What’s keeping you up at night

Is your snoring loud enough to be heard through closed doors? Do you feel tired, fatigued, or sleepy during the day? Do you nod off at stop lights, or during conversations? Has anyone seen you stop breathing, choke, or gasp while sleeping? Do you have high blood pressure? Are you overweight? Is your shirt collar sixteen inches or larger? Are you male? Are you fifty years of age or older?

Pointers for those with diabetes

by Dr. Varuna Nargunan, M.D., is with ProCare Endocrinology in Odessa, TX. She is Board Certified in Diabetes, Endocrinology and Metabolism and also Board Certified in Internal Medicine. http://procareodessa.com/varuna-nargunan-m-d/

As seen in the Odessa American Medical Matters:


With every holiday, office meal, family gathering or night out, people with diabetes have a challenge when presented with so many tempting feasts. Following are a few pointers for those with diabetes and those looking to stay healthy throughout the year:  

  • A donut or bagel has a whole meal’s worth of the daily recommended carbohydrates. (60 to 80gms of carbohydrates)
  • Metformin does not affect the kidney. For a person with kidney damage, Metformin is not given as it is not effectively cleared. 
  • Diet sodas are equally as bad as regular soda. They have a different form of sugar, which breaks down to glucose at the end. 
  • Blood sugar checking should be done different times of the day rather than only in the morning. 
  • Low-sugar reaction is a protective mechanism similar to how you sense fire so you move away from a flame. If a person experiences too many low-sugar reactions, their body will no longer alarm in the same way, which might be dangerous.
  • Shakes are a meal replacement, not a drink that goes with an entrée.
  • Insulin is the final treatment option when non-insulin options are used and blood sugars are still not controlled. But that does not mean death. Insulin levels can be modified to treat the diabetes effectively.
  • Tight blood sugar control in the initial years of a diabetes diagnosis can create a lifetime decrease in cardiovascular events.
  • Eat a whole fruit rather than drinking fruit juice.
  • And as you approach tempting meals or snacks, remember that having diabetes does not mean “no sugar”. It is all about portion control. 

Changes that the body experiences during pregnancy

As seen in the Odessa American’s Medical Matters:


by Sanchita P. Yadalla, M.D.

Dr. Yadalla is Board Certified in Obstetrics and Gynecology and is a Fellow of The American Congress of Obstetricians and Gynecologists (FACOG). She offers a full range of OBGyn services at the MCH ProCare Women’s Clinic and can be reached at (432) 640-2491.

Body changes during early pregnancy

Pregnancy causes many body changes in women. In early pregnancy, most symptoms begin at about six weeks. Every pregnancy, and every woman, is different … so some women can experience symptoms sooner than six weeks and some will experience symptoms later than six weeks. Some women do not experience symptoms of early pregnancy at all!

Body changes in the first trimester

  • Very early in the first trimester (one to two weeks after conception), some women notice vaginal spotting or light bleeding when the fertilized egg implants in the uterus. This is also known as “Implantation Bleeding.”
  • Due to softening of the cervix, it is common to spot or bleed after intercourse, especially in early pregnancy.
  • Light abdominal cramping that comes and goes may also occur, due to growth of the uterus. Bleeding like a period or painful abdominal cramping is not normal and should be evaluated by your physician.
  • Most women experience breast changes during pregnancy. The breasts feel heavier and become much fuller. The color of the areola may change to a darker hue.
  • Most women complain of breast tenderness, but this eases through the pregnancy. It is recommended that pregnant women wear comfortable, supportive bras. It is important to be sure it is sized correctly, especially as the breasts grow during pregnancy.

The body experiences many changes as progesterone, a pregnancy hormone, levels increase:

  • A small amount of white discharge is normal in pregnancy, as long as it is not associated with vaginal pain, itching or odor.
  • Many women experience lack of energy or fatigue. Pregnant women require a healthy sleep routine and are encouraged to get plenty of rest. Your body is growing a human, after all!
  • The increase in progesterone can also cause nausea and vomiting. Due to the nausea, increased sensitivity to smells is not uncommon. Nausea/vomiting in pregnancy can sometimes lead to dehydration. Symptoms of dehydration include abdominal cramping and headaches. It is encouraged to continue proper hydration, as tolerated. Nausea and vomiting usually improves near the end of the first trimester and the appetite returns.

Some pregnant women experience emotional changes early in pregnancy:

  • Sometimes, women report mood swings, being irrational or unexplained weeping.
  • Many women are anxious about being pregnant, which can also cause an emotional reaction.
  • As the pregnancy progresses, many women feel much more relaxed and calm. Many start getting excited in anticipation for the new arrival.

Body changes in the second trimester

With the start of the second trimester of pregnancy, many pregnancy symptoms may stay the same but there will be new changes as well:

  • For many women, morning sickness will improve or only occur sporadically and appetite seems to increase. Changes in appetite can cause constipation, gas or bloating. It is also common to experience heartburn or indigestion.
  • Although there will be a decrease in breast tenderness, the breasts will continue to grow. A supportive, well-fitting bra is still recommended for optimal comfort.
  • White vaginal discharge due to hormone changes is still common as long as it is not associated with other symptoms like vaginal burning, pain or odor.

There are many new changes that can occur during the second trimester of pregnancy:

  • The fatigue from the first trimester fades and the pregnant woman usually has increased energy. 
  • An increase in blood volume during pregnancy can cause some mild swelling of ankles or feet, especially when standing for an extended period of time. 
  • Some women experience sensitive gums that bleed when brushing. It is important to continue routine dental check-ups. 
  • Many pregnant women experience nasal congestion or nose bleeds. It helps to keep the nasal passages moist with saline spray and by using a humidifier at home.
  • The uterus is supported in place by a group of ligaments. As the uterus grows, these ligaments stretch or pull. It is not uncommon for this stretching or pulling to cause aches in the lower abdomen or on either side of the abdomen. As the uterus grows, it becomes heavier. It is encouraged for the expectant mother to use a maternity belt or support to help alleviate these pains. Extreme abdominal pain is never normal in pregnancy and should be evaluated by a physician.
  • During the second trimester, the uterus continues to grow out of the pelvic cavity. Many women see changes in the size and shape of the abdomen. As the uterus grows, posture may change due to the pregnant belly protruding. This change in posture can cause back pain in the pregnant woman.
  • The favorite change of the second trimester to many pregnant women is the ability to feel fetal movement. Feeling fetal movement is sporadic at first, as the fetus is so small. By the end of the second trimester, a pregnant woman should feel consistent fetal movement. Movements in the second trimester may feel “clunky” and as though they are big stretching movements.

Body changes during the third trimester

In the third trimester, most women become increasingly uncomfortable. As the baby becomes larger and settles in the pelvis, new physical discomforts can occur:

  • Due to increased fluid volume produced, there may be an increase in swelling of the ankles and feet, as well as hands and face.
  • Colostrum (or “Pre-Milk”) may start leaking from nipples as the breast prepare to begin producing milk.
  • Some women may alternate times of extra energy (nesting) and extra fatigue as time gets closer to delivery.
  • These discomforts may cause problems sleeping comfortably at night.

After the baby “drops”:

  • After the baby “drops” or settles in the pelvis, a pregnant woman may be able to breathe easier, as there is less pressure on her diaphragm and more room for her lungs to expand. But there will be more pressure placed on the bladder by the baby being lower in the pelvis which may cause more frequent urination.
  • Increased backache and heaviness, as well as buttock and pelvic discomfort are common. Some women even have a sensation of a sudden sharp pain or shock in the pelvic area if the baby settles on a nerve. While uncomfortable, all of these experiences are normal parts of the third trimester.


  • Pregnant women in the third trimester, may have more frequent and intense contractions, called “Braxton-Hicks Contractions”. These contractions are irregular and can be eased with rest, Tylenol administration and hydration.
  • Labor contractions become stronger over time and come at regular intervals. Labor can also be distinguished by vaginal bleeding or leakage of amniotic fluid. If these symptoms occur, a pregnant woman needs to be evaluated by her doctor.

Knowing about changes the pregnant body can experience helps an expecting woman feel calmer about what she is experiencing. If you have any questions or need additional information, reach out to your OBGyn provider. If you do not yet have a provider, the OBGyns at MCH ProCare Women’s Clinic are available to become your provider for your pregnancy and upcoming arrival of your bundle of joy.  

Why your baby needs you to breastfeed

by Candy Powell BSN, RN, IBCLC, RLC, CCE, Lactation Consultant and Certified Childbirth Educator at the Medical Center Hospital Center for Women and Infants.


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



Breastfeeding is a vital part of healthy child development and provides the best start to life for any baby. According to the American Academy of Pediatrics, breastfeeding is the standard for infant feeding.

The World Health Organization recommends:

  • early initiation of breastfeeding within one hour of birth
  • exclusive breastfeeding for the first six months of life
  • introduction of nutritionally adequate and safe complementary (solid) foods at six months together with continued breastfeeding up to two years of age or beyond

Why is breastfeeding important for your baby?  

Breastfeeding provides essential nutrients and antibodies that boost an infant’s immune system, providing protection from childhood illnesses. Benefits for breastfed infants include:

  • reduced risks for diarrhea and respiratory infections
  • protection against childhood obesity
  • protection against non-communicable diseases later in life, including cardiovascular diseases and diabetes mellitus
  • higher intelligence quotient
  • reduced risk for allergies.


Is there any benefit for the mother? 

Yes, breastfeeding is important for mothers too. Women who breastfeed have a reduced risk of breast cancer, ovarian cancer, obesity and osteoporosis.

World Breastfeeding Week

World Breastfeeding Week occurs annually the first week of August and is celebrated in more than 170 countries worldwide. During the week, the World Health Organization promotes the benefits of breastfeeding and raises awareness about this essential part of every person’s life course.

The 2018 theme, “Breastfeeding: Foundation of Life”, encourages breastfeeding as a way to promote mother-child bonding and to provide vital long-term health benefits to both mother and child. According to the Lancet 2016 Breastfeeding Series, “Improved breastfeeding practices have the potential to save the lives of 823,000 children and 20,000 women a year.”

World Breastfeeding Week also calls attention to local efforts that support breastfeeding.

Available local breastfeeding assistance and information

Medical Center Hospital’s Center for Women and Infants (CWI) Infants is designated as a Texas Ten Step Hospital which means policies and practices promote breastfeeding. CWI staff encourages and supports new mothers to breastfeed by giving them information and support throughout their pregnancy, in the hospital and after they are home.


Baby Café (FREE Drop-in Breastfeeding Center)

The MCH Baby Café is a free, drop-in breastfeeding center for mothers seeking more information or help with breastfeeding. Baby Café is free and open to breastfeeding mothers every Wednesday from 10 a.m. to noon in the CWI fourth floor classroom.


Oh Baby! Breastfeeding Basics (FREE CLASS)

Learn about the basics of breastfeeding and how to start off breastfeeding with tips on positioning, latching, how to recognize a good latch and how milk is produced.

Date and Time:  Saturday, August 4, 2018, 10:00 a.m. to noon

Location: MCH Center for Women and Infants, Fourth Floor Classroom


Sustaining Breastfeeding and Returning to Work (FREE CLASS)

Learn about accommodation laws and your rights in the workplace, child care, pumping to maintain and enhance milk supply and how to smoothen transitions from home to work and back.

Date and time:  Wednesday, August 8, 2018, 11:00 a.m. to noon

Location: MCH Center for Women and Infants, Fourth Floor Classroom


For more information on these free local resources, contact:

Candy Powell BSN, RN, IBCLC, RLC @ cpowell@echd.org  or 432-640-1714

Ashley Harry BSN, RN, IBCLC, RLC @ aharry@echd.org  or 432-640-1784


Healthy Lifestyle for the Family

by John Douthitt

As seen in the Odessa American “Medical Matters” at:


The latest studies from the Center for Disease Control regarding obesity in the United States are scary to say the least, and the future projections only show this epidemic to be getting worse. Unfortunately, these latest studies aren’t just regarding the adult population. The childhood obesity rates are just as dire. Below are some of the CDC’s childhood obesity facts.

  • Childhood obesity has more than tripled in the past 30 years.
  • The percentage of children aged six to 11 years in the United States who were obese increased from seven percent in 1980 to nearly 20 percent in 2008. Similarly, the percentage of adolescents aged 12 to 19 years who were obese increased from five percent to 18 percent over the same period.
  • Overweight and obesity are the result of “caloric imbalance,” too few calories expended for the amount of calories consumed. This is affected by various genetic, behavioral and environmental factors.

The various negative effects of obesity on health and well-being include:

  • high cholesterol
  • high blood pressure
  • diabetes
  • bone and joint issues
  • sleep apnea

So, what is the quickest and easiest way to combat this growing problem? Follow the following recommendations and the trends listed above will be reversed.

Children today have many more opportunities to develop sedentary habits than in year past. Computers, computer games and hundreds of television channels are all things children have access to now. When many of us were children, the first thing on our minds when we got home from school was to go outside and play. Unfortunately, today we are unable to turn our children loose outside like parents could before. So what do we do to ensure our children adopt healthy habits?

Healthy Lifestyle as a Family


Adopting a healthy lifestyle as a family is key to improving our overall health. Children will follow their parent’s lead … so incorporating healthy family outings is the first and easiest step. Instead of spending an evening in front of the television, head to the nearest park and play catch, shoot baskets, go for a walk or rediscover the joy of riding a bike.

Healthy Eating:

Preparing healthy meals and avoiding the fast food drive-through is also extremely important.  Our society of convenience has created a dietary disaster. But learning a few, easy recipes to prepare at home will create healthy eating habits.

These are just two easy steps that could have a profound effect, not only on our lives as adults, but also on our children. Healthy lifestyle habits, including healthy eating and physical activity, can lower the risk of becoming obese and developing related diseases.  A healthy lifestyle can pay a lifetime of dividends.

John Douthitt is general manager of Mission Fitness. He earned his Bachelor of Science in Exercise Science from the University of North Texas and has over 25 years of health club and fitness industry experience.



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!