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What’s New

Keep up-to-date on the latest vision-related news and eye care events in our Practice. The items are displayed by year and month. To view older entries use the links in the box below to select the year and month you would like.

BEER CRITERIA FOR ELDERLY UPDATE

You'll see more focus on appropriate med use in adults over 65...as the Beers Criteria from the Am Geriatrics Soc catch up with the evidence. Continue thinking of these guidelines as a "yellow warning light" to use caution with some meds...NOT a "red stop sign" to always avoid them. Expect to...

Smoking Cessation Recommendation

Questions will come up about how to help patients with CV disease quit smoking...due to new guidance from the Am College of Cardiology. Smoking is responsible for up to a third of deaths from CV disease. Ask patients if they smoke...and advise them to quit. Explain that counseling PLUS smoking cessation...

Smoking counseling & Smoking cessation UPDATE 2019

Successful smoking cessation should involve combining behavioral counseling and drug therapy. The chart below reviews available drug products to assist with smoking cessation, including place in therapy, dosing, possible advantages and disadvantages, as well as patient counseling points. Abbreviations: ACS = acute coronary syndrome; CV = cardiovascular; NRT = nicotine...

Can e-cigarettes be used in public places?

Rules vary, but many public places (airplanes, hotels, etc) consider e-cigarettes and vaping within their no-smoking policies. E-cigarettes can trigger some types of smoke alarms. Rarely, e-cigarettes have been associated with explosions (due to the lithium battery) and fires causing serious burns and death. Can e-cigarettes be used by hospitalized...

Are youth who use e-cigarettes at risk of becoming smokers?

Preliminary evidence suggests that youth who use e-cigarettes are more likely to smoke tobacco cigarettes at a later age than youth who don’t use e-cigarettes. Are e-cigarettes effective for smoking cessation? E-cigarettes are not an approved smoking cessation aid. Switching from tobacco cigarettes to e-cigarettes reduces exposure to many toxins....

ARE E-Cigarettes safe ?

Nicotine is highly addictive. Using e-cigarettes can cause addiction to nicotine. The adolescent brain is more susceptible to nicotine addiction than fully developed brains of adults. Nicotine delivered via e-cigarettes is less harmful than smoking tobacco cigarettes. When burned, the tobacco in conventional cigarettes releases thousands of harmful toxins and...

How are e-cigarettes used? 

E-cigarettes are marketed to be used for smoking cessation. In addition, they are also being used for recreation in persons who have never used tobacco cigarettes, particularly in youth. E-cigarettes are also used in alternate ways (with and without nicotine); such as for smoke tricks (including competitions), inhalation of flavors,...

Do e-cigarettes contain nicotine?

Most e-cigarettes contain nicotine however, there are some nicotine-free e-liquids. Nicotine concentrations vary from very low to more than is found in tobacco cigarettes. Many e-cigarette products use “free-base” nicotine. However, higher nicotine concentrations of free-base nicotine are reported to cause “aversive user experiences.” Newer devices, (e.g., Juul) contain protonated...

What are e-cigarettes?

E-cigarette is a common term for “electronic nicotine delivery systems (ENDS).” Other terms used include vaping devices, electronic cigarettes, electronic vapor products (EVPs), vape pens, e-cigars, e-hookah, etc. The act of using these devices also has several descriptors; including vaping, Juuling, etc. Sizes and shapes of e-cigarettes vary (e.g., shaped...

Which risk estimator is recommended?

Use the pooled cohort equations tool for most patients. It is derived from community-based U.S. population. It estimates the risk of “hard” clinical events, such as MI or stroke.2 The ASCVD Risk Estimator Plus can be used to estimate 10-year ASCVD risk. It uses the pooled cohort equation. It is...

What is the role of non-statins?

Patients with very high-risk ASCVD (e.g., multiple major ASCVD events or one major ASCVD event plus multiple risk factors) who cannot reach an LDL threshold of 70 mg/dL (1.8 mmol/L) with a statin: ezetimibe add-on is reasonable. Failing that, a PCSK9 inhibitor* could be added. Adding ezetimibe to simvastatin 40...

Why are there LDL thresholds for some patients now?

Lower LDL has long been associated with lower ASCVD risk.1 New studies published since the 2013 AHA/ACC guidelines show that non-statin add-ons further reduce ASCVD events in patients with very high-risk ASCVD, supporting the idea that LDL reduction, not just statin therapy, is beneficial.3-5...

Is it necessary to check a fasting lipid panel, or is non-fasting ok?

Non-fasting is ok for most patients, but a fasting panel is preferred: when monitoring response to lipid-lowering therapy. in patients ≥20 years of age with initial triglycerides ≥400 mg/dL when screening for familial lipid disorders How do I assess cardiovascular risk to help decide if a patient needs a statin for primary prevention?...

How should statin patients be monitored?

Check transaminases at baseline. Unless the patient has chronic stable liver disease, repeat only if signs/symptoms suggesting of hepatotoxicity occur. Document any pre-existing muscle symptoms before starting a statin to establish a baseline. If severe muscle symptoms or objective weakness occur, hold the statin and check creatinine kinase. Check fasting...

2019 STEP BY STEP UPDATE GUIDELINES HELP PATIENT LOWER CHOLESTEROL

Use this as a guide to start conversations with your dyslipidemia patients during comprehensive medication reviews (CMRs), medication synchronization appointments, or during any patient interaction. Tackle one or two topics at a time, but don’t overwhelm your patients or yourself by doing too much too fast. Start with these ideas...

Should I screen patients for high cholesterol?

A lipid panel is used (1) to identify patients with familial hyperlipidemia, (2) as a baseline to monitor statin efficacy (e.g., in secondary prevention patients), (3) as part of shared decision-making regarding initiation of statin therapy in primary prevention patients 40 to 75 years of age, (4) to estimate lifetime...

WHAT THE NEW FLU MEDICATION ON THE MARKET

Xofluza (zoh-FLOO-zuh, baloxavir) will be the first new oral antiviral for treating influenza in nearly 20 years. Think of Xofluza as an alternative to oseltamivir (Tamiflu). A big difference is Xofluza is ONE oral dose...compared to 5 days of BID oseltamivir. Xofluzaalso seems to cause less nausea and vomiting. Xofluza has a new...

Recommendation for Lipid Reducing Agent

Experts have landed on 70 mg/dL as the threshold to consider adding a non-statin...AFTER verifying adherence to statins and lifestyle changes. The change is based on more data that "lower is better" in these patients.Continue to recommend a high-intensity statin (atorvastatin 80 mg, etc) for very high-risk patients. Then use...

Flu Season 2018-2019 

Most people who get “the flu” have self-limiting symptoms (fever, cough, muscle aches, etc) for about seven to ten days.1 Treatment generally includes rest and supportive measures.2 But some patients have influenza infections that are more serious. There are an estimated 310,000 hospitalizations and up to 56,000 deaths in the...

Mental Health Assistance

The staff-assisted depression care support system required for adults is a multi-component system that goes beyond simple feedback of screening results. In addition to staff support for scheduling follow-up visits and facilitating referrals, other higher-intensity interventions might include elements such as intensive clinician and office support staff training, support staff...

Influenza in Pregnant Women

Multiple studies have shown no adverse fetal effects from administration of the inactivated vaccine to the mother during pregnancy. The AAFP and ACOG both recommend immunization for influenza in pregnant women during influenza season. Pregnant women should not receive the live attenuated vaccine, however.Breastfeeding women should also be immunized, with...

Influenza Vaccines

There is insufficient evidence to support use of the live attenuated influenza vaccine in children under the age of 2. Children between 6 months and 2 years of age should only receive the trivalent inactivated influenza vaccine. Children 6 months or older with evidence of, or a history of, reactive...

Tetanus Booster Recommendation

For the pregnant patient with no identifiable risk factors, a tetanus booster is recommended. Women who will be pregnant during influenza season should receive the inactived vaccine. In addition, this particular patient should also receive hepatitis B vaccine because of her history of high-risk sexual behavior. Tdap would both provide...

Pregnant Women and Inactivated Vaccines

Did you know that pregnant women can safely receive inactivated viral or bacterial vaccines or toxoids? As a general rule, live attenuated viral vaccines should be avoided in the immediate preconception and prenatal time periods (e.g., varicella, live attenuated influenza, MMR). While there is no proven risk of adverse fetal...

What is Varicella vaccine?

Varicella vaccine is recommended for all healthy adolescents and adults who have not received the vaccine and have no confirmed history of chickenpox (SOR A). Two doses are required, given at least 4 weeks apart. Particular attention should be given to immunizing women of reproductive age, international travelers, and close...

About the Recombinant Vaccine

Whereas the live attenuated vaccine was recommended by the CDC for persons over age 60, the recombinant vaccine is recommended for healthy adults 50 years of age and older. Recombinant vaccine is recommended for patients who have had shingles in the past, as well as those who received the live...

What is Shingrix?

Unlike the older herpes zoster vaccine that contains a live attenuated varicella virus, Shingrix is a non-live, recombinant subunit vaccine that combines a lyophilized varicella zoster virus glycoprotein E (gE) antigen and an adjuvant system. It is administered in two doses of 0.5 mL each, with the second dose given...

Immunocompromised People

Since recombinant vaccine is not a live vaccine, it is not contraindicated in immunocompromised persons. However, it is not recommended by the ACIP at this time. The ACIP is expected to review the evidence for its use in immunocompromised persons and will modify vaccine policy as necessary. The CDC does...

Zoster Information

A reported history of zoster does not preclude vaccination, as repeat episodes of zoster have been confirmed in immunocompetent persons. The exact risk for and severity of zoster after a previous episode are unknown, but some experts believe it may be similar to those with no history of zoster. There...

Serologic Testing Recommendations

Although the CDC does not recommend serologic testing when vaccinating adults age 50 and older, if serologic evidence of varicella susceptibility is available to the health care provider, the CDC recommends that providers follow the guidelines for varicella vaccination recommended by the Advisory Committee on Immunization Practices (ACIP). Since the...

Preventing Infections

Advancing age and chronic illness are risk factors for herpes zoster and associated post-herpetic neuralgia. Approximately 99.5% of the U.S. population age 40 and older has serologic evidence of previous varicella infection. Thus, all older adults are at risk for zoster, although many cannot recall any previous history of chickenpox....

Meningococcal Conjugate Vaccine Updates

Meningococcal conjugate vaccine (MCV) is recommended for normal-risk children at 11–12 years of age, although children with certain medical conditions (such as sickle cell disease or apslenia) may benefit from immunization as early as 2 years of age. HIV-infected patients who are vaccinated should receive two doses of the vaccine....

Recent U.S. Preventive Services Task Force Findings

In 2018 the U.S. Preventive Services Task Force (USPSTF) found sufficient evidence to recommend exercise interventions (supervised individual and group classes and physical therapy) to prevent falls in community-dwelling adults age 65 or older who are at increased risk for falls. It also found evidence to recommend that clinicians selectively...

Falling is Becoming More Frequent, Make Sure You’re Prepared

As our population ages, preventing falls is of increasing importance. Approximately 35%–40% of community-dwelling persons age 65 and older fall annually, with 5% of those who fall requiring hospitalization. In addition, it is estimated that up to 40% of nursing-home admissions are fall-related....

Primary Care Screening Outcomes

The U.S. Preventive Services Task Force (USPSTF) found good evidence that patients at risk for adverse outcomes from alcohol abuse can be accurately identified in the primary care setting. They also found evidence that counseling interventions in the primary care setting can positively affect unhealthy drinking behaviors in adults engaging...

Limiting Your Daily Alcohol Intake

According to the 2017 hypertension guidelines from the American Heart Association and the American College of Cardiology, limiting daily alcohol intake to 1–2 drinks in men and 1 drink in women has the least impact on lowering systolic blood pressure (SBP) among non-pharmacologic interventions in hypertensive individuals, with an anticipated...

ACLS Class: July 22, 2018

ACLS 7.22.18

BLS Class: June 13th 2018

BLS Class 2c Thank you to all who attended!

Kudo Care Center Introduces New Concierge Membership Program with Coverage for Medical, Dental and Vision Care

Kudo Care Center is pleased to announce the official launch of their new concierge membership program.

Botox Class: Join Us March 29th

Kudo Care Class

Become Our Botox Class Model!

Kudo Care Class Botox Model

Kudo Care Concierge Membership

Call today for information and to sign up for our Kudo Care Concierge Membership. It is available for all ages with special discounts available for each additional family member. For a one-time activation fee and a low monthly fee, membership will provide access to all three specialties (medical, dental, and...

Vision Center Trunk Show on January 13

Kudo Care Vision Center invites all Irving residents to attend our upcoming trunk show on January 13 starting at 9:00am.

Kudo Care Vision Center to Host Trunk Show on January 13, Offering Lucrative One Day Sale on the Most Popular Eyewear Brands

Kudo Care Vision Center, a division of Kudo Care Center, is all set to host a trunk show, offering attractive rates on numerous products from renowned eyewear brands such as Versace, Coach, Tory Burch, Michael Kors, and others.

Especial de 150 Dólares

Especial de 150 Dólares

USE IT OR LOSE IT

Did you know that you can use your Flex-Spending Benefit / FSA for your medical care, dental care & eye care.

Cheap – Fast & Good

Dr. AJ Nguyen talks about health care costs...

Flu Season Is Coming Up…

We encourage everyone to come and get a flu shot for only $30 dollars all tax included....

Halloween Promotion $100 Labs Special

We are currently running a special for all patients. With your medical visit, you can add on a $100 labs special that includes checking your Liver Enzyme, Kidney blood work, Anemia check, Blood Sugar check, Thyroid labs, Cholesterol Panel, Urinalysis & Your Electrolyte Plus an EKG include interpretation. Visit our...

GRAND OPENING SPECIALS…!

We invite you to visit our center for our our GRAND OPENING SPECIAL...a Comprehensive Exam in all three specialties for $150.00.

Welcome to our New Website

We invite you to take a look around our new site to get to know our practice and learn about eye and vision health. You will find a wealth of information about our optometrists, our staff and our services, as well as facts and advice about how to take care...

Pink, Stinging Eyes?

Conjunctivitis, also called pink eye, is one of the most frequently seen eye diseases, especially in kids. It can be caused by viruses, bacteria or even allergies to pollen, chlorine in swimming pools, and ingredients in cosmetics, or other irritants, which touch the eyes. Some forms of conjunctivitis might be...
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