COVID-19 | DHR Health | Serving McAllen and Rio Grande Valley

09.15.2020

Featured Story

DHR Health Receives Get With The Guidelines-Stroke Gold Plus Quality Achievement Award From The American Heart Association

DHR HEALTH RECEIVES GET WITH THE GUIDELINES-STROKE GOLD PLUS QUALITY ACHIEVEMENT AWARD FROM THE AMERICAN HEART ASSOCIATION

Award demonstrates DHR Health’s commitment to quality care for stroke patients with some of the fastest door-to-treatment times in the nation.

DHR Health has received the American Heart Association/ American Stroke Association’s Get With The Guidelines®-Stroke Gold Plus Quality Achievement Award with Target: StrokeSM Honor Roll Elite and Type 2 Diabetes Honor Roll. The award recognizes DHR Health’s commitment to ensuring that stroke patients receive the most appropriate, timely treatment according to nationally recognized, research-based guidelines rooted in the latest scientific research.

To receive the Gold Plus Achievement Award, DHR achieved higher than 85% adherence to all Get With The Guidelines-Stroke achievement indicators for two 12-month consecutive periods and achieved higher than 75% compliance with seven of 10 Get With The Guidelines-Stroke Quality measures.

To qualify for the Target: Stroke Honor Roll Elite, hospitals must meet quality measures developed to reduce the time between the patient’s arrival at the hospital and treatment with the clot-buster tissue plasminogen activator, or tPA, the only drug approved by the U.S. Food and Drug Administration to treat ischemic stroke. If given intravenously in the first three hours after the onset of stroke symptoms, tPA has been shown to significantly reduce the effects of stroke and lessen the chance of permanent disability. DHR Health earned the Target: Stroke Honor Roll Elite award by meeting specific quality achievement measures for the diagnosis and treatment of stroke patients—demonstrating some of the fastest door-to-treatment times in the nation.

“This recognition from the American Heart Association shows the dedication of our Level One Comprehensive Stroke Center as a leader in the region to provide excellence in stroke care and follow the latest recommended guidelines for stroke treatment to improve patient outcomes.” Dr. Singh, DHR Health Chief Executive Officer

The Get With The Guidelines-Stroke quality measures are designed to help hospital teams provide the most up-to-date, evidence-based guidelines with the goal of speeding recovery and reducing death and disability for stroke patients.

“When treating a stroke, time lost is brain lost. Therefore, this national recognition reflects the dedication and team effort to provide high-quality, efficient care to evaluate and treat patients experiencing a stroke. Our Emergency Department is ready 24/7 to evaluate and treat possible strokes by consistently using a solid team approach supported by the most advanced technology” Dr Javier Cortinas, DHR Health Emergency Department physician.

“We are pleased to recognize DHR Health for their commitment to stroke care,” said Lee H. Schwamm, M.D., national chairperson of the Quality Oversight Committee and Executive Vice Chair of Neurology, Director of Acute Stroke Services, Massachusetts General Hospital, Boston, Massachusetts. “Research has shown that hospitals adhering to clinical measures through the Get With The Guidelines quality improvement initiative can often see fewer readmissions and lower mortality rates.”

DHR Health additionally received the Association’s: Target: Type 2 Honor Roll™ award. To qualify for this recognition, hospitals must meet quality measures developed with more than 90 % of compliance for 12 consecutive months for the “Overall Diabetes Cardiovascular Initiative Composite Score.”

For providers, Get With The Guidelines-Stroke offers quality improvement measures, discharge protocols, standing orders and other measurement tools. Providing hospitals with resources and information that make it easier to follow treatment guidelines can help save lives and ultimately reduce overall healthcare costs by lowering readmission rates for stroke patients. Through its participation, DHR Health has access to best practice strategies and successful efforts to improve acute stroke care, as well as access to world-class experts and a curriculum on timely and effective acute stroke care.

“In addition to the recognition, DHR is certified by the Joint Commission as the Advanced Comprehensive Stroke Center in the RGV. We are best equipped to provide specialized care and better outcomes for patients with the most complicated strokes. Credit for these awards and this certification is not DHR’s alone: the people of the RGV and the EMS services of the RGV must share the credit. Whether delivery of tPA within treatment guidelines or provision of advanced stroke treatment, timeliness is the most important component of effective stroke treatment and it can only be ensured by stroke victims, bystanders, and caregivers who promptly recognize the signs of stroke and by EMS services who promptly deliver stroke victims to DHR. We thank the people and the EMS services of the RGV for their essential role - acting FASTly - which contributed to DHR earning the awards and certification.” Dr. Patrick Noonan, Comprehensive Stroke Medical Director.

About Stroke Treatment and Prevention
A stroke occurs when a blood vessel is either blocked by a clot or bursts, preventing oxygen and nutrients from reaching part of the brain. Cells in the area begin to die and functions controlled by that part of the brain are lost. A stroke can affect your memory and emotions, as well as your ability to walk, talk, or understand.

According to the American Heart Association/American Stroke Association, stroke is the number five cause of death and a leading cause of adult disability in the United States. On average, someone suffers a stroke every 40 seconds; someone dies of a stroke every four minutes; and 795,000 people suffer a new or recurrent stroke each year. Moreover, heart disease and stroke are the number one cause of death among Hispanics and Latinos in the United States. Combined, heart disease and stroke account for more than 26.6% of Hispanic and Latino deaths each year.

Medical research and advances in treatment have greatly improved stroke patient survival rates. But, the chances of survival are even better if the stroke is identified and treated immediately. Immediate treatment may minimize the long-term effects of a stroke and prevent death.

For patients, Get With The Guidelines-Stroke uses the “teachable moment,” the time soon after a patient has had a stroke, when they learn how to manage their risk factors while still in the hospital and recognize the F.A.S.T. warning signs of a stroke. F.A.S.T. is an easy way to remember the sudden signs of a stroke. If you notice these signs, call 9-1-1 for help right away:
F – Face Drooping – Does one side of the face droop or is it numb? Ask the person to smile. Is the person’s smile uneven?
A – Arm Weakness – Is one arm weak or numb? Ask the person to raise both arms. Does one arm drift downward?
S – Speech Difficulty – Is speech slurred? Is the person unable to speak or hard to understand? Ask the person to repeat a simple sentence, like “The sky is blue.” Is the sentence repeated correctly?
T – Time to call 9-1-1 – If someone shows any of these symptoms, even if the symptoms go away, call 9-1-1 and get the person to the hospital immediately. Check the time so you’ll know when the first symptoms appeared.

Beyond F.A.S.T., there are other symptoms you should know:
• Sudden numbness or weakness of the leg, arm or face
• Sudden confusion or trouble understanding
• Sudden trouble seeing in one or both eyes
• Sudden trouble walking, dizziness, loss of balance or coordination
• Sudden severe headache with no known cause

Knowing your risk factors is the first step in preventing a stroke. Stroke risk factors that you can control or treat include high blood pressure, diabetes, and high cholesterol as well as smoking, excessive alcohol, illegal drug use, physical inactivity, and obesity. If you have any of these health risks, talk to your doctor to develop and preventive plan that’s right for you. By having regular medical checkups and knowing your risk, you can focus on what you can change and lower your risk of stroke.

About Get With The Guidelines®
Get With The Guidelines® is the American Heart Association/American Stroke Association’s Get With The Guidelines® is the American Heart Association/American Stroke Association’s hospital-based quality improvement program that provides hospitals with tools and resources to increase adherence to the latest research-based guidelines. Developed with the goal of saving lives and hastening recovery, Get With The Guidelines has touched the lives of more than 9 million patients since 2001. For more information, visit heart.org/quality.

09.08.2020

Featured Story

KRGV News: Valley Teen Shares Cancer Story

EDINBURG - September is nationally recognized as childhood cancer awareness month.

According to Texas Health and Human Services, cancer is the leading cause of disease related deaths in people between one and 24.

As part of childhood cancer awareness month, a teen cancer patient at DHRHealth Hospital shared his story to inspire other children to be hopeful.

Abraham Yanez was diagnosed with Leukemia cancer at the age of ten and diagnosed again at 13.

Before he was diagnosed with cancer, he was diagnosed with autism.

Pediatric hematologist-oncologist physician, Dr. Juan Bernini believes that Abraham is special because, despite his medical conditions Abraham remains active and joyous everyday.

“He’s doing very well with his treatment. We offer him the best treatment available and his chances of being healed are very very good,” Dr. Bernini said.

A short time after Dr. Bernini found cancer cells in Abraham’s spinal fluid in July, Abraham’s mother was diagnosed with a different form of Leukemia cancer.

“It’s not common the Leukemia is first in the son and after in the mom. So it’s really strange, we have no idea what’s going on,” Abraham’s father, Jesus Yanez said.

“The last study we did through research show that at least ninety five percent of kids...with leukemia can be cured,” Dr. Bernini said.

Despite the promising numbers Dr. Bernini believes more research should be done with childhood cancers.

If you feel inspired and would like to participate in raising awareness, DHRHealth will host its childhood cancer awareness month ‘Parade of Gold’ on Saturday, September 19.

The event will take place at the Edinburg Conference Center between 6:00 p.m. and 7:00 p.m.

Officials ask that all participants decorate their vehicles and wear gold in celebration of all childhood cancer survivors.

All child cancer survivors are welcomed to participate.

To RSVP or for more information regarding the parade call 956-362-2114.

Click here to view original story at KRGV.com

08.27.2020

Featured Story

Ask The Expert: Why is It Important to Get Vaccinations? Who Should Get Vaccinations?

Why is It Important to Get Vaccinations? Who Should Get Vaccinations?

Dr. Marissa Gomez-Martinez
DHR Health Edinburg CISD School Based Health Center

Vaccines play a key role in keeping us healthy. The Centers for Disease Control and Prevention (CDC) recommends vaccinations throughout your life to protect against several infections, many of which have no medical treatments. When you skip vaccines, you leave yourself vulnerable to illnesses that can cause serious complications and even death. Getting vaccinated can help you, your family and your community stay healthy.

Vaccines are safe and effective. Before approval for use in the U.S., vaccines go through rigorous testing for safety and effectiveness by the Food and Drug Administration with continued monitoring by the CDC. Through vaccination, a small amount of “weakened or killed” virus causing the disease (antigen) is introduced into the body. The antigen is not strong enough to cause disease but rather triggers the body to produce protective antibodies, preventing infections and serious disease. The U.S. has been able to eradicate diseases such as smallpox with vaccines.

Vaccines help protect the community by preventing the spread of infection from person to person. When a majority of a community has protection against a disease, it decreases the levels of circulating infection and prevents outbreaks. This, in turn, helps protect those who cannot get vaccines, due to age or a medical reason. This is known as herd immunity.

Vaccines reduce healthcare costs by preventing debilitating diseases that lead to visits to healthcare providers, hospital stays and early deaths. They also prevent lost time from work due to personal illness or need to care for a sick loved one.

Immunizations can help prevent some infections that can lead to cancer. Hepatitis B and Human Papillomavirus (HPV) infections are both linked to certain cancers. Vaccines can help prevent certain strains of both of these infections.

Who should get vaccinations?

All of us should get vaccines. Starting at birth and continuing throughout adolescence, children need to complete their primary series of each vaccine for optimal protection from serious illness and complications of vaccine-preventable diseases. Children have a mandatory schedule of vaccines that physicians follow to eliminate outbreaks of preventable diseases. Keeping up with your child’s immunization schedule also protects others you care about, including family members, friends, and grandparents.

As per the National Foundation for Infectious Diseases, approximately 50,000 U.S. adults die from vaccine-preventable diseases every year. Many adults forget that they need vaccinations. It is just as important to continue to maintain an up-to-date immunization status as you age. People age 65 and older and those with comorbidities such as diabetes, heart disease, kidney disease, and lung disease are at higher risk of complications from infectious diseases. As you get older, your immune system weakens, immunity can fade and it can be more difficult to fight off infections. The most important vaccinations adults and seniors should discuss with their physicians include the yearly flu vaccine (important now more than ever), pneumococcal vaccines to prevent pneumonia, shingles vaccines, HPV vaccine and tetanus-diphtheria-pertussis vaccine (Tdap). You can visit the CDC website to get a complete list of vaccines you, your child or a loved one needs.

Update on COVID-19 Vaccination

It can typically take 10 – 15 years to bring a vaccine to market, however several efforts are underway to help bring a COVID-19 vaccine to market in record time. The U.S. government’s “Operation Warp Speed” initiative and the World Health Organization (WHO) are coordinating efforts to develop a safe and effective vaccine as soon as possible.

Vaccines prevent infection, keep us healthy and save lives. We all have a public health responsibility to our community to protect ourselves and each other. Contact your primary care physician and talk about what you need to do to stay up-to-date on vaccinations specific for you and your family.

08.20.2020

Featured Story

Ask The Expert: I Have COVID-19, Is It Safe to Breastfeed?

I Have COVID-19, Is It Safe to Breastfeed?

Norma Garcia, DO
DHR Health Women’s Hospital

Based on what we currently know, pregnant women may be at increased risk for severe illness from COVID-19 infection, sometimes requiring ICU admission. Additionally, pregnant women infected with COVID-19 may have an increased risk for all pregnancy related complications, including preterm labor. It is important to protect yourself and take increased precautions if you think you might be pregnant or are already pregnant.

Research is currently being performed so that doctors can learn if COVID-19 can pass through the breast milk and cause infection to a newborn baby. Most information we have has shown that it is safe to breastfeed your baby if you have COVID-19. Mothers have to remember that breast milk is the best source of nutrition for most babies. Breast milk helps protect babies from illnesses, including infections of the ears, lungs, and digestive system for at least the first 6 months of the infant’s life. For the above reasons, having COVID-19 should not stop you from giving your baby breast milk. Some moms with COVID-19 choose to use a breast pump and express breast milk so that a non-infected family member or nursing staff can feed the newborn. Always make sure to thoroughly clean the breast pump and all necessary supplies in between feeds. If you do choose to breastfeed your child, remember to always wear a facemask and wash your hands for at least 20 seconds before each feeding.

If you plan to breastfeed after delivery and are found to have COVID-19, talk with your OBGYN, pediatrician or other qualified health care provider. Together, you can come up with a plan to allow safe and appropriate breastfeeding for your newborn infant.

Sources: CDC and ACOG

08.13.2020

Featured Story

Ask The Expert: Is Open Heart Surgery My Only Treatment Option for Structural Heart Disease?

Is Open Heart Surgery My Only Treatment Option for Structural Heart Disease?

Norman Ramirez, M.D., F.A.C.C.
DHR Health Structural Heart, Valve and Endovascular Institute

Structural heart disease refers to diseases involving the actual structure of the heart, that can often be life threatening, and previously required surgery to repair and treat. A very exciting area of cardiology today is the treatment of structural heart diseases using minimally invasive/catheter based techniques to avoid open heart surgery.

The most common structural heart problem currently being treated is aortic stenosis. This occurs when the heart valve that lets blood out of the heart, to circulate throughout the body, becomes stenosed or blocked. The valve progressively becomes more scarred, then calcified, and with time the opening of the valve gets smaller...often to the size of a pinhole. As the valve increasingly becomes more blocked, it can cause symptoms of shortness of breath, dizziness, chest pain, and even death. This condition previously required open heart surgery to replace the heart valve, but can now be treated with a minimally invasive procedure called TAVR (trans catheter aortic valve replacement). With the TAVR procedure a new stent valve is inserted through an artery in the leg, the femoral artery, and placed across the stenosed valve. This forces the patient’s own blocked valve to open. Within the stent, there is a new porcine/pig valve in place that begins to function immediately, replacing the prior diseased valve. This procedure works very well, typically causes minimal discomfort, and only 1-2 days in the hospital. Symptoms are usually relieved immediately.

Another common structural heart problem is mitral regurgitation. This occurs when the mitral valve, one of the heart valves that prevents blood from flowing back into the lungs when the heart contracts, begins to leak. As the valve leakage worsens, the lungs fill with fluid, and patients experience shortness of breath, often severe. This disease also previously required heart surgery to repair or replace the valve, but there is a new catheter based technique called Mitra Clip that allows a physician to repair the valve and reduce the leakage significantly. In this technique, a catheter is placed through a vein in the leg, and threaded through the heart across the leaky valve. A “clip” is then placed on the valve to support it, and reduce the leakage. This is similar to a surgeon sewing the valve to reduce leakage, but is done without requiring the chest to be opened.

A different structural heart issue occurs when a patient has persistent atrial fibrillation, which is a problem characterized by a very irregular heartbeat. This places the patient at risk of forming clots in the heart, which can break off and cause major life threatening/disabling strokes. Typically, patients are placed on strong blood thinners for this problem, but many patients cannot tolerate blood thinners due to recurrent anemia/low blood counts, or bleeding issues. Another minimally invasive catheter based technique used to treat this issue is the Watchman device implant. This technique uses a form of filter that is implanted in the area of the heart where clots most commonly form, again through a catheter inserted through a leg vein. The Watchman device prevents clots from forming, and breaking off, therefore preventing strokes from occurring. Once the filter is implanted, patients can be taken off blood thinners.
DHR Health is currently the only hospital in the Valley performing the full range of structural heart procedures.

08.11.2020

Featured Story

Ask the Expert: I Have COVID-19. Is it Safe to Breastfeed?

Based on what we currently know, pregnant women may be at increased risk for severe illness from COVID-19 infection, sometimes requiring ICU admission. Additionally, pregnant woman infected with COVID-19 may have an increased risk for all pregnancy related complications, including preterm labor. It is important to protect yourself and take increased precautions if you think you might be pregnant or are already pregnant.

Research is currently being performed so that doctors can learn if COVID-19 can pass through the breast milk and cause infection to the newborn baby. Most information we have has shown that it is safe to breastfeed your baby if you have COVID-19. Mothers have to remember that breast milk is the best source of nutrition for most babies. Breast milk helps protect babies from illnesses, including infections of the ears, lungs, and digestive system for at least the first 6 months of the infant’s life. For the above reasons, having COVID-19 should not stop you from giving your baby breast milk. Some moms with COVID-19 choose to use a breast pump and express breast milk so that a non-infected family member or nursing staff can feed the newborn. Always make sure to thoroughly clean the breast pump and all necessary supplies in between feeds. If you do choose to breastfeed your child, remember to always wear a facemask and wash your hands for at least 20 seconds before each feeding.

If you plan to breastfeed after delivery and are found to have COVID-19, talk with your OBGYN, pediatrician or other qualified health care provider. Together, you can come up with a plan to allow safe and appropriate breastfeeding for your newborn infant.

Sources: CDC and ACOG

08.06.2020

Featured Story

Ask the Expert: Is open heart surgery my only treatment option for structural heart disease?

Ask the Expert: Is open heart surgery my only treatment option for structural heart disease?
Norman Ramirez, M.D., F.A.C.C.
DHR Health Structural Heart, Valve and Endovascular Institute

Structural heart disease refers to diseases involving the actual structure of the heart, that can often be life threatening, and previously required surgery to repair and treat. A very exciting area of cardiology today is the treatment of structural heart diseases using minimally invasive/catheter based techniques to avoid open heart surgery.

The most common structural heart problem currently being treated is aortic stenosis. This occurs when the heart valve that lets blood out of the heart, to circulate throughout the body, becomes stenosed or blocked. The valve progressively becomes more scarred, then calcified, and with time the opening of the valve gets smaller...often to the size of a pinhole. As the valve increasingly becomes more blocked, it can cause symptoms of shortness of breath, dizziness, chest pain, and even death. This condition previously required open heart surgery to replace the heart valve, but can now be treated with a minimally invasive procedure called TAVR (trans catheter aortic valve replacement). With the TAVR procedure a new stent valve is inserted through an artery in the leg, the femoral artery, and placed across the stenosed valve. This forces the patient’s own blocked valve to open. Within the stent, there is a new porcine/pig valve in place that begins to function immediately, replacing the prior diseased valve. This procedure works very well, typically causes minimal discomfort, and only 1-2 days in the hospital. Symptoms are usually relieved immediately.

Another common structural heart problem is mitral regurgitation. This occurs when the mitral valve, one of the heart valves that prevents blood from flowing back into the lungs when the heart contracts, begins to leak. As the valve leakage worsens, the lungs fill with fluid, and patients experience shortness of breath, often severe. This disease also previously required heart surgery to repair or replace the valve, but there is a new catheter based technique called Mitra Clip that allows a physician to repair the valve and reduce the leakage significantly. In this technique, a catheter is placed through a vein in the leg, and threaded through the heart across the leaky valve. A “clip” is then placed on the valve to support it, and reduce the leakage. This is similar to a surgeon sewing the valve to reduce leakage, but is done without requiring the chest to be opened.

A different structural heart issue occurs when a patient has persistent atrial fibrillation, which is a problem characterized by a very irregular heartbeat. This places the patient at risk of forming clots in the heart, which can break off and cause major life threatening/disabling strokes. Typically, patients are placed on strong blood thinners for this problem, but many patients cannot tolerate blood thinners due to recurrent anemia/low blood counts, or bleeding issues. Another minimally invasive catheter based technique used to treat this issue is the Watchman device implant. This technique uses a form of filter that is implanted in the area of the heart where clots most commonly form, again through a catheter inserted through a leg vein. The Watchman device prevents clots from forming, and breaking off, therefore preventing strokes from occurring. Once the filter is implanted, patients can be taken off blood thinners.
DHR is currently the only hospital in the Valley performing the full range of structural heart procedures.

08.05.2020

Featured Story

Ask the Expert: How do I know if I have Carpal Tunnel Syndrome? What signs and symptoms can I look out for?

Ask the Expert: How do I know if I have Carpal Tunnel Syndrome? What signs and symptoms can I look out for?
Sergio Rodriguez, MD
DHR Health Hand and Wrist Institute

Carpal Tunnel Syndrome (CTS) is the most common compressive neuropathy (pinched nerve) in the human body. It is caused by pressure of the inflamed soft tissue against the median nerve within the carpal tunnel. The carpal tunnel is located in our wrists where the tendons, along with the median nerve, pass through to reach the hand.

CTS symptoms include numbness and tingling in the hand. Typically the thumb, index finger, long finger, and part of the ring finger become numb. Carpal tunnel syndrome can also present as pain or a burning sensation in the hand. Symptoms are frequently more noticeable after lying down and very often cause the patient to awaken from their sleep to shake their hands and relieve the tingling. The pain caused by the pinched nerve is sometimes very severe, not allowing the patient to sleep through the night.

Sometimes people feel clumsy and can frequently drop objects. Dropping objects may be caused by losing the ability to feel the object that you are holding. Carpal tunnel syndrome can make small simple tasks such as, picking up a coin or buttoning a shirt, difficult. In advanced cases, weakness and even muscle wasting can develop in the hand.

The most common cause of carpal tunnel syndrome is repetitive motions or activities involving the hands. Traditionally, CTS was thought to only affect the people that used typewriters day in and day out, however, we now have realized that any repeated manual activity can predispose the development of CTS. Typically women are affected more often than men. CTS is also more common in diabetic patients, obese patients, patients with hypothyroidism, pregnant women, patients with arthritis, and patients with renal failure.

The diagnosis of carpal tunnel syndrome is typically made through a physical exam by your doctor. Sometimes a nerve study may be necessary (electromyogram and nerve conduction velocity). There are other problems that can manifest themselves with pain, numbness, or weakness of the hands which is why it is important to always be evaluated by a physician.

The treatment for CTS depends on the severity of the disease. Typically, nonoperative management is initiated. This includes night splints, activity modifications, and hand exercises. If these fail to improve the symptoms, then a steroid injection into the wrist, may be performed.

If conservative, or nonoperative treatment fails, then surgery is usually recommended. There are two forms of surgery, the traditional open form and the more modern endoscopic technique. The long-term results are the same regardless of the type of surgery performed, however, the endoscopic carpal tunnel release has the advantage of being less aggressive on the body and allows for a quicker recovery from surgery.

07.30.2020

Featured Story

Ask the Expert: What Do I Need To Know About Strokes & COVID-19?

Ask the Expert: What Do I Need To Know About Strokes & COVID-19?
By: Patricia M. Fernandez, MD. MBA
Neurointerventional Radiologist at DHR Health Neuroscience Institute

Stroke remains a serious healthcare problem during the pandemic. Stroke is the blockage of a cerebral artery that carries oxygen and nutrients to the brain by a clot which results in brain cells death. When this happens, the patient suffers a stroke and symptoms such as not being able to speak or move a limb, loss of sensation, vision loss, or facial droop may be present. In Texas, this is a particularly important problem since stroke is the third leading cause of death among Texans, causing 44.6 deaths per 100,000 people.

Medical treatments for stroke patients intend to re-establish blood flow to the brain before the tissue damage is permanent. The available therapies include the administration of tPA, a medication administered through the vein to dissolve the clot, and mechanical thrombectomy, which is a procedure to remove the clot from the artery. The effectiveness of these treatments is based on their fast administration since the brain cells rapidly die when the blood supply is interrupted. Every minute counts during a stroke and recognizing the symptoms could save a life. Systems of care have been organized to provide timely advanced care to stroke patients. This effort requires coordination between multiple resources including hospitals and EMS. Specialized stroke centers are equipped to provide all effective therapies 24/7.

The COVID-19 pandemic is not the time to neglect stroke symptoms. It is postulated that COVID-19 could increase ischemic stroke risk because of its effects on the cardiovascular system. There is also early data suggesting that a stroke could present itself in younger COVID-19 patients. Despite these facts, the stroke admissions and administration of tPA have declined during the initial months of the pandemic. Perhaps, people’s apprehension‘s to seek medical care during the pandemic has played a major role in delaying treatment due to fears of COVID-19 positive patients spreading the virus.

Hospital protocols have been modified to meet the demands and constraints of stroke care during the pandemic. The aim is to continue to provide care to all patients presenting with stroke symptoms. Most stroke centers assume that patients presenting with an acute ischemic stroke have COVID-19 until it can be excluded and all precautions are implemented to equally provide stroke care without delay and to follow safety guidelines. It is very important to highlight that regardless of the concerns about COVID-19, people having stroke symptoms should not ignore them, even if they are mild or transient. The COVID-19 pandemic has affected many, but stroke centers continue to offer effective care.

During the pandemic, the DHR Health Level I Advanced Comprehensive Stroke Center is prepared to care for both COVID-19 patients having a stroke and stroke patients without COVID-19 in a timely and safe manner. If you need immediate assistance for a stroke, please call 911.

07.23.2020

Featured Story

Ask the Expert: Diabetes & COVID-19

Ask the Expert: Diabetes & COVID-19
By: Marcel B. Twahirwa, MD
Medical Director at DHR Health Diabetes and Endocrinology Institute

What are the general risks of a person with diabetes getting COVID-19?
Diabetes, as we know, is one of the most prevalent chronic conditions in our country, over 34.2 million Americans are living with this disease (ADA, 2018). Having diabetes alone does not increase the risk of getting COVID-19; the risk is the same as any person without this condition. Thus, it is crucial to understand the risks of transmission of this virus and do everything possible to help prevent it. Social distancing, hand washing, and wearing a face mask are essential measures we can take to help lessen the risk.

Should I be concerned if I am diabetic and test positive for COVID-19?
If you have diabetes and test positive, there is a reason to be concerned because people with diabetes have a higher chance of becoming ill and experiencing severe complications. Patients with diabetes are more likely to have serious complications, more intensive care unit admissions, extended length of stay, and death from COVID 19. Recent studies have shown that of hospitalized patients with COVID-19 experiencing severe complications, 22.2% to 26.9% reported living with diabetes. In one retrospective study from the United States, the mortality rate was 14.8% in patients with diabetes and patients with uncontrolled diabetes or pre-diabetes, the mortality rate doubled (28.8%). For this reason, taking extra precautions to protect yourself is imperative. If you test positive, the first thing is to remain calm, stay home, and start monitoring your blood sugar more often via finger stick or with a continuous glucose monitoring (CGM) device. Make sure you have all your medications for your diabetes nearby and contact your healthcare provider if you start to notice your blood sugar increasing. When you have diabetes that is not well uncontrolled, having high blood sugars suppresses your immune system function, which can lead to your body having a harder time fighting off the viral infection. So be proactive in your diabetes management, remember you can't control the virus, but you can control your diabetes!

Is there a difference between Type 1 Risks & Type 2 Risks?
Poorly controlled diabetes is a risk factor for infection in general. As of today, there is limited data evaluating COVID-19 in patients with type 1 diabetes. However, both diabetes and obesity appear to be independent risk factors for experiencing severe complications from COVID-19. Analysis of the National Diabetes and mortality data from the United Kingdom before and during the COVID-19 pandemic, noted mortality risk was higher with hba1c above 7.5% and continued to increase as hemoglobin A1c levels rose. Obesity was also associated with increased mortality in both type 1 type 2 diabetes. COVID-19 appears to precipitate severe elevation in blood glucose in patients with diabetes. In type 2 diabetes, COVID-19 may accelerate a clinical picture known as a hyperosmolar state, which frequently may cause patients to go into a coma. In type 1 diabetes, COVID-19 may precipitate diabetes ketoacidosis where patients cannot metabolize blood glucose and plunge into a state of severe metabolic acidosis. Both conditions increase the risk of in-hospital mortality.

We have unique challenges in South Texas. We rank at the top in the prevalence of diabetes and obesity in the nation. Dr. McCormick group found that around ⅔ of the Mexican American population in South Texas has diabetes or pre-diabetes. Diabetes prevalence is 28%, pre-diabetes is 31.6%, with nearly 50% of those patients undiagnosed. Also, 38.2% were found to be heavy smokers. So we have three critical conditions in the RGV community that make our populations most vulnerable to acquire severe COVID-19 outcomes, which consist of diabetes, obesity, and smoking. In another study conducted that looked at almost 1000 Cameron County men, Dr. McCormick and his group showed, diabetes prevalence in men under the age of 35 was 16.7% and 26% in men overall.

Recommendations for patients with diabetes and COVID-19 in the outpatient setting,

Patient with T2DM and COVID19

• If patients can maintain proper hydration with fluid intake, they may or should continue to take their medications. Both oral and injectable medications should continue and may need to be adjusted if glucose levels begin to change. For example: for those patients who are unable to eat or maintain suitable hydration, the use of SGLT-2 inhibitors such as Invokana, Farxiga, Steglatro, and Jardiance or combination of medication that might include this class of drugs should be avoided. These medications may increase the risk of dehydration, genitourinary tract infections, and increase caloric loss. In rare situations, patients who are limiting caloric intake may precipitate and develop diabetic ketoacidosis. Patients who can maintain a healthy diet and fluid intake should continue to take these medications.

• Patients who may be experiencing nausea or diarrhea may consider holding their GLP -1 receptor agonists medications, such as Victoza, Bydureon, Trulicity, and Ozempic. Metformin should also be held since a common side effect of metformin can be diarrhea and gastrointestinal symptoms may need to be stopped.

• Patients taking insulin, may require dose adjustment on current insulin regimens. For this reason, frequent monitoring and contacting your health care provider is essential.

For those patients with type 1 diabetes and COVID19:

• More frequent blood glucose checks either by finger stick (every 2-4 hrs) or by using continuous glucose monitoring device (freestyle Libre or Dexcom) are strongly advised.

• If hyperglycemia is detected (usually more than 240 mg per dL), it is necessary to monitor for urinary ketones or finger stick ketones (home test).

• Adjustment of insulin doses according to blood glucose may be needed, given fluctuations in glucose levels.

• If nausea/vomiting or large ketones persist or are present, patients should seek emergency medical attention given it could be indicating the presence of diabetic ketoacidosis.

Lastly, we strongly advised all patients with diabetes or other chronic conditions to use Telehealth. This technology can save lives by limiting unnecessary exposure to COVID-19.

Reference
Center for Disease Control (DED) The Precarious Health of Young Mexican American Men in South Texas, Cameron County Hispanic Cohort, 2004-2015. Retrieved from: https://www.cdc.gov/pcd/issues/2016/16_0020.htm on July 20, 2020.

Undiagnosed Diabetes and Pre-Diabetes in Health Disparities. Retrieved from: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0133135 on July 20, 2020

07.22.2020

Featured Story

DHR Health Revolutionizes Women’s Health by Launching New Institute for Robotic Surgery with Two da Vinci® Xi™ Surgical Systems

This week DHR Health launched the newly created DHR Health Women’s Hospital Institute for Robotic Surgery, an institute equipped with the two da Vinci® Xi™ Surgical System robots, revolutionizing surgical care for the women of the Rio Grande Valley. As the only hospital in the area fully devoted to all the health needs of women, DHR Health Women’s Hospital is the only hospital in the region with the next generation in robotic surgical equipment completely dedicated to advancing gynecological surgical care at the utmost level. By having the most cutting-edge technology, women in the community will now have the opportunity to experience a minimally invasive surgery in the safest and highest quality of care.

“As an OB/GYN, I am excited to offer this state of the art equipment to our patients,” states Dr. Efraim Vela, Chief Medical Officer at DHR Health Women’s Hospital. “Surgeons can perform complex surgeries using smaller surgical incisions and patients will recover faster,”

In the midst of the COVID-19 pandemic, DHR Health recognizes patients may be fearful when it comes to surgery, which is why providing this minimal contact and safer option is significant for patients. The da Vinci Xi Surgical System allows DHR Health to provide patients with minimally invasive surgical alternatives to open surgery, which provides many benefits. One of the benefits is that it helps reduce contact between the patient and physician. By means of mimicking hand movements through an immersive 3D-HD vision system, the sur-geon oper¬ates from a con¬sole table a few feet away from the patient allowing him/her to per¬form com¬plex pro¬ce-dures with just a few, small inci¬sions. Additionally, the robotic system helps to keep major gynecological surgery to a minimal incision, meaning patients can go home the same day and avoid hospital overnight stays, eliminating the risk of COVID-19 exposure.

"I've used the Robotic da Vinci Surgical System for years now to perform hundreds of gynecological cases with great outcomes. Patients at DHR Health Women's Hospital will benefit from the latest in robotic surgical technology, resulting in the highest quality of care.” states Dr. Rene Luna, OB/GYN Medical Director at DHR Health Women’s Hospital Institute for Robotic Surgery. “We are very excited to have a robotic surgical program dedicated to the women of the Rio Grande Valley; it's a winning combination for our community.”

As the only free-standing women’s hospital in the Rio Grande Valley, the DHR Health Women’s Hospital is thrilled to unveil its DHR Health Women’s Hospital Institute for Robotic Surgery. Leading South Texas in this field, the new institute will be spearheaded by nationally recognized physician, Dr. Rene I Luna, who was recently featured in July’s Texas Monthly Magazine as a Top OBGYN, Robotic Surgeon in Texas. With experienced surgeons leading the way, the Xi Robotic Surgical Systems will provide women with minimally invasive procedures that result in faster recovery times, less pain and less scaring. Surgical procedures offered will include hysterectomy, removal of ovarian cysts and tumors, fibroid removal and many others. DHR Health Women’s Hospital continues to show their commitment in achieving the highest standards in patient care and is dedicated to delivering premier surgical services to women of all ages in the area.

“DHR Health Women’s hospital specializes in women’s health, the XI Robot offers the latest technology for gynecological surgeries,” states, Aida Martinez, Vice President of Operations at DHR Health Women’s Hospital.

To learn more about DHR Health’s robotic surgery program, please call DHR Health Women’s Hospital at (956) 362-BABY (2229).

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07.16.2020

Featured Story

Ask the Expert: What to Know About Pregnancy & COVID-19

Ask the Expert: What to Know About Pregnancy & COVID-19
By: Dr. Carlos Ballesteros, OBGYN
DHR Health Women’s Hospital

The pandemic has been the source of anxiety over the past several months, especially among pregnant women who are getting closer to their due dates. Pregnancy and childbirth can be stressful, and I know the new coronavirus has been causing patients serious strain. Here are ways to help you relax and get the answers to questions you might have about delivering a baby during the COVID-19 pandemic.

What can I do to prepare for delivery? To decrease the risk of acquiring COVID-19 prior to delivery, patients are encouraged to self-quarantine at home two weeks prior to the expected delivery date.

Will I get tested for COVID 19? Anyone who is scheduled to be induced or for a cesarean section should be tested for COVID-19 up to seven days before their scheduled delivery. Hospital may also be equipped with rapid testing capability for deliveries in cases where a more urgent delivery is needed.

Will I be allowed to have a visitor while in labor and postpartum? During your labor and delivery, one healthy visitor is allowed. To help limit the spread of COVID-19, it is recommended that you make plans to have the same individual throughout your stay. Patients and support persons will also be asked to be masked while at the hospital.

How many days will I be in the hospital after giving birth? The time in the hospital will vary depending on the mother and baby, the goal is to send families home safely. Every patient is different and the type of birth could affect the length of stay, but it’s safe to plan a stay between 1-2 days.

What precautions should I take with a newborn? According to the CDC, children do not appear to be at higher risk for COVID-19 than adults. The same precautions you took before giving birth apply while caring for your newborn such as staying at home, avoiding having visitors and sick people and practicing proper hand hygiene. If you want show-off your beautiful new addition to your family and friends, the safest option is via pictures and video.

What happens if I test positive for COVID 19? Your provider will be notified and will discuss care during your pregnancy. Watch for symptoms such as a cough, shortness of breath, fever, chills, new loss of taste or smell, fatigue, nausea, vomiting, diarrhea, or loss of appetite. Report any illness to your provider.

Should my partner and anyone I am in close contact with get tested if I am COVID 19 positive? It is recommended for family members who have been in close contact with you to discuss testing and monitoring with their primary doctor.

How will my labor experience be if I am COVID 19 positive? You will have a dedicated nurse and fewer staff will come in and out of your room. Being COVID-19 positive does not affect the type of delivery or your choice of pain control.

How will postpartum change for me and my baby if I am COVID-19 positive? Your provider and your pediatrician may recommend separation from your baby. This will be decided through shared decision making between you and your provider or pediatrician and options like a healthy person visiting the baby and participating in their care may be available.

07.08.2020

Featured Story

Ask The Expert: Coronavirus and GI Symptoms: What to Know

Coronavirus and GI Symptoms: What to Know

Rama Behara D.O., M.S.
DHR Health Gastroenterology

With the dramatic rise of SARS-CoV-2 (COVID-19) in the Rio Grande Valley, there is certainly a high level of stress and anxiety amongst the community. While symptoms such as cough, shortness of breath, fevers are of utmost priority when seeking guidance, gastrointestinal symptoms are not surprisingly common in patients diagnosed with COVID-19. Abdominal pain, diarrhea, loss of appetite, nausea, and vomiting are some of the many symptoms a person can experience during the course of their illness. In fact, studies have shown that about half of patients hospitalized with COVID-19 have GI symptoms. And though it takes a back seat to the respiratory complaints that get individuals hospitalized, the GI symptoms may actually start first.

Diarrhea appears to be the most common symptom associated with COVID-19, and can last anywhere between one to 14 days, but roughly 5 on average according to a study from Wuhan, China. The problem with this issue is that there’s a large group of people who have GI symptoms but can’t get tested because they don’t have a cough or shortness of breath. The type of diarrhea from COVID-19 is generally not a dehydrating type though it still makes sense for people to stay well hydrated and monitor for symptoms of dehydration, such as decreased urination. To make things more confusing, since GI symptoms are so common, it’s hard to differentiate COVID symptoms from non-COVID related symptoms. For example, stress can cause similar complaints such as diarrhea, abdominal pain, headaches and rapid heart rate, which may make someone feel like they’re infected. Fever is the key deal breaker, since stress does not cause a fever. If you have these symptoms and a fever, let your doctor know as it may clue them into testing sooner. If you’re concerned about transmitting the virus, keep in mind that in some cases, viruses in the GI tract may spread via the fecal –oral route, which emphasizes the importance of hand washing and avoiding touching your face.

The other major concerning population is in patients with underlying inflammatory bowel disease, such as Crohn’s disease or Ulcerative colitis. Many of these patients are on immune modulating drugs or steroids, which could potentially make you more susceptible to getting infected. The consensus from expert panels suggest continuing these medications to prevent a flare up, or even worse a hospitalization where risk of getting COVID is higher. But, steroid drugs are the exception and should be weaned or stopped if at all possible as suggested by the most recent guidelines.

Just recently, there has even been data suggesting the use of proton pump inhibitors (or PPIs) may increase risk for COVID-19 related illness. These medications are typically used to manage reflux or GERD symptoms. As with any medication, these findings suggest using medications when clinically indicated, but at the lowest effective dose.

In the end, what precautions can be taken to help limit spread from the GI route? Well, when you flush a toilet, a “whiff” of viral aerosols may be released. Though unclear if these are infectious particles or not, it’s always better to stay precautious. Simple tips such as putting the toilet down before flushing, cleaning the toilet seat handle and seat with a disinfectant, and not touching your face until washing your hands are reasonable preventive measures. If sharing a restroom with someone who might be sick, consider using a different restroom, but if not possible, a different toilet paper roll for each person is suggested.

The same general precautions need to be taken---hand washing with soap and water or use of hand sanitizer with at least 60% alcohol, avoid touching your mouth/eyes/nose with unwashed hands, and staying home as much as possible. If you need to go out, cover your face with a face covering and maintain a minimum 6 feet of distance. Rest assured, if you need to visit with your GI doctor, telemedicine visits are readily available and are an effective means of delivering high quality care. Please do not neglect abnormal symptoms such as rectal bleeding, unintentional weight loss, trouble swallowing given that of these symptoms may require emergent or urgent attention. The state of the pandemic in the Rio Grande Valley is at a critical juncture and as a community, we must recognize when to seek guidance from local health professionals, but also practice sensible, safe, preventive measures, to defeat this virus.

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