Friday, October 11, 2019

Traumatic Head & Spinal Cord Injury Trust Fund Program is here to help


Whether it’s from a motor vehicle accident, a fall, a near-drowning experience, physical assault or some other trauma, a traumatic head and/or spinal cord injury can be a life-changing event. This kind of event doesn’t just affect the individual — it also impacts the lives of their loved ones, who may eventually become the caregiver, assisting with daily living activities like bathing and dressing.

In Louisiana, the Traumatic Head & Spinal Cord Injury Trust Fund Program (THSCI) helps those with such injuries, who meet eligibility requirements, to return to a reasonable level of functioning and independent living in their communities. The Louisiana Legislature created the program in 1993 with Act 654. Through this act, the program is funded by imposing additional fees on motor vehicle violations in Louisiana for the offenses of driving under the influence, reckless operation and speeding.

The Louisiana Department of Health’s, Office of Aging and Adult Services administers the THSCI Program, which includes but is not limited to processing admissions to the program, paying service providers for services on behalf of eligible individuals and reviewing Plans of Care. In addition, the Brain Injury Association of Louisiana (BIALA) serves as the program’s designated resource center for people with traumatic head and/or spinal cord injuries.

Who may be eligible for assistance through the program?

Louisiana residents who have suffered a traumatic head and/or spinal cord injury may apply for program assistance.

A traumatic head injury is caused by an external physical force, such as falls, which affect the brain, producing diminished or altered state of consciousness. The injury can lead to impaired cognitive and/or physical functioning. Degenerative or congenital conditions do not meet the definition of traumatic head injury as it relates to the program. For example, a person with Alzheimer’s would not be eligible for the THSCI program.

Similar to traumatic head injury, a spinal cord injury is caused by an external force, such as a car accident. This kind of injury can lead to paraplegia (paralysis of the legs and lower body) or quadriplegia (paralysis of both the arms and legs). Degenerative and congenital conditions do not meet the definition of spinal cord injury as it relates to the program. For example, a person with spina bifida would not be eligible for the THSCI program.

To be determined eligible for services, a person must:
  • Meet the definition of traumatic head/spinal cord injury (above), per their treating physician
  • Be a resident of Louisiana and officially domiciled in Louisiana at the time of the injury and while receiving services
  • Have a reasonable expectation to gain improvement in functional outcome with assistance, per their treating physician
  • Have exhausted all other Medicare and Medicaid sources as attested to by the applicant
  • Provide proof of denial from other sources, if requested
  • Be willing to accept services from an approved facility or program
  • Complete and submit the appropriate application for services
  • Cooperate with program requirements

What services are available?

Participants work with their assigned case manager to develop a Participant Service Plan that offers flexible services aimed at improving how they function in their homes and communities as it relates to their injuries. Eligible participants may receive services including, but not limited to:
  • Evaluations and therapies
  • Post-acute medical care rehabilitation
  • Home and vehicle accessibility modifications
  • Medication and medical supplies
  • Personal Care Attendant Services
  • Equipment necessary for activities of daily living
  • Transportation for non-emergency medical appointments
  • Other goods and services deemed appropriate and necessary
  • Post-acute medical care rehabilitation
Service providers must be THSCI Program approved, with in-state facilities and programs receiving priority. All services are on a first-come, first-served basis.

Is there a cap on what I can receive?

An individual’s expenditures are limited to $15,000 for any 12-month period or $50,000 total per person per lifetime

How do I apply?

Call (225) 219-2410 or (888) 891-9441 for questions, additional information or to have an application for services sent to you. You can also download and print the application at this link. Mail the completed forms with original signatures to the THSCI Trust Fund Program, P.O. Box 2031 – Bin #14, Baton Rouge, LA 70821-2031.

Additional resources are available through the Brain Injury Association of Louisiana Resource Center, 8325 Oak St., New Orleans, LA 70118. The association also staffs a 24-hour support line at (504) 982-0685.

Friday, October 4, 2019

Stop the bleed, save a life

By DR. LACEY CAVANAUGH | Region 5 Medical Director, LDH Office of Public Health

You are driving home and a motor vehicle crash happens in front of your very eyes. Wanting to help, you pull over and immediately recognize a life-threatening bleeding situation. What do you do?

Or, maybe it is not a crash. Maybe it is a hunting accident, a power tool injury, a sporting event or a shooting. An injured person may only have minutes to live if bleeding is not controlled immediately. Uncontrolled bleeding is actually the number one cause of death after a mass casualty event.

Knowing what to do in this situation, before emergency medical services are available, can save lives.

The Stop the Bleed program is part of a nationwide movement to help laypeople possibly save a life if ever faced with life-threatening bleeding. Stop the Bleed was developed by the American College of Surgeons Committee on Trauma. The program teaches people the basic steps to stop bleeding, which include calling 911, ensuring personal safety, looking for life-threatening bleeding, then compressing and controlling bleeding using pressure, packing and/or a tourniquet. These skills are intended for field use until the injured person can be transported to a medical facility.


Hands-on learning

The Region 5 Office of Public Health, in collaboration with several community partners, held two Stop the Bleed trainings for the LSU residents, faculty and staff at the Lake Charles Memorial Hospital Family Medicine Residency
Program on August 30 and September 20.

Ted Colligan with the Louisiana Emergency Response Network was the lead instructor and several staff from other local partner organizations assisted with training the participants. The training consisted of a presentation and discussion period, followed by a hands-on practice session of newly learned skills.

The intent of this class was to train future Louisiana physicians to be Stop the Bleed trainers, so that they can then assist in training the rest of the community. This was a unique audience of mostly physicians and a wonderful example of cross-sector collaboration between partners to achieve a goal. Forty-three participants completed these two trainings and nine of them signed up to be instructors.

Representing OPH Region 5 were Public Health Emergency Response Coordinator Mike Parent, Hospital Nurse Coordinator Janet Rider, and APRN Nadine Blake. Jessica Leboeuf with the Calcasieu Parish Medical Reserve Corps, Lake Charles Memorial Hospital System RNs Rezalynn Vincent and Crystal Rollins, and Dr. Danette Null, associate professor with the LSU Family Medicine Residency Program all took part in leading two three-hour classes. We want to thank all of our partners and instructors, in addition to Lezlie Fletcher with the LSU Family Medicine Residency Program, for their assistance in making this training a reality.

For more information, to find a class near you or to request training at your facility, click here.

Friday, September 27, 2019

Opioid harm reduction: A comprehensive approach

By DR. DAVID J. HOLCOMBE | Medical Director, LDH Region 6

Opioid overdoses continue to claim over 100 American lives every day (46,029 in 2017). This slaughter now exceeds the number of annual traffic deaths (37,000 in 2017), which has benefited from gradual reductions related to improved safety in both roadways and vehicles. In an Annals of Internal Medicine article, Drs. Levine and Fraser proposed elements of a comprehensive public health response to the opioid crisis.

They established six categories to approach the crisis: (1) Leadership, (2) Partnerships, (3) Epidemiology, (4) Prevention/Education, (5) Treatment and Recovery and (6) Overdose Prevention. Some of the key elements of each category proved a framework for a coordinated approach in which public health plays a leading role.

Leadership entails the engagement of all leaders from the governor’s office down to community leaders, not only in healthcare, but also in education, corrections, social services and economic development.

Partnerships include not only those within communities, but also those between states, the federal government, faith-based organizations and health community coalitions, among others.

Epidemiology serves to create databases and dashboards available to all interested and engaged parties. The Louisiana Opioid Data and Surveillance System fulfills this valuable role by providing local data relating to specific populations.

Education and prevention involves prescribers, pharmacists and the public. This includes the state Prescription Monitoring Program, regulation of pain clinics, sanctions for over-prescribers, and working with school-based health clinics and the Department of Education to improve drug awareness.

Treatment and recovery must be enhanced with increased availability to rehab facilities, expansion of medication assisted treatment (MAT), use of telehealth in rural areas, and improved post-recovery programs addressing employment, housing, transportation and other social needs.

Harm reduction and overdose prevention must include safe syringe programs (such as one being proposed locally), increased availability of naloxone (Narcan®), and improved diagnosis and treatment of underlying pre-disposing mental health factors such as depression.

This ambitious plan reflects a multi-faceted approach and broad engagement from multiple elements of society. It recognizes the importance of social determinants such as educational level and income, as well as the necessity of addressing glaring issues of health inequity. Public health can have a primordial role in tackling the opioid epidemic, but it cannot act alone or in a vacuum. We all helped create the world of opioid addiction in one way or another, and now we must rise to the occasion to help mitigate and eradicate it.

Friday, September 20, 2019

What do we do when we think it could be Alzheimer’s disease?

By GINA ROSSI | LCSW-BACS, MHSA, LDH Office of Aging and Adult Services

There can be nothing more heartbreaking and frightening than watching a parent or loved one slowly decline with memory problems or signs that indicate they may have dementia. Ask any older person about their biggest fears and inevitably the words “Alzheimer’s disease” enter into the conversation.

Approximately every 6 minutes someone receives an Alzheimer’s diagnosis. In Louisiana, 87,000 people over the age of 65 are living with Alzheimer’s, and 232,000 family caregivers are dealing with the effects of their loved ones needing care and support.

Alzheimer’s disease is a sixth leading cause of death in the U.S.  In 2017, there were 2,188 deaths in Louisiana related to Alzheimer’s, a 170% increase since 2000. This figure is projected to increase by 23.6% by 2025. Frightening, right? Despite this, only 16% of seniors receive regular cognitive assessments during routine health checkups. If you see signs, consult your primary care physician or neurologist.

The more we talk about Alzheimer’s, the more people are educated about its symptoms. The other side of the coin is that without clear guidance and professional consultation, our fears can cause us to jump to conclusions. For this reason, the Alzheimer’s Association provides education about this disease and what signs and symptoms we should be looking for.

It is important to know that dementia is an umbrella term and while Alzheimer’s disease is the most common cause of dementia, there are many reasons why someone may be showing signs of dementia.

Know the 10 signs of Alzheimer’s
  1. Memory loss that disrupts daily life
  2. Challenges in planning or solving problems
  3. Difficulty completing familiar tasks at home, at work or at leisure
  4. Confusion with time or place
  5. Trouble understanding visual images and spatial relationships
  6. New problems with words in speaking or writing
  7. Misplacing things and losing the ability to retrace steps
  8. Decreased or poor judgement
  9. Withdrawal from work or social activities
  10. Changes in mood and personality

The three stages of Alzheimer’s
  • Mild (early stage): The person is still able to function independently but may feel they are having memory lapses such as forgetting words or familiar locations. Friends or family who are close may notice a change. If you are a caregiver dealing with this stage, make plans now for an assessment so future plans (and support for you) can begin.
  • Moderate (middle stage): The disease has progressed and the person may no longer do routine tasks and become confused about their history. This is the longest period and the most difficult for caregivers as they have to deal with the person’s anger, frustration, and increased wandering. If you are a caregiver dealing with this stage, get support NOW.
  • Severe (late stage): In this stage, the person needs 24-hour care with daily activities and personal care. They are no longer responding to their environment and are unable to communicate, which is especially troublesome for those experiencing pain. In the final stages, death is a result of infections such as pneumonia or bed sores. If you are a caregiver dealing with someone in this stage, know that you have done the best that you can. Be kind to yourself.

Clinical trials, research and resources

It is true that there is no cure for Alzheimer’s disease, but through research we know there are ways for us to reduce the risk, including activities such as regular exercise, keeping one’s blood pressure within current healthy guidelines and engaging the brain. These small things help us maintain and protect our brain health.

While there is no cure, clinical trials continue locally and nationally. There are many important advances and efforts to help people better cope with the effects of the disease and to work toward a cure. Research also continues into how to help a person live with Alzheimer’s while focusing on the needs of the primary caregivers who experience the physical, emotional and mental burden of caring for someone who has Alzheimer’s.

Someone who is unable to care for themselves and who needs care in the home may be eligible for home and community-based services. For more information about these services, call Louisiana Long Term Care Options at 1-877-456-1146. Here are some additional places to go for help:

Friday, September 13, 2019

Be a food safety superhero


Many people have daydreamed about being a superhero. Who wouldn’t want to have the power of flight or super strength? Well, those kinds of powers may be out of our reach, but there’s one that isn’t: being a food safety superhero. With September being Food Safety Education Month, it’s a great time to learn about preventing foodborne illnesses and how to keep food safe.

Much like Batman and his familiar rogues’ gallery of villains — the Joker, Catwoman and the Penguin, just to name a few — the kitchen also has its common culprits when it comes to food poisoning and foodborne illnesses. When contaminated and consumed, these foods can make a person very sick. Let’s take a closer look at the usual suspects.

First, a little sanitation: Always wash your hands with soap and warm water before handling food and immediately after handling any raw food. Wash your counter tops, cutting boards, dishes and utensils with soap and hot water between the preparation of raw foods and cooked or ready-to-eat foods.

Chicken, beef, pork and poultry
  • The bad guys: campylobacter, salmonella, Clostridium perfringens, E. coli, yersinia and other bacteria
  • How to fight back: Never wash raw poultry or meat, since this increases the chances of spreading bacteria to other foods and surfaces. Cook your poultry and meat thoroughly to a safe internal temperature using a cooking thermometer and these charts. Don’t rely on the meat’s color or juices to tell you if it’s fully cooked. Refrigerate any leftovers within two hours of preparation at a temperature of 40 degrees Fahrenheit or colder. Divide larger cuts into small quantities for refrigeration, as this helps the meat cool quickly and prevent bacteria from growing.

Seafood and raw shellfish
  • The bad guys: Vibrio, salmonella, listeria, norovirus and other bacteria
  • How to fight back: Cook raw seafood to proper temperatures, usually an internal temperature of 145 degrees. Other ways to tell if seafood is done are if fish flesh is opaque and separates easily with a fork; shrimp, scallop, crab and lobster flesh become firm and opaque; and the shells of clams, mussels and oysters open during cooking (unopened ones should go in the trash). Don’t eat seafood if it smells sour, rancid or like ammonia. Cooked seafood should be refrigerated if it’s been out for more than two hours or for more than an hour when temperatures are 90 degrees or higher. Refrigerate at 40 degrees or colder.

Fruits and vegetables
  • The bad guys: salmonella, E. coli and listeria
  • How to fight back: Wash your hands and all utensils and food prep surfaces before and after preparation. Under running water, wash or scrub your produce and cut away any damaged or bruised areas, then dry with a clean paper towel. Keep produce separate from raw meat, poultry and seafood. Refrigerate your prepared fruits and veggies within two hours, or one hour if it’s 90 degrees or hotter outside. Store in a clean container in a refrigerator at 40 degrees or colder.

Sprouts
  • The bad guys: salmonella, E. coli and listeria
  • How to fight back: Cook sprouts such as alfalfa or bean thoroughly to kill off any germs.

Raw milk, raw milk soft cheeses and other raw milk products
  • The bad guys: campylobacter, cryptosporidium, E. coli, listeria and salmonella
  • How to fight back: Choose products that have been pasteurized — if the label says “pasteurized,” it’s safe to consume. These products include milk, yogurt, ice cream and soft cheeses like queso fresco, queso blanco, brie, Camembert and feta. Pasteurization is a process that heats raw milk to a specific temperature just long enough to kill off germs. This process doesn’t destroy enough of the nutritional benefits of raw milk to make raw milk worth the risk. Refrigerate milk products at 40 degrees or colder. Keep your eye on the expiration date. If a product is past this date, throw it out to reduce your chances of getting sick.

Eggs
  • The bad guy: salmonella
  • How to fight back: Buy and use pasteurized eggs and egg products from stores and suppliers, and never buy cracked or dirty eggs. Cook your eggs thoroughly, until the whites and yolks are firm. If your recipe calls for raw or undercooked eggs, such as Caesar salad dressing or eggnog, make sure you only use pasteurized eggs and egg products. No matter how tempting it may be, do not taste or eat raw batter or dough that contains eggs. Eggs and any foods containing eggs should be refrigerated shortly after cooking. Refrigerate eggs at 40 degrees or colder.

Raw flour

  • The bad guys: E. coli and other bacteria
  • How to fight back: Most flour is a raw agricultural product, which means it hasn’t been treated to kill bacteria. When you cook with flour, the heat from cooking kills off the bacteria. That’s why you shouldn’t eat raw dough or batter. It’s delicious, but it’s not worth the risk. Just don’t do it.

Now that you’re armed with information, you can take the fight to foodborne illnesses. It’s in your power to protect yourself and your loved ones from sickness.

Wednesday, September 11, 2019

Generation Rx part of the prescription to treat the opioid crisis


Prescription misuse among teenagers and young adults was the topic of a workshop during the Louisiana Opioid Action Summit held Sept. 4-6. Summit attendees learned about Generation Rx, a free program created to help raise awareness about misuse of prescription pain relievers. Such misuse has been viewed as a key driver of the opioid epidemic, and the Louisiana Department of Health has led efforts to educate physicians about the dangers of overprescribing opioid pain medication.

However, more can be done to educate people from all age groups about the dangers of prescription misuse. That's where Generation Rx comes in. The program has specially designed educational materials targeting five age groups (elementary, teen, college, adult and older adult), with materials for young people that can be used in K-12 education and in higher education.

Nicole Cartwright Kwieck, a clinical professor of pharmacology at The Ohio State University, where Generation Rx was developed, presented during the summit session on teens and young adults. Kwieck said that a team of researchers and professors created Generation Rx after realizing there was a need for better education around prescription drug use — particularly in school settings.

“We do a terrible job in this country teaching people how to use medications,” Kwieck said. “If you think back on your own experience ... you were probably weren't taught in school. You were probably taught by a parent or a loved one, maybe a professional.”

Reaching younger audiences

The core messages communicated through Generation Rx are:
  • Only use prescription medications as directed by a health professional.
  • Never share your prescription medications with others or use someone else’s medications.
  • Always store your medications securely to prevent others from taking them, and properly dispose of medications that you no longer need.
  • Be a good example to those around you by modeling these safe medication-taking practices and discussing the dangers of misusing prescription drugs with your family, friends, colleagues, students or patients.
In developing the teen and higher education-focused section of the program, Kwieck said, program authors considered the idea that teens and young adults are often seeking new experiences and may see the risk of any type of drug misuse as compelling. They also tend to overestimate the risky behaviors of their peers, leading to conclusions such as “Everyone else is doing it so I can, too.”

The materials were also developed with the idea that teens often don't respond well to lectures and have short attention spans, so the activities are designed to get “them out of their seats” and highlight the dangers that prescription misuse poses. Activities include a Family Feud-style game, an interactive discussion designed around a PowerPoint presentation and skits that allow participants to act out various scenarios.

Rusty Fornea, who spoke during the session for the Washington Parish-based ADAPT Inc., said the organization deployed Generation Rx in parish schools in the spring and received positive responses. Some of those schools, Fornea said, have asked when Generation Rx will return.

“Once we were able to get it rolling, the facilitators and the youth really enjoyed it because it's interactive,” Fornea said.

Widespread misuse

More than 5,700 Americans misuse a prescription pain reliever each day, according to the National Survey on Drug Use and Health.

While 83% of those prescriptions came from a single doctor, more than half of those misused were obtained through a friend or relative, according to data from SAMSHA. That means that misused prescription pain relievers are often not prescribed to the person taking them, which is helping fuel the opioid crisis and leading to addiction and overdose deaths.

You can learn more about Generation Rx here.

Friday, September 6, 2019

We can all play a role in preventing suicide


By DANITA LEBLANC | LCSW-BACS, LDH Office of Behavioral Health

Each death by suicide has a ripple effect throughout families and communities. Over the last 30 years, the suicide rate in the United States has continued to rise. In this country, 47,173 individuals died by suicide in 2017; that is 129 people per day. That same year, 720 individuals died by suicide in Louisiana.

Suicide is generally not on your radar until it affects you personally. Even when a family member or friend is showing warning signs, it can be difficult to talk about. Oftentimes small gestures can make a big difference.

Family, friends and co-workers often see that someone is in distress before professionals become aware of them. We can learn to be alert to the signs that someone might be thinking of suicide, we can learn how to ask about suicide, we can help keep someone safe, we can be there for them and we can learn how to connect them to help.

Some warning signs that someone may be having thoughts of suicide include:
  • Talking about wanting to die or to kill oneself
  • Looking for a way to kill oneself, such as searching online or buying a gun
  • Talking about feeling hopeless or having no reason to live
  • Talking about feeling trapped or in unbearable pain
  • Talking about being a burden to others
  • Increasing the use of alcohol or drugs
  • Acting anxious or agitated; behaving recklessly
  • Sleeping too little or too much
  • Withdrawing or feeling isolated
  • Showing rage or talking about seeking revenge
  • Displaying extreme mood swings
  • Sudden improvement after having been depressed

Five action steps
We can all have a role in preventing suicide. The #BeThe1To campaign encourages these five action steps to prevent suicide.

  1. ASK: Ask directly about suicide in a way that sounds like you want to know the answer. Studies show that asking at-risk individuals if they are suicidal does not increase suicide or suicidal thoughts. Direct questions like “Are you thinking about suicide?” or “Are you thinking about killing yourself?” communicate in a supportive and non-judgmental way that you are open to talking about suicide. You could also let them know what you see, hear, sense or learn about them that provides you with clues that something isn’t right.

    Example: Mary, I’ve noticed you seem distressed and have been keeping to yourself since your house flooded. Sometimes when people have had a traumatic experience like that, they think about suicide. Are you thinking about suicide?

    Take them seriously. Listen while they talk about the situation causing them emotional pain. Also listen for any potential reasons they want to stay alive. Both are important. Do not impose your reasons for why they should want to live; help them focus on their reasons.
  2. KEEP THEM SAFE: Once we agree that suicide is the focus, we need to know a few things about how to keep them safe. To figure out how to keep them safe, we need to know more about the situation and their plan. Have they already done anything to try and kill themselves? Have they thought about how they would kill themselves? Is the plan detailed as to what, when and where? The more detailed the plan is, the higher the severity of risk.

    Reducing a person’s access to highly lethal means that they plan to use to kill themselves is an important part of suicide prevention. Keep the person safe by putting time and distance between the person and their chosen method. Over 40% of the time, the decision to act on thoughts of suicide and the act of suicide is less than 10 minutes.
  3. BE THERE: Support the person at risk of suicide. Stay with them or help connect them to other support. Is there someone else in the person’s life who is available, willing and able to help if needed? Being there could mean being physically present or speaking with them on the phone, or any other way that shows support. Actively listen to what they say and let them know you hear them. Make sure you follow through on whatever you say you will do. Do not commit to anything you are not willing to do.
  4. HELP THEM CONNECT: Help the person with thoughts of suicide connect with ongoing supports that can help them establish a safety net for those moments they find themselves in a crisis. The National Suicide Prevention Lifeline at 1-800-273-8255 (TALK) will connect you to the crisis call center closest to you based on your area code. If texting is preferred, text to 741741; the website www.crisistextline.org has information on what happens when the text is used. If it is an emergency, contact 911 or go to the nearest emergency room.

    Explore some possible supports with the person in crisis. Are they currently seeing a mental health professional? Have they in the past? Is this an option for them currently? Are there other mental health resources in the community that can help? Is there an Employee Assistance Program at the person’s workplace? In Louisiana, local governing entities responsible for behavioral health and developmental disability services may be able to help.
  5. FOLLOW UP: After your initial contact with the person experiencing thoughts of suicide and after you have connected them with the immediate support systems they need, follow up with them to see how they are doing. Leave a message, send a text or give them a call. The follow up step lets you check in with them to see if additional support is needed and conveys caring and concern to the person thinking about suicide. This contact can also contribute to increased feelings of connectedness.

If someone you know is struggling, don’t be afraid to reach out to them. Each of us can be the one to help.


Friday, August 30, 2019

Living a life in recovery


By BRENT AMBACHER | STR and LaSOR State Peer Recovery Support Specialist, LDH

(Note: Brent Ambacher is sharing his recovery story in honor of National Recovery Month, observed every September as a time to increase awareness and understanding of mental and substance use disorders and to celebrate the people who recover. Learn about recovery resources in Louisiana here.)

The last time I had a drink — April 29, 2012 — I didn’t even want one. After about 10 days of AA meetings, I’d heard enough to make me decide I was done, and had given up for good (I thought) about 72 hours earlier. The problem was, after 27 years of consistent and ever-increasing drug and alcohol use, my body wasn’t down with this plan. I was unable to hold down food or water, and had started vomiting blood.

Alcohol is one of the few substances that can actually kill you if you stop abruptly. I sort of knew this. I was fully aware that I was a hopeless alcoholic who hadn’t gone a single day without drinking myself to “sleep” in probably 10 years. But I wasn’t able to connect the dots. I was told I needed to go to the emergency department, but the prospect of waiting for hours in that condition was too horrifying to contemplate.

Brent Ambacher
So, instead of my usual vodka intake of more than a liter, I was sitting on my back porch, crying, sweating, shaking uncontrollably and trying to choke down a glass with a mixture of two-thirds beer and one-third honey.

I could not for the life of me understand how this was helpful, but I knew enough to know that I was in serious physical trouble and that a guy with 20 years of sobriety probably knew more than I did about quitting. The drink was his recipe. It took me two hours to get it down, but it worked. How does somebody end up the way I did — 46, jobless, divorced, broke, homeless and staying with my eldest sister?

Struggling to cope

I was a missionary kid who grew up in Hong Kong and moved back there after college. I’d been a successful photographer, journalist, advertising executive and spin doctor. I’d lived on three continents, married a beautiful, smart and talented English woman, spent nine years in London, moved to New York, traveled the world. I was SOMEBODY. But that was just on the surface.

Inside, I was desperately frightened that one of these days, everyone would figure out that I was a fake, with no talent, and that I didn’t deserve anything I had. I had also been struggling with anxiety and depression for as long as I could remember. Drugs and alcohol were my way of trying to cope with feeling like a failure and prop myself up so I could keep impressing everybody else.

I guess I thought if other people loved me enough, I’d be OK.

I wasn’t. I was a pathetic drunk and I was close to death.

Climbing back from the bottom

That was seven years — and an entire lifetime — ago. I had to start over, from the bottom. I delivered auto parts for a while, and then someone suggested I might look into becoming a Peer Recovery Support Specialist. I’d never heard of one, but I gave it a shot. Besides getting sober, it was the most important thing I’d ever done for myself.

I went to work at a treatment center and spent a little over two years helping people like me. Another person suggested I apply for a job that I never would have dared to try for, but they hired me — as the Statewide Peer for the STR Grant, here at the Louisiana Department of Health’s Office of Behavioral Health. Then they asked me if I wanted to try my hand at facilitating Peer Employment Trainings, so I said yes to that, too. I’ve learned that I don’t often know best what it is that I’m supposed to do next, but saying yes is usually the right idea.

I make about a quarter of what I used to. I don’t jet off for the weekend because I feel like it. But in return, I have so much more than money could buy me. I was able to be present and help nurse my father through the last four years of his decline from Parkinson’s and dementia, and I was at his bed when he died. I have a job where I’m allowed to be useful, and where the pain of my past can light a pathway forward for people who are looking for a way out of substance use and mental health challenges. 

And, for the last 2,600-and-something days, I haven’t needed a drink or a drug to be OK with myself. It sure seems like a good trade to me.

Friday, August 23, 2019

Candida auris: A new fungus among us

By DR. DAVID J. HOLCOMBE | Medical Director, LDH Region 6

Fungi, like bacteria, surround us.

These organisms — which include yeast and mushrooms —come in many forms, including Candida species, a fungus that is common and ubiquitous. Candida albicans, for example, is the causative agent of thrush, vaginal yeast and other skin infections, and can be easily treated. However, this is not true of a “new” fungus on the block, Candida auris.

A highly magnified view of Candida auris.
“Auris” means ear in Latin and is an appropriate name for this organism, which was discovered in the ear of a Japanese woman in 2009. Considered an oddity at the time, Candida auris quickly spread around the world, appearing a year earlier in Pakistan (2008), then subsequently in India (2009), Venezuela (2012), the United States and South Africa (2013), and Europe and Australia (2015).


Candida auris actually exists in at least four distinct genetic variants, leading researchers to believe that it has arisen independently in several different locations around the world.

Candida auris, a relatively new fungus, is a highly efficient killer.


Candida auris is not, however, just another fungus. It has proven to be highly resistant to many antifungal drugs. It spreads rapidly through hospitals, nursing homes and long-term care facilities where it proves difficult, if not almost impossible to eradicate. More common in weakened and susceptible patients, it kills nearly half of those infected within 90 days
.
Evolution and control

Where did this horror come from (besides from the ear of a Japanese woman) and what can be done to control or eliminate it?

Fungal specialists believe that our widespread use of antifungal agents has gradually resulted in the evolution of this previously harmless fungus. Much like the widespread use of antibiotics has caused the evolution of multiple drug-resistant bacteria, antifungal agents have created an environment favorable to the development of fungi that are immune to most antibiotics.

With antifungal agents so widely used in agriculture, resistant fungi will reproduce and flourish. It is not exactly survival of the fittest, but more precisely survival of the most adaptable. Candida auris appears to be one of these highly adaptable organisms.

We cannot easily produce new antifungal agents, nor can we eliminate the use of fungicides (or antibiotics) for agricultural purposes. It may come down to the same principle of highly selective use which has already been applied to antibiotics. Fungicides can be restricted or outlawed, even though the consequences on agricultural production may be dramatic.

For example, the fungus that destroyed the potato harvests in Ireland in the 1840s led to widespread crop failures, disease and famine. The same could occur with a new resistant fungus in our time that could wipe out wheat or rice harvests. Possible reductions in agricultural productivity must be weighed against the dangers posed by these new organisms.
Source: CDC


What comes next?

We can restrict our use of both antifungal and antibiotic agents to circumstances when they are truly required. Hospital infectious disease practitioners must add Candida auris to their already long list of resistant organisms they need to identify, track and eliminate in the hospital, long-term care and nursing home settings.

We are all engaged in this intense battle between humankind and the world's microorganisms, whether they be fungal or bacterial. Common sense must prevail or we will become victims of these horrific microscopic organisms that may kill with impunity because there is nothing available to use against them.

Learn more about Candida auris here.

Tuesday, August 20, 2019

Extreme heat is dangerous

By DR. MARTHA WHYTE | Region 7 Medical Director, Office of Public Health

With temperatures being in the 90s for most of this month, and with heat indexes in the triple digits, Louisiana is facing an extreme heat wave. Although most people understand that it is hot outside and even hear warnings about the risks of high heat, truly understanding and the dangers and taking the necessary precaution is important to prevent heat-related illness and death. Here are some key facts:

Friday, August 16, 2019

You’re always somebody’s type when it comes to blood donation


No matter your blood type, your blood donation can help save a life.

Blood transports oxygen and nutrients to the lungs and tissues, forms clots to prevent excess blood loss, carries cells and antibodies that fight infection, transports waste products to the kidneys and liver for filtering, and regulates body temperature. It is composed of four main building blocks.
  • PLASMA is the main component of the blood, made up of water, sugar, fat, protein and salts. Its primary job is transporting blood cells throughout the body along with other things like antibodies, hormones, nutrients and more.
  • RED BLOOD CELLS are the most plentiful cell in the blood and carry hemoglobin, which gives blood its red color. Hemoglobin helps carry oxygen from the lungs into the rest of the body, returning carbon dioxide to the lungs to be exhaled.
  • WHITE BLOOD CELLS fight off infection. There are two types: neutrophils, which respond immediately to infection, and lymphocytes, which regulate the function of other immune cells, attack infected cells and tumors and make antibodies.
  • PLATELETS are small fragments of cells that help with blood clotting.


Who needs blood donations?

When people think of who benefits from blood donations, typically they think of situations such as a car accident. Obviously, someone who has been severely injured in a car accident is likely to receive blood, but do you know who else needs donated blood?
  • CANCER PATIENTS: Certain cancers and cancer treatments prevent patients from producing their own platelets, a component of the blood.
  • TRAUMA AND SURGERY PATIENTS: Red blood cells carry oxygen throughout the body, so blood is frequently given to trauma and surgery patients, including women with pregnancy- and childbirth-associated bleeding.
  • SICKLE CELL PATIENTS: People with sickle cell disease require frequent blood transfusions that must be closely matched to the donor’s blood type, usually from the same racial and ethnic group. Most people in the United States who have sickle cell disease are of African ancestry, but it’s also common in people of Hispanic ancestry.
  • BURN PATIENTS: Plasma, another component of blood, is important to burn patients because it helps maintain blood pressure and other vital functions.
  • PATIENTS WITH CHRONIC DISEASES: Patients with certain conditions in which the body does not make blood properly, such as hemophilia or anemia, may require frequent transfusions.

Every few seconds somebody is in need of a blood transfusion, making it vital that we have a safe, quality, sufficient supply available at all times. That’s where you, the donor, comes in.

Just your type

Before getting into the donation process, let’s talk about blood types. Some are rarer than others, making them in high demand, but all types are needed for donation.

The four major blood groups are A, B, AB and O; each group breaks down further into subgroups of A+, A-, B+, B-, O+, O-, AB+ and AB-. The + or - refer to a protein called the Rh factor, which can be present (+) or absent (-). Your blood group and presence or lack of an Rh factor determines your blood type.

Because not all blood types are compatible, it’s important during a transfusion that a person receives the right type of blood. If you accidentally receive the wrong blood type, your body could have a dangerous immune response like blood clumping, which can be fatal.

Typically, if you are in need of blood you will be given the type that matches yours, but sometimes that’s not possible. In that case, the universal red cell donor is O-, which means O- blood can be given safely to anyone regardless of blood type. That puts O- in high demand since it’s used for emergency transfusions and infants with compromised immunity, though O+ is also in high demand because it’s the most common blood type.

The universal plasma donor is AB.


How to save a life

So, you’re ready to donate? A single blood donation can save up to three lives! Type “blood donation centers near me” into your preferred internet search engine to find locations where you can donate. The major blood banks in Louisiana are The Blood Center, LifeShare, Vitalant (formerly United Blood Services), Our Lady of the Lake Blood Donor Center and Ochsner Blood Bank. Then, schedule an appointment.

Here’s what you can expect if you’re a first-time donor of whole blood. First, remember to plan ahead: have at least 16 ounces of water and a healthy meal before your appointment, and wear a shirt with sleeves that you can roll up.

When you arrive for your appointment, you’ll get registered — so bring your ID — then go over some basic eligibility requirements and receive information about donating blood. You’ll undergo a short interview about your health history, travel history, prescriptions and medications, as well as checks of your temperature, pulse, blood pressure and hemoglobin level.

Now, it’s time for the draw. You’ll either be seated or lie down, and then an area will be cleaned on your arm and a new, sterile needle will be inserted. It takes about 8 to 10 minutes to complete the blood draw, during which you may be given a ball to squeeze regularly to keep the blood flowing. When a pint of blood has been collected, the needle will be removed and your arm will be bandaged.

With that done, it’s time for a snack and something to drink, which will help replenish the loss of your body’s fluid following the blood donation. After a brief rest of 10 to 15 minutes, you can continue on with your day. Staff at the blood donation center may provide after-donation tips as well, such as drinking plenty of water and eating foods rich in iron. You must wait at least eight weeks between donations of whole blood.

Blood donation is a short, simple process that saves lives — and hey, there’s free snacks! Are you ready to be a lifesaver?

Friday, August 9, 2019

What’s for lunch? Get your child ready for the school cafeteria


By EMILY PINEDA | School Health/Early Childhood Education Manager, Well-Ahead Louisiana and ANGELA VANVECKHOVEN | Health Education Manager, Well-Ahead Louisiana

Getting your children ready to go back to school includes getting supplies, buying new clothes, learning bus routes and many other details. You might not think about what is being served in the cafeteria, but many Louisiana students eat both breakfast and lunch at school, so it’s an important part of your child’s day. 

Here are some questions to ask and things to think about as your kids head back to the school cafeteria.

What is my child’s school cafeteria serving?

Review the cafeteria menu with your child. Menus often list alternate choices, such as entrĂ©e salads and sandwiches, available to students who don’t care for the daily special. Ask your children about the fruit and vegetable choices offered with each meal, and encourage them to try new things.

If you want more information, many school nutrition departments have a page on the school district’s website that lists ingredients, nutritional facts and allergen information.

Finally, make plans to have lunch with your child in their cafeteria, and see for yourself how the meal looks, smells and tastes.

Who should I contact with questions or concerns about the school cafeteria menu?

The school’s cafeteria manager can talk with you about anything from meal preparation to how long students wait in line for their food. If you have more detailed questions, the cafeteria manager may refer you to the nutrition director, who oversees cafeteria operations, food procurement and menu planning for the entire school district. Also, be sure to ask your child’s teacher about classroom policies regarding food rewards and items served during classroom parties.

How can I get involved in my child’s school meal program?

Ask the cafeteria manager and principal about volunteer opportunities in your school cafeteria or school garden, if there is one. Some schools request parent volunteers to help usher students through the lunch line and encourage them to try their fruits and vegetables.

Additionally, all school districts have an advisory council and wellness policy to help establish and update district nutrition and physical activity policies. These policies can affect such things as the choices available in vending machines and the amount of time allotted each week for physical education, among others.

My child has food allergies. Do school cafeterias accommodate special dietary requirements, such as being gluten-free or nut-free?

If your child has a life-threatening food allergy, it is important to build a team of key individuals at school who can help safely manage his or her needs. Start by contacting your school nurse to discuss implementing an allergy action plan. The school nurse can work with parents and healthcare providers to develop a healthcare plan to meet the unique needs of each student.

Is my child’s school a WellSpot?

In and out of the cafeteria, schools make a major impact in the health of children. Schools designated as WellSpots make the well-being of their students and staff a priority.  School WellSpots meet benchmarks that are centered on a campus-wide tobacco-free policy and a school wellness program that includes physical activity and nutrition components for both students and staff. 

To learn more about how School WellSpots make the healthy choice the easy choice, visit Well-Ahead Louisiana’s School WellSpot page and share it with your child’s school.

For more information

To learn more about school health, visit Well-Ahead Louisiana’s website or email wellahead@la.gov.

Wednesday, August 7, 2019

Louisiana’s hepatitis C subscription model: ‘We were going to fix this problem’

In case you missed it, Louisiana Department of Health Secretary Dr. Rebekah Gee sat down with the Brookings Institution on July 22 to discuss the Department’s plan to use a subscription model to obtain expensive hepatitis C drugs. The plan has generated considerable interest given the innovative use of a model that Dr. Gee has said could help Louisiana cure the disease for thousands of patients.

If you missed the video coverage of the panel discussion featuring Dr. Gee, you can find a transcript of it here

At left is Louisiana Department of Health Secretary Dr. Rebekah Gee.
Dr. Gee discussed how difficult it was to find a way around the expensive hepatitis C drugs, but told Brookings moderator Louise Sheiner that “as long as I had the ability to have this role and to fight for the people of my state, and my Governor, we were not going to take ‘No.’ We were going to fix this problem.”

“The goal,” Dr. Gee added, "is to treat everybody with this virus.”

About 90,000 people in Louisiana have viral positives for hepatitis C and in the Medicaid program, there’s about 37,000.

The event drew media attention for the focus on prescription drug prices, which is a topic the U.S. Congress is expected to take up in September.

The Washington Times reported that Neeraj Sood, a University of Southern California professor of public policy, told the panel that Louisiana’s idea is to “give these profits upfront to the pharmaceutical firm but also dramatically improve access because price is not a barrier.”

The Baton Rouge Advocate wrote that Dr. Gee said during the panel discussion that the focus was in helping Medicaid recipients and prisoners at risk of dying of the disease.

These are vulnerable populations,” The Advocate quoted Dr. Gee as saying. “We have to think outside the box."

And The Center Square noted that Dr. gee considered the subscription model a "win-win" that will "provide unlimited access of the drug to prisoners and Medicaid recipients at a cost of up to $58 million, which is about what the state spent last fiscal year to treat far fewer people with the same drug."