Thoughts and Observations on Health Care and Preventative Medicine

While traveling in Florida during spring break, I stopped at a 7-11 store to put gas in my car. What was surprising to me was that each gasoline pump had a bright blue sticker with a message to perform proper hand hygiene…you see, the Florida Department of Health is trying to get the message about H1N1 flu prevention to everyone, using every available opportunity. Maybe their example should be food for thought.

Last night the House of Representatives finally cleared the health care reform bill. I’m in the majority of those who desire health care reform. I’m not certain, however, that the bill that was passed is, in any way, “reform.” It seems to be a way to add insurance coverage without actually “reforming” our delivery model. If we continue to focus on acute care and episodic medicine, then we will simply drive costs higher. At some point, we need to realize that the best approach is prevention. Anything that keeps a patient out of the hospital, or supports a patient who has been discharged, so that patient is not readmitted, should be our ultimate goal. While some pundits suggest that prevention efforts do not reduce costs, I would argue that we haven’t really made a effort expansive enough to even measure the benefits. Labels on cigarette packages, labels on alcoholic beverages, labels on cereal boxes…is that prevention? Exercise? Weight control? Stress management? Are these initiatives getting enough attention? Sadly, the reimbursement model currently applied to health care values high tech procedures, and minimizes non-procedural components. Maybe our model at least partly explains why the United States ranks so poorly when compared to other countries in the arena of health care outcomes. We need true reform. Not just some version of expansion, but truly a sea change that impacts us on all levels. Health reform must include components that touch and affect society at all levels, including education, family life. habits, activity, and personal responsibility.

A final thought:
Where is the willpower to confront the reality in our society which super sizes everything, makes being a couch potato an art, requires elevators to go even one floor, and considers exercise nothing more than bending a elbow as food is moved from plate to mouth? Failure to actively address these and other issues will keep any hope for improved health in our country stalled.

- Dr. Joe Prosser, MD
Chief Quality Officer

Let’s Talk about Prostate Cancer

Prostate cancer has been in the news again this month with the American Cancer Society releasing some new guidelines about screening using the PSA blood test, and whether mass screening opportunities should be offered to the general public. This is a complex topic and much like the recommendations made last year to change the age women should start mammograms, the response from prostate cancer survivors has been filled with confusion and emotion. As the coordinator of the Prostate Cancer Resource Center, I have been asked several times to respond to the issue. The good news is I can proudly say that the program we have at Texas Health Harris Methodist Hospital Fort Worth addresses the concerns expressed in the publication by the American Cancer Society.
The Prostate Cancer Resource Center was opened in January of 2003 with the primary goal to educate and support prostate cancer survivors about their diagnosis. This support includes the STEPs to Surviving Prostate Cancer series and one-on-one counseling with the nurse navigator. Through this education and support process we are able to provide the information a man and his family needs to make an educated decision about treatment choices, potential side effects and potential complications down the road. I have found that most men that take the initiative to be screened are proactive in their health and want to explore some sort of treatment if diagnosed with cancer. At our major screening event in the Fall (during the Cowtown Cruisin for a Cure car show) we provide several opportunities for men to ask questions and understand what is involved in a screening and what the results potentially mean. That information prior to screening and the resources provided through the Prostate Cancer Resource Center meet the standards recommended in the guidelines article.
We’ve recently expanded our resources for survivors to include a chat day on Tuesdays – “Lets talk on Tuesday.. about prostate cancer” is held every Tuesday from 10:00 am – 2:00 pm in the Cancer Resource Center in the Klabzuba Cancer Center. Specially trained THFW volunteers are available to chat with men about their personal journey with prostate cancer and answer any questions men might have about the disease, treatment options and coping with side effects. If you know someone that is newly diagnosed or dealing with prostate cancer issues, please encourage them to come and by.. let’s talk!

Gayle Wilkins, MSN,RN,OCN
Coordinator of Prostate Cancer Resource Center.

Brand Name Versus Generic Drugs: Is Price the Only Difference?

Many Americans are frustrated and concerned with the high cost of prescription drugs. Generic forms of drugs offer consumers an alternative to the sticker shock of brand name drugs. The price of a generic drug is typically less than that of a brand name drug because the manufacturer does not have to complete the same research, development, and marketing process that the original drug manufacturer accomplished.

Before a generic drug is approved for use, the FDA requires that it has the same active ingredients, dosage form, administration route, strength, quality, purity, and stability as its brand name counterpart. Although they contain the same active ingredients, brand-name and generic drugs go by different names.

Mainly due to patent protection, not all medications have a generic equivalent commercially available. Drug manufacturers have to perform such extensive research and development that laws have been created to protect a brand name drug’s patent for a designated number of years. Once the patent expires, generic drugs may then enter the market. Brand name drug manufacturers actually often own generic drug companies.

Although brand name and generic drugs have the same active ingredients, their medication exteriors can vary due to inactive ingredients which can result in different colors, shapes, sizes, and flavors. It is always important to question your pharmacist if you feel uncomfortable about the medication that you picked up due to it having a different appearance from a previous prescription fill. The medication may look different because it is made by another manufacturer, or the generic form may now be commercially available.

In Texas, when a prescriber writes a prescription, it is generally filled with the generic drug if available unless the prescriber designates a brand name prescription as “dispense as written.” Most drug coverage plans require patients to utilize generic medications if available. If a patient chooses to fill a prescription with a brand name drug when a generic drug is available, many drug coverage plans will not cover the patient’s drug expense.

Although many brand name manufacturers try to show an advantage of using their brand name drug versus its generic rival, FDA regulations are in place to make sure the generic drug is providing the same quality of treatment to the patient. Generic drugs provide a safe alternative to brand name drugs and hopefully will have you smiling at your receipt the next time you visit your local pharmacy.

- Alisia Baker
Pharmacist at Texas Health Fort Worth

Source: U.S. Food and Drug Administration.

Nutrition for One Please…A Success Story

The average person has an idea of general nutrition information. Most people recognize that grilled meat is better that fried and wheat bread is healthier than white bread. However, people get confused when trying to piece together what they should be eating at meals and snacks on a daily basis. Often times it takes a registered dietitian to help someone understand how many calories he/she needs, where those calories should come from and how to fit them into nutritious meals and snacks throughout the day.

In 2008, Gary Bishop decided to work with me to help himself lose weight and improve his health. Here is his story:

"I have always been consistent in working out, particularly cardiovascular exercise. However, I have never seemed to do very well on the diet part. I guess I was like many other people who felt like you could eat as much as you want as long as you exercised. This worked fairly well in my younger years but after passing age 40 it did not work as well. Like everyone else, I would try the latest ideas of "hunger curbing methods" such as drinking water before and after meals, but they would only work temporarily. Finally I read about Texas Health Fort Worth Executive Health Program’s registered dietitian Amy Goodson in my City Club newsletter and decided to set up an appointment. I thought I should finally find out what is truly the best way to eat by a professional. During our meeting she asked many questions such as what I ate currently, where did I eat out, what did I eat for each meal, how often did I exercised, etc.

Next, Amy explained to me about nutrition including protein, carbohydrates, fiber - soluble and insoluble, portion size, number of meals per day, proper calorie intake, good fats and bad fats, what to eat at different kinds of restaurants (Mexican, Italian, Chinese, etc) and the correct combinations of food for each meal. Finally after all the years of conflicting information , I felt I had finally heard the correct answers.

Within a couple days, Amy sent me a personal meal plan that included all sorts of ideas for meals and snacks. The part I liked the most was the plan for eating at fast food restaurants for lunch. I consider this real information for the busy lifestyles all of us live today. There was also a list of different foods and brands to pick up at the grocery store that were healthy. I would take the information that Amy provided to grocery store to make sure I picked the proper brands and types of various food products.

I began to lose weight steadily and did not get hungry. I really felt good about eating healthy and of course, excited about the weight starting to come off. I lost 20 lbs easily within about 5 months but still needed to lose another 10 to reach my goal. I felt like I had reached a plateau. So I emailed Amy and told her my situation. Within hours, Amy emailed me back with 3 options that she would guarantee to take off the remaining weight. I picked the additional day of exercise. It worked quickly and the additional weight came off. A few weeks later it was time for annual physical. I was very anxious to see if the weight loss would improve my cholesterol readings. Well, my reading had dropped over 40 points since the previous year and my doctor allowed me to come off my cholesterol medicine. I was very excited! I admit that I have days when I don't eat like I should, but 90% of the time it is easy to stay on track. It has been 15 months since meeting with Amy and the weight continues to stay off.

If you have a question for the dietitian, visit www.texashealth.org/askamy

Amy Goodson, MS, RD, CSSD, LD
Registered Dietitian
Ben Hogan Sports Therapy Institute
Executive Health Program

Sad is not bad.

Not long ago I listened as a grandfather, swollen with pride, brag to his young granddaughter. He explained to her that he had recently been injured but was now okay. The point he emphatically drove home with the child was that throughout the entire ordeal he never once shed a tear, not one. He simply forced himself to keep the tears inside. I was amazed.

As a chaplain I often share time with patients, times when very few words are uttered. Sometimes we sit in silence. On more than one occasion I have been present, in silence, as the patient, family, or staff member wept, sometimes uncontrollably so. With this in mind the well intentioned grandfather’s words caused me to ponder what lesson the young child would take away from this tutorial on the art of sucking it up. Would she hear, and be proud of the fact that her grandfather was one tough buckaroo, able to resist and hold back those dreaded telltale signs of weakness called tears? Or, would she sadly walk away and join the ranks of millions of others in our society who are convinced that crying, i.e. being sad, is bad a thing, a definite Achilles' heel in one’s persona?

Certainly it is not my place to judge the concerned grandfather. Not for one second do I doubt that he desires the absolute best for his granddaughter. And when I hear “there, there, don’t cry” around the hospital I have to remind myself that the comforter is most likely truly concerned for the one who weeps. But what has happened in our society, what has happened to us, and why have we succumbed to this notion that sadness is a bad thing to be avoided at all cost? How did tears become the icon for fragility?

In the midst of this magnificent journey called life it can be healthy if we come to grips with the fact that there will be times of sadness. Happy simply cannot happen on a twenty-four seven schedule. Someone once proclaimed that the brook could not make those soothing sounds if it were not for the rocks. I like that. Our hard times, our days of trudging through the dark valley, blinded by tears of anguish, serve well to multiply the intensity of our joy. Of all the things we seek in life, balance is a prized commodity. It might be hard for some to admit, but we really do not want a life that is nonstop hilarity and knee slapping merriment. Bliss and sorrow, laughter and tears -- all indispensable ingredients for a well-adjusted enjoyable life.

If we must embrace times of weeping, to whom or what can we turn to for solace? Just knowing that the sadness will pass can provide minuscule consolation in the midst of intense agony. Here is where I want to offer that there is One who has promised never to abandon us, never. When I read the Bible I find three letters, two short words that never fail to help me when I am sad. These two words, proclaimed by God, are concise and to the point yet brimming with theology and hope. God’s proclamation of “I AM” is in fact, a not too shabby summation of the divine message for all.
In this decree we find the promise of divine hope in the darkest of our times. In this declaration I hear an assurance, a promise from One who has always been with us, is with us now, and will always be with us. And let’s be honest, when we are sad nothing is more comforting than the presence of a fellow sojourner offering not judgment, nor half baked advice, but his or her nonjudgmental self. Please do not ask me how our Creator does it, but in some mystical and comforting way God shows up, on time, ready and willing to offer succor and hope. This may come as a visit from a friend, church member, chaplain, nurse, or other staff member. Somehow, time and again, God’s ambassador arrives when the stream of tears is about to become an overwhelming river of sorrow. I see this every day, and everyday it gives me hope.
I too have a granddaughter. And it just may be that someday I will speak with her about my being sick, hurt, and sad. And when that happens I know now that I will say “sweetie, Grandpa is going through a hard time. It is so hard in fact, that today I cried my eyes out. But you know what? It’s okay. In fact, it felt good to cry. For you see, sad is not bad.”

- Carey Reynolds, Chaplain

Nutrition from the Ground Up

Do you know that March is National Nutrition Month (NNM)? Well it is!

NNM was developed by the American Dietetic Association (ADA) to promote nutrition education and information. The ADA, the world’s largest organization of food and nutrition professionals, started NNM in 1973.

This year’s theme is “Nutrition from the Ground Up” emphasizing the key to a healthful diet is improving your nutrition…from the ground up. Comparing good nutrition to a farmer planting and raising his crop is so appropriate! A good crop doesn’t happen in two weeks nor does a healthy diet claim to “drop two dress sizes in two weeks”.

Developing a healthy diet takes time. Just like farming, healthy eating requires a good foundation. It requires a plan, daily consistency, and follow-through with that plan. It takes work but the rewards are worth it. Don’t get discouraged, even making small changes can make a difference.

When I teach nutrition education, I always start with the basics:

• Eat at least 5 fruits and vegetables daily
• Consume healthy carbohydrates that are high in whole grains
• Eat more lean types of meat and poultry and try to eat more fish
• Decrease the amount of refined carbohydrates especially in beverages
• Consume low-fat or no-fat dairy products
• Decrease the amount of fat in your diet especially trans-fat and saturated fat

Start with one step to improve your eating habits. Don’t make drastic changes or completely overhaul your diet. Making small, reasonable changes increases the likelihood that you will make them a permanent part of your lifestyle.

For more ideas on building your healthful diet from the ground up and other topics, such as food safety, disease management and prevention, and the tip of the day, visit the ADA website: www.eatright.org. This site is a good resource for nutrition education all year long.

For more information or to get trim in 2010, register for our advances in medicine seminar on Tuesday, March 30th from Noon - 1 p.m. at the Heart Center on the campus of Texas Health Fort Worth. To register, click here.

Jamie Bass, MS, RD/LD
Bariatric Services

What is the value of a strong trauma center...in your opinion?

I love Texas. We have so much to be proud of. The people are friendly, the skies are blue and where else can you wear cowboy boots with a suit? I have lived in several other states, and even in a few other countries. But as Dorothy said, (and I know I’m not in Kansas) “there is no place like home”.

I also love being a nurse and working in a hospital. There is so much hope and energy. I have seen families come and celebrate a birth as well as express tremendous relief when their loved one was spared in a car crash. Because of fantastic medical care given, so many folks have a second chance at living a life and making a difference in their community.

Working in a Trauma Center can be challenging. There are times when my heart is so moved as I see the physical damage that didn’t have to happen. Sometimes the choices are made by the patients we care for, and with others, well, they were just innocent products of someone else’s decision. Working in a Trauma Center has certainly shown me a different perception on life. My own dramas are so minuscule compared to what others are going through. Kind of puts life into perspective. Don’t get me wrong… remember I still have a 16 year old GIRL in my house, and that alone brings drama that can compete with the latest TV sitcoms.

Trauma Centers are a unique place. Studies have proved that if you are involved in a trauma such as a motor vehicle crash, your chances of survival and return to a normal life are much higher if you are treated in a trauma center. There are many specific requirements that have to be met in order to be a designated “trauma center”. Having specialized care physicians, specially trained nurses, and specific equipment are only the beginning. These resources are costly. But what price is life? And what if someone can’t afford medical care? Do we turn them away? Of course not.

At Texas Health Fort Worth all trauma patients are treated with the same high quality of care. One way to offset the cost of trauma is through fines levied at those who choose to drive irresponsibly. These fines are hefty, aimed at discouraging drinking and driving, speeding, and red light running. They supply a resource of revenue for those who are treated in trauma centers. Millions of dollars have been distributed to help designated trauma centers and EMS agencies that care for trauma patients. These fines are currently under attack by Texans who feel they are unjust. This funding is a lifeline for the whole trauma system. Most Texans are not even aware of the stringent laws that are in place to discourage dangerous driving.

We all want superior health care. We need Trauma Centers to deliver. That requires financial support. Health care isn’t economical, it’s quite costly. But when it comes to family and friends, we know that we will do whatever it takes. And when it comes to our patients, we know we will do the right thing. We take care of our community and its families. It’s something we take pride in. And it’s something we do quite well. Thank you all for the job you do.

- Mary Ann Contreras, RN
Trauma Injury Prevention Coordinator

OH BABY!

Are you a new or expecting mom? If so, listen up....

Texas Health is offering a free weekly parenting e-mail for expectant and new parents.

A personalized E-mail comes straight to your inbox each week with information specific for you. You will receive information on your baby’s developmental milestones every week of your pregnancy. There will also be great research findings to give you the most up to date information. Included in the email is a section for resources to better support and guide you. We will offer you weekly tips and advice as well as information about classes and events that are available. Best yet is you will continue to receive emails until your baby’s first birthday. You will also have the ability to email questions that will be answered by a registered nurse.

Since babies do not come with an instruction manual this is a great way to have information at your fingertips. If you have an email address, it is as simple as that. We welcome parents, grandparents, childcare providers and anyone wanting to share in the milestones of your baby. Therefore, do not delay and visit this site or visit www.TexasHealth.org/OhBaby.

- Becky Law
Manager, Childbirth Education