Vital Record » Medicine http://news.tamhsc.edu Your source for health news from the Texas A&M Health Science Center Mon, 03 Aug 2015 14:41:41 +0000 en-US hourly 1 Addressing public health abroad: Aggies team up to provide health services in Ecuador http://news.tamhsc.edu/?post=addressing-public-health-abroad-aggies-team-up-to-provide-health-services-in-ecuador http://news.tamhsc.edu/?post=addressing-public-health-abroad-aggies-team-up-to-provide-health-services-in-ecuador#comments Thu, 30 Jul 2015 15:00:44 +0000 http://news.tamhsc.edu/?post_type=post&p=24050 This summer, an interdisciplinary group of Aggies - composed of students from the Texas A&M Health Science Center School of Public Health, College of Medicine, College of Nursing and College of Pharmacy - spent a week abroad providing basic health services to residents of Guamaní, Ecuador. ]]>

This summer, an interdisciplinary group of Aggies – composed of students from the Texas A&M Health Science Center School of Public Health, College of Medicine, College of Nursing and College of Pharmacy – spent a week abroad providing basic health services to residents of Guamaní, Ecuador.

A small community of about 39,000 residents, Guamaní lies on the southern outskirts of the country’s capital, Quito. A relatively new, incorporated community, Guamaní deals with many public health issues including water, sewer, transportation, safe recreation and reliable trash removal. The students wasted no time getting to work, and within the first two hours, created:

  • a triage center for medical and dental attention;
  • a pharmacy center for filling prescriptions after seeing a doctor, nurse and/or dentist;
  • an education center to teach positive nutrition and health routines;
  • a child care center;
  • and a public health training and interview center.

Throughout the week, students worked with community residents and leaders to implement a community health assessment, conducted focus groups and visited with families to discuss what public health means to them. Additionally, residents participated in a photo voice exercise, walking the community, photographing and simultaneously commenting on health conditions in Guamaní.

“Being on the ground and learning directly from residents about the public health challenges in Guamaní really allowed us to apply what we’ve learned in the classroom,” said Evelia Castillo, a student in the Master of Public Health program. “Despite the challenges, the people are resilient and resourceful. They are already working to address many of the challenges that were documented. I hope the work we completed in collaboration with Guamaní residents can be used to amplify their current efforts.”

The data will be consolidated in a report and sent to Guamaní leaders and participants for their use in creating and implementing future community health development projects.

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When it comes to depression, serotonin deficiency may not be to blame http://news.tamhsc.edu/?post=when-it-comes-to-depression-serotonin-deficiency-may-not-be-to-blame http://news.tamhsc.edu/?post=when-it-comes-to-depression-serotonin-deficiency-may-not-be-to-blame#comments Thu, 23 Jul 2015 16:58:07 +0000 http://news.tamhsc.edu/?post_type=post&p=23965 For the past several decades, those suffering from depression have been told that by boosting serotonin levels, brain chemicals will re-balance and mood will improve.  It’s no surprise then that more than one in 10 Americans age 12 and older take some form of antidepressant medication designed to increase serotonin levels, offsetting the chemical imbalance. ]]>

Woman suffering from possible depressionFor the past several decades, those suffering from depression have been told that by boosting serotonin levels, brain chemicals will re-balance and mood will improve.  It’s no surprise then that more than one in 10 Americans age 12 and older take some form of antidepressant medication designed to increase serotonin levels, offsetting the chemical imbalance. However, new research suggests the link between low levels of serotonin and depression is, at best, a partial answer.

“Chemical imbalance is really an overly simplistic way of thinking,” said Paul B. Hicks, M.D., Ph.D., vice dean and professor of psychiatry and behavioral sciences at the Texas A&M Health Science Center College of Medicine in Temple. “Depression is a very complex problem that we know involves certain parts of the brain, but we don’t have a complete picture. While countless theories have been tested, we still don’t have the final understanding of what changes in the brain with depression and how we should proceed to reverse such changes.”

One theory is the idea that our brains can run low on a neurotransmitter called serotonin. It’s thought that by prescribing a selective serotonin-reuptake inhibitor (or SSRI) antidepressant medication, like Prozac or Zoloft, the imbalance can be medically fixed; bringing serotonin levels back to “normal.”

“This idea is based upon the assumption that serotonin and/or norepinephrine – a neurotransmitter secreted in response to stress – brain levels are low in depression and that antidepressants work by elevating brain neurochemical concentrations,” Hicks said. “It has been valuable in helping to identify all the currently marketed antidepressants.”

SSRIs are designed to boost serotonin levels, helping kick off the production of new brain cells, which in turn is thought to allow depression to “lift.” However, if low serotonin levels were the cause of depression, then increasing levels of serotonin should alleviate the symptoms instantly. Unfortunately, that’s not the case.

“The major problem with this theory is the chronology of the resulting chemical changes in the brain,” Hicks said. “SSRIs release serotonin and increase the amount in the brain almost immediately, while the antidepressant effect can take a few weeks to kick in.”

This time-lapse indicates that there may not be a direct relationship between low levels of serotonin and depression. However, antidepressants are still effective and two-thirds of patients respond to them positively, we just don’t have the entire answer as to why they work, yet.

New hypotheses in depression focus on the role of an excitatory brain chemical produced from glucose, glutamate, which is known to increase brain activity and energy levels.

“Studies link high glutamate levels in the brain with depression and antidepressants are known to decrease these levels,” Hicks said.

In fact, intriguing recent findings show an immediate antidepressant response when ketamine, a drug that blocks glutamate’s actions, is given directly into the blood.

“While brain chemicals, including serotonin and the more prevalent glutamate, seem to play a role in depression, it is also true that specific brain regions appear to mediate the development of depression,” Hicks added.

A brain region called the hippocampus, where stress is mediated and memory consolidation occurs, decreases in size and complexity of chemical connections under the influence of stress and presumably depression.

“We also know that another brain region near the base of the front of the brain, the subgenual cingulate cortex, is overactive in depression and antidepressants decrease its activity when an antidepressant response is seen,” Hicks said.

While serotonin deficiency may not cause depression after all, new research may lead to a more direct and effective treatment than common SSRIs.

“Management of depression is an evolving field and there are many important studies being done to enhance our available treatment options,” Hicks said. “While we don’t have all the answers now, we may have more effective and convenient interventions in the future.”

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Q&A: Why doctors, insurers and patients grapple over cancer screenings http://news.tamhsc.edu/?post=why-doctors-insurers-and-patients-grapple-over-cancer-screenings http://news.tamhsc.edu/?post=why-doctors-insurers-and-patients-grapple-over-cancer-screenings#comments Fri, 17 Jul 2015 13:00:42 +0000 http://news.tamhsc.edu/?p=13410 Dealing with medical tests can be tricky, especially when doctors and insurers recommend different courses of action. We sat down with A. Nelson Avery, M.D., director of the General Preventive Medicine Residency Program at the Texas A&M Health Science Center College of Medicine, to find out why patients sometimes can’t get screening tests their doctors recommend, and how patients can ensure they’re getting the care that will be best for their health]]>

Doctor checking female patient

We sat down with A. Nelson Avery, M.D., director of the General Preventive Medicine Residency Program at the Texas A&M Health Science Center College of Medicine, to find out why patients sometimes can’t get screening tests their doctors recommend, and how patients can ensure they’re getting the care that will be best for their health – which, Avery says, is not always the “most” care possible.

Q: What would you say is the greatest public misconception surrounding cancer screening guidelines today? Maybe it’s hard to name one, considering that there are strong views coming from very different perspectives.

A: I’d say the number one problem is just the total amount of confusion. There are a multitude of guidelines that say opposite things. This leaves the patient, the consumer, thinking that either we aren’t telling them the truth, or that there is someone gaming the system.

Q: And what do you think?

A: I think maybe there’s some of all of the above. Whatever the causes, the result is that ensuring you’re getting appropriate healthcare is worse than trying to buy a car. People have to be so educated about what they want and stand up for their rights, and the bottom line is, they need a conversation with an educated physician who understands them as an individual, and not as a population. These recommendations are population-based; they don’t really dictate what’s important for an individual.

Q: What’s important?

A: Family history, current symptoms, your history of exposures to possible carcinogens. These are the things that help guide diagnosis.

Q: I understand that those affect levels of risk. But look at it this way. Let’s assume I agree that costs should be contained, that the underserved need health care too, and so on, but I also really don’t want to let a tumor get past me undetected until it’s too late. Why would it not be in my best interest – my personal interest – to have every test there is, for every type of cancer? You brought in the distinction between seeing a population and seeing an individual. Could a screening test ever be a bad option?

A: Healthy living is the better option. And yes, too much screening can be bad for your health, for several reasons.

First of all, there are false positives. These include true false positive results in a test, but a lot are due to laboratory error. Over the years when I’ve chased some of these false positives down, it has usually ended up being a bad laboratory. You send the same test to another lab and it ends up being negative. A false positive means you may end up having an invasive and dangerous procedure you didn’t need.

Second, context matters. In most of these screening tests, we’re looking at biomarkers. When we’re looking at blood, we can see the red blood cells, and if there aren’t enough red cells you’re anemic. But let’s say you’ve got chest pain, and you draw blood for a biomarker and it shows muscle enzymes going up; that doesn’t automatically mean you’ve had a heart attack. You’ve got to do it in combination with an electrocardiogram and risk history.

Q: So the test itself does not tell the whole story?

A: Right.

Q: So we have false positives, and we have positive results that must be interpreted in the context of the patient, and sometimes aren’t. Are there other ways a screening test might do more harm than good?

A: Yes, and this is the big one. Let me explain through an example.

A patient of mine in private practice had some very minor head trauma, was in the ER, and for some reason they decided to do a CT scan, and they came back and told her she was fine from the trauma but that she had an aneurysm. That it could break at any time, and where it is, they can’t operate. She was about 45 years of age, and she became a virtual recluse. Within a year she was divorced, stayed at home, wouldn’t get in a car. Up until that time her favorite thing to do was swim and dive from a high dive, and she loved rock climbing. And this diagnosis destroyed her life. Because she suddenly knew that at any moment she could die. Up until that moment that the CT scan was reported to her, she was living her life to the fullest.
It is one of those ironies that has stuck with me all those years.

Q: So you’re saying, why hear bad news you can’t do anything about?

A: No, it’s more than that. That’s an extreme example of what can happen, but I think it’s happening increasingly as we see a more widespread use of some cancer screening tests. And it is cropping up in situations where we think of risks as being high, when in fact they are low.

Let me tell you another story. A long time ago, I worked on a project that involved testing individuals who had to be in exceptional health for a particular job assignment. We gave them the executive-level physicals that screened them for everything under the sun, all of the screening tests you were fantasizing about earlier, including biomarkers for every rare disease. These were people in a low-risk age group, in very healthy condition, no symptoms of any problems. And when all this screening was done, we had found “significant” risks in every single person on that team. Every one. And these were not high-risk individuals.

Q: Okay, okay. I’ll skip the 120-point inspection.

A: You say that now. But as the tools and the guidelines evolve, you get the service without realizing it. Half of

all the breast cancer we’re detecting now is the low-grade breast cancer we never used to detect at all. So now it appears that one woman in eight gets breast cancer, and that this is a major increase. The reason that number is so high is that we’re finding all of these low-grade malignancies, but most of them will never cause the patient a problem. The same thing is happening in prostate screening. Low-grade malignancies are detected, so you get biopsied, but you don’t even necessarily know if you’re clear even after you’re biopsied. So you get another one. They could take four or five biopsies and still miss the cancer cluster. And every biopsy increases the chance that you’re going to be rendered impotent, or have bleeding, or have a potentially life-threatening infection.

Q: So… Americans need less cancer screening?

A: Who knows? There is a new, relevant article on this topic at least once a week. In the last four months I’ve probably amended this talk fifteen times. I almost changed it again today. I have three articles in front of me that I haven’t worked in.

Q: Give me an example.

A: Well, here’s one on cervical cancer screening. This just came out last week. They changed cervical cancer screenings in 2009; before the change, women had been getting screened from the age of 18, and the new guidelines said to wait until the age of 21. So anyone of college age had been getting a Pap test, and now the guideline says don’t start until you’re 21 – that the statistics say Pap smears in those years are essentially wasted effort, because they don’t yield results. And women listened: The number of women who had not been screened in that age group increased from 26 percent to 47 percent. But they discovered that these women who now aren’t getting Pap tests in college are also less apt to get them after they hit 21, and are supposed to start doing it. Now we have a reduction in the 22- to 30-year-olds who, the guidelines say, should still be getting Pap test. That had an increase from six percent to nine percent who have never had one. No one planned for that. It’s an unintended consequence of the policy.

Q: It sounds like we need a placebo Pap test for those early years.

A: There are some questions you should ask yourself before you and your doctor undertake any type of cancer screening. Ultimately, it’s a decision that needs to be made by patients and doctors together, based on individual circumstances and on a careful consideration of the goals and possible outcomes of screening.

Q: And as long as the patient and doctor don’t decide they need something the insurance won’t cover, everything works out fine?

A: Yes, at that point the doctor is no longer under fire – it’s the insurer. And that is an evolving landscape as well, in part based on all this data.

The only certainty is that if the public is angry enough about any one aspect of any guideline, then they have the ability to get it changed. Eventually, our systems are responsive not just to the expertise of doctors, but to the perceived needs of the public at large.

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Advance care planning: A new normal in health care? http://news.tamhsc.edu/?post=advance-care-planning-a-new-normal-in-health-care http://news.tamhsc.edu/?post=advance-care-planning-a-new-normal-in-health-care#comments Thu, 16 Jul 2015 17:53:07 +0000 http://news.tamhsc.edu/?post_type=post&p=23913 Medicare – the country’s largest health insurer with 50 million beneficiaries, most over the age of 65 – announced plans this week to reimburse physicians for conversations with patients about end-of-life treatment options. ]]>

Medicare – the country’s largest health insurer with 50 million beneficiaries, most over the age of 65 – announced plans to reimburse physicians for conversations with patients about end-of-life treatment options. The new plan is expected to be approved and take effect in January.

The proposed plan would pay physicians and other qualified health care professionals to discuss end-of-life wishes with Medicare patients, their relatives and/or caregivers, ultimately allowing patients a say in the type of care they receive in the event of a life-threatening illness.

A close up of the words "End of life decisions" on a form.

A proposed plan would pay health professionals to discuss end-of-life wishes with Medicare patients, allowing patients a say in the type of care they receive in the event of a life-threatening illness.

“The Centers for Medicare and Medicaid proposal is an important development for advance care planning,” said Craig Borchardt, Ph.D., assistant professor in the department of humanities in medicine and president and CEO of Hospice Brazos Valley. “I’m confident that such discussions will contribute to care that reflects patient wishes and enhances quality of life.”

The policy builds on recommendations made by the American Medical Association to create billing codes under Medicare that physicians can use to charge for such counseling sessions. Patients would get advice on a range of care options – deciding, for example, whether they want to die at home or in the hospital, or under what circumstances they would want life-sustaining treatment.

Worth noting, the proposal would prompt more physicians to engage patients in discussions about their preferences much earlier in the disease process, before an illness progresses to a terminal diagnosis.

“The patient should be in charge of what the patient wants in terms of quality of life and treatment,” Borchardt said. “To get everyone on the same page about these wishes, it’s important to begin the decision-making and communication process early on – sometimes even before a diagnosis, if possible.”

The proposal would also assist in addressing health care costs that tend to skyrocket when addressing chronic illness and end-of-life care.

“Statistics show some 28 percent of Medicare dollars – about $170 billion annually – are spent during a patient’s last six months of life, often on futile treatments that lead to suffering,” Borchardt said. “This is a big step forward, monetarily, but it’s not enough to pay providers for utilizing these services, we must ensure physicians are well-trained to engage in these tough conversations with their patients.”

That’s why many medical schools, including the Texas A&M College of Medicine, are including palliative and hospice care within their curriculum. While the field has grown in recent years, most health care facilities lack access to specialists trained to navigate such illnesses.

Ultimately, Borchardt says that the proposal will make it easier for physicians and family members to make important decisions for those nearing their final days.

“Care and treatment wishes will be outlined long before a patient approaches end of life, so hopefully there will be no confusion as the end nears.”

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You Asked: How do you manage overactive bladder? http://news.tamhsc.edu/?post=you-asked-how-do-you-manage-overactive-bladder http://news.tamhsc.edu/?post=you-asked-how-do-you-manage-overactive-bladder#comments Thu, 16 Jul 2015 13:00:45 +0000 http://news.tamhsc.edu/?post_type=post&p=23889 “It’s normal to use the restroom a few times an hour. I must just drink a lot of water. Doesn’t everyone?” Sound familiar? If so, you may be one of the nearly 30 percent of men and 40 percent of women in the United States living with overactive bladder (OAB). An embarrassing phrase to even voice aloud, OAB – while imposing - is actually quite common]]>

Woman entering bathroomIt’s normal to use the restroom a few times an hour. I must just drink a lot of water. Doesn’t everyone?

Sound familiar?

If so, you may be one of the nearly 30 percent of men and 40 percent of women in the United States living with overactive bladder (OAB). An embarrassing phrase to even voice aloud, OAB – while imposing – is actually quite common.

Overactive bladder occurs when nerve signals between the bladder and brain tell the bladder to empty even when it isn’t full. It can also happen when bladder muscles are too active. This sudden, strong urge to urinate is caused when the bladder muscles contract to pass urine before the bladder is full.

“Overactive bladder is very prevalent and often undertreated,” said Timothy Boone, M.D., Ph.D., vice dean of Texas A&M Health Science Center College of Medicine Houston campus and chairman of the department of urology for Houston Methodist Hospital. “People should be concerned if they go to the bathroom eight or more times a day.”

The major symptom of OAB is a sudden, strong urgency to urinate that you can’t ignore. This “have-to-go” feeling – known as “urgency incontinence” – breeds fear that you will leak urine if you don’t go immediately. Other symptoms of overactive bladder include:

  • Frequent urination: Urinating eight or more times in 24 hours.
  • “Nocturia”: Otherwise known as disrupted sleep. A person with nocturia will wake up two or more times a night to urinate.
  • Lifestyle Adjustments: Do you scout restroom locations immediately when you’re in public? Do you avoid social situations because you’re worried about how many times you may need to go? When you make concessions for your urinary patterns you probably have a case of overactive bladder.

While overactive bladder can occur at any time, the risk of OAB increases as you age. According to the National Association for Continence (NAFC), one in five adults over the age of 40 experiences OAB or chronic symptoms of urgency or frequency. Eighty-five percent of those suffering from overactive bladder are women.

Why are women more prone to OAB? The NAFC says this is largely because menstruation, pregnancy and menopause can lead to changes in estrogen levels and weakened pelvic-floor muscles. Likewise, OAB symptoms in men could be caused by an enlarged prostate or damage from prostate cancer surgery.

“Women are more likely to have an OAB at younger ages, but, by the age of 60, women and men will experience it at an equal rate,” Boone said.

Overactive bladder is a needy enemy. According to Boone, those living with overactive bladder often shy away from social events and everyday activities fearing there may not be a restroom available when they need one. “This feeling of isolation coupled with too little sleep may lead to bigger problems like depression and anxiety,” Boone said.

Luckily, there is hope. A variety of treatments can help manage overactive bladder. A health care provider may prescribe treatment for OAB or refer the patient to a urologist to determine the best method of treatment.

Lifestyle changes – or behavioral therapy – are usually the first tactic used to manage OAB. First, you will be asked to limit food and drinks that are bladder irritating. Coffee, tea, artificial sweeteners, caffeine, alcohol, soda and citrus fruit are often the culprit behind exacerbated OAB symptoms. By eliminating these foods and then adding them back one at a time, you can determine which food and drinks may worsen symptoms.

Delayed voiding is another technique health care providers may recommend. “By waiting to void you are training the bladder to wait and not give in to every urge to urinate,” Boone said. “Gradually, you will be able to wait longer between bathroom visits.”

Losing weight, increasing your fiber intake and establishing a fluid intake schedule will also help you control overactive bladder symptoms. If lifestyle changes aren’t alleviating your symptoms, your health care provider may prescribe medication to stop the bladder muscles from contracting when it isn’t full.

The Urology Care Foundation stresses those experiencing overactive bladder symptoms shouldn’t let myths about the condition prevent them from seeking the help they need.

  • OAB is not “just part of being a woman.”
  • OAB is not “just having an ‘enlarged’ prostate (BPH).”
  • OAB is not “just a normal part of getting older.”
  • OAB is not caused by something you did.
  • Surgery is not the only treatment for OAB.
  • There are treatments for OAB that can help with symptoms.
  • There are treatments that many people with OAB find helpful.
  • There are treatments that can help, even if your symptoms aren’t severe or if you don’t have urine leaks.

Your life shouldn’t revolve around the next sprint to the restroom. If you experience chronic urgency, contact your health care provider for further examination and testing. Discuss your options to treat OAB and have the confidence to take a long trip or laugh until you cry. Overactive bladder doesn’t have to rule your life.

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Taking charge: How to start the dialogue about managing your chronic illness http://news.tamhsc.edu/?post=taking-charge-how-to-start-the-dialogue-about-managing-your-chronic-illness http://news.tamhsc.edu/?post=taking-charge-how-to-start-the-dialogue-about-managing-your-chronic-illness#comments Tue, 14 Jul 2015 19:21:00 +0000 http://news.tamhsc.edu/?post_type=post&p=23879 By nature, physicians are trained to cure, so a conversation letting a patient know their final days are nearing isn't always easy. But it's vital. That's why many medical schools, including the Texas A&M College of Medicine, are including palliative care within their curriculum. ]]>
A Texas A&M College of Medicine student comforts a patient who has heard bad news.

According to a 2012 survey by the California Health Care Foundation, 80 percent of people say that if seriously ill they would want to talk to their physician about end-of-life care, but only 7 percent report having had such a conversation with their doctor.

By nature, physicians are trained to cure, so a conversation letting a patient know their final days are nearing isn’t always easy. But it’s vital. Twenty-eight percent of Medicare dollars – about $170 billion annually – are spent during a patient’s last six months of life, often on futile treatments that lead to suffering.

That’s why many medical schools, including the Texas A&M College of Medicine, are including palliative and hospice care – which helps patients deal with the symptoms and anxieties of a chronic or serious illness – within their curriculum. While the field has grown in recent years, most health care facilities lack access to specialists trained to navigate such illnesses. The patient, even in the last months of their life, is still his/her own best advocate.

We sat down with Craig Borchardt, Ph.D., assistant professor in the department of humanities in medicine and president and CEO of Hospice Brazos Valley, to find out how patients can begin vital conversations about their final wishes with family members and their health care team.

Understanding the difference

First things first, it’s important to understand the distinction between palliative care and hospice care.

“Most people have heard of hospice care and have a general idea of what it is,” Borchardt said. “A Medicare benefit, hospice care is typically for terminal illness, which is defined as a prognosis of six months or less left to live.”

Generally, once enrolled in a hospice care program, which is overseen by a team of health care professionals, the care is administered in the home.

Many think hospice care and palliative care are one in the same, but they aren’t.

“All hospice care is considered palliative care, but not all palliative care is considered hospice care,” Borchardt said. “While palliative care and hospice care are both about treating the patient, not the disease, palliative care is not limited by a terminal prognosis and can be received at any time, at any stage of illness. It can even be received while the patient seeks curative treatment. “

Also known as comfort care, palliative care helps relieve symptoms associated with a chronic illness, such as cancer, cardiac disease or Alzheimer’s. The ultimate goal is to surround patients and families with resources needed to assist with decision-making and keep patients home and out of the hospital, while maintaining quality of life.

“The reason the palliative care conversation is so important is because it compels patients to ask, what is it that I want in terms of quality of life even as I’m going through curative treatment,” Borchardt said.

Start the conversation with family

The first step, and always the hardest, is to start the conversation. There is no ideal time to start talking about care wishes, but experts agree having this conversation with family earlier in the treatment can help improve the quality of care.

“The patient should be in charge of what the patient wants in terms of quality of life and treatment,” Borchardt said. “To get everyone on the same page about these wishes, it’s important to begin the decision-making and communication process early on – sometimes even before a diagnosis, if possible.”

To ease the anxiety that often accompanies such discussions, experts suggest starting out by having the conversation with a close friend first. When you are ready, think about the basics. Who do you want to talk to? Who do you trust to speak for you? When would be a good time to talk? Where would you feel comfortable talking? What do you want to be sure to say?

Remember, be patient. Some family members may need a little more time than others. Also, this should be the first of many ongoing conversations – you don’t have to cover everything, or even everyone, in one conversation.

“Talking with loved ones about your treatment wishes gives everyone a shared sense of understanding about what matters most to you.”

Continue the dialogue with your doc

After you’ve had the conversation with loved ones, the next critical step is talking to your health care team to ensure they know your preferences for care.

“Your job is not to come up with a list of treatment options; that’s their job. Your role is to help your physician understand what matters most to you.”

According to a 2012 survey by the California HealthCare Foundation, 80 percent of people say that if seriously ill, they would want to talk to their physician about end-of-life care, but only 7 percent report having had such a conversation with their doctor.

“It’s not unusual for patients to tell us that our team members are the first ones to talk honestly with them about not only their wishes for treatment options, but also the status of their conditions,” Borchardt said. “For this to happen so late in the patients’ care is sad, even tragic.”

First, it’s important to determine who among your health care providers you want to have the conversation with: your primary care physician, nurse or specialist provider for a chronic condition. Choose someone you are comfortable talking to, and someone who knows the ins and outs of your health status.

The Conversation Project, an organization that aims to help people discuss their wishes for care, suggests a series of questions designed to help patients, and families, begin the discussion with their physicians.

Questions include:

  • What can I expect from this illness?
  • What is my life going to look like in six months, a year from now, five years from now?
  • What can I expect about my ability to function independently?

Don’t feel bad asking too many questions, there is never a “dumb question” when it comes to palliative care planning. Also, you don’t have to decide anything right away – the conversations will help lead you and loved ones into a decision you all feel comfortable with.

“Even if you are currently in good health, it’s important your care team knows your wishes, as your health status can change suddenly,” Borchardt said. “Don’t wait until there is a crisis.”

Determine when hospice care is right for you

Hospice care begins when both the patient and caregiver determine it’s the right time. Typically, hospice is reserved for the final stages of a serious illness – when the patient is no longer receiving curative treatment for the underlying disease – and is expected to have six months or less left to live.

There are often physical signs that indicate someone is ready for hospice, which can be discussed with a physician:

  • Health continues to decline
  • Significant weight loss
  • Needing more assistance with daily living activities
  • Physicians admit that there are little to no treatment options left
  • Symptoms begin affecting quality of life
  • Requiring more and more medication or interventions to manage the disease process

“Patients and their families should always feel comfortable discussing all available treatment options throughout the course of their illness, including hospice care,” Borchardt said.

For additional resources and helpful tips to begin palliative care conversations, visit The Conversation Project.

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Emotional highs and lows: There’s a gene for that http://news.tamhsc.edu/?post=emotional-highs-and-lows-theres-a-gene-for-that http://news.tamhsc.edu/?post=emotional-highs-and-lows-theres-a-gene-for-that#comments Tue, 14 Jul 2015 19:07:08 +0000 http://news.tamhsc.edu/?post_type=post&p=23886 Can DNA actually influence personality and emotional reactions? A Texas A&M Health Science Center expert says genetics could be responsible for fluctuating emotional highs and lows, and how we perceive our quality of life]]>

Guy with pictures of himself.Can DNA actually influence personality and emotional reactions? A Texas A&M Health Science Center expert says genetics could be responsible for fluctuating emotional highs and lows, and how we perceive our quality of life.

When we admire a person’s hair or eye color it’s normal to associate their traits with “good genes.” To be scientifically correct, a person receives genetic variants from their parents – known as alleles – that determine their unique traits. Genes are composed of different alleles that may also have a large impact on emotional responses.

Keith A. Young, Ph.D., professor of psychiatry and behavioral science at Texas A&M College of Medicine and Central Texas Veterans Health Care System, has spent the last 20 years studying a genetic variant that plays a major role in emotional behavior.

Young’s research focuses on 5HTTLPR – a specific genetic variant of the serotonin transmitter gene (serotonin is a brain chemical that moderates mood, appetite and desire). A person will inherit two copies of this gene with two variants of 5HTTLPR: A short allele and a long allele.

Previous research linked the short allele with overactive negative emotions and found people who inherited it were more likely to develop depression and anxiety. In a recent study, Young and team looked at how the short allele affects combat veterans deployed to war zones.

“We found the short allele was over-represented in veterans who returned from combat zones with post traumatic stress disorder. Our working hypothesis is that veterans who were deployed to war zones will have a harder time recovering back to normal if they possess the short allele,” Young said.

Additionally, quality of life is another mental health outcome where the short allele may come into play.

“There is now evidence that 5HTTLPR-short allele carriers perceive and report their quality of life more negatively,” Young said. “In our study of veterans, for instance, 5HTTLPR-short allele carriers reported a reduced quality of life.”

Along the lines of Young’s research, other studies suggested short allele carriers sensed changes in perception because of the allele’s effect on non-conscious bias to threat, danger or fear.

“5HTTLPR-short allele carriers might just perceive or think they had a reduced quality of life because they were focusing on all the negative things around them,” Young said. “However, in many studies, there was no test for a non-conscious bias to happy or other positive stimuli, so I think additional work needs to be done.”

“In the case of our study of veterans, we believe that 5HTTLPR-short allele carriers did not just perceive they had a lower quality of life, their PTSD and depression symptoms led to reductions in positive social interactions and other measurable changes that resulted in a lower quality of life compared to their peers not suffering from PTSD,” he said.

While Young’s research on the 5HTTLPR short allele can be interpreted in light of the alleles “negative” influences, new research found this genetic variant is more complex than it’s original reputation.

According to this new research, people with the short allele laugh and smile more than those with the long allele. The study concluded the short allele amplified emotions – emphasizing both negative and positive emotions – and inheriting it may not mean that you will end up looking on the dark side of life.

“The short allele is now thought of less as in black and white, or normal and defective, and is being pursued more quantitatively,” Young said. “It seems to heighten emotional experiences and impact a person’s emotional highs and lows. Those with the long allele do not experience these highs and lows.”

The new results align nicely with Young’s research on brain anatomy.

“Our study measured the enlargement of a certain area in the brain’s thalamus that processes emotional stimuli,” Young said. “Since the brain regions responsible for emotional processing may actually be bigger in these individuals, it makes complete sense that people who possess the short allele have an increase in both positive and negative emotional thinking.”

According to Young, there are still many questions to be answered about emotionality. “I believe more research needs to be done to clearly answer the questions of how serotonin genetic variation influences our emotions and sudden shifts in moods,” he said.

The shift in thinking about the 5HTTLPR-short allele shows researchers may be headed away from black and white outcomes in relation to emotions and genetics. Whether you dissolve into a fit of giggles or keep a more stoic demeanor, the interactions between genes and emotionality are likely to keep scientists invested for years to come.

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You Asked: What is the difference (or lack thereof) between oral and genital herpes? http://news.tamhsc.edu/?post=what-do-you-mean-i-might-have-herpes-the-difference-or-lack-thereof-between-hsv-1-and-hsv-2 http://news.tamhsc.edu/?post=what-do-you-mean-i-might-have-herpes-the-difference-or-lack-thereof-between-hsv-1-and-hsv-2#comments Tue, 07 Jul 2015 16:50:22 +0000 http://news.tamhsc.edu/?post_type=post&p=23851 For a long time, the medical world made the distinction between oral herpes (HSV-1) and genital herpes (HSV-2), because it was thought that HSV-2 led to types of genital and oral cancers. Now we know that the human papilloma virus is the leading culprit for causing cancers specifically focused around the genitals and mouth, not herpes. However, HSV-1 and HSV-2 aren’t mutually exclusive; there is about a 20 percent crossover between the two types]]>
Woman walking

Oral herpes (HSV-1) and genital herpes (HSV-2) aren’t mutually exclusive; there is about a 20 percent crossover between the two types. The U.S. National Library of Medicine estimates that most people will contract oral herpes by the time they are age 20.

A woman stands on a porch, practicing yoga as the sun sets behind her figure. The entire scene exudes tranquility as she turns to the camera and firmly declares, “I have genital herpes,” with a smile on her face.

Most of us have seen these commercials, and have experienced the bizarre and uncomfortable response that is natural when someone brings such a taboo and private matter to light. However uncomfortable it may be, though, it’s important to be informed about Sexually Transmitted Infections (STIs) and the ways you can contract them, including genital herpes. According to the Centers for Disease Control and Prevention (CDC), one of every six people, ages 14 to 49, have genital herpes.

Perhaps the most shocking thing about the herpes simplex virus (HSV) is that it isn’t necessarily transferred from genitals to genitals during intercourse. HSV has two common strains: HSV-1 (widely known as oral herpes, cold sores or fever blisters) and HSV-2 (the traditional cause of genital herpes).

“For a long time, the medical world made the distinction between HSV-1 and HSV-2, because it was thought that HSV-2 led to types of genital and oral cancers. Now we know that the human papilloma virus is the leading culprit for causing cancers specifically focused around the genitals and mouth, not herpes” explained John Wright, D.D.S., regents professor and department chair of diagnostic sciences at the Texas A&M University Baylor College of Dentistry. “However, HSV-1 and HSV-2 aren’t mutually exclusive; there is about a 20 percent crossover between the two types.”

The U.S. National Library of Medicine estimates that most people will contract oral herpes by the time they are age 20. HSV affects the nervous system, and outbreaks can be brought on by many factors including:

  • Hormone changes, including menstruation
  • Stress
  • Exposure to the sun
  • Fever

This 20 percent crossover means that traditional, oral herpes can be present in the genital region, and conversely, HSV-2 herpes can infect the mouth. According to Wright, both strains will exhibit identical symptoms in the mouth:

  • Itching of lips or skin around the mouth
  • Pain on the lips or in the mouth
  • Tingling near the lips and mouth
  • Lip blisters or sores (ulcers) typically where the lip meets the skin
  • Blisters or rash on the gums, lips, mouth or throat
  • Swollen lymph nodes

“The main difference between the two types of HSV is a slight difference in DNA,” Wright said.

Similarly, HSV-1 will present itself like HSV-2 if it becomes present in the genital region:

  • Blister(s) around the genitals, rectum or mouth
  • Sores that take weeks to heal
  • Swollen lymph nodes

“With both types, the first outbreak that occurs will be the most severe, and may even display flu-like symptoms. Recurrences happen more frequently during the first year of infection, with 50 percent of those infected experiencing four outbreaks within a year. However, each subsequent recurrence will display more mild symptoms and may even be asymptomatic, which increases the chance of unknowingly spreading the virus to a partner (viral shedding),” said John K. Midturi, D.O., assistant professor of internal medicine at the Texas A&M Health Science Center College of Medicine in Temple.

Although outbreaks can be asymptomatic, viral shedding increases when they reoccur. While antivirals can treat outbreaks and reduce the chance of spreading it to others, they do not cure the virus.

“Once a person is infected with a strain of HSV, it is permanent,” Wright explained. “Antivirals can manage the symptoms and limit its ability to spread, but they do not cure the patient of the virus.”

Both strains of HSV are highly communicable and can infect other parts of the body, specifically if the virus gets into open wounds, but the marked increase of HSV-1 and HSV-2 being found in the oral and genital regions is attributed to increased occurrences of oral sex. For example, if a person is having a recurrence of HSV-1 in their mouth, and is engaging in oral sex, they put their partner at a higher risk of contracting HSV-1 in the genital region.

While most outbreaks are mild, and many people are unaware that they even have the virus, some people can have severe reactions to it. People who are immuno-compromised may experience outbreaks in less traditional locations, such as the esophagus or liver, and may even develop pneumonia precipitated by the virus. Even in those with uncompromised immune systems, the membranes surrounding the brain or spinal cord can become infected and inflamed, causing herpetic meningitis.

“The best method of prevention is treating outbreaks when they occur, to reduce viral shedding, and using condoms or completely abstaining from sexual activities, especially during outbreaks,” Midturi advised.

Condoms don’t cover all the areas that genital herpes can occur, but they can limit exposure. To reduce the spread of HSV, always wash your hands after touching infected areas or fluids and avoid sharing utensils and other objects that enter your mouth during recurrences.

Always inform your partner if you have genital herpes, so you can make responsible decisions, and try to treat any outbreaks that occur. If you suspect you might have genital herpes, visit your health provider for examination or testing. For more information about genital herpes, visit the CDC site.

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Q&A: Fads, frauds, and the true secrets of dieting success http://news.tamhsc.edu/?post=fads-frauds-and-the-true-secrets-of-dieting-success http://news.tamhsc.edu/?post=fads-frauds-and-the-true-secrets-of-dieting-success#comments Tue, 07 Jul 2015 13:00:03 +0000 http://news.tamhsc.edu/?p=13552 Every popular diet has a theory about why it works, but what diets actually do work? Dr. Kory Gill speaks about popular fad diets, what the data actually says, and what all workable weight loss strategies have in common]]>
Tuna sandwich sitting on a plate,  with chopped vegetables in the background

Most successful diets have one thing in common: calorie restriction.

Every popular diet has a theory about why it works, but what diets actually do work? Dr. Kory Gill, an assistant professor and Director of Sports Medicine at the Texas A&M Health Science Center College of Medicine’s Family Medicine Residency program, a team doctor for Texas A&M Athletics, and a member of the Texas A&M Physicians group, has been looking at this question for a while now. We sat down with him to see how far he’d go in repudiating popular fad diets, what the data actually says, and what all workable weight loss strategies have in common.

Q: What’s a fad diet? How do I know if I’m being swept up in a fad, as opposed to following a dieting strategy that will work?

A: Fad diets are diets that are on the market and then off the market. They appear out of nowhere, they generate a lot of buzz, a lot of people try them, and then they fade and go away. They promise quick, dramatic results, and are not focused on long-term solutions. In the short-term, they generate positive buzz, because intensely following any dieting regimen is likely to help someone lose weight in the short-term. But they also impose a burden on people that can’t be maintained over the long-term, and people gain the weight back.

These diets aren’t really even intended to be long-term solutions, although many people begin them hoping for a long-term solution. So fad diets tend to create unrealistic expectations for people. In general, I would characterize a “fad diet” as any diet that has as its major selling point restricting your access to particular foods, or designing a certain regimen of things you must consume, which means the diet is difficult to maintain for a long time. The testimonials are collected while people are on the diet, but there’s rarely a follow-up ad showcasing the people who lost weight and then gained it back.

All diets can be reduced to one basic fact: If they decrease your calories, you’re going to lose weight. Diets that decrease calories more aggressively also make you lose weight more aggressively. Things like the liquid diets are easily able to modify your calorie intake to a daily calorie intake of 500 or so, which is extreme. But can you maintain a 500-calorie a day diet for the rest of your life? Absolutely not. It is not healthy and you cannot maintain it because you are going to burn out. Once you do, the weight doesn’t stay off – it comes back.

Q: So regardless of what food the diet is restricting, whether it is carbs, gluten, or anything processed, those are just masks for what the diet is really doing, which is just reducing calories.

A: Basically, yes. There is more to diets than weight loss, because there are other factors such as the diet affecting your cholesterol and other health factors. But in regards to weight loss, it’s strictly about calories in or calories out. To lose weight, you either take in fewer calories, or you burn the calories that you took in so that your final calorie balance is low.

Q: It sounds like you are saying all of the diet innovations since doctors nailed down the calorie thing have been smoke and mirrors.

A: To some degree, yes. People have various non-weight loss benefits that they propose as the benefits of using their system – reducing your appetite to make it easier for you to eat the low-calorie diet, or making certain foods easy to fit into your lifestyle. For example, “You don’t have to plan out your meal for the day; you just have to take this shake along with you.” So they’re trying to simplify your process of taking in fewer calories. Fad diets work differently in terms of what they do in your body, and how they work in the short-term, if they do at all. But long term, those diets are hard to maintain. Although they are simple, we as humans like variety and we do not thrive on living off a low-calorie shake for the rest of our lives.

Q: But surely not all calories are created equal. Some things are more filling than others – is that purely a factor of how many calories it has? Or could a diet that is restricting you from a certain type of food be guiding you toward sources of calories that are more fulfilling, or give you a slower release of energy, or providing you with more nutritional benefits, and thus you are more able to live and feel good on fewer calories?

A: That is the goal of many of these diets and some of them tout reasons that they say makes their diet work where others fail. Like with a high-fat diet, the idea is that with fat, you feel fuller and therefore you will eat fewer calories. Other diets – protein-rich, liquid, low-carb, low-sugar, gluten-free – have their own strategy. But most diets can find an explanation for why using their system will enable you to tolerate fewer calories per day.

Q: And here’s where we get to the data. I know you’ve been following the research on these diets for a while. Theories are one thing, but the data doesn’t lie. What does the data say about these diets?

A: You’re right. There is data, and the data is objective. It doesn’t care what theory you’re selling about why your diet should work. And the data shows that with all the diets, less than one percent of fad dieters can maintain that weight loss for more than a year. Another thing that the data shows is that the average weight loss for these diets is around five percent, which is not a lot. So if a 200-pound person was looking to drop fifty pounds that may be an unrealistic weight loss goal. Somewhere around a ten-pound weight-loss goal may be more realistic looking at long-term weight loss using that particular diet.

Q: And that means staying on that diet long-term, just to avoid gaining that 5% of your weight back? That sounds demoralizing.

A: Exactly. Therefore, if you are expecting more than the average weight loss you are going to have to be more aggressive and maintain it for longer than the average person.

Q: How about those healthy frozen dinners? Nutritional value, good replacement for fast food, what’s not to love?

A: Well, they do help with portion control, and they are convenient, and a lot of really unhealthy food is convenience food. So those are good things. But I would limit your intake of those frozen dinners, even lower-calorie ones, because they are often high in other harmful things, like salt, for its preservative value.

Q: What about the types of diets that give you a supplement or something else designed to help you not be hungry or keep you from wanting to eat so many calories? Would you recommend those as an additional aid, to help with portion control?

A: Most of the supplements on the market work in one of two ways. Some reduce the absorption of your food so you can eat more, but it will pass through your body, and you are not going to reap the benefits of having eaten it, or have the side effects of having consumed those calories. The other type of supplement increases your metabolism to help your body burn calories you’ve eaten. However, the supplement that increases your metabolism can also put an increased strain on the heart. That’s why those that alter your metabolism come and go from the market in such a faddish way: They generally put the user at an increased risk of heart attack, and they only last on the market for a short time long enough for those cases to accrue.

The other problems with the supplements are that you are depending on that supplement for life, which can get quite expensive, or as soon as you stop taking the supplement, you go back to your prior weight.

Q: So what actually works, long-term?

A: If you want to be in that one percent, which are the people who are able to lose weight and maintain it for more than a year, there’s one rather large study that looked closely at long-term weight loss. It shows you some of the characteristics of the people who do lose the weight and maintain it. Those people are more successful because they are using a less-restrictive diet. They are also eating more frequent meals. Most of them ate up to five times a day, but they were eating lower-calorie meals, with each meal averaging about 400 calories – far below the average calorie count per meal for the average American. They also all kept track of how they were doing by weighing themselves daily. By objectively measuring themselves every day, there was no guessing as to whether they were doing good or bad on their diet.

Those who were successful also exercised regularly. By maintaining a regular exercise program, they were not only able to keep the weight off, but they were also able to compensate for sometimes eating more calories than their average daily calorie count. That means they could accommodate things they really wanted, while still sticking to their overall plan. That is huge for sticking with diets. Those dieters could do an extra thirty minutes of exercise to burn those extra calories that they consumed. Those are the big factors that they had in common that made them a part of that one percent. And the good news is, these are lifestyle changes that anyone can make. You don’t need a pill, you don’t need a new designer diet. You need to reduce your portions, you need to lower your caloric intake, and you need to exercise. It won’t come up often in the news, because it isn’t “news.” But it’s what works.

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