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Culberson Hospital

Eisenhower & FM 2185
P.O. Box 609
Van Horn, TX 79855
(432) 283-2760
Fax: (432) 283-2581
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Clinic's Corner

Welcome to Medicare Karla Morrow, RN, MSN, FNP-BC

Q. I have relatives on Medicare and know I'll use it one day. I have heard a little bit about "Welcome to Medicare" preventive visits and yearly wellness visits. Where can I get more information?

A. Medicare now offers a one-time "Welcome to Medicare" preventive visit and yearly wellness visits that are fully covered for Medicare patients. There is no co-pay for these visits.

With the passing of the Affordable Care Act in January 2011, Medicare expanded its benefits from simply treating conditions and diseases to emphasizing preventive care to keep patients healthy in the first place.

The "Welcome to Medicare" preventive visit must take place within 12 months of enrolling in Medicare Part B, which covers certain doctors services, outpatient care, medical supplies and preventive services. This visit includes a review of your medical and health history and education and counseling about preventive services including screenings, shots and referrals for other care.

At the visit, your doctor will record your medical history; check your height, weight and blood pressure; calculate your body mass index, and give you a simple vision test. Your doctor will give advice on how to prevent disease, improve your health and stay healthy.

The following information should be brought to your visit:

  • Medical records, including immunizations if you're seeing a new doctor.
  • Family health history.
  • A list of prescription and over-the-counter drugs; vitamins and supplements you are currently taking, how often you are taking them and why.

Medicare is also now offering yearly wellness visits that take place after you've had Medicare Part B for longer than 12 months. These visits help you develop a personalized prevention plan with your doctor and include the following:

  • Review of medical and family history
  • A list of current providers and prescriptions
  • Height, weight, blood pressure and other routine measurements
  • A screening schedule for appropriate preventive services
  • A list of risk factors and treatment options

These preventive care visits include a variety of preventive screenings, vaccinations and counseling. An overview of these preventive benefits can be found in "Your Guide to Medicare's Preventive Services" at http://www.medicare.gov/pubs/pdf/10110.pdf

These preventive benefits are a recent addition to Medicare and although they might seem small, in the end, they can be the difference between sickness and health. Preventive health visits can help establish the baseline for your current health as well as identify any health issues before they become too serious. Overall, these visits can help you maintain and improve your general health and help you lead a happy, healthy life.

Start the New Year off right and make an appointment for your Medicare preventive visit today by calling Van Horn Rural Health Clinic at (432) 283-1020.

Morrow comes to Culberson Hospital with more than 20 years of experience in direct patient care. She has worked in emergency medicine, internal medicine and family medicine. She has also spent time working in rural health clinics and an infectious disease clinic as well as home health. Morrow earned a Masters of Science in nursing from Graceland University, School of Nursing and a Bachelors of Science in nursing from Stephen F. Austin State University in Nacogdoches.


Q. A close relative of mine has Alzheimers so the disease and its effects are very dear to me. What exactly is Alzheimers and what causes it?

A. This is a very timely question because November is Alzheimers Disease Awareness Month. Alzheimers is a commonly known disease that affects the brain. With Alzheimers, brain cells degenerate and die which causes a steady decline in memory and mental function. For most people, Alzheimers results from a combination of genetics, lifestyle and environmental factors that affect the brain over time.

Age, family history and genetics, sex, memory problems and lifestyle are all risk factors when it comes to developing Alzheimers. The risk of developing Alzheimers doubles every five years after the age of 65, and nearly half of those over 85 have Alzheimers. The risk of developing the disease slightly increases if a first-degree relative (a parent, sibling or child) has been diagnosed. Women are more likely to be develop Alzheimers disease than men, in part because they live longer, and people with memory problems, or mild cognitive impairment (MCI) have an increased risk "but not a certainty" of developing Alzheimers.

There are no lifestyle factors that have proven to reduce the risk of Alzheimers disease, but some evidence suggests that activities that put you at the risk for heart disease might also put you at risk for Alzheimers. Lack of exercise, smoking, high blood pressure, high cholesterol and poorly controlled diabetes are all risk factors associated with heart disease as well as vascular dementia, a type of cognitive decline caused by damaged blood vessels in the brain.

Early symptoms of Alzheimers include forgetfulness and mild confusion and later on, development of Alzheimers disease can have a greater effect on memory, ability to speak and write coherently, judgment and problem-solving. Brain changes associated with Alzheimers lead to growing trouble with memory, disorientation, speaking and writing, thinking and reasoning, making judgments and decisions, planning and performing familiar tasks and changes in personality and behavior. Although everyone has occasional memory lapses, memory loss associated with Alzheimers disease persists and gets worse over time. People with Alzheimers might:

  • Repeat statements and questions over and over.
  • Forget conversations, appointments or events and not remember them later.
  • Routinely misplace possessions, often putting them in illogical locations.
  • Eventually forget the names of family members and everyday objects.

To learn more about Alzheimers disease and how you can help in the fight to end the disease, visit the Alzheimers Associations website at www.alz.org. If you notice a friend or loved one experiencing any of these symptoms at home, make an appointment at Van Horn Rural Health Clinic by calling (432) 283-1020.

Dr. Friday has been with Van Horn Rural Health Clinic and Culberson Hospital since 2008. He received his doctor of medicine degree from the Medical University of South Carolina, College of Medicine and did his undergraduate work at Kenyon College in Gambier, Ohio. As a member of the medical staff at Van Horn Rural Health Clinic, Dr. Friday has a family medicine practice where he provides care to patients of all ages. He also has more than 30 years of experience in emergency medicine.

Advance Directives Karla Morrow, RN, MSN, FNP-BC

Q. : I've noticed more and more at the doctor's office and hospital that patient forms ask if I have an advance directive. What exactly is an advance directive and why is it important?

A. Advance directives are very important to the healthcare process for everyone, especially for the patient and his or her loved ones. Hospitals are required by federal law to ask incoming patients if they have an advance directive and supply them with information on advance directives if they do not have one.

Advance directives are documents that state the patient's choices for healthcare, or name someone to make those decisions if patients are unable to make their wishes known because of illness or injury. By putting your wishes in writing, you take the burden off your family and doctors for making those most difficult decisions during difficult times.

It's important to remember that the best time to complete advance directive forms are before a person needs one. Even if a person is young and healthy, it is never too soon to document their wishes in writing. During a medical crisis is the worst time to begin thinking about these critical questions when a patient's family is upset and the patient may be disoriented or in pain.

Advances in medical technology may prolong life for patients in comatose or vegetative states with no hope of recovery. The media is filled with highly publicized legal cases involving families and medical providers who disagree on a patient's end-of-life care. These situations can be avoided by creating advance directives.

Texas law provides for four types of advance directives. You can create one or more to meet your particular needs and wishes. The four types of advance directives include:

  • Directive to Physicians and Family or Surrogates - this directive allows a patient to specify for the provision, withdrawal or withholding of medical care in the event of a terminal or irreversible condition.
  • Medical Power of Attorney - this directive allows a patient to designate another person as the agent for making healthcare decisions if the patient becomes incompetent.
  • Out-of-Hospital Do-Not-Resuscitate Order - this directive allows competent adults to refuse certain life-sustaining treatments in non-hospital settings where healthcare professionals are called to assist, including hospital ERs and outpatient settings.
  • Declaration of Mental Health Treatment - this directive allows a court to determine when a patient becomes incapacitated, and when that declaration becomes effective.

For more information and to download and complete advance directive forms in English or Spanish visit the Texas Hospital Association website at www.tha.org/GeneralPublic/AdvanceDirectives. Once these forms are completed, they should be shared with a person's doctor and family. If the situation arises, these documents should also be taken to the hospital with a patient.

Morrow comes to Culberson Hospital with more than 20 years of experience in direct patient care. She has worked in emergency medicine, internal medicine and family medicine. She also has experience working in rural health clinics. Morrow earned a Masters of Science in nursing from Graceland University, School of Nursing and a Bachelors of Science in nursing from Stephen F. Austin State University in Nacogdoches.

Emergency Room

Q. I'm never sure when I should go to the Emergency Room for treatment or make an appointment with a doctor. What things warrant a trip to the Emergency Room?

A. Great question! It's been estimated that over one half of the millions of emergency room visits made in the US are considered unnecessary. Due to the regulations hospitals have to abide by and the equipment and training required to maintain hospital emergency centers, routine emergency room costs are sometimes three times higher than a simple visit to a doctor's office. Emergency rooms operate according to a "triage system" in an effort to make sure the patients who truly need urgent care get that care before other non-emergent conditions. That means if you go with a non-urgent condition, you may find yourself waiting while the true emergency cases are taken care of first.

Here are some conditions that warrant a visit to the emergency room that may help you make your decision of when to go or when to schedule an appointment with your doctor:

Go to an emergency room if you have a loss of consciousness; signs of a heart attack including pressure, fullness, squeezing or pain in the chest; signs of a stroke such as sudden weakness or numbness of the face, arm, legs, or loss of vision, speech or severe headache; shortness of breath; bleeding that does not stop with direct pressure; poisoning; severe reaction to an insect bite or sting especially if breathing becomes difficult; a major injury or head trauma; coughing up or vomiting blood, and suicidal or homicidal feelings.

These conditions typically do not warrant a trip to the Emergency Room and are better treated by your doctor in his/her office. They include minor earaches, minor cuts where bleeding is controlled, a sprain, sexually transmitted diseases, colds, coughs, sore throats or the flu.

In the event you do end up with a true medical emergency, you should keep the following important medical information about yourself in your wallet or purse:

  • Your doctor's name and number
  • Any illnesses or conditions you may have
  • Any medications you take and the dosage
  • Whether or not you are pregnant or the date of your last menstrual period.

This information can prove valuable to any emergency medical caregiver attempting to diagnose and treat your medical problem.

I cannot stress enough how important it is to have a primary care doctor. A primary care physician with your complete medical history who can arrange to see you in his or her office is your best defense against emergencies.

Dr. Friday has been with Van Horn Rural Health Clinic and Culberson Hospital since 2008. He received his doctor of medicine degree from Medical University of South Carolina, College of Medicine and did his undergraduate work at Kenyon College in Gambier, Ohio.

With a little more than 30 years of experience in emergency medicine, Dr. Friday has proven himself as a quality healthcare leader in the Level IV Trauma Emergency Department at Culbertson Hospital. As a member of the medical staff at Van Horn Rural Health Clinic, Dr. Friday has a family medicine practice where he provides care to patients of all ages.

Blood Pressure Awareness Month

Q. I've heard May is blood pressure awareness month and I have a history of high blood pressure in my family. What do I need to know about high blood pressure and how to prevent it?

A. High blood pressure, also known as hypertension, is the most common cardiovascular disease and affects millions of people, even children and teenagers. Blood pressure refers to the force of blood pushing against artery walls as it flows through the body. Just as too much air pressure in a tire can damage a tire, high blood pressure can threaten healthy arteries and lead to life-threatening conditions such as heart disease and stroke.

High blood pressure is the leading cause of strokes and heart attacks, and more than 30 percent of American adults have it. If you have high blood pressure, you'll probably find out about it during a routine checkup and your doctor can help you learn what to do to bring it under control.

Normal blood pressure rises steadily from about 90/60 at birth to 120/80 in a healthy adult. It is natural for blood pressure to rise and fall with changes in physical activity or emotional state. People with blood pressure readings of 140/90 or higher, taken on at least two occasions, are said to have high blood pressure. High blood pressure can lead to heart disease, stroke, impotence, peripheral vascular disease, kidney disease and even blindness. People with blood pressure readings of 200/130 or higher need treatment immediately.

One of the most dangerous aspects of high blood pressure is that you might not know you have it. Nearly one-third of people who have it do not know it. The only way to know is through regular checkups; this is especially important if you have a close relative who has high blood pressure. If your blood pressure is extremely high there are symptoms to look out for that include.

Severe headaches
Fatigue or confusion
Vision problems
Chest pain
Difficulty breathing
Irregular heartbeat
Blood in the urine
Pounding in your chest, neck or ears

If you have any of these symptoms, contact a doctor immediately. You could be having a hypertensive crisis that could lead to heart attack or stroke.

Treating high blood pressure can include diet changes, medication and exercise. A critical step in preventing and treating high blood pressure is a healthy lifestyle. The following lifestyle changes can help lower your blood pressure.

-Lose weight if you are overweight or obese.

-Stop smoking.

-Eat a healthy diet that includes more fruits and vegetables.

-Regular aerobic exercise.

-Limit alcohol consumption to two drinks per day for men and one drink per day for women.

-Avoid high fructose corn syrup found in soda and other commercial beverages.

-Increase your Omega 3 and Omega 6 fat ratio by eating more fish. Most Americans get
more Omega 6.

  • Use less corn, soy, canola, safflower and sunflower oil.
  • Use more flaxseed, walnut and fish oil.

-Eliminate Caffeine.

-Optimize your Vitamin D levels

  • The farther you live from the equator the higher your risk of high blood pressure.
  • Sun exposure helps your body make Vitamin D.
  • If you take Vitamin D supplements you should follow the levels your physician recommends.

-Control your stress.

-There are many vitamins and supplements that can help lower your blood pressure,
 follow up with your doctor for safety purposes and to avoid drug interactions.

In addition to lowering blood pressure, these lifestyle changes can enhance the effectiveness of high blood pressure drugs. More information on these medications can be obtained from your doctor. If you suspect you have high blood pressure, call the Van Horn Rural Health Clinic today at 432-283-1020 for an appointment

Dr. Friday has been with Van Horn Rural Health Clinic and Culberson Hospital since 2008. He received his doctor of medicine from Medical University of South Carolina, College of Medicine and did his undergraduate work at Kenyon College in Gambier, Ohio. With more than 30 years experience in emergency medicine, Dr. Friday covers the ER at the hospital and has a family medicine practice at the clinic.

Colon Cancer

Q: I understand March is National Colorectal Cancer Awareness Month. I recently had a relative die of colon cancer but no one in my family knows a lot about this type of cancer. What are the symptoms and is there a way to reduce your risk?

A: Colorectal cancer is a cancer that is preventable or most successfully treated when detected early. Specifically, colorectal cancer is cancer of the colon or rectum. It develops from adenomatous polyps which are grape-like growths that can appear on the lining of the colon and rectum. Overtime, the polyps may become cancerous but with screening the cancer can be preventable because the polyps are found and removed before they become cancer. Colorectal cancer affects both men and women and is the third leading cause of cancer death in the US.

Those most commonly at risk include individuals who smoke, are overweight and carry fat around their waists, inactive, drink alcohol especially men, eat a lot of red or processed meats, have a personal or family history of colorectal cancer or benign colorectal polyps, have a personal history of inflammatory bowel disease such as ulcerative colitis or Chrohn's disease and have a family history of inherited colorectal cancer or colorectal syndromes. The risk of this type of cancer increases with age.

In addition to living a healthy lifestyle, everyone should be screened for colorectal cancer. If you are at an average risk, screening should start at age 50. If you are at a higher risk, screening should begin sooner and take place more often. There are several screenings available and the most common one is a colonoscopy which should be performed very 10 years. Other screenings and tests to detect the cancer are also available. You should talk to your medical provider to determine what tests are most appropriate for you and use the information distributed by the American Cancer Society as a guideline.

Knowing the symptoms of colorectal cancer is important in early detection. In the early stages, there may not be any symptoms but in later stages some signs may appear. If you are experiencing bleeding from the rectum or blood in or on the stool; a change in bowel habits; stools are narrower than usual; general problems in the abdomen such as bloating, fullness or cramping; diarrhea, constipation or a feeling that a bowel movement isn't quite complete; weight loss for no reason; being tired all the time or vomiting, you should see your healthcare provider.

March is National Colorectal Cancer Awareness Month and the information distributed by the healthcare industry focuses on preventing the disease. The best way to prevent colorectal cancer and many other forms of cancer is to live a healthy lifestyle that includes regular exercise, maintaining a healthy weight, eating less red and processed meats, reducing alcohol consumption and not using tobacco. weight, eating less red and processed meats, reducing alcohol consumption and not using tobacco. To learn more about colorectal cancer and other forms of cancer, visit www.preventcancer.org.

Women's Heart Health

Q: I've heard February is American Heart Month and that a lot of campaigns target women. As a woman, what do I need to know about heart disease and what can I do to contribute to American Heart Month?

February is the American Heart Association's American Heart Month. During this month, AHA focuses on fighting heart disease. Because there are no quick fixes to heart disease and because procedures like bypass surgery can reopen a blocked artery, they don't truly fix a damaged heart. The best way to maintain a healthy heart is to adopt a lifestyle that prevents and controls heart disease.

In 2004, AHA created the Go Red For Women movement. AHA set out to reach women because in the past men have been the subject of heart disease studies. Because men and heart disease were in the limelight, women weren't as aware of their own risk factors and their awareness of heart disease decreased. Go Red For Women strives to make sure women are aware they are at risk for heart disease and can take the proper steps to take care of their hearts.

Although women of all ages should take steps to protect their hearts, risk for heart disease in women rises between ages 40 and 60. Risk factors for heart disease include family history of heart disease, smoking, high blood pressure, high cholesterol, obesity, stress, depression, alcohol, birth control pills, anemia and an unhealthy diet. Because just one risk factor can nearly double the risk of heart disease, doing just four things such as eating right, being physically active, not smoking and keeping a healthy weight can lower the risk of heart disease by as much as 82 percent.

Common tests for heart disease include blood pressure, blood cholesterol, body mass index, waist circumference and stress tests. Women of all ages should talk to their doctors about heart health. Many women think heart disease is just a man's disease or they're not old enough to be at risk for heart disease, but this is not the case. Heart disease is the leading killer of women older than 20 and kills more women than all forms of cancer combined.

Eating a heart-healthy diet and exercising regularly are excellent ways to keep your heart in good shape. AHA recommends at least 30 minutes of moderate to vigorous physical activity per day as well as a diet rich in fruits, vegetables, fiber, whole grains and monounsaturated and polyunsaturated fats. Sodium and saturated and trans fats should be avoided.

The Go Red For Women campaign advances women's understanding of heart disease and heart disease research. There are many ways to get involved with American Heart Month and Go Red For Women. To learn more about how you can help, visit their website at goredforwomen.org.


Q: During the winter, I often find myself with a small illness of some sort, whether it be a cough, sore throat or cold. In the past, antibiotics have always helped me feel better. This time, my doctor doesn't think antibiotics will help because I have a viral infection, not a bacterial infection. What is the difference between these two types of infections and why can't I take antibiotics for a viral infection?

A: Although many people believe that antibiotics are the solution to almost any health problem, they can actually cause more harm than good if used incorrectly. In fact, antibiotics are the most common cause of emergency department visits for adverse drug events in children, and antibiotic resistance is one of the world's most pressing public health threats. Antibiotics are effective against bacterial infections, some fungal infections and some kinds of parasites. They do not work against viruses. Bacterial infections that can be helped by antibiotics include some ear infections, severe sinus infections, strep throat, urinary tract infections and many wound and skin infections.

Taking antibiotics as prescribed is essential. If someone takes an antibiotic for only a few days instead of for the full course prescribed, it might wipe out some but not all of the bacteria. The surviving bacteria become more resistant and are more easily spread to other people. When bacteria become resistant to first-line treatments, the risk of complications and even death is increased. Saving antibiotics for the next time they might be needed or taking antibiotics prescribed for someone else can also be harmful.

Viral infections including most ear infections, colds, the flu, most coughs, most sore throats, bronchitis and the stomach flu cannot be fought with antibiotics. Rest, fluids and over-the-counter medications are often a better treatment option for viral infections than antibiotics. Taking antibiotics to attempt to cure a viral infection will not cure the infection, keep other people from getting sick or make the patient feel better. It could also cause unnecessary and harmful side effects.

Taking an antibiotic to fight a viral infection will not only be useless against the infection, but it could also contribute to antibiotic resistance. If antibiotics are used too often for viral infections that they can't treat, they become less effective against the bacteria they are intended to treat.

To prevent antibiotic resistance and to successfully fight both bacterial and viral infections when necessary, only use antibiotics when they are likely to be beneficial. If your healthcare provider determines that you do not have a bacterial infection, simply ask about ways to help relieve your symptoms that include over-the-counter treatment options, increased fluid intake and rest.


Q: I've heard from a few people that constipation is more serious than most people think. What do I need to know about constipation and its causes?

A: You're right. Constipation can be a serious problem, especially in emergency rooms. Though it usually is not serious, it is something to be concerned about as it can be painful and frustrating. During the holidays when we tend to not eat right and exercise properly, we often see more cases of constipation in the emergency room.

Constipation occurs when bowel movements become difficult or less frequent. While the time between bowel movements varies from person to person, going longer than three days without one is too long. It is considered being constipated if you strain during a bowel movement, have hard stools or incomplete evacuation more than 25 percent of the time; have two or fewer bowel movements in a week, a swollen abdomen, abdominal pain and/or vomiting.

More serious symptoms include blood in your stool, losing weight when not dieting, severe pain with bowel movements and constipation that lasts more than two weeks.

Constipation is usually caused by a disorder of bowel function. Common causes include inadequate water intake, inadequate diet, lack of activity/exercise, a disruption of regular diet or routine, eating large amounts of dairy products, stress, resisting the urge to have a bowel movement, overuse of laxatives, neurological conditions, antacid medicines containing calcium or aluminum, depression, eating disorders, irritable bowel syndrome, pregnancy or colon cancer.

Certain medicines can also cause constipation, especially strong pain medicines such as narcotics, antidepressants or iron pills. Lack of good nerve and muscle function can be a cause of constipation in some cases as well.

Most people do not need extensive testing to diagnose constipation but if you have constipation for more than two weeks, you should see a doctor to determine the source of your problem and have it treated. The majority of constipation patients do not have serious issues and suffer from either colonic inertia, where the colon contracts poorly and retains stool, or obstructed defecation, where the person excessively strains to expel stool from the rectum.

To avoid constipation, eat a well-balanced diet with plenty of fiber such as fruits, vegetables, legumes and whole-grain bread and cereal and drink one and a half to two quarts of water and other fluids per day and try to drink warm fluids. Drinks with caffeine should be avoided. Some people might also need to avoid milk and other dairy products that can sometimes be constipating. Regular exercise and moving bowels when you feel the urge can also prevent constipation.

If constipation is new for you, you cannot correct the problem yourself or experience the more serious symptoms, call today for an appointment with one of our providers the Van Horn Rural Health Clinic, (432) 283-1020.

Pancreatic Cancer

Q: I know November is National Pancreatic Cancer Awareness Month but this is a form of cancer I've heard very little about. What do I need to know about pancreatic cancer and what can I do to support the cause?

A: You're right, November is National Pancreatic Cancer Awareness Month. Although most people aren't as knowledgeable about pancreatic cancer as other diseases like breast cancer or prostate cancer, it is just as hindering a disease.

Pancreatic cancer is the fourth ranked cause of cancer death, with only 23 percent of people diagnosed living one year from their diagnosis and 4 percent of people diagnosed reaching the five-year survival rate.

Researchers are unsure of what exactly causes pancreatic cancer, but some known risk factors are smoking, diabetes and more. The risk of pancreatic cancer also increases with age, and men and African-Americans have a higher risk factor for developing pancreatic cancer.

To understand the signs and symptoms of pancreatic cancer, it's helpful to understand where the pancreas is, and what it does. The pancreas is located deep inside the abdomen, is only 4 to 6 inches long and shaped like a tadpole. In the "tail" of the pancreas are cells that produce insulin. Tumors at this end are usually endocrine tumors. They're easier to diagnose but are much rarer. At the other end, the "head" of the pancreas, are cells that produce digestive enzymes, and tumors at this end are called exocrine tumors. These are by far the most common, and much more difficult to detect.

The idea that a pancreatic tumor has no symptoms is a bit of a myth. If you look through medical journals and ask patients what they remember, you'll discover a long list of odd signs and symptoms of pancreatic cancer to watch out for; however, it is still a form of cancer that is difficult to detect early and even more difficult to treat.

Taken one by one, the symptoms could mean many things but if you find yourself experiencing two or three of these early warning signs call your doctor and ask for a scan. Imaging techniques can detect pancreatic cancer some of the time, depending on the location of the tumor.

Some pancreatic cancer symptoms include:

  • Yellowing of the skin and eyes
  • Abdominal pain
  • Unintended weight loss
  • Nausea
  • Loss of appetite
  • Itchy skin, especially on the palms and soles of the feet
  • Unexpected onset of diabetes
  • Changes in stool and urine color

Although pancreatic cancer is rare, if you are experiencing any of these symptoms, you should see a doctor. Even if they are not related to pancreatic cancer, they are symptoms that warrant medical attention.

Because November is National Pancreatic Cancer Awareness Month, there are likely many volunteer opportunities available. The Pancreatic Cancer Action Network hosts a November campaign called Volunteer for Progress with volunteer efforts available. More information on the organization's efforts can be found at www.knowitfightitendit.org.

Flu and Flu Shot Facts

Questions: Every year when flu season comes around I hear so many different stories about how I should take the flu shot or why I shouldn't take the flu shot. Where can I get accurate information about the flu and the flu shot?

A: Every year people get the flu, an illness which could be prevented by getting the flu shot. Some people do not get a flu shot because of myths or ideas that are not accurate. By learning the facts about the flu shot and getting vaccinated each year, you may have a bigger advantage in guarding yourself against getting the flu. I hope the information below helps dispel some of the myths you've heard.

The flu isn't a serious disease.

The flu is a serious disease of the nose, throat and lungs and it can lead to pneumonia. Each year about 200,000 people in the U.S. are hospitalized and about 36,000 people die because of it. Most who die are 65 years or older but small children less than 2 years old are as likely to go to the hospital.

The flu shot can cause the flu.

The flu shot cannot cause the flu. Some people get a little soreness or redness where they get the shot but it goes away in a day or two.

The flu shot does not work.

Most of the time the flu shot will prevent the flu. In scientific studies, the effectiveness of the flu shot has ranged from 70 to 90 percent when there is a good match between circulating viruses and those in the vaccine.

The side effects are worse than the flu.

The worst side effect you're likely to get from a flu shot is a sore arm. The nasal mist flu vaccine might cause nasal congestion, runny nose, sore throat and cough.

Only older people need the flu vaccine.

Adults and children with conditions like asthma, diabetes, heart disease and kidney disease need to get a flu shot, as well as older people. Doctors also recommend children six months through five get a flu shot.

You must get the flu vaccine before December.

The flu vaccine can be given before or during flu season. The best time to get vaccinated is October or November but you can get vaccinated in December or later.

I got vaccinated last year so I don't need a flu shot this year.

Influenza viruses change every year and so does the flu vaccine. The effects of the flu vaccine go away over time. Even if you got vaccinated last year, that shot won't help this year.

People with asthma shouldn't get the flu shot.

People with asthma are at high risk of getting very sick from the flu. The flu shot will NOT cause an asthma attack. It is very important for all people with asthma to get the flu shot but they should get the shot and not the nasal mist vaccine.

Vitamin C and Echinacea (a popular herb in the treatment of colds and flu) will help prevent the flu.

Vitamin C and Echinacea won't prevent the flu. Echinacea might modestly help flu symptoms AFTER you are sick.

Breast Cancer

Q: With National Breast Cancer Awareness Month coming up and as a woman, I want to become more knowledgeable on the disease. What do I need to know about breast cancer and how can I help spread awareness in October?

You're right; October is National Breast Cancer Awareness Month. The National Breast Cancer Awareness Month (NBCAM) organization involves several national public service groups, professional medical associations and government agencies in the effort to raise awareness about breast cancer and prevention. These groups work together to build awareness about the disease, share information and provide access to screening services.

What you should know:

Breast cancer is the second most common cancer in women in the United States. It is a malignant tumor that grows in one or both breasts. Although breast cancer is possible in males, it is much more common among women.

Although breast cancer mostly affects women after menopause, it can affect younger women as well. Factors that put women at high risk for developing breast cancer include a personal history of breast cancer or other breast disease, a family history of breast cancer and a history of chest radiation therapy before age 40. Other risk factors include heavy alcohol use, high intake of red meat, dense breasts and obesity.

One of the earliest signs of breast cancer can be an abnormality that shows up in a mammogram before it can be felt. The most common signs of breast cancer are a lump in the breast, abnormal thickening of the breast or a change in the shape or color of the breast.

A key tool for breast cancer detection is the mammogram which uses special X-ray images to detect abnormal growths or changes in the breast tissue. A mammogram is your best defense against breast cancer because it can detect the disease in its early stages before it can be felt during a self-breast exam. Research has shown that mammograms can increase breast cancer survival. Monthly self-breast exams are also an important line of defense for detection.

There are many different treatments for breast cancer but they all have the same major goals: to rid the body of the cancer as completely as possible and to prevent the cancer from returning. Local treatments, which attempt to remove, destroy or control cancer cells in a specific area, include surgery, such as a mastectomy or lumpectomy, and radiation therapy. Systematic treatments, which are used to destroy or control cancer cells all over the body, include chemotherapy, hormone therapy and biological therapy.

What you can do:

  • Get involved with a local event dedicated to the cause of raising awareness about breast cancer such as the Susan G. Komen Race for the Cure. This race is technically a walk so persons of all physical capabilities can participate. If you aren't a runner, find an event that matches your interests such as a golf tournament or a cook-off. Participating in events is a great way to honor a breast cancer survivor or victim.
  • Volunteer by finding a group offering mammograms free or at a reduced cost and ask what kind of help they need. You could provide transportation or help with the screening process in a support role.
  • Get passionate about pink. The pink ribbon has become the international symbol for breast cancer awareness so wear pink in October and join Passionately Pink for the Cure.

For more information about how you can help visit the NBCAM site at www.nbcam.org or the Susan G. Komen website at www.komen.org. If you are concerned you have symptoms of breast cancer, talk to your medical provider about how and where you can get a mammogram or other type of test.


Q: As I get older, I've become concerned with the risks of osteoporosis, especially since I hear it's more common in women. Why do women need to be more concerned and what can I do to prevent osteoporosis?

A: You're right. Osteoporosis is more common in women than men. The reason for this is that women start with lower bone density than men and lose bone mass more quickly as they age, which can lead to osteoporosis. According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases, one of every two women over the age of 50 will have an osteoporosis-related fracture in their lifetime, which is twice the rate of men. Additionally, 75 percent of all cases of hip osteoporosis cases affect women rather than men.

Although it is more common in women, osteoporosis still affects men. Men over the age of 50 are at a greater risk and should still be cautious of osteoporosis, especially if they are over the age of 70 and have any broken bones.

Osteoporosis is a disease of the bones and occurs when people have bones that are weak and break easily. The disease can affect all bones of the body, but the most common breaks are in the hip, wrist and spine. Osteoporosis in the spine can cause serious problems for women. Signs of osteoporosis include sloping shoulders, curves in the back, height loss, back pain, hunched posture and a protruding abdomen.

While there are many factors that contribute to osteoporosis that cannot be controlled, such as gender, age, menopause, body frame, race and family history, there are other factors that can be controlled. Smoking and drinking too much can lead to osteoporosis. Experts recommend no more than one drink a day for women. Not getting enough exercise and diets low in dairy products or other sources of calcium and vitamin D can also lead to osteoporosis.

There are ways to prevent weak bones. It is important to get enough calcium through foods or calcium supplements, which you can get over-the-counter. Foods such as plain yogurt, milk, tofu, frozen spinach and canned white beans contain calcium. Getting enough vitamin D is also essential for healthy bones. Salmon, vitamin D-fortified milk and eggs are all good sources of vitamin D.

Being active also helps your bones by slowing bone loss, improving muscle strength and helping your balance. Walking, dancing, running, climbing stairs, gardening, jogging, hiking, playing tennis, lifting weights and yoga are all great ways to be active. There are also medicines that can prevent and treat bone loss that you can talk with your healthcare provider about.

You can get a bone density test to find out how strong or fragile your bones are. If you have noticed loss in height; slumped or hunched posture; sudden unexplained back pain; are over the age of 45, or post-menopausal and have broken a bone, you should contact your doctor about tests or treatment of osteoporosis. If you are over the age of 65, you should get a bone density test to screen for osteoporosis. If you are younger than 65 and have risk factors for osteoporosis, ask your healthcare provider if you need a bone density test. For help with scheduling a bone density test, call Van Horn Rural Health Clinic at (432) 283-1020.


Q: There are a number of people in my family who have diabetes and I'm afraid I may develop it as well. What are the warning signs I should watch out for?

A: Diabetes symptoms are often subtle. Pay attention to the clues your body's gives you.

Excessive thirst and increased urination

When you have diabetes, excess sugar (glucose) builds up in your blood and your kidneys are forced to work overtime to filter and absorb the sugar. This triggers dehydration.


Many factors can contribute to fatigue and they include dehydration from increased urination and your body's inability to function properly.

Weight loss

When you lose sugar through frequent urination you also lose calories. At the same time, diabetes may keep the sugar in your food from reaching your cells.

Blurred vision

High levels of blood sugar pull fluid from your tissues, including the lenses of your eyes and this affects your ability to focus. Left untreated, diabetes can cause new blood vessels to form in your retina and damage old vessels. Undetected, this can lead to vision loss and blindness.

Slow-healing sores or frequent infections

Observations indicate infections seem more common with diabetes although research has not proved this. It may be that high levels of blood sugar impair the body's natural healing process and ability to fight infections.

Weight gains

Type II diabetes usually starts with increased insulin which causes significant weight gain. If you have been gaining weight you may be pre-diabetic or diabetic.

Tingling hands and feet

Excess sugar in your blood can lead to nerve damage. A tingling and loss of sensation in your hands and feet and a burning pain in your arms, hands, legs and feet may occur.

Red, swollen, tender gums

Diabetes may weaken your ability to fight germs which increases the risk of infection in your gums and in the bones that hold your teeth in place.

Take your body's hints seriously

If you notice any possible diabetes symptoms, contact your doctor. The earlier the condition is diagnosed, the sooner treatment can begin. You can manage diabetes while still enjoying an active, healthy life.

Stop Smoking

Q: I would really like to stop smoking. Can you give me some hints on how to do it?

A: As a tobacco user, you know you should quit. Engaging a health professional to work with you can insure greater success in "kicking the habit". Creating a stop-smoking plan improves your chances of stopping for good and helps you cope with the physical and emotional issues that often come about such as nicotine withdrawal and strong urges to start smoking again.

I'm sure you already know about the health problems related to smoking, the social stigma, the increasing expense and pressure from loved ones. But, only you can decide when you're ready to stop smoking. You may spend a lot of time thinking about it before you're actually ready to stop but don't attempt to quit smoking without a plan in place.

Once you begin seriously thinking about quitting, go ahead and pick a specific day to stop - your own "quit day" and then prepare for it. It's important to select a day in the near future. One suggestion is to select a "quit day" that has special meaning to you. Don't set your "quit day" too far into the future or you may find it hard to follow through on your stop smoking plan.

Remember, it's important to create a plan because the process you define to stop smoking can help you overcome the struggles you're likely to face. Here are some suggestions you can take as you prepare:

Talk to your health care provider. If you haven't talked to your doctor or health care provider about quitting, do so now. Ask about stop-smoking counseling and medications. Using counseling or medication improves your odds of success. Combining them is even more effective. If you'll be using the prescription medication bupropion (Zyban) or varenicline (Chantix), you must start the medication a week before you quit, giving it time to begin working.

Clean house. Rid your home, car, office and other places of your smoking and tobacco products. Don't keep any cigarettes on hand "just in case" because you might not be able to resist the temptation. Also, consider getting your teeth professionally cleaned as motivation to stay smoke free.

Stock up. Have on hand items that can substitute for the cigarette you're used to having in your mouth such as sugarless gum, hard candy, cinnamon sticks and crunchy vegetables.

Reflect. If you've tried to stop smoking before but took it up again, think about what challenges you faced and why you started again. What worked and what didn't. Think about what you can do differently this time; for example, make a list of your triggers and how you will deal with them in a smoke-free manner.

Congratulations on making the decision to stop smoking! If we can help you in any way, give us a call at Van Horn Rural Health Clinic, (432) 283-1020.

Holiday Eating

Q: How can I prevent gaining weight during the holidays?

A: This is a question that comes around once a year just like our birthdays. And, asking this question is the first step to realizing that creating a quality eating plan is important to your health and well being year-round.

The first step to making it through the holidays without weight gain to is to set a firm goal of simply maintaining your weight. This is a tempting time of year but also a time to enjoy celebrating the season with family and friends. So first, get a plan to maintain your weight and stick to it.

Some suggestions include:

Find a buddy. Be it your spouse, a family member or good friend, team up with someone who has the same goal and find strategies for a plan of action. A buddy also provides extra support when temptation knocks.

Don't deny yourself. Clear extra space in your freezer. Once you've enjoyed a small portion of a gift of food or cleared the dishes from a holiday meal, wrap leftovers in single-serving portions and freeze them. If it's not food that will tolerate freezing then share your gift with friends and family.

Learn the menu. Once you arrive at a gathering, look at what food and drink items are being offered and decide which are the healthiest and stick primarily to those items. If you really want a sweet treat or high-calorie food, only take a small amount. A good rule of thumb for portion control is to fill one quarter of the plate with a lean protein, another quarter with a grain and the remaining half with fruits and vegetables.

Stay away from the food table. When at a party, avoid standing and making conversation around the food tables. Find someplace to converse away from the food.

Pay attention to what you drink. Try to stick with water and low-calorie, decaffeinated beverages. Alcohol and surgery punches add calories.

Control your own menu. If you're the host, plan healthy menus. Stick with poultry and fish for main dishes, compliment vegetable trays with low-fat dips and substitute chicken broth for milk and butter in mashed potatoes. Serve water and iced tea.

Keep moving! With so much to do it's easy to put your exercise routine on hold. Resist that temptation. If you can only find time to walk a few minutes each day, do it, and again, find a partner to support you in this effort.

We all know binging on food this time of year isn't good for us but just asking the question of how you can make it through the holidays without gaining weight already puts you on your way to surviving the season in a healthful manner.

I've offered a few ideas for weight control so brainstorm for some of your own ideas and share them with family and friends. And, above all, have a safe, enjoyable and healthy holiday season.

Cholesterol and Stroke

Q: I recently had a cholesterol test done and was told it was high. My family and friends are telling me that with high cholesterol I'm at risk for heart attacks and strokes. Is that true?

A: Your family and friends are right. High cholesterol is a serious condition that can lead to heart attacks and strokes. In fact, the World Health Organization estimates that almost 20 percent of strokes and more than 50 percent of heart attacks can be linked to high cholesterol.

What makes a high cholesterol diagnosis life threatening is that people tend to not take the condition seriously because it is not one that comes with obvious symptoms. With high cholesterol you don't experience pain, feel bad or have any visual side effects from it signs of illness.

Cholesterol is a soft, waxy fat, also known as a lipid, that is made by the body. It is found in the bloodstream and in all of your body's cells. The body needs cholesterol to form cell membranes, some hormones and vitamin D. The danger of high cholesterol presents because it does not dissolve in the blood on its own, it must be carried to and from cells by particles called lipoproteins. There are two main types of lipoproteins that we have all heard about and need to pay more attention to. There are low-density lipoproteins (LDL) the "bad" cholesterol, and high-density lipoprotein (HDL) the "good" cholesterol.

If LDL levels are too high, the excess cholesterol in the blood can accumulate on the walls of the arteries. This build-up is called plaque and can narrow the artery like a clogged drain. When this plaque builds up in the coronary arteries you can develop coronary artery disease. The plaques can also break open and form clots. If a clot gets to the brain and blocks blood flow, it can cause a stroke. If a clot lodges in the coronary arteries, it can cause a heart attack.

You should strive to maintain a level of less than 100 mg/dL of LDL. IF you already have a heart condition you should discuss with your medical provider what level is healthy for you. Your HDL levels should be 60 mg/dL or higher. HDL cholesterol is good because it attaches to the LDL and takes it to the liver where it is filtered out of the body.

Most people should have their cholesterol levels checked every five years. Men older than 45, women older than 55 or those with a family history of high cholesterol should test it more often.

There are also several lifestyle changes that can help manage the situation as well.

  • Eat a healthy diet with foods low in saturated fat like vegetables, fruits, lean meats (chicken and fish) and low-fat dairy products
  • Bake, broil, steam or grill your food when preparing it
  • Add fiber to your diet such as whole grains or dried beans

Your medical provider may also be able to prescribe medications to help regulate your cholesterol. To have your cholesterol checked or talk with a provider about your levels, call Van Horn Rural Health Clinic at (432) 283-1020 today for an appointment.


Q: I recently attended a free health clinic and the doctor there said that I may have pre-diabetes and should talk to my doctor. What is pre-diabetes? How do I know if I have it and what should I do if I do have it?

A: Pre-diabetes is a condition in which blood glucose levels are higher than normal but not high enough for a diagnosis of diabetes. This condition is sometimes called impaired fasting glucose (IFG) or impaired glucose tolerance (IGT) depending on the test used to diagnose it.

Pre-diabetes is a condition that should be taken seriously but also one that can be reversed by the patient in a cost-free manner by simply adopting healthier habits. The US Department of Health and Human Services estimates that about one in four US adults aged 20 years or older, or 57 million people, had pre-diabetes in 2007. In more recent studies, the Center for Disease Controls (CDC) is reporting that one in three adults may have pre-diabetes.

To determine if you have pre-diabetes, your healthcare provider can order one of two tests. Either the fasting glucose test that measures blood glucose after at least eight hours of fasting or the glucose tolerance test that measures blood glucose after at least eight hours of fasting and two hours after drinking a sweet liquid provided by a doctor or laboratory.

Another question patients often ask about pre-diabetes is what are the symptoms. Unfortunately, there are no symptoms. People may have the pre-diabetes for several years without noticing anything. The best way to prevent pre-diabetes is to know the risk factors. If you have one or several of the risk factors below you should talk with your healthcare provider about how often you should be tested for the condition.

  • Being overweight or obese
  • Being physically inactive
  • Having a parent or sibling with diabetes
  • Having a family background that is African American, Alaska Native, American Indian, Asian American, Hispanic/Latino or Pacific Islander
  • Giving birth to a baby weighing more than nine pounds or being diagnosed with gestational diabetes, diabetes first found during pregnancy
  • Having high blood pressure or being treated for high blood pressure
  • Having an HDL (good cholesterol) level below 35 mg/dL or a triglyceride(bad cholesterol) level above 250 mg/dL
  • Having polycystic ovary syndrome, also called PCOS
  • Having impaired fasting glucose (IFG) or impaired glucose tolerance (IGT) on previous testing
  • Having other conditions associated with insulin resistance, such as severe obesity or acanthosis nigricans
  • Having a history of cardiovascular disease

If you should be diagnosed with this condition, there are steps you can take to reverse the condition. The very first steps to reversal of a pre-diabetes diagnosis is to become more physically active and to lose weight. By doing these two things you may not only reverse the pre-diabetes, but you may also avoid developing type 2 diabetes.

If you need to talk with a healthcare provider about pre-diabetes, call the Van Horn Rural Health Clinic today at (432) 283-1020 for an appointment.


Q: During this time of year I always experience watery eyes, a runny nose and sometimes a cough that won't seem to go away. Is it possible I have allergies? How do I know if I do and what can I do to relieve some of the symptoms?

A: It is possible you suffer from spring allergies. Most common in the fall and spring seasons, each year as many as 35 million Americans experience the symptoms of seasonal allergic rhinitis, more commonly known as hay fever. Although there is not a magical cure, there are a number of ways to combat allergy symptoms from medications to household habits. Before I address your questions, it may be helpful to understand exactly what allergies are.

The biggest trigger for spring allergies is pollen, tiny grains released into the air by trees, grasses and weeds for the purpose of fertilizing other plants. When pollen grains get into the nose of someone who is allergic, the pollen grains send the immune system into overdrive. The immune system then mistakenly receives the pollen as foreign invaders and releases antibodies, substances that normally identify and attack bacteria, viruses and other illness-causing organisms. The antibodies attack the allergens, which leads to the release of chemicals called histamines into the blood. The histamines trigger the runny nose, itchy eyes and other symptoms of allergies.

The most common symptoms of an allergy attack include a runny nose, watery eyes, sneezing, coughing, itchy eyes and nose and dark circles under the eyes. Airborne allergens also can trigger asthma, a condition where the airways narrow and make it difficult to breathe which leads to coughing, wheezing and shortness of breath. If you experience either the more common and minor symptoms, or especially the more severe symptoms to the extent that if could be asthma, you should contact your local provider and make an appointment to visit with him or her.

Your provider has a number of options both over-the-counter and prescription medications for helping you. Over-the-counter drugs are effective for many people and include antihistamines that reduce sneezing, sniffling and itching; decongestants that clear mucus out of the nasal passageways to relieve congestion and swelling; antihistamine/decongestant combinations; nasal spray decongestants that relieve congestion and may clear clogged nasal passages faster their oral counterparts; cromolyn sodium nasal spray to help stop the release of histamine before it triggers allergy symptoms and eye drops.

Even though you can buy these medications over-the-counter you should still talk to your provider to make sure you are choosing the right medication. If these medications do not bring you relief, your provider may recommend a prescription medication or allergy shots.

Personal habits you can change to help further relieve allergy symptoms include staying indoors when pollen counts are very high; keeping your doors and windows closed to keep out allergens; using an air purifier; cleaning home air filters often; dusting furniture and vents; vacuuming twice a week, and wearing a mask when you dust and vacuum because these actions kick up pollen, mold and dust trapped in these areas.

If you believe you are experiencing allergy symptoms, call Van Horn Rural Health Clinic today at (432) 283-1020 to make an appointment with your provider.

Skin Cancer

Q: I love outdoor activities and spend a lot of time outside in the spring and summer. Will you please help me understand more about skin cancer and what I can do to prevent it?

A: This is a very timely question and a very important one, too.

Skin cancer develops primarily on areas of sun-exposed skin but it can also form on areas that rarely see the light of day such as the palms, beneath fingernails, the spaces between the toes under toenails and the genital area. Skin cancer occurs when errors (mutations) form in the DNA of healthy skin cells. The mutations cause the cells to grow out of control and form a mass of cancer cells. Skin cancer affects people of all skin tones.

Skin cancer begins in the skin's top layer and much of the damage to DNA results from ultraviolet (UV) radiation found in sunlight and in commercial tanning lamps and beds. Some skin cancers are not the result of sun exposure but other risks such as exposure to toxic substances or a weakened immune system.

There are several types of skin cancer but I'll focus on the more common.

Basal cell carcinoma usually occurs in the sun-exposed areas of the body, such as the face, ears or scalp and it appears as a pearly or waxy bump or a flat, flesh-colored or brown scar-like lesion.

Squamous cell carcinoma also occurs on sun-exposed areas of the body such as the face, lips, ears and hands. It usually presents in the form of a firm, red nodule or flat lesion with a scaly, crusted surface.

Melanoma can develop anywhere on the body in otherwise normal skin or in an existing mole that becomes cancerous. In men, it often appears on the trunk, head or neck and in women on the lower legs. Melanoma can occur on skin that hasn't been exposed to the sun and in people with darker skin tones it tends to occur on the palms or soles or under the fingernails or toenails.

Signs of melanoma include a large brownish spot with darker speckles; a mole that changes in color, size or feel or that bleeds; a small lesion with an irregular border and portions that appear red, white, blue or blue-black; and dark lesions on your palms, soles, fingertips or toes or on mucus membranes lining your mouth, nose, vagina or anus.

Factors that increase the risk of skin cancer include having fair skin, a history of sunburns, excessive sun exposure, living in sunny or high-altitude climates, people with a number of moles or history of abnormal moles, the presence of precancerous skin lesions, a family or personal history of skin cancer, a weakened immune system, exposure to certain toxic substances and increased age.

It is important to remember that most skin cancers are preventable. To protect yourself, avoid the sun during the middle of the day, wear sunscreen year-round with a SPF of at least 15, wear protective clothing that covers your arms and legs and a broad-brimmed hat, avoid tanning bed, be aware of sun-sensitizing medications (ask your doctor or pharmacist for guidance) and check your skin regularly for new skin growths or changes in existing moles, freckles, bumps and birthmarks.

If you notice any unusual skin changes call your medical provider or the Van Horn Rural Health Clinic at (432) 283-1020 for an appointment. Not all skin changes are caused by skin cancer but your provider can help you determine if you need to see a specialist for further investigation.

Rick Gray
Culberson Hospital
Eisenhower & FM 2185
P.O. Box 609
Van Horn, TX 79855
Telephone: 432-283-2760
Fax: 432-283-2581
Van Horn Rural Health Clinic
Eisenhower & FM 2185
P.O. Box 38
Van Horn, TX 79855
Telephone: 432-283-1020
Fax: 432-283-0019

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