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SEPTEMBER 15 | 2016 | DEFENDER
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Defender Special Edition
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tips for dental care
Whether you are 80 or 8, oral health is important. It’s estimated that 100 million Americans fail to see a dentist each year, even though regular examinations and good oral hygiene can prevent most dental disease. Here are some tips from the American Dental Association (ADA).
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Regular dental visits can help spot problems early on when treatment is likely to be simpler and more affordable. Visiting your dentist is also important because some medical conditions have symptoms that can appear in the mouth. Brush your teeth twice a day – especially before bedtime – with a soft-bristled brush. Replace your toothbrush every three or four months or sooner if the bristles are frayed. Use an ADAaccepted fluoride toothpaste. Gently move your toothbrush back and forth in short strokes. Brush the outer surfaces, inner surfaces and chewing surfaces of the teeth. Clean inside the front teeth with up-and-down strokes. Brush your tongue to remove bacteria and keep your breath fresh. Clean between teeth daily with floss to help remove plaque and food particles.
Eat a balanced diet, limit between-meal snacks and drink plenty of water. Beware of foods containing sugar, which can contribute to tooth decay.
Bad breath causes, solutions
Bad breath, or halitosis, is a common and unpleasant problem. According to the American Dental Association, bad breath can happen anytime because of the hundreds of types of bacteria that naturally live in your mouth. When you eat, bacteria feed on the food left in your mouth and leave a foul-smelling waste product behind. Here are some tips on preventing bad breath. • Brush and floss your teeth more often. • Drink enough water. When your mouth doesn’t have enough moisture to produce saliva, odor-causing bacteria can develop. • Be aware of foods that can cause bad breath, such as garlic, onions, various spicy foods, coffee and alcohol. • Take removable dentures out at night and clean them thoroughly. • Use a mouthwash that can help reduce plaque and gingivitis and freshen breath. Mouthwash, however, is only a temporary solution, as are breath mints and gum. The longer you wait to brush and floss, the more likely your breath will offend.
Parents seek oral care on child’s first birthday If you’re the parent of a little one, be aware that their first dental visit should coincide with their first birthday. “Current guidelines by the American Academy of Pediatric Dentistry recommends establishing a dental home by the age of 1,” said Dr. Esther Yang, a pediatric dentist with Texas Children’s Hospital. “The question many parents and practitioners ask is, ‘Why so early and what will the dentist do for my baby at that visit?’ The main reason would be education and prevention, placing the power into the parent’s hands.” Yang said the dental home is an ongoing relationship between the dentist and patient where all aspects of oral health care can be delivered, such as comprehensive care, prevention, dietary counseling and dental trauma care. “At the first visit, the dentist will perform a clinical exam identifying both normal and abnormal oral structures,” Yang said. “The exam is generally minimal and noninvasive. Many times perform-
ing the exam teaches the parents how to open the child’s mouth and identify normal structures. “Tricks to gently maneuver the mouth and teeth so as not to get bitten can be quite helpful. Showing the parents how to clean the infant’s mouth and making the daily habit routine is also part of the first visit,” she said. Yang said that in reviewing healthy dietary habits, the dangers of using a bottle as a pacifier is stressed to the parent. She warned that allowing a child to fall asleep while nursing or bottle feeding bathes the teeth and tongue in milk and debris. “Ideally, dentists discourage frequent nighttime bottle feedings,” she said. Yang added that the most important part of the first visit is allaying fears of the dentist. “Parental apprehension has been proven to be a strong factor in influencing the child’s behavior,” she said. “Therefore, if the parents come in early and have their dental concerns addressed it can pave the way for a healthy, happy dental home.”
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DEFENDER | SEPTEMBER 15 | 2016
health
What Blacks should know about oral cancer disease that will put you at higher risk. Defender: What are Cancer continues to the symptoms of oral take a toll on the Black cancer? community and Black men Gillenwater: The most in particular are urged to important thing to remembeware of oral cancer. ber is that early cancers According to the Nadon’t hurt. What people tional Institutes of Health, usually notice first is a Black men comprise one of sore in their mouth. They the groups at highest risk for may have some bleeding, oral cancer. Though lifestyle such as from the tongue or and lack of medical care cheek. A lump or bump in could be a factors, more the mouth or an enlarged research is needed for the exlymph node in the neck [is act answer, said Dr. Ann Gilanother symptom]. But the lenwater, M.D., a professor of head/neck most common is a sore or ulcer that surgery and director of the Oral Cancer doesn’t heal. There are also symptoms Prevention Clinic at MD Anderson. that are pre-cancer. If you get a white • Avoid tobacco in all forms. In an interview with the Defender, spot in your mouth that you can’t • Drink alcohol in moderation. Gillenwater discussed the disease. scrape off that’s called leukoplakia. A • Remove dentures at night and Defender: What are the most comred spot is called erythroplakia. clean them daily. mon oral cancers? Defender: How is oral cancer • Have dentures evaluated by a Gillenwater: The most common treated? dentist at least every five years. type is squamous cell carcinoma and over Gillenwater: The main treatment • Limit sun exposure; wear a lip 95 percent of cancers of the mouth are is surgery. If it’s more advanced you balm with sunscreen and a hat this type. There are other types such as have to sometimes use radiation therwith a brim. salivary gland cancers or melanoma of apy or radiation and chemotherapy. If • Eat a well-rounded, healthy the mouth but they’re pretty rare. you catch it early you can usually do diet with a variety of fruits and Defender: What are the causes of a pretty small surgery and the patient vegetables. oral cancer? is able to eat and talk. Once it’s in the Source: MD Anderson Cancer Center Gillenwater: The most common more advanced stages it really affects cause in the United States is tobacco the ability to talk and swallow and use, whether that’s cigarettes or chewone’s appearance. ing tobacco. In many cases it can be prevented, but there are Defender: What is your advice for someone concerned also patients who come in and don’t have any of the known risk about oral cancer? factors and we don’t know what causes it. Besides tobacco, if Gillenwater: Usually the dentist is your first line [of detecyou drink a lot of alcohol and you smoke it leads to a higher risk. tion]. It’s important to go to the dentist even if you don’t have If you have poor dental hygiene and have bad teeth and gum any teeth anymore. Also see your primary care physician. By MARILYN MARSHALL Defender
Minimize the risk
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Older adults have special dental needs Among adults ages 75 and up, about one in four has lost all natural teeth. Here are some tips on care from the National Institutes of Health and the American Dental Association. • Many older adults have gum or periodontal disease, irritating the gums and making them swollen, red and more likely to bleed. Advanced gum disease can lead to tooth loss. • A common cause of cavities in older adults is dry mouth, a side effect of some medications. Use oral moisturizers, drink more water or use sugar-free gum or lozenges to stimulate saliva production. • Caregivers for elderly persons should remind them to brush and floss and make sure they see a dentist regularly. Encourage the person to use an electric or large-handled toothbrush so it’s easier to grip. Consider placing your hand over his/hers to help guide the toothbrush. • If older adults with dentures are having difficulty eating denture problems could be the cause. • Older adults are at increased risk for oral cancer. The average age of people diagnosed with mouth, throat and tongue cancer is 62. • Many retirees don’t realize that Medicare doesn’t cover routine dental care such as cleanings, fillings, extractions, dentures or other dental devices. Medicare Part A (hospital insurance) will pay for certain dental services when a patient is in a hospital. Plan for dental expenses in advance of retirement so you don’t have to let your dental health suffer once you’re on a fixed income. • Organizations such as AARP offer supplemental dental insurance plans for members. Discount dental plans are another option that typically have a lower monthly fee than traditional dental insurance.
Message from the Publisher
Sonceria Messiah-Jiles
Good dental health is an important part of our overall health. Teeth and gums that are cared for can give us nice smiles and help us eat and speak better. Neglecting our oral health, on the other hand, can be painful and costly, and anyone who’s ever had a toothache knows how excruciating it can be. There’s an old saying that an “ounce of prevention is worth a pound of cure,” and in this special edition, we are pleased to provide our readers with helpful hints that can help prevent a crisis trip to the dentist. Our tips on dental care are designed for the entire
family, from children to older adults. If you’ve considered dental implants or dentures, our article on options for missing teeth can help. We take an in-depth look at the dental care gap in minority communities and offer resources for low-cost care. In addition, our partners – Kelsey-Seybold Clinic, MD Anderson Cancer Center, Memorial Hermann Health System and Texas Children’s Hospital – provide valuable insight into various health matters. So take care of your mouth. You’ll have every reason to smile.
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SEPTEMBER 15 | 2016 | DEFENDER
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Missing teeth:
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What’s best for you?
t’s estimated that the average adult between the ages of 20 and 64 has three or more decayed or missing teeth. Yet missing teeth can affect the way you speak or eat, and remaining teeth can shift. Dr. Ryan Quock, DDS, a professor and vicechair of restorative dentistry and prosthodontics at UTHealth School of Dentistry, said treatment options available depend on the number of teeth missing and the location of the missing teeth. Quock listed four options:
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Fixed partial denture or bridge. “This treatment is typically an option when one or a few teeth are missing if only in limited geographic area of the mouth,” he said. “In order for a conventional bridge to work, it by definition must have at least one healthy remaining tooth (called abutments) on either side of the space left by the missing tooth. “These healthy teeth are prepared by the dentist to receive a crown cap,” Quock said. “Fused between the crowns on the abutment teeth are prosthetic teeth. This multi-tooth unit is then cemented in place onto the abutments. Thus, you have a ‘bridge’ spanning from healthy tooth to healthy tooth, with a prosthetic tooth (or teeth) filling the gap. Pro: The bridge is fixed in place. Con: The procedure involves removal of otherwise healthy tooth structure from the abutment teeth to accommodate the bridge crowns.
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A dental implant is a titanium screw placed in the jawbone.
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Complete denture. “This is the treatment most people think about when they hear the term denture,” Quock said. “It has been referred to as ‘false teeth’ and variations on this phrase. A complete denture is an option when all of the teeth are missing on the maxilla [upper jaw] or mandible [lower jaw]. An acrylic baseplate is made to adapt to the curvature of the toothless ridges of the upper or lower jaw, and denture teeth are placed in the acrylic base.” Pro: A complete denture is the most sensible solution when all the teeth in either jaw are missing. Con: Speech and chewing efficiency are almost always compromised and complete dentures almost always need to be replaced over the years, because of the “natural resorption of the underlying jawbone.”
Removable partial denture, also known as partial or RPD. “This treatment is typically an option when multiple teeth are missing, both on the left and right side, on the upper jaw (maxilla) or lower jaw (mandible),” Quock said. He said a framework of some sort is fabA complete denture is another option for missing teeth. ricated, either metal or a thermoplastic resin. He said after healing, a prosthetic tooth crown is attached Various clasps are included to grab onto existing to the opening of the screw, which is at the gum line. “The healthy teeth. Individual denture teeth are cuscombination of the screw and the prosthetic tooth are a complete tom adapted to the framework to replace missing artificial replacement for the missing tooth root and crown,” he teeth. Dental implants. “Technically speaking, a dental said. “At the other end of the spectrum, dental titanium implant Pro: It is an economical way of including implant in and of itself is not a replacement for a missscrews can be used to better support complete dentures.” missing teeth in one restoration. ing tooth,” Quock said. “A dental implant is simply a Pro: Successful placement of an implant screw into the Cons: There will be a small amount of give titanium screw that is surgically placed in the jawbone. The aim bone helps minimize bone loss in the area, and when individual or movement which might present a compromise is that the bone accepts and integrates with the titanium implant teeth are replaced, there is no need to remove tooth structure in speech or eating. screw, basically fusing it in place. from surrounding healthy teeth. Also, food debris can If this is successfully achieved, it defendernetwork.com Con: Not all patients are medically good candiaccumulate, requirnow provides a sound mechanical Cost and recovery time of dates for implants. “Existing bone mass and systemic ing meticulous oral anchor on which to attach various implants, dentures disease/conditions can limit their success,” he said. hygiene. dental prostheses.”
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DEFENDER | SEPTEMBER 15 | 2016
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health
Fertility and cancer:
Important things to know “Being diagnosed with cancer and told that it may rule out parenthood can be devastating for people who haven’t yet started or completed their families,” says Terri Woodard, M.D., who leads the MD Anderson Oncofertility Consult Service. Here, Dr. Woodard answers some questions she often receives about fertility and cancer. Dr. Terri Woodard
Another option is suppressing the ovaries with medication to make them more resistant to the effects of chemotherapy; this is considered experimental. Freezing ovarian tissue is the only option for girls who have not gone through puberty yet. It is also considered experimental, though children have been born using this method.
By MD ANDERSON CANCER CENTER
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Can cancer treatment cause infertility? Some cancer treatments can, while others do not. The most common types of treatments that affect fertility include surgery that involves removal of the reproductive organs, certain types of chemotherapy and radiation to the abdomen and pelvis. We do not know how some newer treatments may affect fertility.
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What fertility preservation options are available for men preparing to undergo cancer treatment? For men, the most common and accepted way to preserve fertility is to bank sperm before starting cancer treatment. For boys who haven’t gone through puberty yet, the only option for fertility preservation is to freeze pieces of testicular tissue. This is considered an experimental procedure.
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How will cancer treatment affect my fertility? How cancer treatment affects your fertility depends on many things, including the type of treatment you receive, your age and your current fertility status. Some people might be temporarily infertile while others may have permanent infertility. Your doctor can help estimate your individual risk.
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How long will we need to prevent pregnancy during cancer treatment? You should abstain or use a reliable form of birth control while you are receiving cancer treatment. You also shouldn’t try to conceive within six months of finishing chemotherapy because it may increase the chances of miscarriage or having a baby with a genetic complication.
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After cancer treatment, how long should I wait to conceive? Determining when it is okay to conceive requires thoughtful discussion between you and your health care team. The timing varies between patients and types of cancer. Generally, women should wait at least two years before trying to conceive. This allows enough time for you to get beyond the window of an early cancer recurrence and allows your body to recover from the effects of treatment. If your cancer treatment has caused late effects
7 that might make handling pregnancy more difficult, it may be recommended that you see a maternalfetal medicine specialist prior to trying to conceive.
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What fertility preservation options are available for women preparing for cancer treatment? There are several different ways that we can preserve fertility for women. The most common and accepted way to do this it to use assisted reproductive technologies (ART) to freeze eggs and/or embryos. For patients who will receive high doses of radiation to the abdomen and pelvis, ovarian transposition is a surgical procedure that moves the ovaries out of the radiation field so that they are not harmed.
What should I ask my doctor about cancer and fertility? You should ask if your treatment might cause infertility and, if so, what your personal risk is. You should also ask about ways to preserve or protect your fertility before you start treatment. If you would like to learn more, ask your doctor to refer you to a fertility specialist, who can counsel you about your risk and provide fertility preservation treatments. If you’re a patient at MD Anderson, ask for a referral to the MD Anderson Oncofertility Consult Service.
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When should I talk to my doctor about my fertility? You should talk to your doctor about your fertility concerns as early as possible in the course of diagnosis and definitely before you start treatment. The earlier you have the conversation, the more options you have if you decide to pursue fertility preservation treatment. However, even if you did not have the opportunity to discuss your concerns prior to treatment, you should still talk to your doctor about them because you can still think about your plans for parenthood after cancer. Learn more at MakingCancerHistory.com
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SEPTEMBER 15 | 2016 | DEFENDER
“I have other plans, cancer” Gail Morse | Cancer Survivor People in families with a history of cancer are perfect candidates for MD Anderson’s early detection and prevention programs. The earlier we can find cancer, the better the chances of getting rid of it. Call 1-855-894-0145 or visit MakingCancerHistory.com.
Ranked number one in the nation for cancer care by U.S. News & World Report.
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cente
ORAL
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DENTAL CARE GAP
By MARILYN M Defend
here is a dental communities of of all ages are l receive regular Poor dental health d pretty smile. Left untrea can cause pain and tooth chronic health condition growth and social develo productivity and job opp Two long-time Hous Dr. Matthew Plummer a Poindexter III, said that difficulties and lack of e to the problem. “Dentistry is often p optional health care issu “Our community often o doctor on an as-needed b that if it’s not broken do “It comes from year where people were conc putting food, clothing an According to a recen Charitable Trusts, comm face “real” dental proble dental care delivery syst adequately support the o Americans. The report’s • People of color are whites to suffer from un • Adults and seniors
FIND BEN TAUB ORAL SURGERY DEPT. 1504 Taub Loop 713-873-3320 BERING OMEGA DENTAL CLINIC FOR HIV PATIENTS 1427 Hawthorne St. 713-341-3790 CENTRAL CARE COMMUNITY HEALTH CENTER 3315 Delano 713-831-9654 CITY OF HOUSTON DENTAL CLINICS
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L HEALTH WORSE IN COMMUNITIES OF COLOR
MARSHALL der
l health gap in f color as minorities less likely to r care. doesn’t just impact a ated, oral problems h loss, worsen ns, impair children’s opment and hinder portunities. ston dentists, nd Dr. Zeb F. socioeconomic education contribute
perceived as an ue,” Poindexter said. only goes to the basis and believes on’t fix it. s of conditioning centrating more on nd shelter together.” nt report from Pew munities of color ems and the nation’s tem is failing to oral health of all s findings include: e more likely than ntreated tooth decay. of color are more
likely than whites to lose their teeth. limited and you are more likely to pursue • Children of color are less likely episodic or emergency care.” than white children to “Another factor is whether see a dentist and receive dental care is culturally preventive care. reinforced. Is there emphasis • Children of color are placed on good dental health in less likely than their white the family?” peers to have sealants, Poindexter said there is plastic coatings that protect another reason why people avoid the chewing surfaces of going to the dentist. “There’s teeth from bacteria and a fear factor involved and it’s reduce decay. a psyche from mis-information • When dental pain and mis-education.” becomes too severe to There are various solutions ignore, many people resort to closing the dental gap. They to emergency room visits, include: Dr. Matthew Plummer which provide no treatment • Change the perception for underlying oral health that dental/oral health is less problems. important than general health. “The issue of unmet • Improve dental care access dental needs is not limited and combat health disparities to minority communities associated with poverty, limited but it’s more severe in education or language skills, age, minority communities,” said gender, disability, geographic Plummer, who called the location or existing medical issue “multifactorial.” conditions. “The higher the • Improve access to dental educational level of the insurance. According to the parents it is more likely National Institutes of Health, private insurance coverage for that parents and children Dr. Zeb F. Poindexter III dental care is increasing but still are going to receive dental lags behind medical insurance. care,” he said. “Associated with that is the • Expand community-based health issue of the amount of discretionary funds and prevention programs and increase available to the family. If you’re poor or understanding of what can be done to enhance working for minimum wage, your access is
D LOW-COST DENTAL CARE
La Nueva Casa De Amigos 1809 N. Main 713-547-8076
Lyons Health Center 5602 Lyons 713-671-3024
Magnolia Health Center 7037 Capital 713-928-9825
Northside Health Center 8504 Schuller Road Houston, TX 77093 713-742-1320
COMMUNITY MEDICAL CENTER
11246 S. Wilcrest #190B 281-977-7462 15132 Old Galveston Road 281-990-7462 EL CENTRO DECORAZON Eastwood 412 Telephone Road 713-926-6229 GOOD NEIGHBOR HEALTH CENTER 190 Heights Blvd. 713-529-3260 HARRIS COUNTY HOSPITAL DISTRICT CLINICS
Acres Dental 818 Ringold 281-448-6391 Settegast Dental 9105 N. Wayside 713-633-2020 Aldine Dental 4755 Aldine Mail Rt. 281-985-7600 People’s Dental 6630 DeMoss 713-272-2600 Strawberry Dental 927 E. Shaw 713-982-5900
ng the Houston area for over 85 years
dental health. • Encourage more minorities to seek careers as dentists and increase exposure to STEM (science, technology, engineering and math). “You can’t tell kids early enough to study and go to school so you can become a doctor or dentist and take my place,” Poindexter said. • Increase the availability of dental sealants, which can reduce tooth decay by 80 percent in the two years after placement and continue to be effective for nearly five years. Asian, Black, and Hispanic children remain less likely than white children to have even one dental sealant. • Stress the importance of basic dental care along with early diagnosis and treatment. Poindexter added that patients should not wait until they have a painful toothache to see the dentist. “Instead of coming in and spending $60 a year to get your teeth cleaned, you wait and come in when you’ve got a big, swollen jaw and gum disease and fever or your throat is swollen or you’re scared that you’re going to die,” he said. “Remember that prevention is better than cure. Brush your teeth before you go to bed, and treat your toothbrush and toothpaste like your best friend.” Plummer said that patients must understand the importance of dental care in relation to other health matters. “If you have abscessed teeth and periodontal disease, then that’s going to impact your general health,” he said.
The Greater Houston Dental Society has compiled a list of area dental care resources. Visit www.ghds.org for more information. Gulfgate Dental 7550 Office City Dr. 713-495-3700 Central Dental Ctr 5230 Griggs Rd. 713-757-0572
6410 Fannin 713-704-3368
HARRIS COUNTY PUBLIC HEALTH Antoine Health Clinic 5815 Antoine 713-602-3300
LEGACY COMMUNITY HEALTH SERVICES Baker/Ripley Clinic 6500 Rookin-B 713-351-7350
Southeast Clinic 3737 Red Bluff 713-740-5000
SAN JOSE CLINIC MISSION DENTISTRY GROUP 2615 Fannin Street 713-228-9411
HERMANN HOSPITAL, UT GPR DENTAL CLINIC
LBJ ORAL SURGERY CLINIC 5656 Kelley Street 713-566-5080
SEARCH DENTAL CLINIC FOR
THE HOMELESS 2505 Fannin 713-739-7752 SPRING BRANCH COMMUNITY HEALTH CENTER 8575 Pitner Rd. 713-462-6545 TEXAS CHILDREN’S HOSPITAL DENTAL CLINIC 6701 Fannin, Suite 310 713-739-7752 TEXAS DENTAL TECHNOLOGY SCHOOL 7442 Park Place Blvd. 713-645-1612
UNIVERSITY OF TEXAS DENTAL BRANCH 7500 Cambridge St. 713-486-4000 VECINO HEALTH CLINIC Airline Children’s Clinic 5808 Airline Dr. 713-695-4013 Denver Harbor Clinic 424 Hahlo Street 713-674-3326 Pasadena Health Center 908 Southmore # 180 713-554-0510
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Memorial Hermann Health Centers for Schools
20 years helping students
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By MEMORIAL HERMANN
or 20 years, the Memorial Hermann Health Centers for Schools program has been dedicated to providing access to medical, mental health, nutritional and dental care to uninsured and underserved students in the Greater Houston community. Why? “Because there was a need then and there’s a need now,” said Carol Paret, senior vice president and chief community health officer for Memorial Hermann Health System and the CEO of Memorial Hermann Community Benefit Corporation. Paret’s words are particularly apropos as a new school year begins as the primary goal of the Health Centers for Schools program is to keep students healthy and in school so they can learn and prepare for their futures. The program accomplishes that by serving as the medical home for uninsured students – prekindergarten through 12th grade. Launched in 1996 with two clinics, the program has now expanded to 10 school clinics serving 71 schools in five independent school districts – Aldine, Alief, Houston, Lamar Consolidated and Pasadena. The clinics are staffed by a nurse practitioner/physician assistant, social worker and a licensed vocational nurse (LVN). Additionally, a certified community health worker (CHW) or navigator rotates among the centers and assists parents with CHIP/Medicaid applications and provides social service, medical and dental referrals. Open year round, the clinics offer services that include sick and injury care, general and sports physicals, immunizations, chronic care (asthma, obesity and cholesterol), mental health therapy, social service referrals, nutritional guidance and other care to meet students’ needs. Dental services offered include periodic oral examinations, diagnostic X-rays, prophylaxis, fluoride treatments, oral hygiene instructions, sealants, composite fillings, extractions, stainless steel crowns, pulpotomies and root canals. When Memorial Hermann launched the program two decades ago, it was ahead of the curve as a health system that understood the importance of delivering on a value proposition that could connect the dots between the health and wellbeing of underserved students with their performance in the classroom. Now, Memorial Hermann’s school-based clinic program is evolving to the next level by expanding to offer new exercise and healthy eating programs to help impact obesity and prevent chronic diseases such as diabetes. The program is also partnering with the Houston Food Bank to address food insecurity and availability of healthy food in the household. By focusing on the social determinants of health, the program becomes a catalyst to improving overall community health.
Staff and students at Memorial Hermann Burbank Health Center
Recently, the Mobile Dental Program – which serves as the dental home for uninsured and underinsured students in the greater Houston region – was presented the American Hospital Association’s NOVA Award for its efforts to improve community health. “The primary goal of the program is to serve as a safety net for children in need of regular dental care as well as to educate them and their parents about oral health,” Paret said. “It has made a difference in the lives of many students in measurable and immeasurable ways.” Moreover, the Memorial Hermann school-based clinic program was lauded as “one of the best models in the nation” by the Acting U.S. Secretary of Education John King and Acting Deputy Secretary Mary Wakefield of the U.S. Department of Health and Human Services. During a recent visit to Houston, they highlighted this successful collaboration between a health system and school districts that keeps students healthy and in the classroom. The outcomes for students served substantiate the collaboration. For instance: w Grade point averages have increased; suspensions/ detentions decreased w Absenteeism has decreased w ER visits have decreased w Students return to class on the same day (92%) w Asthma exacerbations and asthma related ER visits and hospitalizations have decreased% w Cavities have decreased For more information on Memorial Hermann’s Health Centers for Schools program, visit http:// communitybenefit.memorialhermann.org/locations/ school-based-health-centers/
Memorial Hermann School-Based Health Centers: w Burbank Health Center (HISD) 315 Berry Road Houston, TX 77022 w Elrod Health Center (HISD) 6230 Dumfries Houston, TX 77096 w Hogg Health Center (HISD) 1100 Merrill Houston, TX 77009 w Jane Long Health Center (HISD) 6501 Bellaire Houston, TX 77074 w Lamar Health Center (Lamar Consolidated ISD) 1002 E. Stadium Drive Rosenberg, TX 77471 w Terry Health Center (Lamar Consolidated ISD) 5500 Avenue N. Rosenberg, TX 77471 w WAVE Health Center (Pasadena ISD) 1500 Main South Houston, TX 77587 w Alief Health Center (Alief ISD) 12360 Bear Ram Road # T-1 Houston, TX 77072 w Kruse Health Center (Pasadena ISD) 400 Park Lane Pasadena, TX 77506 w Nimitz Health Center (Aldine ISD) 2003 W. W. Thorne Blvd., # TM-01 Houston, TX 77073
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SEPTEMBER 15 | 2016 | DEFENDER
FEELING SICK BUT NOT SURE WHAT TO DO? SPEAK WITH A REGISTERED NURSE FOR ANSWERS TO YOUR HEALTH QUESTIONS. When you or a family member is feeling sick, but you’re not sure if you need to see your doctor or go to the hospital, call the free Nurse Health Line. Experienced nurses will help you decide when and where to go for medical care. These trained nurses are available around the clock, seven days a week to answer your health questions by phone. Anyone living in Harris or the surrounding counties can use this free service. Funded through the Centers for Medicare & Medicaid Services and the Texas Health and Human Services Commission.
Free 24/7 Nurse Health Line 713.338.7979 (Toll-Free) 1.855.577.7979 Individuals with life-threatening conditions and emergencies should call 9-1-1.
sponsored by Memorial Hermann Community Benefit Corporation
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DEFENDER | SEPTEMBER 15 | 2016
health Nontoxic vs Toxic 101 By DR. SPENCER GREENE Toxicologist Texas Children’s Hospital
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s a parent, when your child ingests something they shouldn’t it can be very scary. Many times, parents call 911 when these situations arise. However, it’s important to remember that 911 is a valuable and limited resource and much of the time these incidents turn out to be non-worrisome ingestions. The first thing parents should do is assess their child. It is appropriate to call 911 if you note your child is: 1. Having difficulty breathing 2. Seizing 3. Unresponsive If your child is not having any of the above signs, instead of calling 911, parents should call the Poison Control Center at 1-800-222-1222. Poison control is staffed 24/7 by professionals (usually registered nurses or pharmacists) with toxicology training. They can tell parents what ingestions don’t require any intervention and which ones do. Many ingestions that need to be evaluated can wait and parents can drive their children to the emergency center, reserving 911 for potential emergencies. This is also much more cost-efficient for families than calling an ambulance. Parents should never initiate treatment at home (i.e. inducing vomiting or drinking water/milk),
unless poison control recommends it, because some treatments can have the opposite of the desired effect and worsen the exposure. Parents need to remember the dose makes the poison. Meaning, some substances may be toxic in large amounts, but are not in small quantities. For example, in doses smaller than, say, three to four, the following drugs are NOT toxic:
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• ibuprofen (Motrin, Advil) • Naproxen (Naprosyn, Aleve) • newer allergy medications, i.e. loratadine (Claritin), fexofenadine (Allegra), cetirizine (Zyrtec), montelukast (Singulair) • oral contraceptives • certain diabetic and blood pressure medications • certain antibiotics Some non-medicinal substances are also nontoxic: • readily-available rat poison (i.e. TomCat, D-Con) • silica gel (found in packets in boxes of new shoes) • crayons, markers, etc. • dog food • diaper cream (unless a massive ingestion) • small quantities of household bleach On the other hand, there are some medicines that are potentially toxic in single doses, including: • digoxin • verapamil, diltiazem and select other blood pressure medications • sulfonylureas (diabetic medications) such as glyburide, glimeperide, glipizide • antidepressants such as amitriptyline (Elavil) • opioid pain relievers such as Vicodin or Percocet Again, the best thing to do is call 911 if there are worrisome signs. Otherwise, call poison control at 1-800-222-1222. Add the number to your contacts list, so you always have it on hand. Even if poison control recommends an emergency center visit, usually a trip by car is sufficient. Remember, please don’t call 911 for non-emergencies.
Understanding Scoliosis By DR. JOHN DORMANS Chief of Pediatric Orthopedic Surgery Texas Children’s Hospital
The spine is normally straight from the front and curved from the side. Scoliosis is a condition where the spine curves side-to-side and twists to the side over time. Children with scoliosis may have rib asymmetry (or a hump) on their back, an uneven shoulder or one side of their chest may appear larger. These physical changes are related to the twisting of the ribs and spine. It is important for children to see a doctor as this condition will get worse without treatment. Genetics, paralysis, neuromuscular and other issues can cause scoliosis. There also are unknown reasons for the cause of scoliosis. Typically, scoliosis is rarely associated
with back pain; the only symptoms are visual and cosmetic cues.
Three main types of scoliosis
Idiopathic scoliosis: Doctors do not know what causes idiopathic scoliosis. However, it tends to run in families and is not present at birth. Idiopathic scoliosis occurs more in girls than boys and usually gets worse during the growing years; ages 11 to 15. It cannot be prevented, but the curve can be controlled with bracing and/or surgery if severe. Congenital scoliosis: Is present at birth. It usually worsens as your child grows. If severe, doctors may suggest surgery to prevent the curve from getting bigger and from causing other health problems. Neuromuscular scoliosis: Can develop in children
or young adults with other diagnoses such as cerebral palsy, spina bifida and other conditions involving the nerves and muscles. Some of these diseases weaken the muscles around the spine, and other conditions affect the spinal cord causing the spine to curve. If severe, surgery is sometimes the best treatment, but this depends on multiple factors. To accurately diagnose scoliosis, X-rays are taken of the spine. If a curve is seen, it is measured in degrees. An MRI or CT scan of the spine may be recommended. The degree and type of curve, and the age of the patient determines the type of treatment recommended. Based on these findings, your doctor will discuss which treatment options are best for your child. Treatment may include observation, bracing, surgery or a combination of all three.
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SEPTEMBER 15 | 2016 | DEFENDER
Quality health care for $50 or less a year. What a relief.
Texas Children’s Health Plan covers children from newborns to teenagers. We even cover adults and pregnant moms through STAR Medicaid. Families with children who qualify for CHIP pay $50 or less a year. Those who qualify for Medicaid pay nothing. CHIP and STAR Medicaid offer a wide range of benefits including checkups and shots, dental services, medications, and more. With Texas Children’s Health Plan you also get: ■ Over 2,100 doctors. ■ A 24-hour nurse hotline. ■ Transportation to doctor visits at no cost. ■ Pregnancy support program and classes. ■ Help losing weight through the Keep Fit Program. ■ Learn how to play soccer from the Houston Dynamo coaches. ■ Fun member events!
For more information, to receive an application, or to find an event in your area, visit us online or call today.
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DEFENDER | SEPTEMBER 15 | 2016
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health
Back pain can often be solved without surgery By GWENEVERE WILLIAMS, M.D. ‘Kelsey-Seybold Clinic
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ack in the day, back problems usually meant one of two things: living with pain or back surgery. But like everything else, medicine has changed. Now we have several effective nonsurgical options that may help most people live pain-free – or at least feel a lot better.
First step is to find cause
Medicine, therapy may help
Our goal when treating back pain is to reduce or relieve pain, restore function and help patients regain the quality of life they previously enjoyed. It may take several attempts to figure out what works best for you, so be patient. For pain management, we usually start with over-the-counter medications such as acetaminophen (Tylenol), ibuprofen or naproxen (Aleve, Advil). Often this type of medicine is all that is Dr. Gwenevere Williams needed. Along with medicine, I often recommend physical therapy, which includes methods to help reduce pain and help strengthen the back.
The best treatment for you depends on what is causing the pain. Common reasons for back pain include: • Muscle and ligament strain • Disc problems • Arthritis of the spine • Curvature of the spine (scoliosis) • Osteoporosis When you visit the doctor, our first job is to try to identify the origin of the pain and what might improve it. In addition to examining you and asking you questions about the pain, the doctor may order tests, including X-rays, MRI or CT exams, blood tests or nerve tests.
What are next steps?
If your pain is severe and other methods don’t work, we might recommend a series of injections in the spine (ESI). However, those usually are reserved for patients with pinched nerves or small herniated disc. I prefer “watchful waiting” when contemplating surgery in order to give nonsurgical therapy time to improve the patient’s condition. Fortunately, only a small percentage of patients – often those with herniated discs – may require surgery.
Preventing back pain
People are trying to sell a lot of “miracle cures” out there, but don’t waste your money. Most of them have not been proven to work. But there are a few things you can do to help prevent back pain. • Try low-impact, gentle exercise that helps strengthen your back, such as walking or swimming. But be sure to ask your doctor first to make sure you are in good enough health to perform the activities. • Keep your weight at a good level so your muscles aren’t strained. • Watch your posture. • Don’t lift heavy items. If you must, use your legs to help lift the object. Don’t bend and reach with your arms. A comprehensive rehabilitation program with physician and patient working together as a team is often the key to getting pain “off your back.” Dr. Williams is a board-certified Physical Medicine and Rehabilitation/Spine specialist at Kelsey-Seybold’s Cypress, The Vintage and Spring Medical and Diagnostic Center locations. To schedule an appointment with her, call 713-442-0000.
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