Heart Disease Prevention for the Holidays

My brother just had a heart attack. He had classic chest pain and immediately went to the ER. Before he could sneeze, he was transferred from his small town to a regional center for a heart catheterization, where they found a single vessel blockage. He had a stent placed and has no significant damage. He’s doing great. He’s more upset that A&M lost to LSU.

I’m the one not handling it well.

You see, my brother is only five years older than me. He exercises regularly, jogging 3 miles at a time. He’s even been to the Cooper Clinic in Dallas for all sorts of tests. Our father will be 80 years old in a few weeks, and he has not had a heart attack. Why my brother? And, to the point of my worry, why not me?

Now, I know that we all just gorged ourselves over Thanksgiving, and Christmas is right around the corner. Any talk of diet and exercise should wait until after the first of the year, right? If you are like me, it takes awhile to get psyched up for this. Habits are hard to start and easy to break. This needs to be a lifestyle decision. Mind you, I am not a stranger to exercise… I just haven’t been very friendly with him lately.

If you are like me, there are things you just don’t really want to change. I like my morning latte from Standpipe Coffee and cookies from Confections (shout outs to Ben and Dawn!), and when I travel, I often seek out nice restaurants. At 178 lb, many would say I am not overweight. The insurance industry, however, would disagree. My BMI is right at 25, the cutoff for being “overweight”. Scary word, that one, but not as frightening as “obese”, which a significant percentage of Americans are now.

Dr. Huber, my internist, would like to see me lose 10 lb or more. He told me so last year. In one ear and out the other… Actually, I did lose weight, but gained it back. I should learn to schedule my appointments at the low end of the scale.

As a cancer physician, I preach prevention and early detection every day. The facts with cancer are irrefutable: diet, exercise, and not smoking are three very important things we can do to help lessen our risk of getting cancer. Well, those three things also happen to be the key to lowering one’s risk of heart disease, which kills even more people than cancer.

We are fortunate to have access to incredible cardiac care right here in Lufkin. Truly excellent cardiologists and cardiac surgeons practice here. I would not hesitate to have my heart cath done down the hallway from my office here at Memorial if I had to. But like my cancer patients tell me, they really didn’t want to ever see me professionally, and I’d just as soon keep my relationship with my cardiology friends a social one.

I don’t want to be a “do as I say, not as I do” role model and end up on the cardiac cath table in five years. I see Dr. Huber this month to discuss what other measures – tests? medication? – I need to take for heart disease prevention.

And, I’ve decided that December is a good time to start my diet and exercise program. Yes, I’m going to enjoy Christmas! But maybe I can limit my portion sizes some and NOT go for that second (or third) slice of pecan pie! (Or that second cookie at Confections!)

Giving Thanks!

Thanksgiving is just around the corner, but why wait! I want to send a big thank you to Debbie Jackson, my hardworking co-chair for local enrollment for the American Cancer Society’s CPS-3 study, and to all of the CPS-3 Champions who helped get 423 people enrolled in this amazing cancer prevention study. Our enrollment sites – Memorial Health System of East Texas, Power of Pink!, Lufkin Industries, First Assembly, and the C. L. Simon Recreation Center in Nacogdoches – were fantastic.

Thank you to Becca Chance (along with her powerhouse committee), whose leadership and grace under pressure – and under thunder and lightning! – resulted in another successful Cattle Barons Gala. Thank you to Yana Ogletree and Lindsey Mott with Memorial Health System of East Texas, who hosted an amazing 21^st annual Power of Pink! luncheon. Since 1990, breast cancer deaths in the U.S. have decreased by 27%. Much of that is due to education about mammograms and the importance of screening and early detection.

Today is Election Day. I’m thankful for the right to vote! The most important issue on the ballot today is a constitutional amendment on funding the state's water plan. Voter turnout is expected to be light — below 10 percent of all registered voters — because we just don’t get too excited when actual people aren’t on the ballot. But you need to go vote for Proposition 6. The proposed amendment would authorize the Legislature to withdraw $2 billion from the Rainy Day Fund to begin funding the state’s 50-year water plan. The benefits from a long range planning and economic prosperity standpoint far outweigh and possible downside. And frankly, I think it is poetically appropriate to use a rainy day fund for water planning anyway. Be thankful you can vote, and vote YES on Prop 6.

Thursday is Salute to Healthcare, the Lufkin/Angelina County Chamber of Commerce’s awards banquet to recognize and thank outstanding leaders throughout the healthcare sector for making Lufkin and Angelina County a better place to live and work. As a physician, I have considered it my highest honor to serve as Chairman of the Chamber board this year. The healthcare sector is now one-fifth of our local economy and drives more jobs and more shopping, retail, and dining dollars than any other industry. Our community can show their support for the healthcare sector not only by coming to the banquet Thursday night, but also by “voting with your feet” when you choose where to go for healthcare. The reimbursement changes that are being implemented at a national level could easily kill what we have here locally if you don’t make the conscious decision to stay here for your healthcare needs. Like anything else, if you don’t use it, you lose it. I applaud the Chamber for starting this event several years ago and for thanking our physicians, nurses, and so many others who help care for us.

Finally, as a cancer doctor, I deal daily with the highs and lows of cancer – celebration and victory for many, but bad news and eventual death for others. I’m thankful I can “be there” for my patients, walking alongside them, no matter which path they are on. You can, too. Comfort is one of my favorite words. Its Latin roots paint a picture of coming along side with strength. Each of us needs to be a source of strength during the holiday season for those around us who are hurting, needy, and hungry. Join in helping others with Community Food Drive, Angel Tree, or other efforts with your church or in the community. And be thankful!

Choosing Wisely

My specialty society, the American Society for Radiation Oncology (ASTRO for short) is a participant of Choosing Wisely®, an effort to support and engage physicians in being better stewards of finite health care resources. The goal is to identify commonly ordered procedures or treatments that not only may not be necessary but, in fact, may be harmful. Each participating specialty provides five such procedures they believe are over-utilized or inappropriately ordered.

I was struck by two of these treatments in particular, the first because of its technological "sophistication" and the second because it points to new standard of care.

The "sophisticated" procedure is proton therapy. Unfortunately, the "new" in medicine is often assumed to be the "best". After all, technology only improves our lives, right? Sometimes investors are too cozy with equipment manufacturers who then get the federal government to reimburse a technology well before that technology has been proven to be any more effective than what is currently available.

In the case of proton therapy, investors saw a way to make a LOT of money, because proton therapy was originally being reimbursed at more than six times the rate of standard radiation therapy ($850 per daily proton treatment versus $132 for standard radiation treatment). Proton installations cost tens of millions of dollars to install. MD Anderson's cost $125 million when it was built in 2006. The Houston Police Officers' Pension System was one large backer ($10 million) expecting a sizeable return on their investment.

ASTRO, in a bold move that was sure to ruffle the feathers of some of its profit-minded members, announced last week at our meeting in Atlanta that one of its Choosing Wisely® recommendations is: "Don't routinely recommend proton beam therapy for prostate cancer outside a prospective clinical trial or registry." Their reason? After seven years of proton profit in the marketplace, "There is no clear evidence that proton beam therapy for prostate cancer offers any clinical advantage over other forms of definitive radiation therapy. Clinical trials are necessary to establish a possible advantage of this expensive therapy."

Bravo. I have bemoaned for years the grab for the money that goes on in medicine, and how that leaves the poor and under- or uninsured with even fewer healthcare resources, as these expensive technologies are, for the most part, only available to those with means to pay for them. I am proud that the House of Medicine is taking steps to control healthcare costs by pointing out our own dirty laundry. Let's hope these recommendations are taken to heart. (I'm not holding my breath.)

The second recommendation is far more positive, and will be a game changer in my specialty: "Don't initiate whole breast radiotherapy as a part of breast conservation therapy in women age >50 with early stage invasive breast cancer without considering shorter treatment schedules." A just-released important study concluded that a particular treatment schedule common in Europe is equivalent to a longer schedule of treatment that we use in the US, and that long term side effects are less! The benefit for women is that a typical course of treatment will be reduced from 5-6 1/2 weeks down to 3-4 weeks. For women who have to travel longer distances to get in for treatment, this can be significant. In addition, it is less expensive. Again, Bravo.

Healthcare is, indeed changing. I have given you two examples of change - one negative, one positive. Educate yourself, and choose wisely.

For information on Choosing Wisely® and recommendations across medical specialties, visit www.choosingwisely.org. Do your part to help cure cancer; enroll in CPS-3 at www.CancerStudyTX.org. 

Your Role in Cancer Prevention

Cancer. Got your attention now? I live and breathe cancer. It's my job. Who knows, I may die with cancer. But my odds are improved because of some choices that I make. First of all, I do not smoke. Ninety eight percent of the patients I see with lung cancer either smoke or have smoked, and lung cancer remains the most preventable cause of cancer death. I try not to get too much sun exposure. That's not easy living in Texas (and driving a convertible). I also exercise regularly and strive to maintain a healthy weight. Finally, once I turned 50, I had my first screening colonoscopy in case there were any polyps that needed to be removed. Removal of polyps can prevent colorectal cancer. My wife, for her part, has regular mammograms (to detect breast cancer early when it is highly curable) and Pap smears (again, to detect changes that could lead to cervical cancer).

Of course, that does not guarantee that I won't get cancer. But the good news is that we cure two-thirds of cancers today. That's right... cure. Most people mistakenly think of cancer as a death sentence. Of course, if you get lung cancer, your chance of cure may only be about 15%. Terrible. Especially since it is almost always preventable. But if you detect breast, prostate, or colorectal cancer early - some of our most common cancers - cure rates run 80-90% or greater. Fantastic!

What are you doing to improve your cancer risk? Do you smoke? Quit! Are you overweight and inactive? Diet and exercise! Are you getting your mammograms, Pap smears, screening colonoscopies, checking your skin for irregular or changing moles? Take charge of the risks that you can.

It is not enough to cure cancer or just diagnose cancer earlier. We want to prevent cancer altogether. What can YOU do to help us win this fight?

Participate in CPS3 - Cancer Prevention Study 3! The American Cancer Society has undertaken a huge, nationwide, multiyear study to better understand the lifestyle, environmental and genetic factors that cause or prevent cancer. If you are between the ages of 30 and 65 years old and have never been diagnosed with cancer, you are eligible to enroll.

Participating is easy and involves the following:

1. Read and sign an informed consent form.

2. Complete a survey packet which will ask for detailed information on lifestyle, behavioral, and other factors related to your health.

3. Be measured for waist circumference.

4. Give a small blood sample (similar to a doctor’s visit). The blood sample is drawn by a trained, certified phlebotomist.

5. Completing a mailed survey every few years over the next 20-30 years

All personal information and any individual results of blood analyses that may be performed will be kept strictly confidential by CPS-3 research staff. There will be no cost to you to participate.

Enrollment will be available at the following locations, your choice:

Tuesday, October 15th (7:30am–11:00am) - Memorial Health System of East Texas, Lufkin

Tuesday, October 15th (4:00pm–7:30pm) - C. L. Simon Recreational Center, Nacogdoches

Thursday, October 17th (1:30pm–5:00pm) - After Power of Pink! at Lufkin Convention Center

Saturday, October 19th (9:00am–12:30pm) - Lufkin Industries

Sunday, October 20th (9:30am–1:00pm) - Lufkin First Assembly of God Church

We need 500 people locally to enroll, and we need ALL racial and ethnic groups to participate. To sign up, go to cancerstudytx.org or call toll-free 1.888.604.5888. Do it for your friends or loved ones who have had cancer. With your help, we can finish this fight!

Shop Local, Get Well Local

I have the privilege this year of serving as Chairman of the Board for the Lufkin/Angelina County Chamber of Commerce. The Chamber, along with the City of Lufkin and the Economic Development Partnership, commissioned a retail study that will help us in recruiting even more business to the area. Do you support our local economy by shopping local?

Even more important to our economy, where do you go for your healthcare?

As a physician community leader, I have a unique perspective on the healthcare sector. Across the state level and nationally, healthcare accounts for 11%-12% of a local economy. In the Lufkin area, it is nearly double that at 20%. Over the last 11 years, all other sectors of the economy combined have shown miniscule growth (0.5%). The healthcare sector grew by 36.3% during that same period. 7,424 Lufkin area jobs are directly linked to the healthcare sector, with a direct tie-in of $193.26 million in annual disposable income. It is not an understatement to say that the healthcare sector is a strong driver of Lufkin’s economic growth.

Of course, everyone is a bit nervous about the recent changes at Lufkin Industries and Temple-Inland. In my role with the Chamber, I am grateful for the recent outreach from new leadership from both GE/Lufkin Industries and Georgia Pacific. I urge both companies to continue the legacy left to them of strong involvement with the Chamber, the United Way, and the many other organizations that contribute to our quality of life. But, each of us has a responsibility to our community. Now – more than ever – how we act as individuals will drive our local economy.

We love to tout how much we love Lufkin, then we turn around and head to Houston for healthcare… when our local facilities and personnel are top notch. Those of us who are blessed with jobs and insurance have a responsibility to our community to direct our healthcare dollars locally as much as possible.

Why? Your community non-profit hospital, Memorial Health System of East Texas, has a mission to care for all – even those who do not have insurance or means to pay. For example, the Arthur Temple Sr. Regional Cancer Center has never turned a patient away due to inability to pay. Those Houston hospitals aren’t going to care for our indigent or uninsured, but they are more than happy to take our insurance. MD Anderson, for example, has a history of not even giving appointments without proof of payment up front. When you leave for healthcare services that can be delivered locally, you are diverting resources away that can not only help support local care for all, but improve our local economy. In these times of ever-increasing bureaucracy and ever-tightening reimbursement, we need to consciously support what we have here… or it may go away.

Ah, but then the argument turns to perceived quality of care. A couple of years ago, I looked at our cancer patient population to determine the #1 cause of delay in starting treatment. It was not income level or lack of insurance. It was seeking a second opinion out of town. Ironic, isn’t it, that thinking you need to go somewhere else for treatment might actually hurt you in the long run! Your local healthcare providers are perfectly capable of making the decision of what needs to be treated in the big city, and it is far less than what most people think.

To tweak an expression: “What stays in Lufkin is good for Lufkin.” Shop local? You bet. Stay local for healthcare? Absolutely.

A Texan, West or East?

I am a 4th generation Texan, born in Abilene and raised in Midland. Moving away from West Texas wasn't easy for many reasons, but mainly because I didn't want to take my kids too far from their grandparents. East Texans understand this well, because everyone is related! I was warned early on that you don't talk bad about anyone in East Texas because they are probably related to the person you are talking to. Can I get an Amen?

Tired of feeling left out of the "related-to" crowd, I told Rosemary Blackstock one time many years ago that I was related to a native Lufkinite. She got all excited and asked, "Who?" When I confessed it was my youngest daughter, Phoebe, she deflated a bit and quipped that it wouldn't really count to some old Lufkinites unless she had gone to Kurth Elementary. Of course, Rosemary is actually from San Augustine, which makes the whole "Who's from Lufkin?" joke even funnier. But that was another time, and no one really cares any more.

Anyway, when Catherine and I were considering moving to Lufkin, my mother - who wasn't too keen on us taking the grandkids so far away - engaged in just a tad bit of guilt tripping and manipulation. The conversation went something like this:

Mom: You know there are fire ants in East Texas.

Me: Yes, mother, I know.

Mom: You know there are roaches, too.

Me: Yes, mother.

Mom: It's so hot and humid. And, it rains all the time, and you can't see anything for all the trees.

Me: (Sigh.)

When none of that seemed to work to convince me not to move, she pulled out the trump card (or, in 42-playing West Texas, a domino): "You know, your kids are going to grow up speaking like East Texans..."

Well, that nearly did it, because the only East Texan I knew through my college years was a Baylor friend of Catherine's from Tyler, who had a syrupy, southern-in-the-excess whiney drawl that, luckily, I have rarely heard since.

Undaunted and unintimidated, we made the move. That was more than 20 years ago, and we never looked back.

Don't get me wrong. I appreciate the West Texas desert and its austere beauty. I love driving out to Midland into the expansive, color-swathed West Texas sunset. The pioneer, can-do spirit in West Texas is a big part of what fuels our economy. The bittersweet smell of an oil refinery is the smell of money. (Somehow, the odor from paper mill never had the same connotation to me.)

But I am an East Texan now. I love the trees. I think I appreciate the pine trees even more than many East Texans, who simply want to cut them down. The variety of hardwoods is astounding. And when spring comes around with its procession of pear blossoms, dogwood, redbud, and wisteria, there is no place I'd rather be. I told my mom I can kill fire ants and roaches. (She didn't know about copperheads, water moccasins, and love bugs, thank goodness!) Yes, the heat and humidity is awful. No way around that. But the people in East Texas are friendly, hospitable, incredibly generous, grateful, and loyal folk. I'm a Texan and Lufkin is my home. Oh, and my kids don't have TOO much of an accent... at least, not as thick as my mother's!