Houston Medical Times

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Serving Harris, Galveston, Brazoria and Fort Bend Counties

HOUSTON

July Issue 2014

Inside This Issue

NEW RULES ON DIRECT PATIENT ACCESS TO LABORATORY TEST REPORTS By Mark S. Armstrong Epstein Becker Green

Blocking Key Enzyme minimizes stroke injury See pg. 14

INDEX Marketing Essentials......pg.4 Mental Health...............pg.6 Healthy Heart ...............pg.9 Age Well Live Well .......pg.12 Framework .................pg.18

A recent federal rule (the “Rule”) was finalized amending provisions of the Clinical Laboratory Improvement Amendments of 1988 (CLIA) to require clinical laboratories covered under CLIA to make available to patients, upon request, completed test reports. The Rule also amends the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy Rule to grant individuals the right to access such reports directly from laboratories without the ordering provider’s approval. Prior to the amendments, a CLIA laboratory could only disclose laboratory test results to three categories of individuals or entities: (1) an ‘‘authorized

person,’’ (2) the person responsible for using the test results in the treatment context, and (3) the laboratory that initially requested the test. In Texas and other states that did not allow individuals to access their own test results, patients were required to receive their test results through their health care providers. The Rule amends the CLIA regulations and gives an individual (or the individual’s personal representative) the right to access, upon request, to the individual’s

completed test. HIPAA covered entities have until October 6, 2014 to comply with the Rule. I. THINGS TO KNOW ABOUT THE NEW RULE: 1. The Rule Preempts State Laws Prohibiting Release of Test Reports.

see Direct Access page 20

CHANNELVIEW HUSBAND AND WIFE SURVIVE BREAST CANCER TOGETHER Five Foods for Radiant Summer Skin See pg.18

Juan and Nora Marroquin of Channelview have shared a lot in their 35 years of marriage, including successfully raising two children. However, their knack for sharing goes well beyond the usual—as both have survived breast cancer.

First diagnosed with a cancerous lesion above his left eye in 2012, Juan told his doctor of a suspicious lump around his right breast. Tests later confirmed it, too, was cancer. Less than a year later after performing a breast self-exam, Nora noticed a suspicious lump in her right breast, which was cancer. Both were diagnosed and treated at Harris Health System’s facilities—Ben Taub Hospital, Lyndon B. Johnson Hospital and Smith Clinic. As if sharing the same cancer diagnosis wasn’t enough, both have in common the same date for surgeries—June 20. Juan had his back-toback surgeries to remove cancerous cells from his forehead and breast in 2012. Exactly a year later, Nora also had surgery to remove cancerous cells from her breast.

Juan and Nora Marroquin

“What are the chances? We thought what a big coincidence,” Nora recalls. “We want 2014 to be without any kind of incident.” Juan says, “Maybe we’ll win the lottery this time.” Nora quickly replies, “We’ve already won it—we’re alive and well.” see Breast Cancer Couple page 21

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Houston Methodist and Texas A&M join forces to enhance physician education and research innovation and treatments, and provide them the skills they need to turn these ideas into realities that improve health for patients Houston Methodist and Texas A&M everywhere.” Health Science Center are partnering The medical degree program will to bring more innovative research and begin with two years of basic medical medical education to the state through science and pre-clinical training at new health professions degree programs Texas A&M Health Science Center in the Texas Medical Center. Beginning College of Medicine in Bryan and in 2015, 24 Texas A&M medical continue with the third year rotation students will begin clinical training and options for fourth year electives at Houston Methodist and Texas A&M Health Science Center have teamed up to train the next and graduate research in Houston, with Houston Methodist Hospital. As part generation of physician leaders in the Texas Medical Center. plans for that number to double by 2016. of a joint M.D./Ph.D. degree program, research institutes. build our Houston campus, and in turn, lead world-class research and medical Texas A&M will work with Houston “The Texas A&M and Houston “Through combined efforts, Texas education in the most important healthMethodist to provide translational Methodist joint degree programs A&M and Houston Methodist related district in the world.” research opportunities on the Houston combine the strengths of our institutions are offering aspiring physicians campus. Those individuals pursuing an to train the next generation of physician M.D./Ph.D. joint degree will take their and clinician scientists a unique, The partnership is part of a larger leaders,” said Tim Boone, M.D., Ph.D., medical and graduate sciences classes at unparalleled educational opportunity Houston expansion plan for the Texas co-director of the Houston Methodist Texas A&M campuses and complete in an academically rich environment A&M Health Science Center and Institute for Academic Medicine and three to four years of doctoral thesis renowned for scientific discoveries and follows the recent announcement of the new regional vice-dean for the work at the Houston Methodist Research translational clinical research,” said Brett a two-year ground lease in the Texas Texas A&M College of Medicine. “Our Institute or the Institute for Biosciences P. Giroir, CEO of Texas A&M Health Medical Center for future construction programs will mentor young physicians and Technology, both leading medical Science Center. “These are exciting times to nurture their ideas for new cures for the Aggie family as we continue to see Houston Methodist & A&M page 21 By Holly Lambert Texas A & M Health Science Center

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Marketing Essentials

The First Thing Every Successful Doctor Should Know about Marketing By Lonnie Hirsch Co-founder of Healthcare Success Strategies

When you need it.

For most medical doctors, the typical workweek is somewhere north of 50 hours. And that doesn’t include the time thinking about the marketing part of the business. Professionally trained, experienced and licensed in the healing arts, a practitioner spends a day mostly applying clinical skills. It hardly seems like there is any time to spare, but many physicians are

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also inventors, thinkers, and community leaders. And, on top of that, the successful doctors we know are business-savvy entrepreneurs. They are ”MD” full-time, and medical practice Chief Executive Officer (CEO), and Chief Marketing Officer (CMO) at other times. Fortunately, the time-stretched MDslash-CMO—a solo practitioner or the designated marketing champion of a multi-specialty group—there’s a key concept that drives medical marketing. It’s a “long-view” leadership principle that’s worth keeping top-of-mind. We like the way that author and professor Peter Drucker—arguably “the man who invented management”—put it: Marketing is not a function, it is the whole business seen from the customer’s point of view.

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Some physicians dislike marketing; It’s too much like “selling,” or they feel it is someone’s assigned task. In Drucker’s perspective, top management can’t hand off the task. Entrepreneurial doctors embrace the idea and lead from the proposition that marketing is an essential ingredient that fuels the enterprise. In a word, what the patient is buying is happiness. It’s the one and only reason people buy healthcare. Drucker’s words are a reminder that the customer (patient, prospective patient) is of primary importance. A customer-centric business identifies the problems and needs of the audience, and succeeds by effectively delivering solutions that answer those

needs. A patient-centered practice is the product of leadership of a top-to-bottom culture. To borrow an example from business, consider Amazon’s core values where “customers are an obsession,” (and Amazon is the world’s largest online retailer.) In their words, “Leaders start with the customer and work backwards. They work vigorously to earn and keep customer trust. Although leaders pay attention to competitors, they obsess over customers.” The big idea for doctors is that marketing is not an added task appended to a busy schedule. It is the whole business seen from the customer’s point of view. MDs share management and leadership qualities with the best-of-class marketing executives. And in a previous article, we listed some of the characteristics of the successful MD who thinks like a CMO.


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Houston Medical Times

Special Feature: Vacation Home Ownership Report

Vacation-home ownership made simple Private Residence Club-style living is a perfect solution for busy professionals Overworked professionals understand High-pressure and high-responsibility professionals, physicians among them, are perhaps more in need of vacation getaways – places to “unplug” – than most. But an irony of second-home or vacation-home ownership is that, with upfront expenses, ongoing maintenance obligations, and travel to and from resort or exotic destinations, those second homes end up becoming responsibilities in and of themselves. What should be a peaceful retreat ends up as one more thing to “manage.” Private Residence Clubs have emerged as an increasingly popular response to that reality. Sophisticated, upscale vacation-home owners the world over have embraced the convenience and budget-friendliness of luxury Private Residence Club living for years. It’s a way of enjoying a second home in a resort or vacation destination that’s based on shared, or fractional, ownership. With this style of ownership, the upfront and ongoing costs are dramatically less than with full ownership – and, more importantly, the headaches and hassles of traditional home ownership are virtually eliminated.

absentee management of a multimillion-dollar vacation home doesn’t make sense, the ownership of a share in a Private Residence Club does. With convenient reservation arrangements that provide for flexible use for owners and their guests; with five-star amenities and services; and with a real estate investment that can be resold or transferred at any time; it's small wonder that the “PRC” has taken off as robustly as it has. Today, about 70% of American households who can afford to purchase a million-dollar vacation home choose not to. They do so for a host of reasons, including avoiding the burdens of absentee ownership, and because of concerns that they won’t use the property enough to warrant buying it. The conveniences of fractional ownership hold significant appeal for these families – perhaps yours among them.

low-density with great views, which is precisely why we chose this location. Space, light, views – in many ways, these are the real definitions of luxury.” Visitors to Seahorse remark upon the unspoiled nature of the place’s rolling dunes, waving beach grasses, and clear Gulf waters. It’s an idyllic landscape, the setting for a menu of resort-level amenities. Among them will be Seahorse’s expansive 9,000-square-foot Club House with kid’s recreation center, fitness room, spa, and bar, and the kind of dining options you’d find in a fine hotel. On-property, residents enjoy a scenic elevated pool that overlooks the Gulf, as well as private picnic pavilions, playgrounds and sports areas; walkable nature preserves; even private crabbing and fishing piers. A full-time onsite concierge makes it all run smoothly, while the beach club will ensure that the beach experience is maximized by providing beach

Over the years, luxury fractional ownership of vacation homes has become one of the fastest-growing segments of the luxury vacation-home industry. The list of fine Private Residence Clubs includes Capella Pedregal in Cabo San Lucas, Mexico; the Isle de France Club on St. Barth’s in the Caribbean; Miami Beach’s Residence at Island Gardens; and Pond Bay on St. John in the U.S. Virgin Islands. Even urban locales like New York, San Francisco, and London are home to highly sought-after Private Residence Clubs for city-lovers – properties that often cater to elite business travelers as well as urban vacationers.

A lifestyle of flexibility and good sense The fact is, for the large segment of successful professional and executive families for whom the ownership and

return year after year . . . if the homes themselves match your vacation-home dreams . . . if the idea that you are buying into a lifestyle full of amenities and service as part of the purchase appeals to you . . . then a Private Residence Club like Seahorse may be just the ticket.

PRIVATE RESIDENCE CLUBS: 5 COMMON QUESTIONS WHAT IS A PRIVATE RESIDENCE CLUB (PRC)?

A PRC is the luxury end of fractional property ownership. A PRC provides owners with the full services and amenities that they'd expect in exclusive high-end or five star luxury hotels and resorts.

WHAT ARE THE ADVANTAGES?

Owners enjoy abundant and flexible use of their vacation homes with luxurious services and amenities typically unavailable to second-home owners, inluding world-class design and furnishings. They profit from the financial good sense of minimal investment. They share their home with friends and family. And often they can exchange reservations for accommodations at sister-PRCs in other desireable locations around the world.

CAN PRCs BE RESOLD?

PRC memberships are just like any other form of real estate – they can be transferred or sold, subject to individual PRC policies.

An ownership style that has evolved Historically, the Deer Valley Club in Park City, Utah, established in the early 1990s, is often cited as the first modern Private Residence Club – embraced by ski-resort-loving owners frustrated by the financial, managerial, maintenance, and other obligations that go along with ownership of a multimillion-dollar second home.

Page 5

DOES ONE OWN A PARTICULAR HOME OR UNIT? Now, Private Residence Club living has come to the Texas Gulf Coast, with the anticipated opening of Seahorse Beach Club & Residences – a family-oriented “country club on the beach”

The first on the Texas Gulf Coast Now, Private Residence Club living has come to the Texas Gulf Coast, with the anticipated opening of Seahorse Beach Club & Residences – a family-oriented “country club on the beach” that includes both beachfront and bayfront homes in a resort style setting. The exclusive 108-acre master-planned vacaction home community is located on scenic Follett’s Island, one of Texas’s barrier islands – just west of Galveston and about an hour’s drive from downtown Houston via 288 South. Residences at Seahorse are spacious four or five-bedroom, architecturally distinguished mini-estates conceived with respect for the traditions of Gulf coast design and the lifestyle that has brought families to Gulf beaches for generations. In the words of John Howton, Houstonian Developer of Seahorse, “We wanted to offer the Private Residence Club experience close to home, and wanted to give owners

seats/umbrellas and non-motorized beach toys, including boogie boards and kayaks. Many area executives, professionals, and their families who have always dreamed about owning their own vacation home in Galveston/Surfside are discovering Seahorse – a genuine escape, yet close enough to use for short-notice weekend getaways, truly a one-of-a-kind beach and resort community. Best of all, the Seahorse Private Residence Club is affiliated with the Registry Collection, so Seahorse residents will have the flexibility, on an exchange basis, to enjoy million-dollar homes at fine resorts throughout the world.

Is a PRC right for you? Are Private Residence Clubs like Seahorse for everyone? No. If you have extended periods of vacation time off, for example, 30 to 60 or more days off at a time, it might not be right. But if this is a destination to which you, your family, and your friends will want to

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Yes, owners receive a deed to a particular unit and PRC owners have flexible access to all villas, townhouses, cottages, or apartments at their ownership level.

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July 2014


Houston Medical Times

Page 6

Mental Health

Researchers uncover new insights into developing rapid-acting antidepressant for treatment-resistant depression UT Southwestern Medical Center researchers have generated fresh insights that could aid in the development of rapid-acting antidepressants for treatment-resistant depression. The researchers found that by blocking NMDA receptors with the drug ketamine, they could elicit rapid antidepressant effects in patients with treatment-resistant depression. Ketamine was developed as an anesthetic, but is better known publicly for its abuse as the party drug Special K. Researchers are now seeking alternatives because ketamine can produce side effects that include hallucinations and the potential for abuse – limiting its utility as an antidepressant. Therefore, researchers had been investigating a drug called memantine, currently FDA-approved for treating

moderate to severe Alzheimer's disease, as a potentially promising therapy for treatment-resistant depression. Memantine acts on the same receptors in the brain as fast-acting ketamine, said Dr. Lisa Monteggia, Professor of Neuroscience. However, recent clinical The different effects of ketamine and data suggest that memantine does not memantine alter signals emanating exert rapid antidepressant action for from NMDA receptors, in particular reasons that are poorly understood. those that determine antidepressant efficacy. Dr. Monteggia noted that the “Although, both ketamine and new findings point a way to blocking memantine have similar actions when NMDA receptors to control depression nerve cells are active, under resting with fewer side effects. conditions, memantine is less effective in blocking nerve cell communication compared to ket amine, T his fundamental difference in their action could explain why memantine has not been effective as a rapid antidepressant” said Dr. Monteggia, who holds the Ginny and John Eulich Professorship in Autism Spectrum Disorders.

Guidelines by the American Psychiatric Association suggest medications are the preferred treatment for moderate to severe depressive symptomatology. About one in 10 people in the U.S. aged 12 and over takes anti-depressant medication, and about 14 percent of those individuals taking antidepressant medication have done so for 10 years Dr. Monteggia’s lab focuses on the or longer. molecular and cellular bases of neural plasticity, the fundamental property of Antidepressants were the third most nerve cells to alter their communication, common prescription drug taken by as they pertains to neuropsychiatric Americans of all ages between 2005 disorders, as well as understanding the and 2008, and the most frequently used mechanisms underlying antidepressant prescription drug by people 18 to 44 efficacy. see Mental Health page 21

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Texas A&M boosts health care workforce with largest graduating class Leading efforts to alleviate the state and national shortages of health care professionals, the Texas A&M Health Science Center graduated 624 students at commencement ceremonies across the state last month. This is the largest graduating class to date, and is indicative of Texas A&M’s commitment to educate exceptional health care leaders in medicine, dentistry, nursing, pharmacy, public health and medical sciences.

average with 97 percent matching to residency programs across the nation, and half serving their residencies in Texas.

Health Science Center is meeting this challenge by providing an influx of compassionate, well-trained, diverse health care professionals,” said Brett P. Giroir, M.D., executive vice president and CEO of the Texas A&M Health Science Center. “These graduates not only will provide citizens of Texas the highest quality health care and prevention programs, but will also develop into national leaders who transform health care delivery so that it is more affordable and of higher quality.”

Texas A&M College of Nursing – 117 students received a Bachelor of Science in Nursing (B.S.N.). The college ranks first among nursing graduates nationwide based on percentage of graduates passing the national licensing exam.

Texas A&M University Baylor College of Dentistry – 96 students received a Doctor of Dental Surgery (D.D.S.), 29 a Bachelor of Science (B.S.) in Dental Hygiene and 41 students with graduate’s degrees and certificates in specialty programs. Nearly one-third of “The state and nation face a dire health all dentists in Texas are graduates of the care workforce crisis, and Texas A&M Texas A&M Baylor College of Dentistry.

Graduates for each college are as follows: Texas A&M College of Medicine – 143 students received a Doctor of Medicine (M.D.), two a Master of Science (M.S.) in Medical Sciences and 10 a Doctor of Philosophy (Ph.D.). This year, the graduating class exceeded the national

Texas A&M Irma Lerma Rangel College of Pharmacy – 86 students received a Doctor of Pharmacy (Pharm.D.). To date, more than half of the college’s graduates remain in South Texas to practice Texas A&M School of Public Health – 69 students received a Master of Public Health (M.P.H.), 28 a Master of Health Administration (M.H.A), one a Master of Science in Public Health (M.S.P.H.) and two a Doctor of Public Health (D.R.P.H.). The school ranks in the Top 25 “Best Grad Schools for Public Health” by U.S. News & World Report.

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Page 8

Houston Medical Times

Back from the Dead – Patients Reunite with ICU Staff By Bobbi Gruner Memorial Herman

Boxing was Derek Hunt’s exercise of choice. “I thought I was in good shape. Life was great and I was on top of the world,” said the 39-yearold father of three. While hitting the bag at home last August, Hunt suffered a massive “It’s hard to believe I was so sick that I can’t almost two months of my life,” said heart attack. His heart stopped remember Angelica Wheeler, a 42-year-old mother of two, twice before the ambulance made at the Memorial Hermann Southeast Hospital it to Memorial Hermann Southeast ICU Reunion on June 12, 2014 with her husband and ICU Clinical Manager Janet Gregory. Hospital. There, Hunt, who is also the pastor of Vision Church in and healing, the reunion also Pearland, was only given a 50-50 brought closure to painful chapters chance to live. for some, inspiration to many, and a chance to express thanks from On Thursday, June 12, Hunt family and patients. joined other appreciative patients at a gathering with the Memorial The ICU at Memorial Hermann Hermann Southeast Intensive Care Southeast has 24 intensive care Unit (ICU) doctors, nurses, and beds, 8 intermediate beds, and 12 staff members who saved their lives. overflow beds. It treats patients

threatening. These patients need special equipment and medication, and constant monitoring and support from specialists. “We do everything humanly possible so our patients are able to get back to their families and friends and resume their lives as soon as possible,” said ICU Patient Care Director Mary Carrillo, R.N., B.S.N., C.V.R.N. “Then, we are on to the next emergency.” Because of that, ICU staff members usually never see patients again. So periodically, Carrillo and the ICU staff invite former patients back to share their experiences and progress.

PHOTOS: Memorial Hermann

said Wheeler, a 42-year-old mother of two who lives with her husband in southeast Houston. “It’s hard to believe I was so sick that I can’t remember almost two months of Patients like Angelica Wheeler. my life.” Admitted to Memorial Hermann S out heast last Novemb er, Wheeler almost lost more than Wheeler was suffering from that. At one point, the physicians double pneumonia, the flu, and told her family to be prepared to complications from being a smoker. make funeral arrangements.

“I was really sick, coughing up with extremely serious injuries and blood, but I always took care of my Planned as a celebration of survival illnesses, many of which are life family and friends before myself,”

July 2014

After suffering a massive heart attack, Derek Hunt, the 39-year-old father of three, was only given a 50-50 chance to live. “There is no doubt in my mind that I am alive because of the care and the people who work at Memorial Hermann Southeast,” said Hunt with ICU nurses, Brent Bean and Michelle Krause.

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“They have such good hearts, see Back from the Dead page 22


Houston Medical Times

Page 9

OUTSMART THE HEAT THIS SUMMER, AND KEEP ACTIVE By Shelly Millwee with staff contributions, American Heart Association

It’s July and you know what that means in Texas – it’s HOT, HOT, HOT! Often the heat can derail us from getting outside and staying active. Let’s face the heat can be miserable and even dangerously hot as we move into late summer. But, exercise is important and many studies indicate that the key benefits of exercise are lost in four to six weeks of inactivity. Here are the top five ways to stay active this summer and outsmart the heat:

4. Dress the part. Wear minimal amounts of clothing to facilitate cooling by evaporation. “Remember, it’s not sweating that cools the body; rather, the evaporation of sweat into the atmosphere,” Franklin said. Wear lightweight, light-colored clothing in breathable fabrics such as cotton. 5. Team up. If you can, exercise with a friend or family member. It’s safer, and could be more fun.

Because vigorous exercise in hot and humid conditions can lead to heat stress, 1. Hydrate, hydrate, hydrate. Maintain heat stroke and related complications, salt-water balance by drinking plenty you should know the signs of danger to of fluids (preferably water) before,

during and after physical activity. keep an eye out for. Avoid alcoholic and caffeinated beverages. Symptoms of heat exhaustion: 2. Exercise smarter, not harder. Work out during the cooler parts of the day, preferably when the sun's radiation is minimal — early in the morning or early in the evening. Decrease exercise intensity and duration at high temperatures or relative humidity. And don’t hesitate to take your exercise inside, to the gym, the mall or anyplace else where you can get in regular physical activity.

Headaches

Heavy sweating

Cold, moist skin, chills

Dizziness or fainting

Weak or rapid pulse

Muscle cramps

Fast, shallow breathing

3. Ease in to summer. Allow your body to adapt partially to heat through repeated gradual daily exposures. “An increase in the body's circulatory and cooling efficiency, called acclimatization, generally occurs in only four to 14 days,” Franklin said.

Nausea, vomiting or both

Symptoms of heat stroke: ∙

Warm, dry skin with no sweating

Strong and rapid pulse

Confusion and/or unconsciousness see Active in the Summer page 22 medicaltimesnews.com

July 2014


Houston Medical Times

Page 10

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there is destruction of the insulinproducing cells of the pancreas. The American Pediatric Association recognizes that "early exposure of infants to cow's milk protein may be an important factor in the initiation of the beta cell destructive process in some individuals," and "the avoidance of cow's milk protein for the first several months of life may reduce the later development of IDDM or delay its onset in susceptible people."

I still remember as if it were yesterday. The topic of the medical school class was type 1 diabetes, and the professor informed us that we currently do not have any idea what causes this type of diabetes. Surprised by the comment, I raised my hand and said, “There The Link between Animal Product is evidence that cow’s milk may be Consumption and Type 2 Diabetes a culprit.” The whole class started to laugh. I happened to carry the In the Marshall Islands, diabetes book that every medical student is

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required to read in their pathology class and quoted from it: “Children who ingest cow’s milk products early in life have 1.5-fold increased risk for type I diabetes.” There was an immediate silence in the room, as I had just “won” the argument.

was virtually unknown before the 1950’s. In March 1, 1954, the US tested a nuclear head that was 1,000 times larger than the bomb dropped in Hiroshima. As a result of the radiation, many islanders were affected and sued the US government, winning the suit and getting a big settlement. What did they do with that money? They changed their whole lifestyle from simple plant-based foods to Spam™, frozen turkey tails, and fast food full of fat, salt, and sugar. Today the Marshall Islands have one of the highest rates of diabetes in the world.

Type 1 diabetes is one of the fastest growing diseases in the world. There are many possible etiologies for type 1 diabetes that we are still learning about, one possible explanation is that cow’s milk has a protein that is similar to a protein in the pancreas. In certain people, the cow’s protein is identified as a foreign substance in the body, and the immune system Subsequently, diseases like diabetes, tries to get rid of it. It is eliminated heart disease, and cancers (among from the blood, but since there is others) dramatically increase. One a similar protein in the pancreas, see Not So Sweet page 22 July 2014

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Houston Medical Times

Page 11

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Page 12

Houston Medical Times

Age Well Live Well

Ombudsmen go to bat for nursing home residents – just all kinds of noise.”

By Jeff Carmack, Texas Department Of Aging and Disability “My goal is to take care of little problems before they become big problems.” -Linda Reynolds When Linda Reynolds’ mother needed a full-time caregiver, she retired from the job she had worked for more than 25 years at the Texas Department of Child Protective Services. When her mom needed to live in a nursing home, she recognized the need for advocates for residents of long-term care facilities. After her mother died, Reynolds volunteered to be an ombudsman. A big part of a long-term care ombudsman’s role is to listen to residents’ concerns and intervene on their behalf. Ombudsmen hear a lot of complaints. Reynolds said the number-one complaint she hears concerns the lack of respect and dignity for residents. “They may not say specifically ‘I’m not being treated with dignity’ but many of the complaints come back to that,” she said. “I hear complaints like, ‘I’m spoken to like I’m a child,’ or ‘I’m not called by my name.’

Poor roommate matches can cause irritation as well. “Some nursing homes don’t do a real good job when personalities and interests don’t match,” she said. When this happens, an ombudsman can work with residents and management to find a solution, and also help with long-term solutions. This approach emphasizes residents’ rights to have their preferences honored, and also gives them a real sense of choice and control. Reynolds is quick to put in a good word for the hard work accomplished by facility staff. “Most try very hard to create a comfortable and respectful environment,” she said. “Social workers are great, especially with roommate and dignity issues, and activity directors are quick to deal with boredom issues.” She believes her efforts pay off. “My presence makes thing better,” she said. “Just my being there, walking through and talking to people makes them feel better. Residents know that I will take their complaints to the administrators or directors of nursing, and they know that I will follow up and see if complaints are being addressed.”

“Everyone wants to be called by their name, and many if not all of the people I talk to want to be addressed as Mister or Missus.” “Sweetie” and “Sugar” don’t show the same respect.

For example, Reynolds remembered a woman with MS who used an electric wheelchair. The administration reprimanded her twice for going too fast in the hallways. After she ran into – but did not injure – another resident, the administrator decided to discharge her.

Another regular frequent complaint is medication not being given on time. “Nurses have a two-hour window to administer medications, but when the medications control pain, timeliness is of particular concern. “They don’t want their pain meds 45 minutes later – they need them now,” Reynolds said.

That’s when Reynolds went to work. “I pointed out to the administrator that she had not been counseled about her behavior, that he had not developed a corrective plan of action for her behavior, nor had he contacted the wheelchair company to see if some sort of governor might be installed on her chair. I told him he could not discharge her.”

Boredom and the lack of stimulating activities also come up as big issues for residents. “No one goes into a nursing home hoping for Bingo to be the highlight of their life,” she said, “Too often that’s the main activity and those who don’t like Bingo feel left out.”

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Nursing homes can be noisy places, which takes away from the environment feeling like home. “Staff talking loudly, or rolling laundry carts or trash cans down the hall

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Reynolds prevailed. The woman’s wheelchair was fitted with a governor device, the expense and hardship of transferring were avoided, and the administrator was satisfied. To find out more about becoming a volunteer ombudsman, call 1-800-252-2412.

Become a volunteer ombudsman! Volunteer ombudsmen listen and resolve concern… And advocate for residents in nursing homes and assisted living communities. We make a difference in residents’ lives every day.

To talk to an ombudsman call 800-252-2412. July 2014

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Blocking key enzyme minimizes stroke injury, UT Southwestern research finds

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A drug that blocks the action of the enzyme Cdk5 could substantially reduce brain damage if administered shortly after a stroke, UT Southwestern Medical Center research suggests.

While several pharmaceutical companies worked to develop Cdk5 inhibitors years ago, these efforts were largely abandoned since research indicated blocking Cdk5 long-term could have detrimental effects. At the The findings, reported in the June 11 time, many scientists thought aberrant issue of the Journal of Neuroscience, Cdk5 activity played a major role in the determined in rodent models that development of Alzheimer’s disease and aberrant Cdk5 activity causes nerve that Cdk5 inhibition might be beneficial cell death during stroke. as a treatment. “If you inhibit Cdk5, then the vast Based on Dr. Bibb’s research and that majority of brain tissue stays alive of others, Cdk5 has both good and bad without oxygen for up to one hour,” effects. When working normally, Cdk5

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said Dr. James Bibb, Associate Professor of Neurology and Neurotherapeutics at UT Southwestern and senior author of the study. “This result tells us that Cdk5 is a central player in nerve cell death.”

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adds phosphates to other proteins that are important to healthy brain function. On the flip side, researchers have found that aberrant Cdk5 activity contributes to nerve cell death following brain injury and can lead to cancer.

More importantly, development of a Cdk5 inhibitor as an acute “Cdk5 regulates communication neuroprotective therapy has the potential between nerve cells and is essential for proper brain function. Therefore, to reduce stroke injury. blocking Cdk5 long-term may not be “If we could block Cdk5 in patients beneficial,” Dr. Bibb said. “Until now, who have just suffered a stroke, we may the connection between Cdk5 and be able to reduce the number of patients stroke injury was unknown, as was in our hospitals who become disabled the potential benefit of acute Cdk5 or die from stroke. Doing so would inhibition as a therapy.” have a major impact on health care,” In this study, researchers administered Dr. Bibb said. see Stroke page 21

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UTMB nurses recognized for excellence Gold and silver medals honor best in faculty and nursing administration

The Good Samaritan Foundation each year honors Excellence in Nursing in six categories, awarding gold and silver medals to the profession’s “best and brightest.” This year, nursing professionals at the University of Texas Medical Branch at Galveston were recognized with two gold medals and one silver.

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Linda Rounds, the Betty Lee Evans Professor of Nursing at the UTMB School of Nursing, received the gold medal for faculty. In the nursing administration category, Jaime Heffernan, nurse manager of the Blocker Burn Unit, received the gold medal, while Charles Machner, Dr. Linda Rounds – DNP Program Director, nurse manager of the Medical Intensive Professor, UTMB Care Unit brought home the silver medal. that the Good Samaritan Foundation has chosen to recognize not one but two “The UTMB School of Nursing is of our nurse managers with their gold beyond proud to have Linda Rounds and silver nursing administration and on faculty,” said Pamela G. Watson, leadership awards this year. We are proud dean of UTMB’s School of Nursing. “She of Jamie and Chuck. They demonstrate is a truly exceptional leader in nursing compassion and skill every day, and it education. Rounds is the third School is fitting that they have been recognized of Nursing faculty member to become a through these awards.” Good Samaritan Foundation Gold medal award winner. How wonderful for her Nursing is part of the DNA at UTMB: and for UTMB students.” the School of Nursing was established in 1895 and was the first nursing school This is the latest recognition for Rounds, west of the Mississippi River. Moreover, who was inducted into the American

Jaime Heffernan, nurse manager of the Blocker Burn Unit

Academy of Nursing last fall. She has devoted her life to advanced practice nursing, serving as president of the Texas Board of Nursing for 10 years and recently guiding the first class to receive doctorates in nursing practice.

UTMB was awarded Magnet Recognition for nursing, a certification held by fewer than 10 percent of hospitals in the United States.

The Good Samaritan Excellence in Nursing award winners are nominated by “The nurse manager role is one their peers and selected by a distinguished of the most complex roles in health committee of nursing leaders. Those care, and effective leadership skills are nominated must demonstrate passion crucial in today’s complex health care for the nursing profession and exemplify environment,” said David Marshall, vice excellence in teaching, mentoring, president and chief nursing and patient leadership and service. care services officer. “We are thrilled July 2014

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Eating pretty: Five foods for radiant summer skin Chances are you have seen glowenhancing creams and serums lining the shelves of your local supermarket. Some are marketed as age- defying and promise to energize skin in a matter of days. But when it comes to obtaining a glowing complexion, what you put in your body is just as important as what you put on it. “Eating the right foods can help protect skin from oxidative stress that contributes to the aging process, clear up acne and brighten a dull complexion,” said Kari Kooi, a registered dietician at Houston Methodist Hospital. “As the name implies, watermelon hydrates cells so they’re plump and full; the high protein content in almonds stabilizes blood sugar, thereby minimizing acne flare-ups. These ingredients will not only brighten your plate but your overall appearance.”

Here are five super foods for attaining a summer glow: ∙∙ Watermelon: With more than 90 percent water content, the fruit plays a vital role in beauty enhancement by hydrating cells to increase the production of collagen. This increase revitalizes skin, revealing a firmer and more youthful appearance. Kooi recommends enjoying a watermelon salad that’s bursting with flavor by simply cutting the watermelon into bite-size pieces and combining with spicy arugula, red-wine vinegar, thinly sliced red onion, and a sprinkle of crumbled goat cheese. ∙∙ Pumpkin seeds: With increased intake into your diet, the Zinc in hulled pumpkin seeds or “Pepitas”, aid the skin-cell renewal process to control the hormone and oil production linked to acne. July 2014

Sprinkle a handful of seeds into your morning oatmeal or yogurt for an added crunch and slightly sweet, nutty flavor. ∙∙ Almonds: Abundant in skinnourishing vitamin E, almonds provide powerful antioxidant protection to help neutralize skin damaging free radicals. Its 48 percent magnesium content is believed to decelerate signs of aging and acne breakouts. During mid-summer at the height of their season, almonds are a versatile addition to any sweet or savory meal. ∙∙ Pineapple: Its distinctive yellow color makes pineapples synonymous with summertime. It’s filled with an enzyme that helps soften skin and brighten complexion. Kooi says to select a pineapple with a sweet

fragrance at the stem end and to make sure that it is heavy for its size. Pineapples ripen from the bottom up, so the shell’s transformation in color from green to gold is the distinguishing signal the fruit is ready to enjoy. ∙∙ Carrots: Incorporating carrots into your diet will not only add a pop of orange to a salad, but also helps to achieve a healthy, sunkissed glow without spray tans or potentially harmful UV exposure. The carotenoid antioxidants in carrots, including beta-carotene, give carrots their deep orange coloring and provide a subtle natural tan by the pigments being deposited in the skin. Beta- carotene keeps skin youthful by targeting and repairing skin damage as well as protecting skin from the ravage of excess sun exposure.

Family Fertility Center at Texas Children’s Pavilion for Women opens new IVF lab, first in Houston to offer new monitoring technology Texas Children’s Pavilion for Women, one of the nation’s premier hospitals for women’s, fetal and newborn health, announced the opening of their new state-of-the-art in vitro fertilization (IVF) lab featuring the latest technology and techniques in reproductive endocrinology, including the first IVF clinic in Houston to utilize a leading-edge embryo monitoring system called the EmbryoScope. The clinic also offers a full spectrum of pain management options tailored to each patient’s individual needs and supervised by board certified obstetric anesthesiologists. The hospital’s new IVF lab has two EmbryoScope systems that provide continuous moving time-lapse images of embryos in a controlled environment, which have been shown to increase IVF success. Other advanced equipment in the lab includes specialized miniature incubators and a state-of-the-art alert system that provides real-time monitoring of embryo pH and temperature.

knowledge and experience in women’s reproductive health. Gibbons notes that in his years of experience offering this level of coordinated care is unique because it provides the highest level of patient comfort and safety during IVF procedures, an “To create one of the top fertility centers important part of the patient experience in the country, we utilized the expertise of at the Family Fertility Center. world-renowned consultants and assembled a nationally prominent team to assist in the Another key component of the Family design and implementation of our lab,” said Fertility Center is the fertility preservation Dr. William Gibbons, medical director of program for women facing cancer. the Family Fertility Center and chief of Texas Children’s Pavilion for Women reproductive medicine at Texas Children’s is collaborating with The University of Pavilion for Women. “Our vision has been Texas MD Anderson Cancer Center, to offer our patients the latest and most one of the largest cancer centers in the advanced fertility treatments available to world, to provide women facing cancer improve pregnancy success rates, especially the option of preserving their fertility in those complex cases our team is known before they undergo cancer treatments. for taking on.” Gibbons is a past president Dr. Terri Woodard, a fertility specialist of the American Society for Reproductive who is affiliated with MD Anderson, the Medicine, the Society for Reproductive Pavilion for Women and Baylor College Endocrinology and the Society for Assisted of Medicine, offers expert care for cancer Reproductive Technology. He is also the patients of childbearing age. director of the Division of Reproductive Apart from their patient care role, the Endocrinology and Infertility at Baylor fertility experts from the Pavilion for College of Medicine. Women and Baylor College of Medicine The Family Fertility Center’s new IVF lab is overseen by two internationally recognized experts, embryologist Kathleen Miller, director of the IVF lab, and reproductive biologist, Gary Smith, Ph.D., director of the andrology lab. Anesthesia care is a central part of the unique services offered at the center and is led by Dr. B. Wycke Baker, chief of anesthesiology at Texas Children’s Pavilion for Women. His team includes highly skilled anesthesiologists and certified registered nurse anesthetists with

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will focus on research that advances the field of reproductive endocrinology. “To be a center of excellence on the forefront of medicine and provide our patients with the best care possible, our goal is to use research to provide new insights into women’s and men’s reproductive health, to be a hub of innovation and to find answers to questions that haven’t even been asked,” said Gibbons. Because of Texas Children’s commitment to research, Gibbons notes, the center has the ability to perform sophisticated investigations in order to evaluate and improve the IVF process.


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Direct Access

Continued from page 1 The Rule and the CLIA, and HIPAA amendments it finalizes, preempt a number of state laws that prohibit laboratories from releasing test reports directly to individuals or individuals without their ordering provider’s approval. Now, under the HIPAA Privacy Rule, all HIPAA-covered laboratories (including primary laboratories, reference laboratories, and hospital laboratories) are required to provide test results upon patient requests, and may provide the results directly to the requesting patients.

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their laboratory test reports within thirty (30) days of the request. In instances when retrieving records may take longer than thirty (30) days, laboratories may request one thirty (30) day extension as long as the laboratory provides the reason for the delay in writing to the requesting individual. 6.

Interpreting Lab Reports.

The Rule does not require laboratories to interpret test results for patients. Patients merely have the right to inspect 2. Who May Access Laboratory and receive a copy of their completed test reports and other individually identifiable Results. health information maintained in a designated record set by a HIPAAThe Rule gives an individual, or the covered laboratory. individual’s personal representative, the right to request access to their protected 7. Charges for Producing PHI. health information (PHI) directly from HIPAA-covered laboratories and these A HIPAA-covered laboratory may laboratories may not require these charge an individual a reasonable, costindividuals to make such requests based fee that includes only the cost of: through their providers. (1) labor for copying the requested PHI, (2) supplies for creating the paper copy 3. Pat ient Aut hent ic at ion or electronic media; (3) postage, when Requirements. the individual has requested the copy be mailed and (4) preparation of an The identity of patients requesting explanation or summary of the PHI, if information from laboratories and their agreed to by the individual. authority to request such information must be verified by the laboratory prior to releasing any information. The laboratory may verify a person’s authority by asking for documentation such as a health care power of attorney, general power of attorney, durable power of attorney that includes the power to make health care decisions, proof of legal guardianship, or, in the case of a parent, information that establishes the relationship of the person to the minor individual. 4. Transmitting PHI to Another Entity.

8. Revising Notices of Privacy Practices. HIPAA-covered laboratories must revise their privacy practices by October 6, 2014 to inform individuals of their right to access their own test results directly from the laboratory and must include a brief description of how the patient can exercise this right. II.

CONCLUSION.

The newly enacted Rule gives patients greater access to their laboratory records so that these patients may begin taking Under the Rule, HIPAA-covered more active roles in managing their laboratories will be required to abide health care. However, the Rule imposes by an individual’s request to have the additional regulatory obligations upon laboratory transmit the copy of the HIPAA-covered laboratories. These individual’s PHI to another person or HIPAA-covered laboratories should begin taking affirmative steps to ensure entity designated by the individual. that they are in compliance with the 5. Deadline for Responding to amended CLIA regulations and Privacy Information Requests. Rules before October 6, 2014, the compliance date of the Rule. Generally, laboratories will be required to provide individuals with access to July 2014

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Breast Cancer Couple Continued from page 1

Brandon Lausser, manager, Radiation Oncology, Smith Clinic, coordinated the radiation treatments for the Marroquins. Radiation treatments are one of the many options available to rid patients of cancer at Harris Health. Smith Clinic has several of the most advanced linear accelerators in the Texas Medical Center, and has quickly become a Houston leader in providing cancer care.

diagnosis last year, while Nora was given The Marroquins were excellent patients the all-clear in late March. because they kept up their treatment plan, asked questions and remained engaged in the process,” he says. “They’re also Both still have routine follow-ups, and very positive and diligent about their are confident that their cancer scares are over. well-being.”

away from your life because you ignore them. People need to realize they are responsible for their health and well-being. We learned that after cancer.”

According to the American Cancer Society, men are 100 times less likely to Aside from surgery to remove the cancer, “We want others to know that no one have breast cancer than women. Juan and Nora each underwent extensive is going to take care of your health better bouts of chemotherapy and radiation than you,” Nora says. “Cancer, diabetes treatments. Juan was given a cancer-free and heart disease aren’t going to stay

Houston Methodist and Texas A&M Continued from page 3

of a multidisciplinary research and spirit of collaboration that is emerging education building adjacent to the Albert across the Texas Medical Center.” B. Alkek Building that currently houses the Texas A&M Institute for Biosciences Participating Houston Methodist and Technology. doctors and scientists will receive Texas A&M faculty appointments and titles.

M.D., interim dean of medicine and vice president for clinical affairs, Texas A&M Health Science Center. “Together we are opening new doors for the future of medical education, all the while ensuring Aggie doctors are amply prepared to address the ever-changing health care “We are pleased with the announcement needs of Texans.” of this partnership between two “This partnership will afford Texas prestigious members of the Texas A&M medical students the opportunity Mauro Ferrari, Ph.D., president Medical Center, Houston Methodist and for specialized training alongside worldand CEO of the Houston Methodist Texas A&M Health Science Center,” class doctors and scientists at Houston Research Institute and director of the said Robert Robbins, M.D., president Methodist as they complete their journeys Houston Methodist IAM, said initiatives and CEO of Texas Medical Center. toward becoming the next generation of like this one join the strengths of two “This is a great example of the new health care leaders,” said Paul Ogden,

Texas institutions in a way that benefits Texans. “These are the kinds of programs Texas needs to cut through the barriers to medical innovation. They empower physicians at our nationally recognized hospitals, to partner with our excellent universities and our growing biotechnology industry to use research dollars more efficiently and achieve real progress in treating the worst diseases.”

Stroke

Continued from page 14

a Cdk5 inhibitor directly into dissected a systemic drug that could be used to brain slices after adult rodents suffered a confirm the study’s results and lead to stroke, in addition to measuring the post- a clinical trial at later stages.” stroke effects in Cdk5 knockout mice. Currently, there is only one FDAapproved drug for acute treatment of “We are not yet at a point where this stroke, the clot-busting drug tPA. Other new treatment can be given for stroke. treatment options include neurosurgical Nevertheless, this research brings us a procedures to help minimize brain step closer to developing the right kinds damage. of drugs,” Dr. Bibb said. “We first need to know what mechanisms underlie the Additional UT Southwestern scientists disease before targeted treatments can be from the Department of Psychiatry who developed that will be effective. As no contributed to this study were lead author Cdk5 blocker exists that works in a pill and former postdoctoral researcher Dr. form, the next step will be to develop Douglas Meyer; postdoctoral researcher

Dr. Melissa Torres-Altoro; Instructor Dr. Advanced Comprehensive Stroke Florian Plattner; and former postdoctoral Center certification. This designation is the highest level of certification for researcher Dr. Janice Kansy. stroke care by The Joint Commission. The work was supported by grants UT Southwestern’s Robert D. Rogers from the National Institutes of Health. Advanced Comprehensive Stroke Center Pharmaceutical company Boehringer offers the most advanced treatment Ingelheim provided the Cdk5-inhibiting available from a multidisciplinary team compound indolinone used in the study. of vascular neurologists, endovascular specialists, vascular surgeons, neuroThis work is just one of numerous radiologists and neuro-intensivists who cutting-edge stroke research studies are on call 24 hours a day to treat stroke taking place at UT Southwestern, patients. where patients have access to the newest treatments and clinical trials due in part to the stroke center’s recent

Mental Health

Continued from page 6 years old, according to surveys by the Centers for Disease Control. According to the CDC, comparing the 1988–1994 period with the 2005–2008 period, the average rate of antidepressant use in the U.S. among all ages increased nearly 400 percent.

Overall, women are two and a half times more likely to take antidepressant medication as men, with 23 percent of women aged 40 to 59 taking antidepressants – more than in any other group.

The CDC estimates that nearly 8 percent of people over age 12 report being currently depressed, with women reporting higher rates of depression than males in every age group. Women between 40 and 59 years have the highest rates of depression (about 12

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percent). Depression generates more than 8 million visits to physician offices, hospital outpatient and emergency departments, and nearly 400,000 inpatient stays, which average 6.5 days.

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Back from the Dead

HOUSTON

Continued from page 8

I really found another family at Memorial Hermann Southeast,” said Wheeler. “When I was in pain or crying, they were there for me – the most beautiful people you have ever met.”

care and the people who work at Memorial Hermann Southeast,” said Hunt, who also completed cardiac rehabilitation at the hospital. He now bikes 12 to 24 miles a day and continues his ministry work.

life, and experiencing that every day sometimes takes an emotional toll on our staff,” said ICU Clinical Manager Janet Gregory, R.N., B.S.N., C.C.R.N. “We are so thrilled when patients visit and share how they are doing. Seeing them happy and “There is no doubt in my mind “We realize being in the ICU is healthy is what makes this job so that I am alive because of the a challenging time in someone’s rewarding.”

Active in the Summer routine. Certain heart medications can exaggerate the body’s response to heat.

any of these symptoms.

Editor Sharon Pennington Associate Editor Lorraine McColley Director of Media Sales Richard W DeLaRosa Creative Director Lorenzo Morales

Continued from page 9

∙∙ High fever

Published by Texas Healthcare Media Group Inc.

∙∙ Throbbing headaches

Remember, if you’re a heart patient, older than 50 or overweight, you might Also remember to avoid the outdoors ∙∙ Nausea, vomiting or both need to take special precautions in the in the early afternoon (about noon to 3 p.m.) because the sun is usually at its Take steps to cool down and get medical heat. Always check with your healthcare strongest, putting you at higher risk for attention immediately if you experience professional before starting an exercise heat-related illnesses.

Not So Sweet

Account Executives Christina Pastrana Distribution Director Angelo Rose Accounting Liz Thachar

Continued from page 10 of the common denominators in this transition is the inclusion or increase in animal product intake. This is a phenomenon we are now experiencing on a world scale; you can literally see geographical diabetes maps of disease directly related to income and animal product intake. Animal products are naturally pro-inflammatory, which is one of the triggers of diabetes. One study showed that high levels of inflammation were created in just half an hour by a typical breakfast of sausage and eggs. Regular consumption of these types of foods creates havoc in the human body. We need to return to a simple plant-based diet to prevent or reverse these problems.

proteins, sugars, and too much fat. It is like trying to use gasoline to extinguish a fire. This advice does not reflect the scientific knowledge we have accumulated so far. For example, the use of chicken and dairy products will not increase the Help Heal Yourself in Days glucose levels of patients on the short term, but rather the excess protein My personal experience is that the will put an extra burden on the majority of diabetics can either stop kidneys and will increase insulin, the progression or completely reverse cholesterol, and inflammation levels. their disease if they are willing to make permanent changes in their I have never seen, in my 18 years lifestyle. In regards to diet, the focus of experience, a single patient that should be to adopt a wholesome, has reversed their diabetes by strictly low-fat, non-inflammatory diet that following the American Diabetic has a low glycemic load (i.e. food is guidelines. A landmark study in digested slowly) that can help to lose 2006 shows the clear advantages of a weight, specifically lose visceral fat. vegan diet against the current ADA The best diet is based on legumes diabetic guidelines. The vegan group (beans, lentils, garbanzos, etc.), was able to control glucose much whole cereals, and vegetables that better and improve other health grown from the ground. markers such as cholesterol and Current dietary guidelines from weight. Even if the diabetes cannot the American Diabetic Association be completely reversed, a change push a "westernized" diet. They to a full plant- based diet will help clearly ignore the health needs while to keep sugar under better control encouraging a “sanitized version” of and, in many cases, will lead to less the Standard American Diet and diabetic medication. will have high blood pressure and 80% of diabetics will die of stroke or heart disease. Diabetes is also the number one cause of blindness in the US.

In the US, the lifetime risk of diabetes for Hispanics is 53% for females and 45% for males and for Caucasians 39% for women and 33% for males. The main problem with diabetes is the associated complications including kidney failure, amputations, nerve and ligament problems, and cognitive decline. Three out four diabetics the fast-food culture with animal July 2014

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Office: 713-885-3808 Fax: 281-316-9403 For Advertising advertising@medicaltimesnews. com Editor editor@medicaltimesnews.com

Houston Medical Times is Published by Texas Healthcare Media Group, Inc. All content in this publication is copyrighted by Texas Healthcare Media Group, and should not be reproduced in part or at whole without written consent from the Editor. Houston Medical Times reserves the right to edit all submissions and assumes no responsibility for solicited or unsolicited manuscripts. All submissions sent to Houston Medical Times are considered property and are to distribute for publication and copyright purposes. Houston Medical Times is published every month P.O. Box 57430 Webster, TX 77598-7430


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