Friday, December 13, 2019

Holiday stress, depression and blues


By DR. JAMES E. HUSSEY | Medical Director, LDH Office of Behavioral Health

Holidays are often seen as a time of celebration, family gatherings, gift-giving, joy and other happy moments. But, for some, it is a time of additional stress, anxiety, blues or depression. In one survey conducted by the American Psychological Association, 38% responded that their stress levels increased during holidays (including lack of time, money, commercialism, gift pressures) and 56% responded that they experience most stress at work (only 29% at home).

There may be several reasons why people become more anxious, sad or depressed during the holidays:
  • SOCIAL ISOLATION: Those with small social circles or minimal family support due to few or no relatives living close by sometimes begin to feel lonely, unsupported, and left out and isolated. Winter/cold/bad weather also contributes to staying inside.
  • GRIEVING: For those gathering with relatives, they may become more aware of those who are no longer part of the gatherings or celebrations due to severe illness or death during the prior year.
  • INCREASED WORK DEMANDS: With holidays, vacations, end-of-year deadlines, reports, taxes and other demands, there can be real increases in work demands, leading to stress and anxiety.
  • FINANCIAL STRESS: Money issues can become very obvious during holidays. Finding the money to provide gifts for everyone is stressful. Worries about debt or not providing enough for family, kids and others can lead to despair, sadness, depression and anxiety. Maybe as many as 53% of people report this as a source of stress, according to a Principal Financial Group survey.
  • SEASONAL AFFECTIVE DISORDER/DEPRESSION (MAJOR DEPRESSION WITH SEASONAL PATTERN): It should be noted that there are depressive episodes that can go beyond the blues, become more sustained, and sometimes occur more frequently during the fall and develop during the winter. Most people stop having these symptoms during the spring and summer, but some may persist. This may have to do with the length of the days being shorter, decreased exposure to light or other factors. For more severe symptoms of depression, treatment should be sought, such as light therapy, talk therapy or medications.
  • HEALTH AND WELLNESS: Overeating, weight gain and bloating can be problematic for some.

Dealing with holiday depression
  • Talk to your doctor if dealing with depression or sadness for long periods of time, or if it begins to affect your functioning, activities of daily living, appetite or sleep, or if suicidal thoughts come into play.
  • There are resource help lines such as the National Suicide Prevention Lifeline (1-800-273-8255), Veterans Crisis Line (1-800-273-8255) and the Crisis Text Line (www.crisistextline.org). For emergencies, call 911.
  • Otherwise:
    • Make sure you get enough sleep.
    • Eat healthy.
    • Exercise 30 minutes per day (if tolerated).
    • Continue or begin new holiday traditions like family gatherings, outings or vacations instead of staying home.
    • Be mindful of holiday pressures.
    • Volunteer at soup kitchens, church activities, gift drives, helping elderly neighbors with yard tasks, etc.
    • Get back to nature with walks in the woods, parks along a lakeshore, etc.

Contrary to popular belief, suicides do NOT spike during holidays. November, December and January are actually low months for suicide. Peak months may be more like April through August.

Friday, December 6, 2019

Vaping use among Louisiana students triples since 2015

E-cigarette and vaping devices come in an array of sizes and shapes.

By ANGELA VANVECKHOEVEN | Health Education Manager, Well-Ahead Louisiana

A recently released report compiled by Well-Ahead Louisiana and the Louisiana Campaign for Tobacco-Free Living shows that vaping among the state’s middle and high school students has doubled since 2017 and tripled since 2015. 2019 E-Cigarette Use Among Louisiana Youth reveals that 32% of high school students and 15% of middle school students vape, which follows the national trend of increased vaping among youth and youth adults.

These numbers are especially alarming in light of the current outbreak of lung injury (EVALI) associated with e-cigarette use, also known as vaping. The CDC launched an investigation into the outbreak on Aug. 1, and as of Dec. 4 has confirmed 2,291 cases in 50 states, the District of Columbia, Puerto Rico and the U.S. Virgin Islands, with 48 of the patients dying because of the illness. In Louisiana, 32 cases have been confirmed, with two deaths. The median age of victims is 24 nationally and 28 within the state.

As of Nov. 8, the CDC found vitamin E acetate in lung fluid samples from 29 patients from 10 states, the first detection of a potential chemical concern in biologic samples from EVALI patients. Vitamin E acetate usually does not cause harm when ingested as a vitamin supplement or applied to the skin. However, previous research suggests when vitamin E acetate is inhaled, it may interfere with normal lung functioning. Vitamin E acetate is used as an additive in the production of e-cigarettes because it resembles THC (tetrahydrocannabinol) oil, and it’s also used as a thickening ingredient in e-liquids. Click the links to learn more about the national outbreak and the Louisiana cases.

Action steps

Even without the threat of EVALI, vaping can harm a teenager's still-developing brain and negatively affect memory, learning and concentration. To effectively protect young people from all forms of tobacco — including e-cigarettes, cigarettes, cigars, little cigars and hookah — Well-Ahead Louisiana offers the following resources and encourages adults to take action.
  • KNOW WHY TEENS VAPE: According to the new report, 45% of middle school students and nearly 37% of high school students said the reason they vape is because a friend or family member does. More than 14% of middle school students and nearly 21% of high school students like that vape products are available in flavors. Nearly 7% of the middle school students and almost 15% of the high school students believe that vaping is less harmful than other tobacco products.
  • KNOW THE RISKS AND EDUCATE YOUTH: In addition to harming brain development, nicotine exposure in youth can increase the risk for future addiction to other drugs. Well-Ahead has compiled resources to educate parents, teachers, coaches, etc. about the harmful effects of these products, as well as how to talk to teens about vaping.
  • HELP YOUTH QUIT: Youth who vape are four times more likely to go on to smoke cigarettes. Quitting nicotine isn't easy, but it can be done with the right support. Find access to youth cessation resources here.
  • IMPLEMENT EFFECTIVE, 100% TOBACCO-FREE SCHOOL POLICIES: Every Louisiana school district is required to have a written 100% tobacco-free school policy that prohibits the use of any tobacco products, including e-cigarettes, on campus and at school-related events for students, staff and visitors. It is important to educate and promote compliance among school staff to support this policy. Visit wellaheadla.com to ensure your school’s policy complies with Louisiana law and to find resources for effective implementation.

The bottom line

Because nicotine and other chemicals in e-cigarettes can be damaging to the development of a teen's brain, yet youth do not see vaping as being harmful, it's important for adults to understand the products youth are using and be prepared to talk about their effects. For more information, visit wellaheadla.com or contact us at wellahead@la.gov.

Friday, November 29, 2019

Vaccines save lives. Period.


By DR. DAWN R. MARCELLE | Region 2 Medical Director, LDH Office of Public Health

Keeping our children safe and healthy rank among the highest of parents’ concerns — and where safety and health meet, the topic of vaccines will often arise. While parents have the right to make decisions about their children’s health, as a pediatrician and a mother of two, I can confidently say without hesitation that overall, vaccines are safe and effective.

Vaccines are the best way to protect your child against a number of illnesses, including measles, whooping cough (pertussis) and mumps, all of which have made a comeback in recent years due to a drop in vaccination rates. Other vaccine-preventable illnesses include tetanus, diphtheria, varicella (chickenpox), rubella, hepatitis B, polio, meningococcal meningitis and influenza, especially now with flu season in full swing across Louisiana.

How they work

A vaccine contains a version of the bacterium or virus responsible for a particular disease. Vaccines can be live (containing a weakened form of the bacterium or virus) or inactivated (containing a killed version of the bacterium or virus).

For example; if you receive a chickenpox vaccine, the presence of the chickenpox virus in the vaccine causes the body to think that it’s under attack. This activates the immune system, which treats the weakened/dead chickenpox virus (antigen) like a full-blown infection and makes antibodies to fight off the disease. These chickenpox antibodies remain in the person’s immune system, ready to provide active protection if you come into future contact with live chickenpox virus.

Immunization schedules

With so many vaccines out there, how is a parent to know which vaccine is needed and when? That’s where immunization schedules are helpful. Developed with your child’s safety in mind, immunization schedules show which vaccines are given at which stages of your child’s life. Following such schedules provides immunity early in life before most infants and children are exposed to life-threatening diseases.

Vaccination schedules are developed by the CDC’s Advisory Committee on Immunization Practices (ACIP). The committee includes physicians and public health practitioners who are dedicated to keeping children safe and healthy. All vaccines listed on immunization schedules have been exhaustively tested to be sure they are safe and effective. Sometimes multiple vaccines will be given at a single pediatric visit, and this is safe and normal. There’s not enough antigens in vaccines to overload a healthy baby’s immune system. In fact, during an average day a baby will encounter more antigens than they will receive in a vaccine.

Some parents, expressing concern about the number of vaccines their children receive from infancy to school age, may wish to follow an alternative schedule that spreads out vaccines or even skips some entirely. This practice is discouraged by the American Academy of Pediatrics, which recommends parents follow established immunization schedules. These schedules are for your child’s protection, and following them gives your child immunity early in life, before they can be exposed to potentially deadly diseases like measles.

Keep in mind that some children can’t be vaccinated, such as those with weakened immune systems due to an illness or medical treatment. The best protection for these children is for everyone around them to be vaccinated — that includes parents, grandparents, siblings, aunts, uncles and any caregivers.

Life savers

As a pediatrician, let me say once again that vaccines are overwhelmingly proven safe and effective. I encourage parents to follow the recommended immunization schedules to give their children the best possible protection against a number of serious diseases.

The American Academy of Pediatrics considers vaccines to be one of the the most significant medical innovations of our time. Considering the countless lives saved thanks to vaccines, I couldn’t agree more.

Helpful links


Friday, November 22, 2019

Friends and family will be thankful for these healthy Thanksgiving dishes


Thanksgiving is famously known as a time for good eating. Your eyes are often bigger than your stomach, and you may be eating special foods that only come around once or twice a year. In anticipation of packing so many delicious dishes into your belly, you may even bring out your “fat pants” so you have extra room.

But, instead of letting temptations run free, why not make a healthy and delicious contribution to the Thanksgiving table? A little planning and preparation can go a long way toward giving you and your loved ones’ waistlines something to be thankful for, like one of these better-for-you side dishes from Well-Ahead Louisiana.

If you’re serving a larger group than what the recipe calls for, no worries — just double or even triple the recipe to meet your needs. Click on any recipe card to enlarge it.





When Thanksgiving is over, what can you do with leftover turkey besides sandwiches? Try a hot, comforting and healthy cup of soup. To make this soup lower in saturated fat, prepare it ahead of time to cool and skim off the fat that rises to the top.


For more healthy lifestyle advice, visit Well-Ahead Louisiana.


Happy Thanksgiving!

Friday, November 15, 2019

Time to travel, but do it safely


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

With summer well behind us and school in session, it is a great time to travel. Seniors, with time and disposable income, can devote more of their life to exploring the U.S. and abroad. In fact, world travel for all ages has exploded in the last few decades, with more people traveling to more and more exotic locations, often remote and underdeveloped.

Travelers need to consider many precautions, however, prior to any long-distance, prolonged voyage in order to have a safe experience.

Precautions start in the airplane. Reduced cabin pressure, prolonged inactivity and close quarters predispose travelers to reduced oxygen, deep venous thromboses and increases in airborne or contact transmitted infections.

Once on site, exotic foods, wild animals and insect-borne illnesses all pose threats to travelers. Avoiding unfiltered water and raw or undercooked foods, especially from street vendors, can go a long way toward preventing food- and water-borne diseases. Never touch or approach any dogs, cats, or other domestic or wild animals, since rabies is common around the world.

Safe driving, safe sex and mosquito avoidance can prevent a whole host of serious health issues.

High altitude carries its own danger of altitude-related sickness, a significant risk for older travelers and those with chronic heart or lung diseases. Careful acclimatization or the use of medications such as Diamox may be required.

Remember to use caution when climbing the steps of that wonderful, ancient pyramid or magnificent cathedral.

Vaccinations

Vaccinations largely depend on the location of travel. All travelers need to consult www.cde.gov/travel for site-specific vaccination recommendations.
  • Yellow fever vaccination is required for multiple areas of Africa and South America. Unfortunately, stocks of the vaccine are severely limited worldwide and there is only a single site in Louisiana — in Metairie — with consistent availability.
  • Hepatitis A and B vaccines should be up to date since both diseases remain widespread in developing countries. Because both vaccines are administered in a series that takes from four to six months to complete, do not wait until the last minute. That being said, it is better to be partially vaccinated than not vaccinated at all.
  • Meningitis vaccine remains necessary for most of Sub-Saharan Africa, especially in the dry winter season from December through June.
  • Typhoid vaccine, as either an injection or four capsules taken over seven days, offers protection, especially for travelers in Southeast Asia.
  • Japanese encephalitis vaccine is also recommended in some parts of Asia, especially rural areas.
  • Cholera, transmitted by contaminated food and water, remains a danger and travelers to countries where it occurs should be vaccinated with a single oral dose of the vaccine.
  • Influenza (flu) varies depending on the season, which differs in the Northern (winter) and Southern (summer) hemispheres. Annual vaccination against the flu protects in either hemisphere although variations occur in the organism due to genetic shifts in the virus.
  • Measles, mumps and rubella remain worldwide threats and that particular vaccine (MMR) should be administered to those born from 1957 to 1989. Measles is highly contagious and rates are much higher outside the U.S., even in Europe.
  • Poliomyelitis and TdaP (tetanus, diphtheria and pertussis or whooping cough) vaccines should be up to date prior to any travel.

Pregnant women and those with complex medical conditions should always consult a physician prior to travel. Both MMR and varicella are live vaccines and should not be given to pregnant women.

Medications and insurance

Everyone should carry enough medication for the entire trip as well as a complete list of his or her medications (with commercial and generic nomenclature) and the doses.

For older travelers, remember that Medicare does not work overseas. Some private insurances do cover clients out of the U.S. but this coverage varies significantly. Supplemental health insurance for travelers is available for a price, often hefty in senior citizens.

Travel should be a mind-expanding experience and not one ending in costly medical problems or death. See the world, have fun, but be sure to take all the necessary precautions for safe travel. Prevention is always the best medicine at any age and anywhere in the world.

Friday, November 8, 2019

Vulnerable adults can be easy targets for financial abuse


By SHARON JACKSON | Adult Protective Services Program Director, LDH Office of Behavioral Health

News headlines in recent months have brought us stories of elderly Louisianans who have been tricked into withdrawing money from the bank or taking money from a family member’s account without permission, among other stories of financial abuse. While cases such as these are handled by the Governor’s Office of Elderly Affairs, which serves people ages 60 and older, there is a resource within the Louisiana Department of Health that serves a similar purpose for those under 60.

Adult Protective Services (APS) operates under the umbrella of the Department’s Office of Aging and Adult Services, serving ages 18 to 59 and emancipated minors (those who are legally considered an adult). APS investigates reports of abuse and arranges for services to protect vulnerable members of these populations who are at risk of abuse, neglect, exploitation or extortion.


Financial abuse, including exploitation and extortion, is one of the allegations APS investigates, and the number of cases APS investigates has been on the rise over the past several years. Reports of vulnerable adult Louisianans falling victim to financial abuse climbed from 760 in 2017 to 828 in 2019. It’s the third most common kind of abuse investigated by APS in Louisiana, after caregiver neglect and emotional abuse. While being highly common, financial abuse is also highly underreported.

What is considered financial abuse?

Adult Protective Services handles issues of theft and fraud by a family member, caregiver or other parties known to the adult.

Theft involves assets taken without the adult’s knowledge, consent or authorization. It may also include the taking of their cash, valuables, medications or other personal property. Fraud involves acts of dishonestly by those entrusted to manage the adult’s assets but instead use them for unintended purposes. Fraud may include falsification of records, forgeries, unauthorized check-writing and Ponzi-type financial schemes.

According to the National Adult Protective Services Association (NAPSA), vulnerable adults who fall victim to financial exploitation may be subject to:
  • Loss of trust in others
  • Loss of security
  • Depression
  • Feelings of fear, shame, guilt, anger, self-doubt, remorse and/or worthlessness
  • Financial destitution
  • Inability to replace lost assets through employment
  • Inability to hire an attorney to pursue legal protections and remedies
  • Becoming reliant on government safety net programs
  • Inability to provide long-term care needs
  • Loss of primary residence

Sometimes, people who have been the victims of financial abuse may also be victims of physical and/or emotional abuse or neglect.

Reporting abuse
Louisiana’s Adult Protective Services Reporting Law requires all Louisianans to report abuse, neglect, exploitation and extortion of adults with disabilities. Any citizen who reports in good faith and who cooperates or participates in judicial proceedings to assistant in an investigation by APS is granted immunity from civil or criminal liability.

Under this law, anyone who knows of such an incident and fails to report it or knowingly makes a false report is subject to criminal penalties.

To report a case of a vulnerable adult (between ages 18 and 59) who may be at risk of abuse, call APS at 1-800-898-4910. This toll-free hotline takes reports 24 hours a day, seven days a week. If the situation threatens the life of an adult with disabilities, call 911 immediately.

You don’t have to give your own name when making a report, but doing so along with providing your contact information helps APS with its investigation if additional information or details are needed at a later date. If you choose to share your name, it will be kept confidential unless the case requires the involvement of law enforcement.

When reporting a case to APS, you’ll need to provide the alleged victim’s name, location and details of the alleged abuse. Share as much information as possible. APS will screen your report to make sure it’s appropriate for APS services. If deemed appropriate, an APS specialist is assigned to the case. This specialist will conduct an investigation and arrange protective services for the victim.

Investigating abuse

Depending on the victim’s risk of harm, an investigation will begin within 24 hours or before 10 business days of the report being filed, with investigations being completed within 30 days. Because APS is not a law enforcement agency, these probes are not criminal investigations. However, APS may refer a case to law enforcement or the District Attorney’s Office when a crime is suspected.

If during the course of the investigation the victim is determined to be at continued risk of harm or mistreatment has occurred, APS will use social service or civil legal options to protect the victim. Interventions to protect the victim or reduce their risk of harm go into action within 90 to 120 days, though competent adults have the legal right to refuse intervention.

APS investigations are confidential, so results can’t be shared or released except for certain information and only to the victim and/or their legal representative and with law enforcement, medical or social service agencies, as needed, to coordinate services to the victim.

Remember: If you suspect or have evidence that someone is being financially abused, report it. Help keep some of our most vulnerable Louisianans safe.

For more resources on Adult Protective Services, click here.

Friday, November 1, 2019

Center for Evidence to Practice working to improve behavioral health


The Louisiana Department of Health’s Office of Behavioral Health and the LSU Health New Orleans School of Public Health are proud to say the Center for Evidence to Practice is up and running.

Now, you’re probably wondering — what is the Center for Evidence to Practice? This initiative serves Louisiana as a hub for training and implementation of best practices for behavioral health services for children, youth and families.

Behavioral health evidence-based practices are therapies that have undergone the multiple, rigorous, randomized controls vital to determine whether a practice has proven to be effective. While many behavioral health therapies exist, only a handful are considered best practices. Evidence-based practices in behavioral health are a nationally-recognized strategy to seeing improved outcomes, and it’s something that’s been gaining steam in Louisiana.

Resources at your fingertips

One of the biggest achievements of the Center’s launch is its website, laevidencetopractice.com. If you’re a parent seeking help for your child, a behavioral health service provider or any other kind of stakeholder in behavioral health, you will want to check out this website.

There’s a statewide map that shows where to find specialized, trained providers certified in evidence-based practices and providers currently working toward certification. This map is continually being updated, so if you find inaccurate information, just use the “Contact Us” function on the website to report it so that it can be corrected.

Another feature is a calendar listing events and trainings for behavioral health providers, sponsored by the Center and by other partners such as state agencies and managed care organizations. Many of these trainings are free of cost to providers who serve Medicaid-eligible youth.

You also will have the option to sign up for the Center’s newsletter, Behavioral Health Buzz, which includes monthly updates on evidence-based practice trainings and implementation.

Coming soon is E2P Learn, an online e-learning platform for behavioral health provider agencies, practitioners and other stakeholders. This platform will use videos and webinars to provide comprehensive support for the implementation and sustainability of evidence-based practices in Louisiana.

Find behavioral health providers certified in evidence-based practices using a map available
on the Center for Evidence to Practice website, laevidencetopractice.com

Best practices

So, what are these evidence-based practices? The Center currently recognizes these 10 evidence-based practices in Louisiana:
  • Homebuilders: A home-based intensive family preservation services treatment program that enlists families as partners in assessment, goal setting and treatment planning, with the aim of avoiding unnecessary placement of children and youth into foster care or other out-of-home placements.
  • Functional Family Therapy (FFT): Home-based intensive therapeutic model for families with multiple risk factors, serving youth ages 10 to 18 in the context of their families. The goals are to reduce behavioral and emotional problems in youth through family therapy that engages and motivates the family to improve family functioning, and change behaviors such as truancy, aggression and substance use.
  • Multisystemic Therapy (MST): An intensive home-, family- and community-based treatment serving youth ages 12 to 17, in the context of their families, who are exhibiting significant negative behaviors such as chronic or violent juvenile offenses.
  • Assertive Community Treatment (ACT): An intensive home- and community-based intervention delivered by an interdisciplinary team, for individuals 18 and older with a severe and persistent mental illness, with the goal of promoting symptom stability, increasing the individual’s ability to cope and relate to others, and enhancing the highest level of functioning in the community.
  • Functional Family Therapy – Child Welfare (FFT-CW): Home-based intensive therapeutic model for families of youth ages birth to 18, where there are issues of child safety/neglect/family violence. The goals are to address safety and risk factors, change referral behaviors, reduce child maltreatment risk and preserve home placement.
  • Parent-Child Interaction Therapy (PCIT): Therapy that focuses on improving parent-child relationships, by coaching the parents of young children in specific skills to help establish a nurturing relationship with their child, foster positive behavior and discourage negative behavior.
  • Child-Parent Psychotherapy (CPP): A parent-child therapy for children up to age 6, which addresses trauma with the caregiver and child, with the goal of supporting and strengthening the parent-child relationship as a vehicle for restoring and protecting the child’s mental health.
  • Youth- and Preschool-PTSD Treatment (YPT and PPT): For children who have experienced trauma, a therapy that works with parent and child to acknowledge the trauma experienced, learn skills to cope with trauma reminders and reduce the severity of trauma-related symptoms.
  • Triple P Positive Parenting Program (Triple P-Standard Level 4): Parenting skills program for parents seeking intensive training in positive parenting skills.
  • Trauma-Focused Cognitive Behavioral Therapy (TF-CBT): For youth ages 3 to 18 who have experienced trauma, this therapy provides skills for relaxation, emotion regulation and coping, and helps both the child and the caregiver to understand and process the trauma experience, to reduce trauma-related symptoms and enhance future safety.

By identifying these evidence-based practices, Louisiana behavioral health providers are able to apply the most appropriate therapy to youth and families, helping them to heal and live full, healthy lives.

To learn more about the Center for Evidence to Practice, visit laevidencetopractice.com.

Friday, October 25, 2019

Knowing your family history can help you catch cancer early





(Note: October is Breast Cancer Awareness Month. The following is a transcript of the video posted above, which was originally shared by Taking Aim at Cancer in Louisiana [TACL] on its Facebook page.)

Hello, I’m Gerrelda Davis, the executive director of the Louisiana Primary Care Association. In collaboration with TACL and its Knowing Your Family History campaign for Breast Cancer Awareness Month, I’d like to tell you about my story.

In 2010, I actually had a mammogram, and it was my second mammogram ever in my life. I was 40 years old and I, thank goodness, had decided when I was 39 and pressured my doctor to have a baseline mammogram. They thought I was too young, but I told them I needed it. I’d only at that point in my family history had one maternal aunt that had been diagnosed with breast cancer.

So, at 40, when I turned 40 and had the test done, unfortunately about a day later I got a call and they were telling me that I needed to come back in for further tests. So, it took me about, I think, five tests later for them to diagnose me with Stage 1 breast cancer. It really turned my life upside down, not knowing whether or not I would survive, what I would have to go through.

Gerrelda Davis, right, with Louisiana Department 
of Health Secretary Dr. Rebekah Gee
But I’d say — and this is not a plug for them, believe it or not — Ochsner Health System in New Orleans, they were so, so welcoming and kind to me, and the doctors that worked there were just a blessing. And, then when I found out that those same doctors had been on the same team that my aunt had been when she was diagnosed, I was just so comfortable, and by the grace of God I got through what I had to get through.

Because of my age, I had to go through a very long and extensive amount of chemo, a chemo regimen, and after that I had to do radiation. But I had the support that I needed from family, from friends, from work. I had the best bosses at that time who allowed me to take off when I needed to, to do my treatment and come back into the office whenever I could. And, it was just an experience I’d say that could have really shattered my life but didn’t because of the support that I had, the connectedness.

And then, though, at the very end, after the radiation, after the chemo, I will say that for anyone, you, that after you’re not going to the doctor every single day or every week it makes you feel lost. And, I did feel lost. Because I wasn’t sure. Every time I thought about it, I’m like, “OK, is it gonna come back?” Also, I had that survivor’s guilt — I thought about all those people that were diagnosed who didn’t survive. But thank goodness, by the grace of God I got through that because of, once again, the support system that I had.

And, I’ll tell you, there’s this quote by Eleanor Roosevelt that I actually decided to make a mantra for in my life and it says, “You must do the thing you think you cannot do,” and that’s to be a survivor. And, I determined after all of that, that no matter what I would be a survivor. No matter what, whether or not my hair grew back, my eyebrows grew back — you know, being a female and being very, I guess, vain about those types of things — no matter what, I determined that I would be a survivor.

And, here I am, nine years later, still surviving — going to my oncologist every six months, having a clean bill of health — and thankful and very grateful that I determined to survive. And, by the grace of God, I have. Thank you.

Friday, October 18, 2019

Flu season’s making an early appearance this fall


By DR. GINA LAGARDE | Medical Director, LDH Region 9

As the heat of a seemingly endless summer finally begins to wane and the crisp coolness of fall takes its place, it’s the perfect time to schedule flu vaccinations for you and your family. Why now? Because here in Louisiana, flu activity is off to an earlier start than usual.

The Louisiana Department of Health’s Infectious Disease Epidemiology Program has already seen statewide influenza-like activity, which is a fever greater than 100 degrees Fahrenheit plus a cough and/or sore throat, in the absence of another diagnosis. In Louisiana, 4.4% of patient visits were due to influenza-like illness, which is higher than the regional baseline of 3.8% and the highest level of influenza-like activity so far in the nation this flu season.

The flu is a highly contagious respiratory illness that kills thousands of people every year. Last year in Louisiana, there were 14,000 hospitalizations, 1,400 deaths and one confirmed pediatric death. If you are 6 months or older and you don’t have a medical reason, such as a prior allergic reaction to the flu shot, you should get vaccinated. It’s the best way to reduce your chance of getting and spreading the flu.


Cold or flu?

It’s often hard to distinguish the difference between a cold and flu since both illnesses share several of the same symptoms. While both are unwelcome, a cold settles in gradually and flu shows up abruptly. Here’s how to tell the difference between the two.
  • It’s flu if you have …
    • Fever
    • Cough
    • Sore throat
    • Runny or stuffy nose
    • Body aches
    • Headaches
    • Chills
    • Fatigue
    • Diarrhea
    • Vomiting
  • It’s a cold if you have …
    • Loss of appetite
    • Sore throat
    • Sneezing
    • Cough
    • Vomiting

With plenty of fluids, rest and treating symptoms with over-the-counter medications, most people will recover from the flu on their own. If you have had the flu, stay home for at least 24 hours after the symptoms subside, unless you’re very sick and in need of medical care.

Anyone suspected of having the flu is strongly recommended to take antiviral drugs. This treatment may make the illness milder, shorten the time a person is sick and prevent serious complications and/or even death. If you or a family member may have the flu, call your doctor immediately.

These healthy everyday habits help slow the spread of flu:
  • Coughing/sneezing into your sleeve or tissue and throwing the tissue in the trash
  • Washing your hands often with soap and water, or using an alcohol-based sanitizer
  • Avoiding close contact with sick people


Why the flu shot matters

Flu can be especially dangerous to the very old, the very young, pregnant women and people who have certain chronic medical conditions. When everyone around people from these groups is vaccinated, the so-called “herd immunity” of a large population of vaccinated people helps to keep them from getting sick.

Pregnant women are especially at risk when it comes to flu, but don’t worry — it’s safe to get your flu shot, and it’s recommended by the CDC. Changes in the immune system, heart and lungs during pregnancy make pregnant women and up to two weeks after birth more prone to severe illness from flu, including illness resulting in hospitalization. Flu is also a danger to the developing baby, who may have neural tube defects or other complications due to flu symptoms in the mother. Fortunately, a mom who gets her flu vaccine during pregnancy will pass antibodies on to her baby, helping protect the baby from flu after birth.

Schoolchildren are another group particularly affected by flu. Every year, about 28% of school-age kids come down with the flu. For every 100 children with the flu, there’s an average of 63 missed school days a year. Not only that, but for every 100 kids with the flu, 25 family members will come down with the flu within three days, leading to lost work time and reduced productivity.

Don’t wait — vaccinate!

An annual vaccination is your best prevention against the flu. It’s available either as the traditional shot or a nasal spray. The spray is recommended for healthy people ages 2 to 49 who are not pregnant and don’t have chronic illnesses, but check with your doctor or other primary care provider before getting the spray.

We have had flu vaccines for more than 50 years now and they are very safe. The CDC and FDA closely monitor vaccine safety, and vaccines are given in a setting where healthcare staff can rapidly recognize and treat a potentially severe allergic reaction with equipment on site. Besides safety concerns, people cite lots of reasons why you shouldn’t get a flu shot. These reasons are all wrong. Learn more about these myths – and the facts –here.

This October and November, flu vaccine clinics where you can get a flu shot at no cost to you are being held around Louisiana. To find the location closest to you, click here. Make sure to bring your private insurance, Medicaid or Medicare card, and wear short or loose-fitting sleeves. If you’re unable to make it to one of these clinics, you can get a flu shot at any time during flu season from your parish health unit, local pharmacies, clinics, doctors’ offices and federally qualified (community) health centers. Find a provider near you by clicking here.

For more information, visit ldh.la.gov/FightTheFlu.


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: