Allergies

We welcome you back to the blog completed by Dr. Harbison. A lot of things have happened over the past couple of years, and I thought it would be best to start with a topic near and dear to everyone's hearts right now: allergies.

Since the weather has been improving, there has been some rainfall, we now have many plants growing, and blooming. There is pollen everywhere, on the ground, on cars, on our clothes. And what happens, is that two types of our white blood cells, eosinophils and basophils, attack the foreign pollen, and cause us misery.

Why does this happen?

This happens because we live in a developed world. Since we don't commonly deal with parasites, the white blood cells that are normally responsible for killing parasites and worms, attack other things that seem similar. Most of the time, this is some type of pollen, or dander, fur, or the like. When the WBC attack the pollen, they then release histamines, which is what makes our eyes water, nose run or become stuffy, sneezing, and itchy skin.

What are some treatment options?

Various over the counter (OTC) medications include: loratadine (claritin), cetirizine (zyrtec), and levocetirizine (xyzal). These medications work by decreasing the effects of histamines and symptoms overall. Fluticasone propionate (flonase) works by narrowing blood vessels in the nose, which causes less drainage. A prescribed medication option is montelukast (singulair) which stabilizes certain types of WBC so that they do not release histamines.

Steroids can also be helpful, but only for short term treatment. If people are on steroids for longer periods of time, it can start to suppress the immune system and cause various hormone levels to change.

What services are offered at Transcend Medical Group?

An option for testing and treating of bad allergies is skin testing. It is a fairly quick procedure where various wells are placed on people's back. If significant allergies are noted, patients may get immune therapy. This therapy is for a minimum of 1 year treatment. Once treatment serum is received, people will get weekly injections and the dose of allergy medications increase over time.

It's wicked hot out

We have hit the time of year that some people like, but most people dread. That is the wonderful, hot, humid days of Texas summer. Even this physician has been surprised by how hot and unruly this weather can be. However, there are some tips to keep folks cool.

The first thing is, try to stay out during the heat of the day. The worst times tend to be from 11am-3pm. If you have to be out during the day, stay covered. Lighter colors are better than darker. Wearing a hat can help keep the sun off of your face.

When outside, wear sunblock, especially if you are fair skinned. Do not forget to reapply it within the time frame recommended on the bottle. The more skin damage one sustains throughout their lifetime increases their risk of different forms of skin cancer.

Drink plenty of water. Our bodies are made up of 60% water. During the heat of the day, our bodies cause more water to evaporate. This increases our need for water.

If you have any questions or concerns, please see your friendly neighborhood family doctor.

On Well Woman Exams

This is one of the things that women both dread and anticipate. A well woman's exam. During a well woman's exam, normally both a gynecological exam and a breast exam occur. Most women believe that they need to have them done annually. This is not accurate, unless something is abnormal.

I try my best to follow the guidelines set out by the ACOG: American College of Obstetrics and Gynecology. These standards do change over time, but these are the current recommendations. They recommend that cervical cancer screenings start at age 21 and end at age 65, unless some abnormal results occur. For ages 21-29, it is recommended to get a pap every 3 years, and for ages 30-65 it is recommended to get a pap every 5 years. This is assuming that your results are normal. If there are ever any abnormalities, then that would change the time period.

Women do not need to get a pap smear yearly, unless she has a history of abnormal results, or a history of cervical cancer. Part of my current practice is attempting to prevent unnecessary additional pelvic exams.

Reopening Texas

As of today, Governor Abbott, has officially started to reopen Texas again. This is in an attempt to help stabilize the economy and return life back to normal. For those of you like myself, I have been watching the curve flatten over the past few weeks, and have been very impressed by all the new guidelines that have been implemented for our safety. For example, now many places of businesses are requiring that people wear masks in order to enter, to help continue to decrease the spread of COVID-19. Let's start with what exactly Governor Abbott has stated:

People are thought to be most contagious early in their illness, but COVID-19 can be spread to others by infected persons even before they show any symptoms. That is why we must remain cautious — to avoid further spread or a new outbreak. As we begin to open Texas, we must continue to follow these critical health guidelines: 
 Stay home if you can. 
 Wash hands often and for 20 seconds, or use hand sanitizer with at least 60% alcohol. 
 Cover coughs and sneezes with a tissue, then throw the tissue away. 
 Avoid touching your eyes, nose, and mouth with unwashed hands. 
 Disinfect surfaces, buttons, handles, doorknobs, and other places touched often. 
 Avoid close contact with people who are sick.

Continue to practice social distancing, avoid crowds, and limit physical contact. The Centers for Disease Control and Prevention (CDC) also recommends using simple cloth face coverings in public to help slow the spread of the virus.

He has separate recommendations per different age groups. In his document, he starts with those individuals that are 65 years old or older:
People 65 years or older, especially people 65 years or older with medical issues like heart disease, diabetes, cancer, or a weakened immune system, are at a higher risk for getting very sick or dying from COVID-19.

1. Stay Home If You Can:

• Minimize face-to-face contact with others. Avoid young children.
• If someone is assisting you, you and your family members or caretakers should wear cloth face masks. Remember a family member or caretaker can give you the virus even if they don't appear to have symptoms.
• Try grocery or restaurant delivery, mail order prescriptions, and phone appointments with your doctor. Call 2-1-1 if you need help with essentials.
• Reach out to friends, family, or neighbors who can deliver essential items.

2. Help Save Lives:

• If you must go out, wear a cloth face mask, and stay six feet away from others.
• Wash your hands often and for at least 20 seconds, or use hand sanitizer with at least 60% alcohol.
• Disinfect surfaces, buttons, handles, knobs, and other places touched often.
• Do not share dishes, drinking glasses, cups, or eating utensils with others.
• If you have mild symptoms (difficulty breathing, or a rapidly worsening cough or fever), call your healthcare provider. If symptoms are severe, call 9-1-1.

3. Check In:

• Check in regularly with neighbors, friends, and family by calling, texting, emailing, video chatting, or even writing letters.
• Walking, gardening, digital books, games, and online religious services are great ways to stay active and connected.

For people that are younger than 65 years old, basically, you should follow the old guidelines. Continue social distancing, self screen for symptoms, and wear masks in public.

For restaurants: No tables more than 6 people. Customers should wash/sanitize hands after payment process.

Movie theaters: remote ticketing, keep at least 2 empty seats between parties in any row, alternate rows between customers, clean seats, do not leave foodware at tables.

Museums and libraries may open at 25% capacity

Outdoor sports participants: may engage in outdoor sports, no contact, no more than 4 participants per sport at a time, no public pools.

Church: at risk people should view via remote, keep at least a few seats between parties, alternate rows between attendees.

Basically, even though the state of Texas has officially "reopened", we are still to maintain the same recommendations as before, just now around others. Of course, if you are sick, STAY AT HOME!

For more specifics, please visit:
Texans Helping Texans, Reopening Texas Document

Dealing with emotions in the time of a Pandemic

This has been a very odd period of time. If I had been asked years ago if I thought I would ever be in the middle of a pandemic, I would have never thought so. I also never fully understood what it meant to live during a pandemic. And let me be honest with you, it has not always been the best for my nerves.

I do have a combination of anxiety and depression, and I am on medication for that, which I take faithfully every day. However, with all of this social distancing, me wearing a different set of clothes at home and at work, wearing two sets of masks while at work, and having people wear various amounts of PPE, it is a whole lot of stress to deal with. I often feel like I am isolated. Yes, I work with a significant amount of people at work, both my colleagues and the patients, and I have a very loving family, but outside of my work, I do not really see anyone anymore. And that is very depressing. I have even allowed myself to view me as a leper, where no one wants to interact with me anyway, because of the possible COVID-19 due to me being a doctor. So, what can you do when you have feelings like this, of inadequacy, of fear, of loneliness?

Well, I do a few things. I talk to those that I love and trust, and first unload my cares on them. I don't try to have a pity party, but more of just expressing it so I can move on. Then, I try to move on. I am religious, and I have found a lot of comfort in reading Scriptures, praying, and reading encouraging books. One of the books that I have found very helpful is called, "Wildly Optimistic: Gaining New Perspective for Life's Challenges" written by Al Carraway. If that doesn't work for you, go outside, if only to walk around the block, walk in a neighborhood, just get out and move. Being stuck in the same area for a long period of time isn't good for anyone. If you need more help, there is a line that is available for free: COVID mental health number.

Journaling can also be very helpful. That is part of the reason why I blog, to get my thoughts and emotions out. That way, I can read through it, and better understand what I am feeling. Music can also be helpful, both listening to and performing. And for the inability to physically connect with people, use other forms. Write, email, text, or video. I have found this very helpful. And also remember, that this too will pass. This will not be for forever. And remember, that I am also available as well to help anyway I can medically.

So, what do you think about COVID, Doc?

I'm writing this post as a response to a question I am now getting multiple times a day working in a clinic in Pantego. With this pandemic currently underway, the media bringing fear and panic into the lives of many individuals, I thought I would do my best to stick to the facts.

What is COVID-19?
Coronavirus disease 2019 (COVID-19), is a respiratory virus that can spread from person to person. Since it is a virus, this means that antibiotics do not kill it, and that we mostly need to manage the symptoms. COVID-19 was a novel virus that came from Wuhan, China.

How does COVID-19 spread?
We believe that COVID-19 originally mutated from an animal source, and now has been spreading from person to person. The virus can spread within people that are in close proximity (6 feet or less), through respiratory droplets when a person coughs or sneezes. It is also possible that the virus can stay dormant on surfaces where a person touches, and then an individual touches that surface, an touches their face, they can potentially get the virus.

How many cases are there in the world of COVID-19?
Uptodate counts of where COVID-19 is.

What does it mean to be in a pandemic?
According to the World Health Organization, a pandemic is declared when a new disease for which people do not have immunity spreads around the world beyond expectations.

What does it mean to be in a state of emergency?
This means that local officials are working together to contain and diminish the amount of possible cases. This means that various events that would have large groups of people coming together are currently postponed until further notice.

What symptoms should I be watching out for?
Patients with COVID-19 have had mild to severe respiratory symptoms, along with

• fever
• cough
• shortness of breath

In severe cases, this can lead to pneumonia in both lungs, multi-organ failure, and death.

How can I help prevent the spread of COVID-19?

• Avoid close contact with those who are sick.
• Avoid touching your eyes, nose, and mouth with unwashed hands.
• Wash your hands with soap and water for at least 20 seconds. If you cannot wash your hands, use alcohol based sanitizer that contains at least 60% alcohol.
• Stay home if you are sick.
• Cover your cough or sneeze with a tissue, then put the tissue in trash.
• Clean and disinfect frequently touched objects and surfaces.

What steps are in place to prevent the spread of COVID-19 at Transcend Medical Group?

• We now have the testing capability for COVID-19 at the Randol Mill location.
• If a patient comes in for testing for strep, respiratory panel, or flu, we are now keeping them in their exam room until the test is completed.
• We are sanitizing surfaces more frequently.
• We are encouraging our employees to wash their hands frequently.
• For the COVID-19 testing, we have one employee testing patients, and that employee is wearing protective equipment.
• We are currently partnering with UT Southwest to monitor the current outbreak of COVID-19.
• Dr. Harbison will be employing fist bumps with patients, since that decreases the spread of germs by 90%, and she will continue to frequently sanitize her hands and wear gloves, when appropriate.

What should I do if I, or someone I know, is concerned they may have it?
They should go to their closest medical facility that has testing available for COVID-19. You may call your local ER ahead of time to ensure the testing is ready. Or, you can go to our main campus on Randol Mill and Davis.

What online resources are available for individuals?
Please see this link to be connected with the World Health Organization's page with factoids about COVID-19.

I hope that this post alleviates some fears. If you, or others, have any questions about COVID-19, please do not hesitate to ask a doctor you trust.

Weight Loss

Some folks may or may not remember that I have been working on my own weight loss for awhile. I have been attempting to eat more healthy food, like munching on peanut butter and carrots, while still having ice cream occasionally. I have also gotten back into running, and have been successfully running for a few months. I have noticed a slight decrease in my weight, by about 10lbs, which is very encouraging. Some people are unable to do even that, and may need medication to help. That's where it helps to have a doctor on your side.

One of the cheapest forms of weight loss medication that does work is called Orlistat, also known as Alli. You can even buy it over the counter. How this one works is that it does not allow your body to digest fat, and instead of digesting it, your body completely excretes it with your feces. This causes fatty bowel movements, and occasionally patients have issues with being able to control their bowel movements, meaning that they may soil themselves. Hence, it's affordable quality. I don't tend to recommend this to patients unless they are okay with that possible side effect and they have a bathroom nearby.

Another medication is called Victoza/Saxenda. This is a diabetic medication, that is an analogue (man-made version) of the GLP-1 hormone. This hormone is the one that triggers your body to let you know that you are hungry, and to get more glucose into the body. By taking this class of medication, your appetite is decreased. It is an injection that has to have doses adjusted over time. It can work, as long as the patient is okay with doing injections, and okay with the possible side-effects of nausea and upset stomach. Also, since insurance companies are not the easiest things to work with, this can also be quite expensive. It is a good idea for patients that are either diabetic or prediabetic because it will lower your blood sugar readings as well.

If needles are not for you, another option is a medication called phentermine. This is a controlled medication, because of possible addictive qualities to it. Due to the controlled nature, patients have to come in monthly for medication refills. It does work as an appetite suppressant. However, this medication can only be used safely for 12 weeks at a time. "Phentermine is not approved for long-term use. Clinicians should carefully examine the potentially benefits against potential risks associated with use of medications in this class. Consult weight loss guidelines for current pharmacotherapy recommendations. Therapy should be used in conjunction with a comprehensive weight management program." It will work, but should only be used for a short term period.

Another option is a medication that called contrave. It is a combination of bupropion and naltrexone. Bupropion (wellbutrin) is an antidepressant, which also helps diminish appetite. It can help with mood, and with quitting smoking. This medication should not be used if the person has ever had any issues with seizures, because it lowers the seizure threshold (the likelihood of a seizure occurring). This medication also has to be titrated over time to help with weight loss. This medication tends to be well tolerated and can be used for longer periods of time. This is an expensive medication, but through the company's website, they do offer a deal of only paying $99/month.

The final medical option of a pill, and not surgery (which is a whole other discussion), is called qsymia. Qsymia is a combination of phentermine (at low dose) and topiramate (a medication commonly used for migraine prevention). The combination is good at decreasing appetite. This medication has to be titrated over time and is safe for longer periods of time. This is also expensive, but the company has a deal of paying $99/month if you use their portal.