Ebola — you won’t get it from shaking hands

Dr. Victor Sierpina

Dr. Victor Sierpina

A strange thing happened to me last Monday when I went to the clinic.

With the report of a man in Texas with Ebola who had been discharged from a Dallas hospital, then readmitted very sick a couple days later, I realized that any patient I came in contact with that day, or any day, might have this deadly virus.

Now we don’t usually think of work in health care as inherently a hazardous profession — say like being a soldier, firefighter or policeman. Yet it has actually always been so. From doctors and nurses who cared for patients with leprosy and bubonic plague in medieval times to those caring for the Ebola epidemic in Africa today, our colleagues in white coats put their lives on the line caring for those who have no other recourse for help.

Emergency workers, ambulance crews, and paramedics are often called into dangerous settings after shootings, bombings, and other catastrophes where the sites are not always secure or safe. They transport people with unknown diseases and unknown risk.

Of course, we have developed methods of reducing risk. Part of annual training at UTMB for all clinical staff includes reviewing universal precautions, which include several levels of infectious disease control. These range from basic hand washing and use of rubber globes to advanced personal protective equipment, including specialized gowns, masks, and in some cases like the Galveston National Laboratory, even hazmat type suits and respirators. Continue reading

The real skinny on holistic bariatric surgery

Dr. Victor Sierpina

Dr. Victor Sierpina

I recently read a really well-done book by a highly successful bariatric surgeon in Dallas and former UTMB medical student.

Dr. Nick Nicholson’s book, “Weight Loss Surgery: The Real Skinny,” is an essential read for those of you who might be contemplating surgery for your weight problem, as well as for your family and friends. Such surgery has become the second most common general surgery procedure after gallbladder removal. So if you haven’t met someone who has had this surgery, you surely will.

Bariatric means relating to weight loss, thus bariatric surgery involves one of several types of procedures to help people lose weight. This is not a minor event. If your six-pack has turned into a 12-pack, you are 10-30 pounds overweight, don’t fit into your favorite dress or jeans, bariatric surgery is likely not for you. It is not a cosmetic treatment like getting a face-lift or getting a boob job.

Your BMI needs to be over 40, or over 35 if you have certain obesity related medical conditions to even qualify for this kind of surgery. Additionally, most insurances, if they cover this treatment, require psychological evaluation, documentation of failed attempts at diet, exercise, and the usual approaches to losing weight. Continue reading

New DEA rules on pain killers are coming soon

Dr. Victor Sierpina

Dr. Victor Sierpina

The US Drug Enforcement Agency, after lengthy debate and public input, has implemented a rescheduling of the most widely prescribed group of drugs in the U.S., the hydrocodone-acetaminophen combinations. These are drugs with brand names of Vicodin, Norco and Lortabs.

There are 135 million prescriptions annually for these hydrocodone combination products (HCPs), much more than for the next most common prescriptions for thyroid, blood pressure, and cholesterol lowering drugs.

Some time ago, government rules reduced the total acetaminophen (trade name Tylenol) content to 325 mg a day per pill as greater than 4,000 mg daily in combination with hydrocodone was placing patients at risk for liver damage.

Those addicted to these meds might have been taking 10, 20 or 30 pills a day, way exceeding the safe amount of acetaminophen the liver can handle.

Now, this HCP group of drugs is moving from a Schedule 3 to a Schedule 2 class, entering the same category as morphine, Dilaudid, oxycodone, Percocet, Demerol, Fentanyl and other powerful and highly addictive pain medicines. Continue reading

7 steps to improving empathy

Dr. Victor Sierpina

Dr. Victor Sierpina

Last week, we discussed the topic of empathy, how it is different from compassion and how essential empathy is to human relationships.

This matters not only in health care but in families, in business, in friendships.

Based on research from Harvard’s teaching hospital by Dr. Helen Riess and her research coordinator, Gordon Draft-Todd, the following is a an acronym published in the journal Academic Medicine, August 2014. I hope you find it helpful.

The E.M.P.A.T.H.Y. approach to better communication and connection:

E. Eye Contact. This is so essential to connection and engagement, and even the neurobiology of relation, that we need to attend to it. Be aware that some cultures find prolonged eye contact intrusive, seductive or even rude. As a physician, it seems harder to maintain good eye contact throughout an encounter because of the ever-present electronic record which requires us to document, review results, write orders, refills, write work or jury excuses, etc. Early, late, and as often as possible, eye contact is what I recommend to my students and colleagues despite the intrusion of the electronic environment and a busy clinic schedule with short office visits. Also, I recommend patients shut off their phones during visits as the precious time we have can be interrupted by frequent calls and texts. Continue reading

Agavin offers more choices to those watching caloric, sugar intake

Drs. Norbert Herzog & David Niesel

Drs. Norbert Herzog & David Niesel

Medical Discovery News

Next time you have a bitter pill to swallow, think about reaching for a spoonful of agavin instead of sugar to help the medicine go down.

You might not know what agavin is yet, but you’ve probably noticed that a number of alternative natural sweeteners like Stevia have been added to grocery store shelves next to traditional sugar.

These products sweeten foods but often do not add calories or raise blood sugar levels. Recent research suggests that a sweetener made from agave, the same plant used to make tequila, may lower blood sugar levels and help people maintain a healthy weight.

Agavin is a natural form of sugar, fructose, called fructan. With fructan, individual sugar molecules are linked together in long chains.

The human body cannot use this form of fructose so it is a non-digestible dietary fiber that does not contribute to blood sugar levels. But it can still add sweetness to foods and drinks. Continue reading

Empathy is a vital skill for health industry

Dr. Victor Sierpina

Dr. Victor Sierpina

Editor’s note: This the first in a series.
Empathy is the ability to detect, understand, and relate to another’s emotions. It is the basis of deep interpersonal relationships, including therapeutic relationships such as between a healer and a client or patient. Much of empathy is a nonverbal process.

Empathy is different from compassion. Compassion is a positive trait embraced by all major faith traditions. Compassion literally means “to suffer together.” It is defined as the feeling that arises when you are confronted with another’s suffering and the feeling you have motivating you to relieve that suffering. Continue reading

Reading an easy way to shape a better life

Dr. Victor Sierpina

Dr. Victor Sierpina

I have always been an incessant reader. Throughout my life, the world has entered my mind and experience through words.

New places and persons, extraordinary ideas, philosophies, faiths, art and all the panoply of what is available through literature has been instantly available to me though books and magazines.

It is even more so now through electronic sources. As a kid, summer vacations occasioned biweekly trips to the Phoenix Public Library where I would check out the maximum allowable 10 books.

Biographies of famous people like Thomas Edison, outdoorsmen like Kit Carson and Teddy Roosevelt served to inspire and keep me busy during hot summer days. Novels, nonfiction and hobby themes abounded as well in my reading lists. Continue reading

Thirdhand smoke is dangerous, too

Drs. Norbert Herzog & David Niesel

Drs. Norbert Herzog & David Niesel

Medical Discovery News

Science has long proved that smoking is bad for you and those around you, with 90 percent of lung cancer cases caused by smoking.

Even secondhand smoke is dangerous enough to warrant banning smoking in public places. The idea of thirdhand smoke premiered in 2009, and scientific evidence shows that it, too, can harm human health.

Thirdhand smoke is the many toxic compounds from tobacco smoke that settle onto surfaces (particularly fabrics) such as carpet, furniture and the inside of a car. Researchers have identified chemicals in thirdhand cigarette smoke called NNA and NNK that can bind to DNA, a person’s genetic information, and cause damage and mutations that could lead to cancer. Continue reading

Toenails play role in your health – take care of them

Dr. Victor Sierpina

Dr. Victor Sierpina

This week, please allow me to address a topic that seldom makes the top ten of health care problems: toenails. Take a moment now, and look at your toenails. Can you say with all honesty that you love and appreciate them? Or do you prefer they remain hidden under glitzy toe polish or buried in a boot or shoe? Are they the nice, symmetrical, pink-white shiny nails of youth or the horny, crusty, yellowed hooves of old age? Are they all the same color, or are some darker, green, yellow, or even black?

My inspiration to write about this came Saturday night when I had to do my bimonthly toenail trimming. Reaching them is harder every year and requires more exotic and garage-worthy equipment. For some older folks, the best bet is to let a family member, doctor, or foot specialist trim your nails. This is especially important for those with diabetes or peripheral vascular disease as a bad nail or nail infection in these folks can result in an amputation or worse.

A patient of mine with diabetes came in very concerned about a black toenail. She was sure it was diabetic gangrene. After an exam, we concluded that the blood flow was good and likely it was a bruise under the nail. Three months later when the “bruise” had not resolved, I sent her to Dermatology for a biopsy. We found that it was a melanoma, a potentially deadly kind of skin cancer growing under the nail. Off with the toe and 12 years later, she is alive and well. Continue reading

Take inventory of words

Dr. Victor Sierpina

Dr. Victor Sierpina

We create our lives from the inside out. From our thoughts come our ideas, from our ideas our words, our attitudes, our actions, and, ultimately, our outcomes in life.

Cause and effect. For many years, I had this exactly backward. I figured if I got a lucky break, met a powerful, rich friend, the right mentor, stumbled on a good business opportunity, met the right girl, an so on, then life would unfold as I wished it to be.

Except for luckily meeting the right girl, it has not really been that way.

The most common worldview in our day is that outside events shape our destiny.

Note the fluctuations in the stock market based on belief, fear and negative expectations, rather than any significant change in the businesses they invest in.

What is so often underemphasized is the power we have within to shape the map of our lives.

Rather than seeing ourselves as dependent beings awaiting the whims of fate, we need but recall the classic words of Ralph Waldo Emerson. In his essay “Self-Reliance,” Emerson offered us this timeless advice: Continue reading