What should you do if you are taking Valsartan?

by Dr. Fernando Boccalandro

As seen in the Odessa American’s Medical Matters at:


The U.S. Food and Drug Administration (FDA) protects the public health by assuring the safety, effectiveness and security of human drugs, vaccines and other biological products for human use, as well as medical devices. Recently, the FDA announced a voluntary recall for various drug products containing the active ingredient valsartan. Valsartan is an effective and commonly used medication prescribed to treat high blood pressure and heart failure. It is commonly prescribed combined with a diuretic called Hydrochlorothiazide. The recall is due to the presence of an unexpected impurity in the products manufactured by only three companies that produce valsartan including Major Pharmaceuticals, Solco Healthcare LLC (which owns Prinston Pharmaceutical Inc.) and Teva Pharmaceuticals Industries Ltd. Not all products containing valsartan are recalled. The FDA found N-nitrosodimethylamine in the recalled products, which is classified as a substance that could cause cancer based on results from laboratory tests. The FDA review is ongoing regarding the levels of this substance in the products, possible effects on patients and measures to eliminate this issue in the future.

If you are taking valsartan, please continue taking your medication until you have a replacement product since it is used to treat serious medical conditions. To determine if your medication needs to be changed, look at the drug name and company name on the label of the prescription bottle. If the company manufacturing your medication is not any of the three companies mentioned above, there is no need to change your prescription. If the information is not on the prescription bottle, you should contact the pharmacy that dispensed your medication to determine the manufacturer of the drug.

If you are taking one of the recalled medicines you should contact your pharmacist or your health care professional that prescribed the medication to discuss your treatment, which may include an alternative treatment option or another valsartan based-product.


Dr. Fernando Boccalandro, MD, FACC, board certified in both Cardiovascular Services and Interventional Cardiology, is with ProCare Odessa Heart Institute. 


Look Who’s Talking!

by Dr. Kevin Benson, Board Certified in Pediatrics, ProCare Healthy Kids Clinic

As seen in the Odessa American’s Medical Matters:



One of the reasons pediatricians have you bring your babies and children in so many times during their first few years of life is to monitor their development. And the area that is both the easiest to recognize, and to miss, is speech development.

Babies should enter into the world of verbal communication early in life. They usually start life with a loud cry and things proceed from there. They respond to our voices when they are infants, even if they do not really understand what we say. Infants will start to coo in the first few months of life. At six months, they usually have a variety of sounds, especially if they get a reaction from their parents. It’s not unusual to hear a scream to get our attention. (My daughter thought a fake cough was funny.)

At nine months, you often hear some basic consonants such as “dada” and/or “mama”. However, this can be very meaningless. (Sorry “Dada”.) At a year, most children will have a meaningful dada and mama sound, as well as one other word. Unfortunately, it is often the dog’s name! Children’s receptive language usually precedes their expressive language, so they understand more than they can say back.

Speech often plateaus a bit. Then by 18 months, most children have an explosion of meaningful language. At a year and a half, most toddlers will babble out some form of about 10 to 15 words, although probably only family members will recognize their meaning.

Two-year-olds will have many words, and start to put them into two-word sentences. They will be about 50 percent understandable to strangers at that age. Three-year-olds about 75 percent understandable and 4-year-olds, you guessed it, should be 100 percent understandable to strangers. Just in time for school!

Now there is a large variety of speeds in which language develops, some children are just naturally more verbal (and no, not just the girls). It is important to recognize language issues early in life. There is a certain “developmental window” in which speech is easier to develop. (Ask anyone who has tried to learn a foreign language as an adult.) I have witnessed parents who have ignored speech issues early on, only to try and make up for that lost time in speech therapy later. Be proactive and keep your routine physical appointments, bringing up speech concerns as soon as they come to mind.




Gynecological Needs After Hysterectomy

by Dr. Avelino Garcia, MCH ProCare Women’s Clinic

Many women assume that once a hysterectomy (removal of the uterus) is completed, they no longer have need for a gynecologist. This, in fact, is not true! There are many health care needs for women, even after hysterectomy.

Pelvic Pain or Pain with Intercourse

A yearly pelvic examination is encouraged for all women, even after child bearing years. During a pelvic exam, the gynecologist assesses the vaginal anatomy, looking for any skin abnormalities or lesions. During a bi-manual examination, the gynecologist feels internally and externally for any masses or abnormalities. These examinations also help to assess women who suffer from pelvic pain or pain with intercourse.

Bladder or Bowel Issues

Some women have problems with pelvic support, or a relaxation of the muscles that support the bladder and rectum. These women may suffer from urinary leakage, difficulty completely emptying the bladder or issues moving the bowels. These are issues that can be diagnosed and assessed by an annual pelvic examination by a gynecologist.

Menopausal Symptoms

As women age, menopausal symptoms can occur, even long after a hysterectomy. Some women suffer from hot flashes, especially at night. Many women complain of problems falling or staying asleep. After menopause, vaginal dryness and recurrent infections in the urinary tract (bladder infections) are very common, which can also lead to painful intercourse or pelvic pain.  These are also important issues that are addressed by a gynecologist during your annual examination.

Bone Changes

Bone changes occur as women age. According to The American College of Obstetricians and Gynecologists (www.acog.org), “A small amount of bone loss after age 35 years is normal for both men and women. But during the first four to eight years after menopause, women lose bone more rapidly.” This increases the risk for osteopenia or osteoporosis. This is addressed by Bone Density Screenings (DEXA Scans) that are ordered every other year after the age of 65.

Breast Health

Breast health is also an important issue addressed yearly by the gynecologist. During an annual examination, a breast exam is completed by the provider. Yearly mammograms are ordered to screen for breast cancer.


Yearly examinations by a gynecologist are still important, even if you do not have uterus. Make your health a priority! Call MCH ProCare Women’s Clinic for an appointment today at (432) 640-2491.

Why to Reconsider Vaping

by Elizabeth Ybarra RRT, TTS – Medical Center Health System Cardiopulmonary Staff Educator

As seen in the Odessa American’s Medical Matters:


Society changes and upgrades are everywhere. For example, look at fashion, art and television. Other changes include actions and what is “popular” at any particular time. That being said, smoking cigarettes has been around for centuries … that is nothing new. However, “vaping” is a new trend that is being highly utilized by the population.

What is “vaping”?

Vaping is also known as electronic nicotine delivery system, or E.N.D.S. These electronic nicotine devices have become the new trend, especially in the younger populations. The allure has to do with these “e-cigarettes” being small, having no smell and providing a variety of flavors that are fun and appealing.

Are “e-cigarettes” good or bad for you?

Some news sources and our society have been implying that e-cigarettes are harmless and a better alternative to regular cigarettes. But that message is not necessarily accurate.

To understand the good and bad of these devices, one has to know a little more about how they work. The devices have a heating element that heats up a cartridge filled with nicotine. The heat produces a vapor that is then inhaled. The e-cigarette contains a humectant, typically propylene glycol, flavoring and nicotine (rti.org).

Why are e-cigarettes something to reconsider?

There are three main reasons to reconsider ever “vaping” in the first place, or certainly never again.

  • The biggest reason is that these devices are not regulated by the FDA. Therefore, the amount of nicotine and humectant might not be disclosed or accurate.
  • These devices have simply not been around long enough for adequate clinical findings on how these ingredients effect the body when heated.
  • The popularity of vaping creates the potential to encourage non-smokers to start experimenting with nicotine. According to Quit.com, research suggests that nicotine is as addictive as mood and behavior altering drugs such as heroin, cocaine and alcohol. It is tough to quit nicotine, so why start using it to just be part of a trend?!

Is there anything good about vaping?

The only good thing about vaping is that there is no combustion with e-cigarettes like there is with normal cigarettes. (NationalAcademies.org) The combustion aspect of a lit cigarette is that it releases over 7,000 chemicals.

There might not be that same worry with vaping, but do not be fooled. There are still toxins being inhaled that affect smokers and nonsmokers as well. (TruthInitiative.org)

So, the next time someone wants a companion to vape with, opt out of that dangerous experience and put your health first.


Sports Injuries – Spring into Action

by Tim “Trapper” O’Connell MS, LAT

MCHS Divisional Director/Pro Care Orthopedics/CHW Family Med/Occupational Med


As seen in Odessa American Medical Matters:


Sports injuries occur in the spring due to many conditions and it is now the time of the year to address preventive measures. As a parent, coach or athlete, preparation and understanding your level of fitness will help reduce pain, injury, lost playing time and money.

The first tip is to continue to hydrate.

Yes, you have to drink more water to compensate for fluid loss during exercise. A loss of body fluid is a set up for dehydration and cramps. This will ultimately be a step in prevention of muscle strains and possible tendon injuries. Drink water before, during and after practice and games. Warming up five to seven minutes before your activity is essential and good time to start drinking water. Are sports drinks good to drink before your activity? Let’s address that at a later time. The short answer for now is, drink more water.

A consideration for all age groups is skin care.

Use generous amounts of sunscreen products and of course SPF 30 is recommended as starting strength in most cases. Take into account for younger age group, face protection and wearing clothing and/or a hat in peak UV exposure. Burns are painful and can be debilitating.  Re-application is a strong method to boost skin coverage for those extended hours in the sun.  Follow instructions on the container.


Great fitting and supportive shoes will prevent the blisters, shin splints and “kneecap” (patellar) bony and tendon inflammation.

Warm up and Cool down

Another good rule of thumb for all athletes is “warm up and cool down”. Use heat to increase circulation before the event and ice after the event to decrease pain and inflammation. Rest and recovery are good to allow the body to charge back up. Take frequent breaks and ease back into activity after your break.

Basic first aid kits are an excellent tool to have available in your car or at sports events. If you do incur an injury, here are some simple tips.


If bleeding occurs, apply pressure with a clean cloth. Clean and/or rinse area. Cover with bandage and secure area. If bleeding continues, seek advanced medical help.


If swelling occurs, assess area for instability (dislocated, unable to walk or move body part). Compare to opposite limb if possible, ice or cool compress for injured area. Seek advanced medical help in regard to his/her perceived level of pain or level of disability.


Consistency in exercise is a key factor to physical conditioning and starting your spring and summer outside activities. Short periods of exercise each day need to include a functional, dynamic warm up. Take a walk or jog, depending on your physical restrictions. I recommend walking for time and not distance. This will allow you to exercise in minutes and not concern yourself with how far you have moved in your activity. We will also address your heart rate and exercise heart rate in another article. For now, address your exercise and heart rate with your primary physician.

If you have questions or concerns about an injury, please don’t hesitate to call Trapper, ProCare Orthopedics, at 432-640-2793.

Get outside and have a SUPER SPRING! 


Colon Cancer: One of the deadliest, yet most preventable cancers

by Ramalinga Kedika

March is colon cancer awareness month.  Have you had your screening colonoscopy yet?

Colon cancer is the second leading cause of cancer death in the United States. Approximately one out of 25 Americans will develop colon cancer in their lifetime. The median age of diagnosis is 67. However, we are seeing a rise in colon cancer in younger patients. Of the new diagnoses, 10 percent occur in patients under 50 years old.

Although colon cancer is a common and deadly cancer, there are very effective screening techniques. Colonoscopy is a powerful screening technique because you can not only diagnose polyps that are precursors to colon cancer, but also remove them during the procedure. It is this removal of polyps which reduces colon cancer risk. If everyone had a colonoscopy when they should, colon cancer would almost be non-existent!

However, many Americans are not participating in colon cancer screening. Approximately one in three aged 50 to 75 have not been tested for colon cancer. Benjamin Franklin once said, “An ounce of prevention is worth a pound of cure.” This is true across the medical field, but especially pertinent when it comes to colon cancer screening. It is a lot easier to prevent colon cancer than to treat it once it occurs.

Colonoscopy is often performed using deep sedation which allows the patient to not have any awareness during the procedure. In fact, the most memorable part of a colonoscopy is not the procedure, but rather the prep you have to drink the night before. Laxative preps have reduced in volume over the years and are easier to consume. The procedure is also very safe. The risk of a serious complication such as perforation is one in 1,000. Colonoscopies performed for screening are often covered by insurance plans … so take advantage of this!


Make Physical Activity a Priority for Heart Health

by Millie Gonzales, RN, BSN Cardiac Rehab Nurse


As seen in Odessa American Medical Matters:


With Heart Disease on the rise, it is vital to make cardiovascular exercise a priority. Most of us find it challenging to make time in our day to invest in our health. Although, rearranging your daily schedule and setting a reachable exercise goal every day is a start!

Benefits of cardiovascular activity

  • Decreases risk of coronary artery disease and stroke
  • Reduces symptoms and decreases chances of another heart attack
  • Improves heart and lung performance while creating healthy habits
  • Improves blood pressure, blood sugar and blood cholesterol levels
  • Maintains a healthy body weight
  • Increases energy and stamina while decreasing stress levels


How to get started and what to do. (Hint – Make it fun!)

Create a specific exercise goal including frequency, intensity, time and type of exercise. Make a personal commitment to your plan. And get started!

Walking is an easy, safe and effective way to begin. Be flexible and make it fun! Start slowly and build up gradually to at least 30 minutes a day on most, or all, days of the week.

Make this a priority for one month and work out at the same time every day. By doing so, it will become a habit. After a month, evaluate your progress and make changes accordingly.

With time, this will create great changes and benefits to your health. The American Heart Association recommends at least 150 minutes per week of moderate-intensity aerobic activity such as brisk walking and at least 75 minutes of vigorous activity, or an equal combination of both. Please note that heart patients and individuals with specific medical questions or needs should consult with their physician regarding what type of physical activity is safe for them.

Your health is so important and is worth the investment of time. Your heart will be happy you made this a priority!



Parents’ questions about the everlasting flu season of 2017-2018

by Dr. Kevin Benson, Board Certified in Pediatrics, ProCare Healthy Kids Clinic

As seen in the Odessa American’s Medical Matters:


There is endless information about the flu available to anyone with a smartphone. Rather than reprint information that is available elsewhere, I would like to answer a few questions that parents ask every day at my office.

Can you get the flu twice?

I chuckled seeing a report on one of those sensational nightly news shows that highlighted “This boy has had the flu TWICE!” I didn’t realize that any of the many patients I have seen with the flu twice this season could make national news. Unfortunately, catching one strain of the flu does not protect a person from catching one of the many other strains. Flu just doesn’t play fair … you can even have multiple strains at the same time! It is unlikely that you would get the same strain more than once though … if that makes you feel better.

The flu test was negative, does that mean my child doesn’t have the flu? 

Unfortunately, no. They still might have the flu. The flu test is very specific. So, if you have a positive, it is extremely accurate. However, the sensitivity of the test varies with the quality of the specimen (yes, we need boogers) and the length of illness. I have had families where every child is positive but one, but they are all symptomatic. A child can be diagnosed clinically with the flu.

Is Tamiflu (osteltamivir) good?  Is it bad?  What if they can’t finish it? 

This medication decreases the flu virus’ ability to reproduce. It does not “kill the flu” like an antibiotic might kill a bacteria. It is supposed to shorten the course of the illness. It is best started within the first 48 hours of illness.

Like every medication, Tamiflu (osteltamivir) has side effects. Most commonly, the side effects include stomach issues, but there are many more. I tell parents, if the side effects are worse than the illness, stop the medicine. The clear majority of us will still make it through the flu. Before the introduction of this medication, humans still survived the flu, and probably continue to.

Is it too late to get a flu vaccine?

Flu season, as a rule, is from October to April. So we give vaccines through March. Remember – the vaccine takes at least two weeks to be effective. This year’s effectiveness rate has been about 30 percent, which sounds low. However, remember that according to the Centers for Disease Control and Prevention, 85 percent of children who have died this flu season were unvaccinated.



H. pylori – Who should be tested?

by Ramalinga Kedika


As seen in the Odessa American’s Medical Matters:



Did you know there is a stomach infection present in approximately half of the world’s population? That infection is a bacteria called Helicobacter pylori, or H. pylori for short.

Signs and symptoms of H. pylori

Most people with H. pylori will never have signs and symptoms and therefore routine screening is not needed in the United States. Some people will have stomach symptoms including pain, nausea, poor appetite, burping/belching, bloating and/or weight loss. It is these patients that should be tested for H. pylori infection by their healthcare provider.

Long-term complications

Some of the long-term complications of infection include stomach and intestinal ulcers, irritation of the stomach lining (gastritis) and stomach cancer. It should be noted that the presence of H. pylori infection combined with excess over-the-counter NSAID (Motrin, Advil, etc.) use will significantly increase your risk of developing ulcers. It is a common misconception that stress alone is a cause of ulcers!

How do people get infected with H. pylori?

The exact way is not known, but most people acquire the infection in their childhood. What we do know are the risk factors for infection. These include living in crowded conditions, lack of clean water, living in a developing country and living with someone who has the infection.

How is H. pylori diagnosed?

  1. pylori can be diagnosed in multiple ways. The easiest way for patients is often a breath test that can be done at most laboratories. Other ways include a stool test or upper endoscopy (scope test into the stomach) with biopsy. If diagnosed, H. pylori should be treated with a 10 to 14 day regimen of antibiotics and acid reducers.

One interesting historical tidbit. In 1984, scientist Barry Marshall drank a Petri dish containing H. pylori to help show that the infection caused gastritis and ulcers. For this, Marshall and his colleague Robin Warren earned the Nobel Prize in 2005!


RSV and the Nose Goblins

By Dr. Bonnie Carter, Board Certified in Family Medicine


As seen in OA Medical Matters:



RSV … three simple letters that strike fear into the hearts of parents everywhere. Probably everyone knows someone whose child has been hospitalized due to the respiratory syncytial virus (RSV). We’ve all heard the horror stories and, if diseases had a Most Wanted List, RSV would definitely be on it. According to the CDC, RSV accounts for approximately 2.1 million office visits, 57,000 hospitalizations in children under five, 177,000 hospitalizations for adults over 65 and 14,000 deaths in adults over 65.

The peak season for RSV is late fall to early spring, with January and February seeing the highest numbers. It is estimated that by the age of two, 90 percent of children will have had RSV at least once. RSV is the leading cause of bronchiolitis and pneumonia in children under the age of one. There are multiple strains of the virus, which means you can get it more than once. At this time, there is no vaccine available.

The symptoms of RSV are similar to the common cold: fever, cough, congestion and runny nose. What distinguishes RSV from other upper respiratory infections is the diffuse wheezing and difficulty breathing. For most healthy children over the age of two and healthy adults, RSV is just a bad cold. While uncomfortable, it does not present a danger to most in this age group. However, for children under the age of two, and especially those under six months, RSV can be a ticket to the hospital.

So why is RSV so bad for babies? One of the main reasons babies have so much trouble with RSV is that they don’t know how to breathe out of their mouth until they are older. When a baby’s nose is congested, they can’t breathe. This is why it’s important to use the bulb syringe and suck out any of those nasty nose goblins and boogies that get in there. And there are a lot of nose goblins with RSV! It creates an excessive amount of nasal drainage and secretions. It also causes inflammation of the air tubes, or bronchioles, causing bronchiolitis.

Signs that are concerning for respiratory distress in an infant or small child are tachypnea (rapid breathing), nasal flaring, retractions (caving in between the ribs with inspirations), use of accessory muscles (arm muscles and abdominal muscles) to breathe and perioral cyanosis (turning blue around the mouth).

One question I’m often asked is, “How do I know whether to take my baby to the doctor’s office or the emergency room?” Obviously, our goal is to keep you out of the ER as much as possible. They are busy and don’t need to be bogged down with non-emergent visits. But if your child is having respiratory distress with any of the signs listed above, that is where they need to be. If your kiddo has a runny nose, cough, fever, sore throat or earache, then call your physician and bring them into the office.

Treatment of RSV is symptomatic and it requires the tincture of time to resolve. RSV is a virus and therefore does not respond to antibiotics. Likewise, antibiotics do not prevent the illness from worsening. Like the commercial says, “That’s not how this works…that’s not how any of this works!” Parents often pressure physicians to prescribe antibiotics, especially when the child appears moderately ill. When we tell you antibiotics are not necessary, it’s not that we don’t believe your child is sick, or that we want your child to suffer longer. Trust me, if I had the magic wand to wave and make it all better, I would do it in an instant. Unfortunately, I never got my letter to Hogwarts, so I went to medical school instead. Also, we do not recommend cold medication such as cough medicine, decongestants and antihistamines for small children because studies have not shown an improvement of symptoms with their use and they often cause adverse side effects. The one therapy that has shown any consistent improvement is bronchodilator therapy (nebulized breathing treatments). I do recommend frequent nasal suctioning to help keep their nose clear and Tylenol to help fever. On average, an infection with RSV lasts about a week, with the worst symptoms being in the first three to four days.

As the old saying goes, “An ounce of prevention is equal to a pound of cure.” Preventing RSV infection is always the best plan, but sometimes the best laid plans go astray. Do not take your baby out to stores, church or anywhere there is a group of people who could be sick. If you do have to take your baby out, keep their carrier covered with a blanket to protect them from respiratory droplets. I know that everyone wants to see and hold the new baby, but it is safer to keep away from Grandpa Bill and his germs if he is sick. If someone in the house gets sick, try to keep them isolated in a separate room, especially at night. Cover your mouth and nose when you cough or sneeze and wash your hands. You can use Lysol to spray surfaces such as countertops, door knobs, or toys that might be contaminated with respiratory droplets. As tempting as it is, don’t Lysol the baby (or the dog, or your sibling, or your husband …)!