HEALTH CHECK 1988

A Community Service of the Dallas County Medical Society Auxiliary

What is Health Check?

■It is physicians and their families explaining the many specialties of medicine and helping you check up on the state of your health;

■the coordinated efforts of hospitals, health agencies and supporting organizations to demonstrate the vast array of health care resources available to Dallas area citizens;

■hundreds of volunteers caring enough to help you learn how to star well and healthy.

■It is the senior Citizens Walk Fest before the mall opens on Friday morning;

■an expectant mother learning at the obstetrical sonography exhibit that she is going to have twins!

■It is learning what it’s like to be screened for skin cancer glaucoma, diabetes, high blood pressure and: other diseases;

■discovering your body fat content and resolving to eat better and exercise.

Sponsored by the DCMS Auxiliary and the physicians of your community. Health Check is not a diagnostic exam. Its purpose is to raise community awareness of health issues and trends. To accomplish this, Health Check has many activities, including the demonstration of resources available in your community to assist with or screen for certain health care problems and diseases. If, through the screening process, a problem is found, you are encouraged to see your own physician for help. If you do not have a physician, the Dallas County Medical Society offers a physician referred service that will help you find one. Call 948-3622.

Epidemic of disease Epidemic of fear

You don’t get it from hugging. You don’t get it from sharing a water glass. You don’t even get it from social kissing. Yet since AIDS (acquired human immunodeficiency virus) was first diagnosed in 1981, the rumors surrounding its transmission have been almost as difficult to treat as the virus itself. Health officials insist that casual contact plays into the fear of the disease rather than the spread.

’’As the problem grows, as we get more and more cases in our community, I think we’ll see more and more of the fear associated with the disease,” said Charles Haley, MD, epidemiologist of the Dallas County Health Department.

Actual transmission of the AIDS virus depends upon the degree of contact. “You really need to have prolonged, intimate exposure in order to transmit this virus,” he said. “What we’re mainly talking about is sexual contact”

Right now people are scared. The AIDS virus has fatal consequences and medical experts don’t yet know how to cure it. So far our only defense has been “safe sex,” mutual monogamy and sheer abstinence. Researchers worldwide are looking for some way to arrest the virus. Some 1.5 million people in the United States have been exposed to the human immunodeficiency virus (HIV), and an untold number have been infected and don’t even know it.

Local statistics also are astounding: the number of cases reported in Dallas each year nearly doubles the total recorded for the previous year. More than 800 cases have been reported in the county as of November 1987, and an estimated 28,000 residents are currently HIV infected.

Researchers have isolated the three primary modes of HIV infection: sexual intercourse, blood transfer (direct inoculation) and mother-to-child (perinatal) transmission.

Because HIV is a fragile virus, it cannot survive outside the body for any length of time. Although deadly in certain mediums – blood, semen and vaginal secretions – it is easily destroyed by common household bleach. There is no current medical evidence that AIDS can be transmitted through teardrops, saliva, sweat, sneezing or coughing.

So what do you do about the rumors? How do you convince people that you don’t get it from toilet seats, from hot tubs and swimming pools, from cats or mosquitoes? “I don’t know how you get that across,” Dr. Haley said. “We’ve been trying for three years.”

All segments of the community are concerned about this dual epidemic of fear and disease. The Dallas County Medical Society is printing and distributing AIDS: A Guide for Survival which explains AIDS in simple terms and explodes the myths associated with the virus. Published by the Harris County Medical Society and Houston Academy of Medicine, this guide covers everything from modes of transmission to false fears and ways to approach AIDS in personal relationships. Copies of the guide are being distributed by county medical societies across the nation.

While a positive HIV test does not automatically mean a person has AIDS, officials estimate 35%-40% of the people who show presence of HIV antibodies will eventually develop the virus. According to Dr. Haley, the epidemic is still too new to know any more about the path of the virus beyond a period of seven years.

“One of the problems is you’re measuring an interval of time from a fairly artificial date, the date of diagnosis of AIDS, to a very concrete date which is death. The interval you really want to know is the time a person was infected until the time when that person died,” he said.

Not everyone who tests positive develops AIDS; some develop AIDS-Related Complex, or ARC. Persons who are HIV positive may develop many symptoms of the AIDS virus, however the symptoms are not as severe. ARC may or may not develop into AIDS.

Many symptoms of the AIDS virus are similar to those of the common cold or flu; however, they differ in severity and length of time that they last.

Physicians advise people to be realistic about the situation; present health is no sign of immunity. If you have engaged in risky behavior in the last seven years or you show signs or symptoms, see a physician who is knowledgeable about the AIDS virus.

The county health department estimates 5,000 Dallas residents have been tested for AIDS since 1985. Fifteen hundred of those tests have been positive for HIV antibodies. “If you test positive, you need to consider that you’re infectious whether you show signs of symptoms or not,” said James W. Black Jr., MD, a Dallas psychiatrist.

When individuals first receive news of a positive test, it is normal for them to experience feelings of anxiety, anger, guilt, depression or apathy. Dr. Black added that it may take several days or even weeks for that depression or anger to set in.

“Disease is not a punishment for behavior but a consequence,” said Dr. Black. ’As a psychiatrist, I see this as sort of a wished punishment for something done earlier, maybe an affair with a cheerleader back in high school.”

“A positive test is obviously a major piece of bad news,” said Dr. Haley. Therefore, the pre-counseling sessions offered by the county health department, or any physician administering the test, serve to alert the counselor to an individual’s personal support system.

“The counselor will provoke you to actually think about how you will react if the test comes back positive,” he said.

Because of the high demand for testing, the Dallas County Health Department takes only those cases which are considered to be high risk. Individuals may test under a false name at the health department for $10. Confidential tests may be taken at a doctor’s office for approximately $75; this price includes lab costs and office visit.

Fear keeps many people away from testing sites. “I just don’t know that I’m prepared to handle a positive test result,” said one woman. “Sometimes I think it’s easier to just avoid it.”

Yet for others, the test can be a sign of relief. One 24-year-old said she was relieved to find out she had tested negative. “This thing has really scared me. 1 wanted to know if 1 was a victim too.”

Still, there are those who view the test as merely a “green light” for future activity. “I tested negative this time,” said a 34-year-old man. “1 plan on being tested every six months.” However, as Dr. Haley said, testing negative repeatedly will not protect him from the disease.

Through its testing program, the health department hopes to identify individuals with high risk behaviors and offer them low risk alternatives.

“A single approach to behavioral change won’t work,” Dr. Haley said. “We’re living in a multifaceted society which needs a multifaceted approach.” The health department has identified several sub-populations considered to be high risk. Studies show AIDS cases are high among gay/bisexual men, IV drug users, prostitutes, blacks and Hispanics. Dr. Haley said Dallas statistics were in line with expectations for the size of the city and its ranking in the top 10 for the number of cases recorded.

The majority of Dallas AIDS patients are gay white males 30-39 years old; the second highest age group is 20-29. The city is skewed towards the younger age group when local statistics are placed on a national scale, said Dr. Haley. Approximately 98% of the patients are male. As for race, 85.2% are white, 9.5% are black and 5.3% are Hispanic. More than 80% of Dallas cases are among homosexual men.

Reaching these high risk populations has not been easy, Dr. Haley said. The health department’s general message is “Know your partner, reduce your number of partners and use condoms.”

A decline in syphilis, gonorrhea and other sexually transmitted diseases, as recorded by the Dallas County Health Department, indicates some behavior change has already occurred, he added.

Testing positive can have devastating effects on one’s emotional state. Many patients seek psychiatric support to deal with feelings of anger, fear and denial. Friends and physicians are encouraged to look for trouble signs and should help HIV positive patients find the support they need.

The health department further assists with recommendations for future activity, including notifying sexual partners of the positive result. “This is a difficult issue because some do, some don’t,” Dr. Haley said. “We discourage people from being too free with that information. Most of the bad social justice problems have resulted from patients inappropriately telling people they thought they could trust.”

Dr. Haley said he knew of no leak of this medical information from any medical source, whether physician, public health office or hospital. Leaks tend to come from the patients themselves.

It is important for HIV positive patients to find a trusted physician and stick with that physician throughout the course of the virus. “Tell the physician that you’re HIV positive and let that physician follow you through the future,” says Dr. Haley.

The best defense against the AIDS virus right now is a combination of education and behavior change, Dr. Haley said. “People keep talking about education as the cure to AIDS. Well, that’s true and that’s not true. The only way to prevent AIDS is behavior change, and education is a part of that program.” Counseling and peer sup-port are additional components of this behavior change.

As for education, AIDS has reached into the school districts on all levels. Nearly 8,000 teachers at the National Education Association’s July convention called for a crash program to put AIDS education and prevention programs in all schools for the 1987-1988 year,

The Dallas Independent School District received a grant from the U.S. Public Health Service to help fund education and prevention programs for the next five years, according to Richard M. Adams Jr., MD, Director of Health Services for D.I.S.D. 1987-1988 marks the third year that the district has included AIDS in its curriculum. Dr. Adams said the schools use the guidelines issued by the county health department.

So what does the future hold?

A vaccine is the only real cure, according to Dr. Haley, but that vaccine is still decades away. Drugs such as zidovudine (formerly A2T) and imuthiol are not practical or truly effective for treatment of the AIDS virus.

The economic impact continues to grow. The Centers for Disease Control (CDC) in Atlanta, estimates the average lifetime hospital costs to be $147,000 for each AIDS patient. While insurance could help cover that, most insurance companies will not insure AIDS victims, or even individuals who have tested positive for HIV antibodies. Therefore, future assistance is likely to come from political, rather than professional, guidance of health care programs.

It’s recognized that a large portion of society is not going to dramatically change its behavior in terms of limiting the number of sexual partners or adopting the safest lifestyles, Dr. Haley said. But, as responsible public health officials, it’s necessary to offer alternatives. “Condoms are not 100% effective and I’m not sure I would want to trust my life to a thin piece of latex. But there are many people who would want to take that risk..”



Picture this…

It wasn’t much bigger than a pin head. Being that small, it couldn’t possibly be found through breast self-examination. Undetected, it could be fatal.

But it was found, through screening mammography, a low-dose x-ray which creates an image of the breast. This kind of x-ray is 85-95 % accurate in detecting even the smallest breast tumors. . .so why are you waiting?

The second Texas Breast Screening Project begins February 22, 1988. Sponsored by the American Cancer Society, the project is part of a national campaign to increase awareness of screening mammography and to stress the importance of early detection..

Early detection is the best defense against breast cancer, said Phil Evans III, MD, a diagnostic radiologist and chairman of the Dallas Breast Screening Project Committee.

“So far we don’t know of anything that will prevent breast cancer. We have drugs that can treat the disease and surgery that can hopefully cure it. But the key is finding it early,” said Evans.

Breast cancer is a leading cause of death among women, second only to lung cancer. One out of every 10 women will face breast cancer in her lifetime.

The American Cancer Society (ACS) urges women to guard against the disease with regular physical examinations by a doctor as well as breast self-examination.

In 1987, more than 30,000 Dallas women called the Texas Breast Screening Project hotline to receive a coupon for a $50 mammogram. The Dallas response was the best in the nation, according to ACS project coordinators.

“The Texas Breast Screening project of fers an unbelievable opportunity for a woman to have a screening mammogram which could possibly save her life,” Evans said. “This is an opportunity all women should take advantage of.”



Just Forgetful?

Don grabbed his car keys from the kitchen counter on his way out the back door. Once outside, he just stood there turning them in his hand. He didn’t know what to do with them next.

Millie had lunch with “the girls” every Tuesday. In the middle of the meal, she suddenly dropped her fork and began staring at the four faces around the table. Who were these people?

Disorientation, memory lapse and confusion are all symptoms of Alzheimer’s Disease, a progressive degenerative disorder which attacks the brain and results in impaired memory, thinking and behavior. An estimated 2.5 million Americans are victims of the disease, and it is the fourth leading cause of death among adults after heart disease, cancer and stroke.

Alzheimer’s Disease usually affects people over the age of 65, and it is nondis-criminatory in that it affects both men and women, rich and poor, black and white, brilliant and average.

The toll that Alzheimer’s Disease takes on its victims and their families and friends is devastating. The physical and emotional drain leaves a residue of frustration, anger, guilt, embarrassment and grief.

“I think the worst thing people can do is assume that it’s old age, and that it’s natural to be forgetful when we grow older because it’s not,” said Valerie Stephenson, CSW, project director of the Alzheimer’s Disease Resource Center in Dallas.

“There are a lot of things that can cause memory impairment and stress can be one of them,” Stephenson said. But if symptoms continue and you can’t seem to get things under control, then it’s time to pay attention to those symptoms and see a doctor.

The course of the disease is slow and remains virtually unnoticed in its early stages. An individual may have trouble finding words, finishing thoughts or following directions. There also may be a change in personality-less sparkle and ambition. While such things can alert the family that something is wrong, the disease affects each individual differently.

Memory lapses may be blamed on fatigue, stress, grief, overwork and even other people. The victim also may behave carelessly; for example, he may walk across a busy street with little regard to oncoming traffic. Later on, the victim may lose interest in normal activities; and as time goes on, the person may become unable to write or speak coherently or to recognize anyone, including himself in a mirror.

The duration of the disease depends upon the age of onset, individual health status and available support services. “Alzheimer’s Disease is a long-term problem and it may last anywhere from two to twenty years,” Stephenson said. “The family needs to think about that; they may be dealing with this for a long time.”

The cause of Alzheimer’s Disease still is not known, but researchers continue to look for answers. Furthermore, because the cause is not known, prevention is not possible either.

“There’s really not a medication that’s going to stop the disease, halt it or make it go away,” Stephenson said.

Currently, treatment for Alzheimer’s is geared more for the family. ’There is treatment in terms of helping the family learn more about the disease and helping the family cope with management techniques necessary for the day-to-day care of the Alzheimer victim,” she said. A lot of those center around basic things like reducing the confusion in the environment, reducing noise, and approaching the person with a calm and soothing voice.”

Stephenson added that families should anticipate problems which might create additional anxiety or frustration for the Alzheimer sufferer. “As a natural way of coping, people will go through periods of denial when symptoms persist. But, of course, as the disease progresses, those abilities, those higher cognitive processes, diminish.”

No single diagnostic test for Alzheimer’s Disease exists at this time. A complete physical, psychiatric and neurologic evaluation by a physician experienced in the diagnosis of dementing disorders should be obtained. This kind of detailed exam is about 90% accurate. However, actual confirmation is possible only at autopsy.

Microscopic examination during autopsy reveals tangles of fibers {neurofibrillary tangles) and clusters of degenerating nerve endings (neuritic plaques) in the areas of the brain that are important for memory and intellectual functioning. Another characteristic of Alzheimer’s is the decreased production of certain brain chemicals which are necessary for normal communication between nerve cells.

As the disease progresses, care of the Alzheimer patient can entail 24-hour-a-day supervision. “It’s very typical for most families to keep their Alzheimer person at home for as long as possible,” Stephenson said. “About two-thirds of the families do. However, a lot of times the caregiver’s health is at risk because he gives so much and wears himself down and neglects himself. We see this in spouses especially; they risk their own health for the care of the Alzheimer victim.”

The key to surviving the emotional, physical and financial costs of Alzheimer’s Disease is planning ahead. “There will come a time when the person is not able to make decisions for himself so power of attorney will give the family some legal access to financial assets and also give them the ability to help with decision-making for the person,” she said.

Professionals also advise families to screen nursing homes early in the course of the disease for out-of-home respite care opportunities. Twenty-four hour care can run approximately $30,000 a year. Nursing home care typically in the Dallas area will range anywhere from $40 a day on up, Stephenson said.

Only limited financial assistance is available through private insurance, the Veterans Administration or Medicaid. These do not provide much in terms of long-term care, she said. “Medicare does not pay for long-term nursing home care for an Alzheimer’s victim, and that’s one of the biggest misunderstandings of families.” Medicare is an acute care insurance that pays for short-term nursing home stays for rehabilitation purposes. Alzheimer’s Disease does not fall into that category

The Alzheimer’s Disease Resource Center can help provide in-home respite care through its volunteer program, the AD CARE CORPS. The center also provides information, referral services and counseling regarding all aspects of the disease.

The Resource Center operates as an arm of the Alzheimer’s Disease and Related Disorders Association-Greater Dallas Chapter. The center was set up in Dallas in 1985 as a pilot program and specializes in direct services.

For more information on Alzheimer’s Disease call your family physician or the Alzheimer’s Disease Resource Center.



Nightlife



“I don’t get enough.” “I get too much.” “I get eight hours but feel like I haven’t slept a wink.”

Adults and children alike complain about sleep at one time or another. While such complaints are usually shrugged off, sleep problems often signal a deeper problem that may be physically or psychologically related. Sleep disorders can interfere with work, and some may even be life threatening.

Obstructive sleep apnea is a collapse of the throat which causes a person to stop breathing many times during sleep. When the brain receives a signal that something is wrong, the person wakes up long enough to resume breathing but not enough to remember the incident. Individuals are usually not aware of the problem until they begin falling asleep, almost uncontrollably, during the day. They can fall asleep during a conversation with friends or even while driving a car.

This excessive daytime sleepiness, hy-persomnia, is by far the most debilitating disorder, said Philip Becker, MD, medical director of the Sleep/Wake Disorders Center at Presbyterian Hospital. Treatment may be as simple as a weight loss program or may involve surgery to diminish health risks associated with the disease.

Sleep attack, or narcolepsy, is a pathology of the rapid-eye movement (REM) sleep stage. The disorder is characterized by excessive daytime sleepiness and cata-plexy, a paralysis of the muscles which occurs when the person experiences high or unexpected emotion. “When someone laughs or is surprised, he can collapse into sleep,” Dr. Becker said. The body is paralyzed during this dream state. In normal REM sleep, the paralysis is important to keep people from acting on their dreams, he said. Narcolepsy attacks are brief, lasting anywhere from a few seconds to a couple of minutes.

Insomnia is the most common sleep disorder, affecting approximately one-third of the adult population. This loss of sleep may be related to breathing problems, temporary stress or anxiety, or it may be caused by a dependence on some drug or medication.

Some insomniacs may actually be “short sleepers” who need only three or four hours of sleep at night instead of eight. Others have abnormal sleep/wake rhythms and have trouble regulating their bodies to daylight savings time or a new work shift.

If the insomnia is due to stress or learned habits, treatment may take four or six weeks before the patient begins to show improvement. Psychophysiologic insomnia is a type of learned habit-people make their bed their enemy by working to fall asleep. Dr. Becker said the harder they work to go to sleep, the more aroused they become. Soon they begin to associate their bed with hard work.

“When you can’t fall asleep, get up out of bed; do something that is relaxing or boring; stop trying and wait for your body to say ’you are getting sleepy,’ ” he said.

Richard Bootzin, PhD, at the University of Arizona found children who assume the same position each night fall asleep more quickly than children who have many different positions. Dr. Becker encouraged problem sleepers to learn to associate pleasant things with their bed.

Parasomnia refers to an event which occurs while sleeping such as bedwetting, sleepwalking, sleeptalking, night terrors or teeth grinding. Frequently seen in children, such problems often fade once the cause is identified and explained.

Contrary to belief, sleep is not an effective form of escape. The vast majority of people will find that the problems they are trying to escape from are usually the same ones that keep them up at night.

Others claim to escape with sleep when, in actuality, they are “crashing and catching up” on sleep missed during a period of high stress or anxiety. Only about 20% of the population can use sleep as a coping mechanism, he added.

Most of the sleep disorders can be effectively diagnosed and treated; however, different problems require different treatment approaches.

If you or someone you know has sleeping or waking problems, look into the cause behind them. Sleep centers work with you and your physician to diagnose problems and treat them.



Growing up’s tough



“Come on, everybody’s doing it. What’s wrong with you? Are you chicken?”

These words signal trouble situations, and kids hear them most every day from friends. It’s negative peer pressure; pressure to do something which goes against one’s better judgment and coupled with the threat “If you don’t, you’re not one of us.”

Peer pressure can be positive, but it’s usually negative, an attempt to get your kid to do what “everyone else is doing.” And this negative pressure to which kids succumb often has much heavier consequences, especially when most are too young to really understand those consequences.

Is it possible for kids to just ignore these kinds of pressures? Say no? Merely walk away? According to counselor Sharon Scott, the answer is “yes,” if the kids are taught how.

The number one reason why kids make dumb decisions, including breaking the law, is that they can’t say no to their friends for fear of being cut from the group, says Scott, author of How to Say No and Keep Your Friends and Peer Pressure Reversal (Human Resource Development Press, 1-800-822-2801).

While working as director of the Dallas Police Department’s First Offender Program, Scott made two important observations about delinquent teens: one, rather than being deprived kids, the majority were bright kids from caring families; and two, these kids did not act alone.

“Most kids don’t want to get in trouble, but they don’t want to lose friends either,” she said. “If we can teach them how to do that combination-how to say no and save face-then they will use it.”

Scott has developed a series of practical youth skills which she calls Peer Pressure Reversal. She shows kids how to analyze a situation; make logical rather than emotional decisions; and act to avoid trouble situations, confidently and friendly.

“When most people hear “negative peer pressure’ they generally think of the ’big three-alcohol, drugs and sexuality,” Scott said. “But we sometimes don’t realize that kids are facing all kinds of other peer pressures. And if they can’t say no to even the smaller peer pressure situations, such as cheating on a test or lying to parents, then they’re more vulnerable to the bigger things even though they know they shouldn’t do it.”

The average kid does not even know when he is in a peer pressure situation because it is a subtle form of emotional blackmail, she said.

“If we bother to listen to kids they will tell us that it’s hard to say no to four groups of kids: best friends, older kids, popular kids and boyfriend or girlfriend.

Adolescence is not a time of high self-esteem, Scott said. And it is this low self-esteem that causes kids to pressure one another in various situations.

More teens and preteens drink than don’t, she said. The national average age for an invitation to drink is 12 1/2, and this invitation most often comes from peers.

“In my experience the average parent who realizes the child is using drugs realizes this a year and a half after usage begins, and they think it’s just the first or second experimental time,” she said.

“Things we want our children to learn well, we practice with them-little league, multiplication tables. Yet on decision making, few people teach their kids how to make a decision and few people do any rehearsal or practice,” she said.

Peer Pressure Reversal teaches kids survival skills which Scott summarizes in three basic steps:

1. Check out the scene and recognize a peer pressure situation. There are signs, clues to look for. “There are peer pressure sentences-’Everybody’s doing it. It’s no big deal. Trust me,’” Scott said. “I tell kids they’ve got to be trouble detectives.”

2.Make a good decision based on logic rather than emotion. Kids know what they are supposed to do, but in the moment of decision they don’t think. “The friend only comes up with the good stuff; in their mind, kids must weigh the possible (bad) consequences,” Scott said.

3. Act to avoid trouble, Scott developed 10 different ways of handling peer pressure, and she works with kids on how to master them. “I show them a total of 10 because kids have different personalities. If you’ve got a child who’s very quiet, perhaps timid, you better teach him nonverbal ways of getting out of trouble. If you have the class clown, help that child with funny ways of getting out of trouble.”

One Peer Pressure Reversal response is to return the challenge when a friend’s pressure gets tough, even hostile. It involves quick thinking and is best used , when the friend is saying things like “scared” or “chicken.” Throw the peer’s comments back by saying, “Scared to go by yourself?” If the peer says “no.” then say “prove it!” and walk away.

For parents, Scott offers workshops to teach them the Peer Pressure Reversal skills so that they may, in turn, teach them to their children.

“If people are your friends, they like you for who you are, not for what you do with them,” Scott said, adding that “even adults get into peer pressure situations. For example, adults are often asked to pad their expense account or have an extra drink over an afternoon business lunch.

“As adults, if we can’t say no to our peers, and as parents, if we can’t say no to our children when we need to, how are they going to learn to do it?”