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.

Contraception

What you may not know about me, is that the uterus is my favorite organ.

I love all the things that the uterus can do. I love helping women get pregnant, taking care of babies, and helping women prevent pregnancies when they are not wanting to have a baby. Today, I would like to talk about the options for contraception.

First, a helpful chart:

This shows that family planning (going off of your cycle), and spermicide, are the least effective methods of birth control.

Next comes barrier methods, which still have a high fail rate.

After barrier methods, are the prescription medications, that a lot of women are interested in.

There are combined oral contraceptive pills, that still have a fail rate of 9%. This rate is so high because it is hard to take a pill every single day, and there are a fair amount of medications that do interact with oral pills.

Then there is the depo-provera shot. This is effective for 90 days at a time. It has with it an associated 2-4lb weight gain, and can cause some osteoporosis, which tends to be reversible after the medication is stopped. It has a fail rate of 6%.

Next come two rings. One is the NuvaRing, which is a vaginal ring that is placed inside the vagina for 3 weeks at a time, and is removed after 3 weeks to have a period. It has a fail rate of about 9%. Women need a new prescription after every month to get a new ring. Some women complain about the fit of the ring. Next, is a different ring called Annovera. With this ring, it is very similar to the NuvaRing, but does have some advantages. With one prescription, one ring, the woman can use it for 13 months. The ring goes inside for 3 weeks, and out for 1 week, like the NuvaRing, but then she washes it, and uses it again for the following month. With the Annovera, it tends to cause less weight gain because of the way the hormone is derived. It is also a lot cheaper because you are only needing to buy the prescription once. Also, it's fail rate is only 2%, a lot better than NuvaRing.

Annovera

Sterilization is the next most effective, with the vasectomy for guys and the tubal ligation for women.

Surprisingly, both the IUD and the implant are more effective than the surgeries, and they are also reversible.

For IUD, there is the Mirena. It goes inside of the uterus and thickens up the mucus keeping semen from going inside of the cervix. It can prevent pregnancies for 5 years. It has a fail rate of about 0.2-0.5%.

And lastly, the most effective method of birth control is the Nexplanon. It is a progesterone only small 4cm rod that goes right under the skin in your arm. It can help prevent pregnancies for 3 years, and has a fail rate of 0.28%.

Nexplanon

All of these forms of birth control can also be effective methods in helping control periods, making them less frequent, less painful. Feel free to contact us directly if you want to learn more.

Injuries happen to the best of us

As some of you may know, I have been working on a couch to 5k running program. My dad helped me find it, and with only needing to participate a minimum of 3 times a week, helps me fit it within my schedule of seeing patients, learning Spanish, and spending time with my family.

Recently, the program has had me ramping up the amount of running I've been doing. And, I had been ignoring my body. After some of my runs last week, I could barely walk. Even when I went in the pool after running, it still hurt a lot. So, I finally listened to what my body was telling me to do, rest.

Why do we get injured? It is actually more common than people may think. This especially happens if we don't properly train, stretch, and put too much on our body at once. That's where I've been struggling. I'm the person who comes home from work, quickly changes, goes for a run, and comes home, and works with children, ignoring water and stretching. I can no longer do that. Stretching is very important. It helps keep muscles loose and helps improve pain. Also, drinking enough water can also help you recover quicker. 

Another thing I have learned by accident that can help me recover quicker, is wearing compression stockings. They compress the areas of pain and swelling and improve healing. They are also useful for treatment of varicose veins, and other leg swelling.

I have diagnosed myself with patellofemoral syndrome. It presents with anterior knee pain, and it worsens with squatting, running, and by doing stairs. It sometimes has a catching sensation. This condition tends to occur when individuals increase the amount of training. Treatment in the acute phase is to rest, and to modify the activity that was causing the pain. For me, that means rest, compression, and elevation when I can. After this initial phase ends, I need to work on strengthening my hip abductors, and my quadriceps. 

I will continue to press forward, and never give up. I feel like a lot of people give up when problems face us. Keep pressing forward, keep running the race, and we will succeed. Let's face another day together!