker is the focus of a partnership between UNT Health Science Center and the Fort Worth AYA (Adolescents and Young Adults) Oncology Coalition, a nonprofit foundation made up of health care providers, service organizations and more than 100 health care professionals, cancer survivors, caregivers and volunteers. “A lot of the time, younger people with cancer are treated like hot potatoes,” said W. Paul Bowman, MD, UNTHSC Chairman of Pediatrics. “Oncologists who usually treat older adults aren’t as familiar with cancer diagnosis and management in younger adults, but neither are pediatric oncologists who are accustomed to treating children. “The result can be a patient bouncing around between providers and no one sufficiently focused on their specific needs.” Innovative registry Young adults and adolescents are far less likely to get cancer than adults in their 50s, 60s and 70s. But when they do, their prognosis is often worse. Researchers do not fully understand why, Dr. Bowman said. However, several likely factors include: • Biological differences. The genetic nature of cancer in young adults may


cancer registry

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At a glance

make it more aggressive or drug resistant. • Delayed diagnosis. Young adults and their physicians may not suspect cancer as the cause of obscure symptoms so diagnoses are often delayed, giving the cancer time to spread. • Treatment compliance. Adolescents may rebel and refuse treatment. Young adults, independent and adjusting to autonomy, may be less likely to follow their treatment plans. Investment in pediatric cancer research and specialized training for caregivers has greatly improved survival rates in children. But a similar emphasis has not been placed on the AYA population. Young adults tend to have the lowest enrollment rates of any age group for clinical trials that could identify new life-saving treatments, according to the American Cancer Society. That’s the focus of a $150,000 grant from the Joe and Jessie Crump Foundation to the Health Science Center. UNTHSC, in partnership with the AYA Coalition, is developing an innovative registry that will track incidence of cancer and outcomes for adolescents and young adults to enhance research and identify improved delivery of care for patients. The registry will be accessible to caregivers across North Texas. As a leading academic research institution, the Health Science Center was a natural home for the research aspects of the project, said Karen Albritton, MD, the AYA Coalition’s Medical Director. “The partnership with the Health Science Center is a key part of eventually

THE RESPONSE A partnership between UNT Health Science Center and the Fort Worth AYA (Adolescents and Young Adults) Oncology Coalition hopes to provide better care and support.

THE PROBLEM Young adults and adolescents are less likely to get cancer than adults in their 50s, 60s and 70s. When they do, their prognosis is often worse.

achieving our vision of ensuring that every young adult cancer patient in our community receives the highest standard of comprehensive and age-appropriate care,” she said.

Paul Bowman, MD, and Riyaz Basha, PhD, will direct an innovative registry at UNTHSC to track incidence of cancer and outcomes for adolescents and young adults.

THE SCOPE 70,000 adolescents and young adults between the ages of 15 to 39 are diagnosed with cancer in the U.S. each year.

Unique challenges The unique challenges that adolescents and young adults face after cancer diagnoses go beyond a lack of research. Because young adults often lack longevity in their employment, they have a harder time taking extended time off. Some are finishing high school, in college or hoping to get pregnant. “Some of the things that are very important to a 60 year old with cancer are often very different from things that are important to a

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25 year old,” Dr. Albritton said. Parker, and her husband Andrew, had always planned to have a second child so their 2-year-old daughter, Blair, would have a sibling. But chemical-induced menopause was part of her treatment. “We looked into freezing my embryos before I started treatment so we could eventually try to have a second child,’ Parker said. “But we didn’t want to delay my chemotherapy and risk waiting any longer. “It’s a decision you never in your life consider yourself having to make. Of course, you never expect to be 32 years old with a toddler and wondering if you will be alive in a year either.”

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Dr. Karen Albritton, Medical Director of the Fort Worth Adolescents and Young Adults Oncology Coalition, says the challenges faced by AYA cancer patients are different from those faced by children and older adults.

Jessica Orona Bernal says the social isolation that followed her cancer diagnosis was devastating.

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Social isolation Young adults and adolescents often feel out of place at cancer treatment facilities. A 17-year-old cancer patient is surrounded by young children in a pediatric center while a young adult draws sad or confused looks

from older patients at an adult center. “The older patients there would say, ‘Oh, but you are so young’ or ‘I thought you were here visiting your mom,’” said Kim Jones Penepacker, who was diagnosed with lymphoma in December at age 25. “And they mean well. But eventually you just want to say ‘Yes, I know, I’m young. And it didn’t help!’” Reducing the social isolation is among the AYA coalition’s goals. Cook Children’s Medical Center and Baylor Scott & White All Saints Medical Center Fort Worth have both created spaces designed specifically for young adults and adolescents. Laura Rutledge, whose daughter Carley was diagnosed with Ewing’s sarcoma at age 15, founded the Rutledge Cancer Foundation in 2011 to raise money for cancer research and supportive services for young people with cancer and their families. The foundation has funded innovative cancer treatment research at UNTHSC and provided funding to the Moncrief Cancer Institute/Rutledge Foundation Fertility Preservation Program. It also organizes social events like bowling nights, outings to Texas Rangers games and retreats. “After my daughter was diagnosed, she described it as feeling like everyone else’s lives kept going while hers came to a complete halt,” Rutledge said. “We try to help these young people get a break from their stress, relax, share stories and encourage each other.” Jessica Orona Bernal, a 17-year-old Trimble Technical High School student, was diagnosed with leukemia last summer before her junior year. The loss of social activity that followed devastated her. “I was always the person at school being around people, laughing with friends and doing usual teenage stuff,” she said. “Once I got sick, I had to be homeschooled, and it was just me and my teacher sitting at the kitchen table. “Sometimes it’s so hard not to feel alone and mad.”


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FACES OF CANCER

• 15 percent decrease in testosterone

• 20 percent increase in driving accidents Alexis Frailey, 15, Denton • 30 percent increased risk ofFrailey obesity thought her lingering cough was bronchitis. But after her stomach distended, her mother took her to a hospital in Denton for an ultrasound.

• 45 percent increased risk of Suddenly, heart attack Frailey was in an ambulance bound for Cook Children’s Medical Center in Fort Worth, where she had surgery the next day to remove a large mass in her abdomen. The

• 2.5 times increased risk of teenager diabetes had an uncommon cancer known as immature ovarian teratoma with yolk sac tumors. Three rounds of chemotherapy brought plenty of unwanted side effects, including hair loss. “One day my mom said she was going to cut my dad’s hair, and I said, ‘Let’s just do mine, too,’” she said. “We tried to have fun with it. First, we did the skater look. Then we did a Mohawk. Finally, we shaved it all off. “If you get upset, you just make it harder for everyone else, and that doesn’t help. I know my family understands when I do get upset, of course. But I try to stiff upper lip it for them.”

Dhana Rimal, 34, Fort Worth In 2017, Rimal developed pneumonia and a lingering cough. She made an appointment with a lung specialist but the first open appointment was a month away. Days passed by, and she felt like she was drowning. Her husband took her to the hospital emergency room, and she underwent multiple procedures, tests and scans. Soon after, a team of doctors gathered around her hospital bed with solemn news – she had stage 4A serous carcinoma. “I did six rounds (18 treatments) of chemotherapy and have taken part in an experimental drug trial for ovarian cancer,” she said. “I don’t know if I took the real drug or got the placebo. If anything, I just want to help the future generation of women who get this awful cancer.”

Benjamin Alvarez, 17, Fort Worth A swollen lymph node in Alvarez’s neck was the first sign that something was wrong with the Young Men’s Leadership Academy student. He had 31 lymph nodes surgically removed and 25 tested positive for thyroid cancer. Since he got sick, Alvarez said he has undergone 32 needle biopsies. “I like to think of myself as a baseball star, but the statistics on my baseball card would be the number of biopsies and surgeries,” he said. “I keep track of them.” Alvarez said he never lost his sense of humor during treatment. “I never cried but my best friend did,” he said. “I tease him now – I say, ‘I knew you loved me.’ It was a hard experience, but I’m ready to move on. I have too much to live for.”

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giving

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Protecting their daughters’ generation Ralph and Janet Heath make generous gift to faculty members fighting Alzheimer’s

By Alex Branch

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anet Heath has a deeply personal interest in Alzheimer’s disease. Her mother suffered from it, as did her grandmother. Heath spent the last 10 years of her mother’s life trying to coordinate high-quality care as the disease took its terrible toll. That’s why Heath and her husband, Ralph, made a generous gift to UNT Health Science Center and faculty members Sid O’Bryant, PhD, and Janice Knebl, DO, MBA. Heath says she views their work as vital to one day preventing Alzheimer’s and improving care for those who have it. Dr. O’Bryant, Professor of Pharmacology

and Neuroscience, pursues novel ways to diagnose and treat Alzheimer’s disease. Dr. Knebl, Professor of Geriatrics, prepares future health care professionals and caregivers to recognize early-stage cognitive issues and provide innovative, team-based care. “I support Dr. O’Bryant’s research into the science of Alzheimer’s because I want to protect my daughters’ generation from this disease,” Heath said. “I support Dr. Knebl’s work because she is educating the kind of caregiver that would have made a world of difference to my mother and me.” Heath’s mother was diagnosed with Alzheimer’s when she was 78. Heath, who


giving

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Janet Heath says she and her husband hope their gift will “help create the type of caregiver that people with Alzheimer’s truly need.”

lives in Fort Worth, made repeated trips to her parents’ home in Phoenix to help care for her mother. It was a stressful and tiring experience, and Heath was unhappy with the outside care her mother received. “We went through various groups of caregivers who would come in the house and check on my mother,” Heath said. “But they weren’t really trained on how to deal with people with dementia. They didn’t do flash cards like I did with her when I visited to stimulate her. They didn’t nurture her. “Often they would just plop her down in front of the TV,” she said. Heath was already familiar with the Health Science Center. One of her two daughters graduated from the UNTHSC Graduate School of Biomedical Sciences in 2006. Heath also has participated in aging research. The gift was made through the Heath Family Foundation at the North Texas Community Foundation. Ralph Health, retired President of Lockheed Martin Aeronautics Company, is a member of the North Texas Community Foundation Board of Directors. The gift will support Dr. O’Bryant’s efforts to discover ways to detect cognitive loss in people earlier in life and develop personalized medicine models that target specific therapies for specific subsets of people. Dr. O’Bryant also is developing a simple blood test to screen for Alzheimer’s. The gift will allow Dr. Knebl to fully develop training modules that follow a virtual geriatric patient through experiences in ambulatory care, hospital care, surgical interventions, nursing care and hospice. The programming emphasizes team-based, interprofessional care. “My goal is to help save the next generation from Alzheimer’s,” Heath said. “And to help create the type of caregiver that people with the disease truly need.”

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The science of sleep Second winds are bad, naps are your enemy and other fun facts to help you get your seven-to-nine hours of sleep every night.

By Alex Branch

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sleep science

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B

Dr. Brandy Roane, a certified sleep medicine specialist, says a carefully considered routine before bed can help you get the kind of sleep your body demands.

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lackout curtains darken the windows in rooms where Brandy M. Roane’s family spends time after dinner, namely the bedrooms and the office and gaming room. Table lights, not bright overhead lights, provide illumination. As the hour grows late, an alarm sounds to remind Dr. Roane, her husband and two teenage boys to shut down any electronic equipment they’re using. It is time to get ready for bed. Not surprisingly, the Roanes sleep well. Roane, PhD, an Associate Professor of Physiology and Anatomy at UNT Health Science Center, is a certified behavioral

sleep medicine specialist. Her family’s carefully crafted bedtime routine is an example of the help she provides children, teens, families and adults with sleep disorders. At least 40 million Americans have a chronic sleep disorder and 20 million more have trouble sleeping, according to the National Institutes of Health. Lack of sleep can impact physical health, mental health, employment, personal relationships and more. Dr. Roane has spent her career researching sleep patterns and how sleep disorders impact health. Here are 10 things about sleep she says you should know:


sleep science

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“Scientists have researched what happens when you deprive animals of sleep, and, quite simply, they die. Sleep is required to sustain life.” — Dr. Brandy Roane

1

Our bodies do amazing things during sleep. It is kind of weird to think about – but every night we lie down and become unconscious and paralyzed. During our brain’s most active phase of sleep – called Rapid Eye Movement (REM) sleep – our bodies lose all muscle tone. “Our eyes and our diaphragm are the only things moving,” Dr. Roane said. During sleep, our blood pressure and body temperature drop. Growth hormones release. Memories consolidate. Muscles repair. Our brains’ nerve cells rewire, mapping new connections and discarding old ones. Our immune system enters overdrive. “Scientists have researched what happens when you deprive animals of sleep,” Dr. Roane said. “And, quite simply, they die. Sleep is required to sustain life.”

2

Not all sleep is the same. There are four stages of sleep, each one necessary. Stage 1 is the transition from wakefulness to sleep, hazy moments when we still hear noises around us. Stage 2 is the first official stage of sleep, though it’s not yet deep. Stage 3 is deep sleep. This is the restorative stage, when the body repairs itself and memories are transferred from short-term memory to long-term memory. If awakened, we feel the groggiest. Stage 4 is REM sleep – the final stage. It’s the stage when our brain is

exploding with activity and cleaning out clutter that did not make it into longterm memory. “To reach REM sleep, you have to go through at least one other stage first,” Dr. Roane said. “If you wake up, you don’t always immediately sleep back into the stage you woke from. Your sleep becomes fragmented, or disorganized. That’s why sleep disturbance is so problematic.”

3

Naps are not our friend. Dr. Roane discourages naps in most patients over the age of six. Two hours of sleep during the day may feel necessary but doesn’t help you reach REM sleep at night. “The brain doesn’t recognize, ‘Oh, I made it to this stage this afternoon so I’ll just pick up there,’” Dr. Roane said. In fact, naps make restorative sleep at night more difficult. We build sleep pressure – basically sleepiness – during the day. At night, we relieve it during sleep. Sleep pressure takes twice as long to build as it does to release. Naps release that pressure prematurely, making it harder to get to sleep at night and achieve all four sleep stages. “If you must nap, do it before 2 p.m. and limit it to 20 minutes,” Dr. Roane said. “It can still feel refreshing without releasing too much sleep pressure.”

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sleep science

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“If you feel like you are about to nod off or need a nap badly, that means you aren’t getting sufficient sleep at night.”

4

There is a reason we feel tired every afternoon. Our bodies’ functioning is coordinated by the master clock – a group of about 20,000 neurons that comprise the suprachiasmatic nucleus, situated in the brain just behind the optic nerve that connects to each eye. This master clock produces a circadian rhythm that promotes alertness and runs on a 24-hour cycle. This rhythm usually dips to its lowest activity between 2 a.m. to 4 a.m. when most of us are asleep. But it also dips between 2 p.m. and 4 p.m. to allow our sleep drive to build pressure. That’s why we often feel drowsiness in the afternoon. “If you just feel drowsy, that is perfectly normal,” Dr. Roane said. “If you feel like you are about to nod off or need a nap badly, that means you aren’t getting sufficient sleep at night.”

5

A ‘second wind’ is a missed sleep window. Sometimes we feel tired all day but get a “second wind” of alertness by the time we get in bed to sleep. That might be because we missed our sleep window. Our master clock wants cues for it to stop promoting wakefulness. It wants us to go to bed at the same time each night and follow a familiar bedtime routine. But if we took a nap earlier or we didn’t dim the lights as evening fell, we get into

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bed and don’t feel tired enough to sleep. We resort to non-sleep conducive behavior, such as looking at our phones. Our master clock is surprised. “It says ‘Oh, we’re not going to sleep right now! Let me help you stay awake.’ And we get that second wind,” Dr. Roane said. Sleeping late in the morning can have the same effect. It sends a signal to the master clock that the daily timing of things has shifted later. “That’s why it is so important to pick a sleep schedule and stick to it,” she said.

6

We worry at night because a bear might eat us. Not really, but the concept is

the same. In primitive days, sleep was a dangerous task. We lay defenseless as danger lurked –a large, hungry bear, for example. For those predisposed to sleep problems, it’s like our minds are wired to be hyper-vigilant to threats during sleep. In modern times, we no longer fear the bear, so our minds seize upon other anxieties. We lie in bed brooding over stresses at work, money problems or that weird creaking noise coming from the kitchen. Our fight-or-flight instinct activates, quickening our heart and breathing rates, and making it even harder to get to sleep. “Anxiety and insomnia go hand in hand,” Dr. Roane said. “People already prone to anxiety often struggle the most with this.”

7

Sleep aids often don’t work but are hard to quit. Most sleep aids don’t work well because sleep is such a balance of our body’s mechanisms that forced medicated sleep doesn’t have the same restorative value, Dr. Roane said. However, once we start taking a sleep aid, it’s difficult to stop. The body essentially


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discovery

“Anxiety and insomnia go hand in hand.” WWW.UNTHSC.EDU

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sleep science

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throws a temper tantrum because it isn’t getting something it has come to expect. So it becomes harder than usual to sleep the first and second nights after we quit. On the third night, we cave. We take the sleep aid and sleep better. Not because the sleep aid worked, but because our body’s tantrum has ended. “I tell patients that if they can hang in there one week, their sleep will go back to normal or often even better than before they started using sleep aids,” Dr. Roane said.

“That’s why cramming all night for a big test is a bad idea if you actually need to learn something.”

8

Sleep is the magic from which memories are made. Sleep is critical to our memory. As things happen to us throughout the day, sensory information enters our brain. Our brains decide what is important and moves it to our working memory. Our brain then determines what needs to be filed in our short-term memory. Think of this as the “temp folder” on a computer. During sleep, those memories get transferred to our long-term memory. Think of that as the computer’s hard drive. The transfer isn’t perfect; some things get lost. But without deep sleep, the information accumulated throughout the day clutters up our short-term memory, and we struggle to process new information the next day. Or, to complete the computer analogy, the “temp folder” is now an overflowing mess. “So we start merging information and our memories become confused,” Dr. Roane

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said. “That’s why cramming all night for a big test is a bad idea if you actually need to learn something.”

9

We should eat peanut butter and crackers. Going to bed with a full stomach is not conducive to good sleep. It leads to discomfort, acid reflux and, because we digest food slowly at night, makes us more likely to skip breakfast. Breakfast is a cue for our master clock to know we have started our day and to promote wakefulness. Dr. Roane recommends eating dinner at least three hours before bedtime. But going to bed hungry is not conducive to good sleep either. So a light snack before bed of less than 200 calories that includes a protein and a carbohydrate can tide us over without making us full. Peanut butter and crackers is a great choice, she said. A boiled egg also does the trick.

10

We are all different. There is no fix all for our sleeping problems. Just like some of us hold our alcohol better than others, some of us handle less sleep better than others. Not all of us require the same amount. The trick is to find the amount that suits each one of us and stick to it. “Think ‘Goldilocks,’” Dr. Roane said. “Not too little. Not too much. But just right.”


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sleep science

INSOMNIAC FACTS • 15 percent decrease in testosterone • 20 percent increase in driving accidents • 30 percent increased risk of obesity • 45 percent increased risk of heart attack • 2.5 times increased risk of diabetes

HOW MUCH SLEEP? • Adults require 7 to 9 hours of sleep • Teens require 9 to 11 hours • Children require 11 to 15 hours

SLEEP TIPS • Set an alarm reminding you to power down electronics 30 minutes before bedtime. • Use your bedroom only for sleep or sex. • Use box fans to create white noise. • Use dim lights in the late afternoon and evening to promote sleep. • Foods containing calcium, magnesium and potassium promote sleep. Avoid caffeine, alcohol, high fat and sugar. • Exercise during the day, but not too close to bedtime. • If you don’t fall asleep within 15 to 20 minutes of getting in bed, get up and do low-key activity (no electronics). When sleepy, return to bed. Rinse and repeat. • Wake up at the same time each morning, even on weekends.

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who we are

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Why I do what I do

The ATV accident that changed my life By Dr. Rita Patterson

Dr. Rita Patterson and her husband, Les.

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was attending an event at work when I learned that my husband, Les, had crashed his allterrain vehicle near our Weatherford home. The ATV rolled onto his leg, crushing it. He hollered for help until a neighbor heard him and called 911. The next year was a painful slog of related medical problems and rehabilitation that ultimately resulted in the amputation of his leg. Les went on long-term disability and had to leave his job as a plant manager. I was no stranger to the many ways lost mobility impacts lives. Ironically, the study of movement and pursuit of novel treatments for people with function and balance problems is precisely what I do at UNT Health Science Center. Trained as a biomedical engineer, I joined

UNT HEALTH SCIENCE CENTER

UNTHSC in 2007 and oversaw development of the Human Movement Performance Laboratory. This innovative and collaborative lab uses advanced technology to discover ways to improve the quality of life for amputees, children and adults with autism, stroke victims, people with diabetes and Parkinson’s disease and more. I had always empathized with the research participants I encountered, of course. They are the focus of my life’s work. But as Les and I adjusted to his limited mobility, I learned some things that deepened my passion for the people we try to help. I learned that many otherwise mundane tasks — like simply bathing —can require gigantic effort for a person with limited mobility. I learned that knowing when to help someone and when to let him or her accomplish a task alone is important. I learned how people with disabilities are often treated in public. Some store owners seem to believe they are all poor and have no money. When I talk to research participants or their families, I am able to tell them: “I understand how you feel. We have been through that, too.” My husband’s accident was eight years ago. Today, Les walks on a prosthetic leg and has developed a passion for people with prostheses. He founded the Fort Worth Amputee Coalition, a support group that has achieved nonprofit status. In a sense, we now share the same goal — to help people move a little better in this world. Dr. Rita Patterson is a Professor of Family Medicine, Director of Research for the Department of Manipulative Medicine and Director of the Human Movement Performance Laboratory.


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Solutions Magazine Fall 2018  

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