Thank you for watching this program tonight with the best physicians of the region.

My name is Dr. Luis Munoz.

I'm the president of El Paso County Medical Society.

It is our hope that you will find this program informative and interesting.

We at El Paso County Medical Society invest in community education with our programs.

I hope you'll find this program very informative, with great medical advice and great medical information.

Thank you again for watching this program tonight.

And have a great night.

Vaccines, it's a hot topic with COVID vaccines taking most of the media attention over the last several years.

The focus has been steered away from other vaccines that are important for the entire household, protecting both children and adults.

This program is underwritten by the city of El Paso, Department of Health.

Thank you very much, Dr. Ocaranza and all of your team there.

And we also want to say a big thank you to the El Paso County Medical Society who has been doing this show now for 27 years.

I'm Kathrin Berg and this is the El Paso Physician.

Thanks again for joining us this evening.

We're going to be talking about vaccines back to school.

When do you get what, vaccines, etc.. And we have a great team with us.

Everyone is a veteran on the panel, which is really nice.

We have Dr. Alison Days, who is a pediatrician.

She's also the editor of the El Paso Physician magazine.

And we were just discussing how long she's been doing that.

Anywhere between a decade and 17 years.

So I get that because you've just been doing it and doing it.

Doing it.

But it is a discipline that is underrated in so many ways.

So thank you so much for doing that all this time.

And she's also the medical director of UMC Health Care Partners and Healthy Days Pediatrics.

So thank you so much for being here.

We also have Dr. Roxanne Tyroch, and she is in telemedicine and the Texas delegate to the American Medical Association.

So thank you so much because there's a lot of stuff that people don't know that you do on that end.

And we can talk a little bit about that toward the end of the program as well.

And then we have Dr. Hector Ocaranza, who is a pediatrician and also the city of El Paso Health Authority.

That just sounds so official.

And also a physician would St Anthony's Pediatrics.

So thank you so much for being here.

We did a vaccine program not too long ago, and I feel like there are so many myths out there.

There are so many good things that come out of vaccines.

And I know that we had Dr. Hendryx and I wanted to give him a nod, too, because last time he came on and talked about how vaccine was first started in the world and how many lives were saved and not even realizing if it was going to work.

And on this is we're talking centuries ago.

So thank you again for being here, because this is so important.

One of the first things I want to ask and Dr. Days, I'm going to start with you when I know that when Dr. Nikki enter, we talked about Dr. Nikki for a second and the Paso del Norte Health Foundation at that time had this great ad that was two, four and six months old, El Paso, Juarez and Las Cruces.

I mean, we remember that.

And I'm wondering, too, because PBS tends to skew a little older, that people that are listening and watching right now may remember that, too.

But what was that about?

I just remember the song.

I was younger at the time, but that was all about vaccines.

And when you get vaccines, so kind of take that from there first and then we're going to talk about introducing everyone.

But that's super important of why we're here today.

Sure.

Yeah, that that song was I mean, we always want to make sure that people remember something and mnemonics or songs or jingles are a good way to get them to remember it.

So at that time, the times that you should get vaccines for babies were at those ages of two months, four months, six months, nine months and a year.

And so that was that was the basis of the creation of that.

So he got the jingle.

So people remember two, four, six, you know, those kind of things, and it would just get in your head and then parents wouldn't forget, hopefully, you know, you did it.

Whereas, you know, now we don't hear that much anymore and people do forget when they're supposed to go back.

So maybe we need to bring those back.

We should do like a retro thing.

Everything's retro and everything.

That was retro.

The Western Playland broccoli thing, I mean.

Right, Exactly.

That watch, watch.

This is going to start happening.

And given a couple of months on that note, I'd like for you to stay on you for a little bit so you have so many things in your background.

I'm going to go to each one of you and ask about this.

So we have you're now working with UMC medical director over there and pediatrics in general.

If you can explain to our audience kind of what your background is and it's always nice for them to hear where you're coming from in the answers that you're giving.

So if you can give that out to the how far of a background pediatrician, pediatrician out there, and again, the editor of El Paso magazine and then healthy days, we talk about healthy days a little bit and then how that is affiliated with UMC.

Sure.

Well, first, I will mention that prior to healthy days, I did work with Texas Tech and I also received my a public health degree from University of Houston Public Health Department of Public Health.

So I also have a public health background as well.

And when I was in residency, I did a lot of work in public health.

So that's that's another part of my background.

But in terms of the healthy days itself, I found it healthy days And 2012 as a private pediatricians office, we started and we did very well.

We got through COVID, we managed to survive through COVID.

And then after that, UMC approached me as wanting to possibly partner up with an outpatient pediatric clinic, which is an area they're just starting to sort of go out and learn about and and partner with.

So I'm one of the second ones in town that's doing that with him in the pediatric realm.

And thus far it's been a good partnership.

So it's very nice.

Beautifully explained.

Dr. Tyroch In telemedicine.

And explain to the audience what that means.

I mean, we are all familiar with it, but that's not something you hear about all day.

So internists, internal medicine in telemedicine, correct?

So explain kind of what your background is.

Certainly.

Well, I graduated from medical school in 91 and briefly went to California before coming to Texas.

And I, like Doctor Days, was at Texas Tech for about seven years, small stint with the education program residency at William Beaumont, and then a hospitalist with the Tenet system for about five years before opening in telemedicine, about two years after doctor days in 2014.

So it's this is a ten year anniversary year.

It is a primary care clinic and so as a primary care physician, we take responsibility for helping patients be up to date with their vaccine that those vaccine responsibilities that they that they have.

And it's a joy and a pleasure.

And it's nice to know that the El Paso community cares about infection control.

Exactly.

I'd like to also talk about, I don't think others or at least it hasn't been brought up to be a Texas delegate to the American Medical Association.

So explain what you do or what your role varies, because that again, that's kind of behind the scenes of what everybody sees on this table all the time.

What is your role there and what is it that you how do you make the world better by being that girl?

Does that make sense?

That's exactly how I see that position is that we're you know, every state has delegates based on the number of AMA members.

They have to get a delegate for each 1000 members.

Okay.

So potentially, if every single team physician was in AMA member, we would have 57 delegates, but we don't.

We have about half that because only half of the team Texas Medical Association physicians are AMA members.

So Texas Medical Association focuses on state legislation and AMA will focus on national legislation.

Been a delegate for ten years and it just gets more and more fascinating as time goes on.

And well, thanks for thanks for hanging in there, because I know that's not easy because it's a lot of not fighting but advocating for the right thing.

And sometimes that's hard to do when you're trying to convince people of the right things.

So thank you so much for doing that, Dr. Ocaranza.

How are you doing?

Well, Kathrin, still, we will see.

You know what my favorite part of the show is?

All the talk that we get to do before we actually do that.

That's so fun because we were just trying to remember when the last time was or the first time was that we met.

But I want to go through what your specific title is.

You are with the City of El Paso.

You were the health authority.

And I want to ask, what does that mean in that specific role?

What do you do for the city of El Paso?

For all of us that see you on the air here and there, It's like, oh, there's that guy again.

He's telling us how to stay safe, etc..

But explain what your role is there exactly.

What that means is I need to be able to take care of the community to stay healthy.

So what does that entail?

Well, it seems so simple, but it's so complex because we need to tell the people to be ready for any kind of emergency like the floods that we got in 2006.

How do you take care of your loved ones if they're disabled and they're not able to take care of themselves?

How to be ready for that, how to be ready for a pandemic or what to do during a pandemic?

And that's when the people used to see me all the time.

And before that they will see me.

That's fine.

I don't mind that until something like that happens.

And also the way that we need to be addressing our community in how to tell the people what to do, to live longer life, to live a happier life.

We need to collect statistics on what's happening, how many people get sick with specific disease, how many people are dying for from specific disease or natural causes, birth etc., etc.

So it's quite complex, but it's mainly and simple to keep our community safe and healthy.

You know, on this program we throw out a lot of numbers, a lot of statistics, and you're one of the group of allowing that to happen because somebody has to gather the information.

So on that note, in our audience, too, if you're a person that answers the questions that people ask regarding public health, some people like, Oh, I don't answer that questions to you private, but it really does help the masses to know what's happening out there in Dr. Days.

That kind of brings me to something that we talked about before the program start because of the masses who knew that measles was something that was coming back without somebody taking note of that and writing it down, thinking, oh my gosh, there's new numbers, what's going on there?

And I do want to talk very specifically about vaccine hesitancy, because for many years, I feel like decades it was it was wiped out.

So I'm just going to let you take it.

Yes.

Maybe you'd like to to.

Sure.

So measles has been around for a very long time in this country.

It's probably one of the earliest known right after chicken pox.

I mean, right after.

Sorry, smallpox and some of those measles was pretty early in terms of when it was discovered as a disease.

But in this country, I think it's been I want to say we finally eradicate cated or somehow eradicated it from this country.

We reduced our our numbers to a very small amount in the 80 solid eighties, early nineties.

I think if you want to corroborate that doctor or Ocaranza but I think it was around then and ever since then for quite a while it's been extremely low numbers in the United States and most of the people that we've seen that have come in with measles have come into the country with measles.

And they're isolated cases because the majority of people here were vaccinated and so they didn't catch it.

What we're seeing in the last definitely in the last ten years, I would say, is when we started to increase our numbers very slowly at first and now much more rapidly, as there has been more and more and more vaccine hesitancy and quite a bit more since COVID that we've seen parents and groups of people, communities choosing not to vaccinate their children at the young ages, that they should get the measles vaccine.

And so we have groups of people that are going around unvaccinated.

And the more you get unvaccinated at a certain level, you reduce what we call our herd immunity and then we're no longer immune.

As a community, you might individually be immune if you're vaccinated or not, but as a community, we're no longer immune.

And so what we've seen over the past, you know, 12 to 24 months as we started to spike up in outbreaks of measles, isolated on the country, but they've gone up so significantly in the past year to two years.

Last year, 2023, we had our first year of big uptick and we only had four outbreaks last year.

And that was considered almost an epidemic at that point because prior to that point we'd had maybe one or two and a year up until that point.

So we had four last year.

This year we have 13 that have been named as of August 1st, and that's a lot of increase.

Okay.

And several of them and they consider those outbreaks.

The definition of that is two or I think it's more than three people with a disease that are connected to each other.

So it's 13 times this year there have been more than three people with measles that were connected to each other.

So in there, we're going to look and have this show next year.

And it's going to be an interesting number right there.

And I'd like to in fact, with all three of you, I'd like to talk about hesitancy in general and I'd like to talk about and you used the the golden word during COVID.

Right.

And I know that the wording of herd immunity and people are like, what exactly does that mean?

And then all of a sudden there are these definitions, that word definitions that people were just kind of throwing out there what it is.

So Dr. Ocaranza and Dr. Tyroch, I want to get to you in just a second.

But because that was part of your life for a year and a half, two years, herd immunity when we're talking about that was a COVID vaccine.

But in general, let's bring it back to COVID, because that's how most people heard that for the first time.

What does that mean when an entire populace and this was a global populace, not just America, not just, you know, certain countries when you are trying to convince is a bad word, trying to encourage vaccines as well.

I want to mention something there and it's something to Dr. Days.

Vaccine hesitancy hasn't been just recently.

It has been for many, many centuries.

Even when they started with the smallpox vaccine done in at the beginning of when they were want to know what's going in them and they want somebody else to do it first.

Exactly that.

Then they saw that by doing the specific thing, which was in vaccination, you were preventing diseases.

And nowadays you don't see diseases going around the communities.

But talking about the older people, which I didn't feel like, and older people.

But I think I'm starting to and hopefully we can we come to fashion now as the oldest.

But I'm sure that if you ask the grandparents and you ask them, Hey, how many kids in your block when you were a kid didn't walk anymore because they have polio and they will say two or three out of 20 kids that were out playing and all of a sudden we don't see any one.

Right.

We should be wondering, is there a reason why?

Yes, there's a reason why vaccination is what has made that successful.

But the people are not believing in the vaccines because they don't see.

Right.

And if you don't see them, why should you do it?

And that is actually bringing us to what the herd immunity is when everybody else is protecting a single individual in a community or a group of people.

When you have enough people vaccinated, specific infectious disease is not going to come in, start spreading from one person to the other.

That's that's how the herd immunity is the simplest way to to define it.

So that's what we were trying to do when we tell people, hey, get vaccinated.

So we don't want to see the hospitals, we don't want to see all these bunch of people dying, you know, So we're the place I want you to go is when you're looking at some cases is one thing, but when you're looking at the overrunning of hospitals and people could not get in and people were dying because there wasn't enough service, because there were too many people overloading the hospital.

So that to me is something that I think we need to stress more.

We had about eight really bad months, three horrible months, and that was the issue that there just wasn't enough room because and then once people really started to go get their vaccines, that started lining up the load.

Yes.

And I think my mother so my mother was born in 1941.

She did have polio.

She she called it her her polio wobble.

So she had a like a weeble wobble.

She had a little polio wobble.

She does anything.

She's been gone 30 years.

I miss the heck out of her.

But but that was kind of the thing.

And her children like polio.

That's something you see in the movies or that you know, that show that you saw.

That's back in the 1910s and twenties and thirties.

That's polio.

We don't know anything about that.

And to your point, all those vaccines took place and then there was the global effort.

Rotary is a club that is global.

And so they took that on as we're going to eradicate polio.

And I won as president of the Rotary Club here 2016 and 17.

I want to say the following year is the year that there was complete eradication of polio and then one or two creep back in.

So it is this game here.

Yeah.

On that note, may I mention one more thing before you go on about that and please.

Yes, two quick things I wanted to say about what Dr. Ocaranza was saying about people not seeing it.

So that's one thing I try to do in my practice is actually not only show them pictures, but specifically tell them, hey, in our lifetimes, you know, not in 1949.

In pictures in my lifetime, since I did residency, I've seen things like rotavirus go away.

I've seen things like varicella go away, and people will still say, parents will say, isn't my kid going to get chickenpox?

No, hopefully not, because you got the vaccine.

So there's things like that that we see going on.

In other things, specifically about measles that I wanted to mention is that W.H.O., the World Health Organization, also has lists throughout countries of which countries are, you know, vaccines which have epidemics or endemics of certain diseases.

And we have been listed by W.H.O.

for many, many years as being eradicated for measles.

Right.

We were about to lose that designation because of these outbreaks that are coming up.

So as we as we creep up in the number of outbreaks we have, we lose our designation as a country that is no longer a move to measles.

Right.

So that's coming up as well.

That will happen.

So again, next year at this time is going to be an interesting program, correct?

Goodness.

Dr. Tyrod I want to talk about I'm not done with COVID because the world's still not done with COVID six is going around again, but we'll get back to it.

But I do want to talk about some other vaccines and there is a specific one, Tdap.

I mean, we hear about it a lot.

What exactly is that for and how is there any hesitancy around Tdap?

T Deb, I would say there's more procrastination than there is hesitancy about Tdap.

Of course, we do have people that that are hesitant to take the Tdap, but t stands for Tetanus de stands for diphtheria, a P stands for a cellular pertussis.

And people used to have bad reactions to the cellular pertussis vaccine.

And then there was even a cellular pertussis version that reduced a lot of the adverse reactions.

So some of the older people may remember that and have hesitancy about that, but things have changed.

So what has changed that it went from the cellular to the only cellular with less reactions.

Gotcha.

So tetanus is something that children are vaccinated and then as adults, you're supposed to continue keeping track of that and getting that every ten years.

If you have a penetrating wound, you need to.

And it's you know, it wasn't just yesterday that you got your Tdap, Then you would get another tetanus vaccine.

Lockjaw is another word for tetanus, where people will have the inability to swallow, inability to open the mouth.

It's a terrible disease.

And the CDC, every now and then, we'll have reports of people that did not immunize their child.

And unfortunately, the child would get it rare, but it happens.

Diphtheria is a respiratory illness that is extremely rare in the United States.

But we do have an outbreak going on in Nigeria, and that was a thick gray material in the back of the throat, making it difficult for for the individual to breathe.

And so as an adult, if you're around children, just keep in mind the airway of a child is so small and they just really can't tolerate something like that.

So do it for yourself and do it for your loved ones.

On that note, because I think that's a perfect timing, because we were talking about childhood vaccines.

And then also this is a vaccine that you can get at any time of your lifetime.

Is it a vaccine that is, for example, I'm a parent and then naturally you just go to your pediatrician and they've got these are the things that you need.

And I was like, okay, is it a vaccine that is naturally on the list without a better way of describing it?

And a primary care physician is going to be pestering you after ten years?

Oh, okay.

So every ten years that you're taking a shot.

And so, yes, when everybody said that every ten years, get your tetanus shot.

So this is absolutely technically the tetanus shot that also has diphtheria, etc., etc..

I'm going to try to explain the AP word, obviously Glad she's saying that.

So I can't pronounce that.

As an adult.

You can also get a TD, which only has tetanus and diphtheria.

Without the pertussis you can get it based on availability at the pharmacy or the physician's office.

You go in for your tetanus shot.

Is it naturally the Tdap shot or is it naturally, or do you have to request which one you want?

Emergency rooms will tend to give just tetanus toxoid, but you chime in if you want.

But I don't see officers having that.

Most of the offices will have Tdap or TB.

Gotcha.

Yeah.

And one important thing about the Tdap is that it's not only going to be protecting the adults now we're recommending that for the pregnant women so we can protect the infants.

And we're seeing in our community cases of pertussis.

Pertussis is the whooping cough, what they call it.

And in three or four out of five cases of pertussis, the parents and the grandparents are the ones that are transmitting that.

So that's why it is recommended that in all these pregnant women and all the adults around the baby get their vaccine as well.

So I'm again, I'm a layperson.

So I think whooping cough, I don't know what movie I was watching, but I remember the doctor coming out saying, okay, everybody be quiet.

And then a baby was whooping, coughing.

And then she said, You get in here quickly.

And the reason I'm saying that is that why is whooping cough so bad to help people to get that vaccine.

So why is it that that doctor we can see that baby, right, that in there the pediatrician for her definitely in those babies can be endangered.

Their life is in danger because because of the cough they're going to be coughing so much.

They're are going to turn blue.

They're not getting enough oxygen.

And some babies actually have passed away because of that infectious disease that could have been prevented.

Right.

And how do you know that it's a whooping cough versus another cough?

It has a very distinctive cough.

And even the grandparents can tell you that.

And they would hear it like, oh, that's not a good cough, Mijo.

I kind of wish we had sound effects.

And they are uncontrollable Yeah, yeah.

Okay.

So it's like you can't get your breath.

They can't say yes.

Okay.

Okay, good.

Yeah, yeah.

I love that.

And I know that you were, you were going to go on with something else too when I, when I asked about that.

And if you may have lost your train of thought because that was me interrupting you, actually, Dr. Ocaranza went into it, You know, with pertussis, we really have very little pertussis in the United States.

In the United States, thanks to people's dedication to vaccination.

But China is where we still have problems with pertussis.

So it's still out there.

It's not, you know, eradicated.

And again, there's world travel.

And that's what's so, you know, it's so easy to travel, which is great, but you don't know if somebody is coming in, coming out.

So, again, when you have herd immunity, if that's a possibility and these vaccines, that's where it's always, in my opinion, Great.

Dr. Days, I have a question here for you.

So it's kind of piggybacking on what we talked about with the two, four and six months.

But there are different ages as people are going to school that they receive different vaccines.

And I'd like for you to expand on that some years, elementary school years, high school.

And then there's even I remember when my kids went to college like, oh, great, you got more shots.

You know, I thought we were done.

Yeah.

I always tell people, you're never gotten you're never you never done.

They stretch out, but you're never done.

So I ever did.

So yeah, I mean, generally and I think we talked about this a little bit at a last time we did this talk, which is that vaccines, I'm not going to go into detail, but vaccines are are given at times that are not random.

They're given for specific reasons whether the two, four and six ones are given, because those are the ones that were studied.

Those are the times that kids are most at risk.

Those are the times they don't have a natural immunity to those things.

So there's various reasons why and and to how many doses they get as well.

There's very specific reasons.

And when they study and when they research these vaccines as to why we give them at those ages.

So it's not arbitrary.

And so some of the ones we are looking at now, a lot of people will tell me after that infancy period, oh, when do they need the next ones?

So usually that last infancy doses that 18 months, 18 months to two years, you'll get some and then you get a little bit of a break and then realistically the next group is going to be on entry to elementary school.

So I always tell my patients is, as you said, it's an entry to certain schools.

So entry to pre-k, kindergarten, entry to elementary school, we say, is the time.

Now, obviously, if you're in daycare at four, you're still going to need it, but that's basically what you're going to think.

And the ones we give that are the ones that, again, are the most likely for them to come in contact with you, the most likely for them to have problems with.

So those are going to be what we mentioned before, measles.

That should be their second dose of their booster dose of measles, mumps and rubella that come together.

It should be their second dose of the Tdap we were talking about right now.

So they should get that one again.

They should also get another polio and they should get their varicella.

Okay.

Now, those can be given generally as four separate shots or they can be given as two separate shots.

So there are accommodation spots where they can get to.

So if the parents are willing to do the combination vaccines, some are, some aren't.

But I think it's better because then they only get two instead of four.

Right.

But it used to be there did used to be, I think, a jingle also that was like four shots at four years or something like that.

But now we do the two shots at four years, so that's different.

So that's that.

And then I told them after that shot, you know, they're all upset and the kids are crying because they didn't realize they were going to get a shot again.

And they say, Hey, listen, you won't need any for a really long time now.

Maybe the flu shot in the winter, but other than that, not a whole lot until you're 11 or 12 and they go, oh, that's forever.

Yeah, right.

So the next set beyond that is going to be our middle school entry ones.

And those are primarily the main ones at that point are obviously you catch them up if they're delayed for some of the other ones.

But you're going to do the Tdap again.

Actually, I should have said earlier, it's the DTaP.

So when they're four, it's the detect when they're younger to up, which are the same viruses are same same toxoid and things like that.

They're just in different forms.

So the D, the diphtheria we mentioned is a bigger risk at that age than the tetanus, because if you have a child walking around a lot, that probably not going to be exposed to tetanus, right?

So the theory is much greater when you're going to school, respiratory virus, things like that.

So the D is a greater amount in that than the T is.

But as you get older, the T is more important.

So then you go to Tdap at 11 or 12.

Okay, So you get a dose of that and then after that it's the ten years, every ten years after the 11-12 dose.

Okay.

And then you're going to get your meningitis shot, your first meningitis one.

Okay.

And that one is for middle school.

Yes.

And that is now required entry to seventh grade.

So we say that is required as is to 12.

When I say you like in the last decade ish, it's about the last decade for that age group.

Yes, it's been around longer because I received it when I was in high school a little bit later than that.

But at that time it was a late high school, early college vaccine.

And then so yes, but now we give it because we realized the exposure starts earlier.

So you're more exposed to meningitis if you're in close quarters, You know, college dorms, military, that was where it was before.

And then we realize our kids at middle school are spending sleepovers, are going into clubs or going on trips with their cheerleading squad, you know, So it's the same behavior, you know, So we started vaccines sooner for that.

And then you get the second booster of that one at 16.

Okay.

The other one given somewhere between 11 to 13 to 14.

I mean, realistically, it's sort of 9 to 15 years and that one's a little bit more voluntary at this point.

Still is the HPV.

We push it and we tell patients this is the one you're getting at 11, but it's technically not required by schools yet.

It is recommended.

Yes, yes, yes, yes.

I would love to know is that's something that Texas Medical Association, AMA, how does that turn into not required yet to being required and I know I'm throwing this out there without asking ahead of time.

Is that even something that we can talk about?

Because I don't there's a lot of energy in the room on that, but I think it's part of what we do to try to convince people that, you know, you can only control so much in life and you may think your life is going this way and it may end up going that way.

And it's always good to be prepared.

I kind of like this therapy session.

Absolutely.

And I think I think maybe they can talk more about it with adults.

But in in kids, because I do get the question a lot.

Well, why are we giving So again, just to preface HPV as human papillomavirus, okay, It's a sexually transmitted disease.

And so people will ask me all the time, why are we giving a sexually transmitted disease vaccine to 11 and 12 year olds?

So, number one, it doesn't cause the virus.

Number two, we're not suggesting that you need the virus.

I mean that you need the vaccine because you're sexually active.

But realistically, it's again, it's a dosing it's a timeframe, period.

Okay.

So when it was studied, they found that actually you need a couple doses of it first and four, to be fully vaccinated and it can take a while to have full efficacy.

Okay.

And so we're saying maybe we are sort of thinking that around 16, 17 they might be sexually active.

And as Dr. Tyroch said, we don't know.

We can say our 11 year olds are never going to have sex, are not going to have sex till they're 30, whatever.

Right.

You think.

But we've seen it time and time again.

They they often you know, a lot of kids become sexual active in high school.

And so with that thought in mind, if we vaccinate 11 to 12 by the time they are 16 or 17, they're fully vaccinated and they get exposure and they don't get them.

And those rates kind of know exactly.

And so I do that a lot of explaining that because it's not necessarily, hey, the vaccine and it's different.

You know, the flu vaccine takes effect in a couple of weeks.

Right.

HPV, it takes a couple of years.

And so you really need to sometimes explain that to people because they think all vaccines are the same and they act the same and they come the same.

And with HPV now, it was was there a time where it was three doses or two doses or how that work now?

And I know that's changed a little bit.

It changed a little bit because initially when there's so young, they recommend two doses.

And if you start the series a little bit later, it's going to be the three doses.

But when one one to echo what they've been saying, Dr. Tyroch and Dr. Days, all these recommendations on the vaccines are based on the risk.

What is the risk that we have?

How is this vaccine going to positively affect that risk the people have?

So this way we recommend that is going to be a given to the doses, three doses... at what age?

When is it that they're going to be having and touching on the HPV... One thing that I also tell my parents is like, well, this is not going to prevent STDs.

You didn't need to take care of this in different ways.

This is going to prevent cancer.

And not just so cervical cancer is going to prevent cancer on boys on the genital area, but one of the things that they have failed to do is, I guess, throw some of those out there is I remember that being so fascinating because I think everybody does think of it as only female cancer, but it's not.

a big percentage of the throat cancer is HPV.

And they're like, how ?

I'm not going to explain why.

But there's many ways that this virus is so there's so many ways that this virus can get into the body and stays dormant in the body.

And what we want is get them protected with a vaccine.

By the time they're exposed to the virus, the body's going to recognize and it's going to be fighting and it's not going to be the virus.

They're in the body to produce a cancer.

So how great it is to prevent cancer with only one vaccine And how, when and how can you say that with anything else?

That's one of the only one is a big motivator right there.

It's like how yes, it's certain type of cancers.

And yes, you know, there's all kinds of but if you can prevent a certain type of cancer by a vaccine, it just it so I just I find that always to be quite fascinating.

Yeah, exactly.

And it's it's great and it resonates quite a bit with people that they've had cancer and they're like, oh my God, if I would have minded, if I would have known this before, give it to me now.

Sorry, Not anymore.

But to your kids, to your grandkids.

Is this should be a testament that there's ways that you can protect your loved ones.

Right?

Agreed.

And one never knows when you're going to acquire some kind of condition that will lead to immunodeficiency if you get cancer.

And now you're on chemotherapy.

If you get HIV, if you get leukemia, HPV, do those conditions is very different.

It's not just a little wart that is a real sight to see.

So what?

Be blunt and specific bold.

That's why we're here.

So describe what it is that that happens to tumors in and of itself.

Okay.

And so one just never knows what's going to happen in the future.

One may think you have complete control over what will happen to your body.

And some you know, sometimes you never know going to happen to a person.

So you want them protected.

And Dr. Ocaranza, you said, too, that this can lie dormant for a long time.

And when it becomes active and I don't know if there is a certain amount of time, everybody's different.

I completely respect that.

Is it something that, for example, women get pap smears at a certain age?

I get that.

But other than that, and those that are hesitant to do so and I know we have a community that doesn't always go to the doctor when they should or get screenings when they should.

But are there symptoms, Are there signs to look out for?

And you know what?

What's canceled that whole question is it does it make sense with what I'm about to ask?

So to have the prevention in place And again, we're trying to advocate for having vaccines not pushing people to do so.

That's a whole different thing.

But in general, prior to sex and that's the question is we're talking years to be in your system for it to be effective.

And that's kind of where my brain was going with the mouth was was going into a different question.

So we're asking that at 11, 12 years old, even if they're not having sex until 16 or 17.

It might just be getting to the point where it's protecting the body.

Doctor Ocaranza, because we are not flu season, I feel like every month is a flu season.

But in our offices, for example, I worked downtown in the Mills building and it's like, Oh, we got three people out with COVID and we've got two people out with COVID.

We have.

And it's not the crazy COVID that we had a couple of years ago, but the questions are coming back again with vaccines for COVID.

And I know that when we were doing the show a couple of years ago during COVID, we were talking about will eventually the flu vaccine is going to be paired with, as you were talking about, combination vaccines with COVID and flu.

Is that something that's happening?

I think last year I got my COVID shot and then separately, a flu shot is that's how it is.

Just in general, what are you all talking about in your offices?

And I'm looking to jump in.

Yeah, it's still going to happen.

And what we want is to combine these respiratory viruses that are going to be causing a lot of complications.

And as you mentioned previously, what we want is not to over fill the hospitals in talking to a little bit more specifically El Paso, I want to give some some numbers because we need to talk about numbers.

And people say, well, if I get to just call 911 and they're to take me to the hospital, we walk all the three of us and many of us physicians, we walk.

The hospital said there was no beds, there were nothing.

We set up tents outside of the hospital because of COVID.

We only have eight hospitals to care for people in El Paso for 870,000 people.

So and then ancillary people come in from the communities outside of our hospital, which we don't.

So if you're filling with COVID, if you fill it with flu, who's going to take care of those that come with heart attack, with appendicitis, with some other things that you really need to be taking care of.

So that's why we would tell you that it is a good idea to vaccinate.

And these are going to be the resources because we already gather all that information for you.

We try to provide in simple ways why?

What are the benefits?

And also, we need to tell you whether they're going to be the risk of getting the vaccinations.

And yes, they're working and getting the combination of the vaccines.

So this way it's going to make it a lot easier for people to get the vaccine and be protective, prevent that.

And we do want you to be in the hospital.

We want to see you out in the mall.

We want to see you out in the park walking and doing some other activities.

But in the hospital is not going to be the right place to see you.

So that's basically what we as physicians want you you people that are watching us to stay healthy at home, we want you to just celebrate, celebrate whatever you want to celebrate in life.

I agree.

And Dr. Tyroch, you said, you know, you never know what's going to happen when.

But if there is something you can take control of, this would be one of those things.

That's right.

We have we still have a good like 16 minutes to go.

But what I'd like to do is kind of stop what I have in my paperwork because each one of you in your disciplines have something that you may have wanted to say tonight or talk about tonight that we haven't talked about yet.

And on that note, in doctor days, I always think about you because I know that she's like, Why me first?

Because he just finished talking.

But and at the same time and we can continue doing all this and we still have a lot to go.

But again, you you have such a specific discipline and you've been around for a long time.

And again, being the editor of the El Paso physician magazine, that kind of takes you also outside of your current is.

Absolutely.

So what have you seen?

What is it in this program idea that you want to bring up tonight that we haven't yet?

Well, it's a good question.

Well, I think I did want to tag on a little bit to something Dr. Tyroch said about the not knowing what happens to in your life, because I do really think that's a great point on multiple levels and I bring it up sometimes with my parents as well because one of the big groups where I see vaccine hesitancy are in parents who are hesitant about other things as well.

So for instance, you know, they say, you know, I'm really worried my child, you know, might get bullied at school or may do this.

And so I'm in a home school and whatever the reason or they have an academic or behavioral issue, I'm going to homeschool them so they don't need the vaccines.

And that's probably the biggest reason.

And the biggest group I see our home schoolers or people who maybe have one or two kids, they don't have big groups of kids at home, so they say they're not exposed.

We hardly ever go out as a family, Right?

We hardly ever do anything.

We don't go to the mall.

We don't go to a movie theater.

We don't do stuff like that.

You know, we're insular group at home and we're, you know, like in COVID, we bubble basically.

We do our schooling at home, etc..

So why do we need these vaccines?

And I kind of bring exactly that point up.

I said, okay, they're one years old now.

They're two years old now.

You can control that now.

But when they're 16, you're not going to when they're you're not going to when they're 25, you're not going to.

And I've seen it happen exactly that way where they've had kids.

There have been 17 year olds come into my office and say, I've never been vaccinated.

I want you to give me everything now because I want to go here, I want to travel, I want to go into the military.

I can't do it unless you do this.

I want to do this and that.

And they are mad at their family because they say, I could have caught up by now and now I can't.

Now I have to take this time to catch up to do what I want to do at this age.

And so I just put that out there.

I'm not saying that there's not reasons for people to be hesitant, and I think it involves more education sometimes about it.

But I think that that thought process of I will control my child's life forever and this is how I'm going to do it, by keeping them homeschooled or by not vaccine them and by preventing them from going to these places.

I just tell parents, you know, that is a fallacy and I've learned it personally.

I've learned it professionally.

You know, you can't control that forever.

And to know that what you can control is protecting them now against these diseases and to protect them later against these diseases by immunizing them now.

So I think that's a good point to bring up.

You know, and like you said, it takes years to adjust to all of.

Yeah.

Dr. Tyroch, anything from you?

If not, we have futuristic stuff also at the health Department, so I can give you some more time to think if you want.

Well, she's so great again.

You I.

You are a girl after my own soul.

All these notes And I love everything about it.

You guys are way too smart.

Yeah, yeah, yeah, yeah.

I need everything in front of me, but talk to us about some of the.

So if there are a lot of vaccines that children are responsible, well, parents are responsible for getting for their children and a lot of vaccines that adults are responsible for keeping up with year after year.

And you can go to the CDC website and you can keep track of this yourself and keep a log of when you're getting them.

And just pay attention.

It may be every year in the spring or some time just say, you know, let me check and make sure I'm up to date on everything.

I also, for those who are unaware of this, I'll just briefly discuss the National Vaccine Injury Compensation Program.

This is a result of the National Childhood Vaccine Injury Act of 1986 because it's a no fault alternative to traditional tort system.

And it was done because when physicians and vaccine companies were getting sued, a lot that we developed vaccine shortages.

People weren't getting vaccines.

And that's not what we want to do to have a healthy nation and a healthy city.

So that's where it comes from.

And so it is The Department of Health and Human Services host program, Department of Justice represents healthy Human services in court, and the court of federal claims will make a final decision whether a petition is going to be compensated.

I've never talked to anybody that has done this, but it is there.

It is there.

And I when you said that earlier, too, I had not heard about it before.

So how is it so we're doing it on this program now.

But in general, when people want to access that, is that also on the CDC website or is that in a different place where they can look up that information?

Yes, they can look it up at the CDC website and they're going to be able to do it.

And if they feel that the vaccine cause any harm, they can provide a report that the vaccine adverse events, the various website.

So again, this is called the vaccine compensation program, which I think is great that then yeah, yeah.

Dr. Ocaranza Okay, here are my questions to you, because you are you are the authority.

Oh, my God.

I know.

That's I mean, literally, that's your title, Chief El Paso Health Authority.

You were talking earlier about a health assessment, a community assessment that is happening and going on right now, I think was called a community health assessment.

And is that something that's already been done?

Is it happening now?

Are you going to activate that later?

Actually, it's already been done.

And we proceeded to city council.

So all the people can be aware of what we found.

And what we did is that we conducted surveys and we brought a lot of people in to ask for the service from the community, from stakeholders, meaning government, public entities, private entities, all a big variety of people.

So we can have a good idea of what was happening in our community and what the community health assessment is, is going to tell us where we need to be deploying resources or where we need to be working a little bit more closely based on the needs of the community here in this community.

Health assessment, there were three big areas that were identified as the greatest in these.

What are those?

One is dealing with the chronic conditions, the vast majority of chronic conditions that we are battling right now in our community are high blood pressure and diabetes.

Who doesn't know somebody that has diabetes?

I have diabetes, my family has diabetes.

And there's a lot of people that have diabetes that if they don't take control of that, they're going to end up with a lot of complications.

And that's what we see, a lot of dialysis centers because they're taking care of all this.

People that their kidney function well, the high blood pressure is can lead to strokes and other complications if you don't control.

And that is one of the areas.

The next area that we found that he was going to need a lot of attention is our behavioral health and mental health.

That is extremely, extremely important.

And people are going to be like, well, those are the same now.

They're not the same.

They're a little bit different because mental health, you'll be needing to deal with depression, with anxiety.

Some other central behavioral health is basically substance use abuse.

And how are we going to be able to respond to some of those issues?

There is a big need of health care providers and those are included with the mental health providers.

There's a big need of mental health providers as well, but we all need to help each other.

In that sense.

COVID brought a lot of those issues in mental health because being in lockdown, they happened to not be the funniest thing.

And I very much I had two kids.

Yeah, I'm telling you, I have no hair because my kids were at home and they were coming with a hoodie just showing their face.

And during the Zoom meetings and I knew your last years of high school, it was still.

I love how you said, though, because you've got behavioral health, which for the most part is behavior that you one, you know better, you do better.

You know, usually it's behavior that you know that you can work on, do better.

It's your behavior.

Mental health is different because you don't have the option.

And again, there's not to take control of your mental health.

Usually you need an outside force to help you with that.

Those, you know, depression anxiety is not, oh, I'd like my depression to go away.

Oh, I like my anxiety to go away.

Okay.

I'm going to go walk the dog.

And yeah, that's great.

That is the behavioral health of it.

But the reason I want to focus on that is that we have not done a mental health show in a long time and we really need to do one exclusively because I feel like it is the day and age where people are allowed to talk about it and they're not, you know, embarrassed or this and that and the other.

It used to not be that way at all.

And I think that we're more and more at that point.

So let's advocate with the County Medical Society.

We're going to try to get a mental health show there.

But talk a little bit about that with what you are.

Again, emergency preparedness, COVID.

What are you seeing now mental health wise as far as having other people in the community either learning to be psychiatrists, psychologists, counselors?

Is that something that you're seeing younger generations come into that practice more?

We talked a little bit about this with I can't remember who it was, but I feel like there's a need of that and people are starting to see that these are the studies that we're trying to steer students into.

That's right.

That's a great medium.

Actually.

You brought up a very, very good point because there's there was a lot of stigma in mental health and nobody was going to talk to you about, Yes, I'm feeling low and feeling depressed.

And we just see the rate of suicide was going up so much more than automobile accidents.

And those accidental deaths are no fun.

So we need to address and we need to talk openly about that.

And that is a great point that we definitely want to bring something about mental health to the program so people can see which way each and every one of us can help somebody new.

So it takes somebody in the family, take somebody that is a friend.

It takes somebody just to hold him to somebody else that is going to let him see that, Hey, I feel supported in many times.

I helped a lot more just having a word of support.

But definitely there has to be those mental health professionals that know how to do their job and they're going to teach us what else do we have in our toolbox that are going to help us come out of that?

This big hole that we had or the big dark cloud that we have following us so we can have a better life and we can see that their shine is bright.

I mean, the sun is shining bright.

So yeah, there is I think again with with the highlighting of there and again just getting more and more people into that world.

I relate to that.

This is just to answer your question as well.

We also have seen I don't know if it's necessarily gone up, but it's definitely been highlighted more, as you said, more adolescent and even younger age mental health issues and depression and suicidal ideations and things like that.

But one thing that you brought up that I actually have seen and sort of elicited lately in my practice is that quite a few of my teenagers, I ask them, what do you want to go into when you get older, what you want to do?

Quite a few of them are starting to say, I want to be a therapist, I want to be a psychologist.

All of these things and I have seen that increase in even the last six months.

I've seen that.

So yeah, and I don't know where I heard that the first time, but I feel like over this last year I've been hearing more and more about that.

What are you what are you going to study when you go to medical school?

If it's medical school of not So I'm glad to hear that.

That's kind of Dr. Tyroch, You had something to say.

I would really like to see an emphasis in a future program on teaching people how to identify a person that is approaching suicidal ideation or their team, how to have the courage to ask the right questions and intervene and help guide the person to therapy.

And it really is a matter of courage, you know, because everybody thinks, well, it's just none of my business or I'm being nosy or I'm being aggressive.

And there's a point where you just need to to step of, you know, step out and do it.

So I if you don't mind, after the program, maybe sometime next week, I might reach out to you just to find out who it is that we can speak to that might be present.

So you okay with that?

Of course.

I said that on public TV, so I know she has to.

It's the way it is.

So I wanted to talk about pneumonia vaccine really quick because we talked about cold.

We talked about flu.

But I don't feel like we talk about pneumonia vaccine often.

So because I have you here, how do we automatically get that?

Is that risk age populations that you refer that vaccine to or how do you.

Yes, and actually we provide that vaccine to all the babies.

But also there's a risk population that we are providing extra doses of the pneumonia.

And those are the children that we have, asthma children that we have some other pulmonary conditions.

And also the adults are requiring to have that pneumonia vaccine.

And Dr. Tyroch can tell us a little bit more about those those adults.

But definitely you're not off the hook with the vaccine, even if you're adult.

Don't say that you're not a kid and you don't need vaccine.

You do need vaccines.

You need to go see your primary care physician and you really need to talk about all that, get all three.

So usually, again, I am I am a flu shot girl.

All my life always had always happened.

So now I'm a flu shot, COVID girl.

Now should I be a flu shot?

Pneumonia grow as well.

And so you say Yes.

And then I guess advocate that to all of my of course.

And I can take you there.

You get to see.

There you go.

And I can take you there.

Very nice.

I want to say thank you so much to all of you and really Dr. Ocaranza.

You kind of help make the show happen.

So the underwriting of the show this evening was a city of El Paso, Department of Public Health, and again, healthy days.

Pediatrics is around.

We have Saint Anthony Pediatrics.

We have a woman here that is a Texas delegate to the American Medical Association.

I learned an awful lot tonight.

So I thank you so, so much.

And if you are either just tuning in or would like to watch this program again, there are several places you can go do that.

You can go to PBS El Paso.org and you can find the El Paso physician within there.

You can also go to the El Paso County Medical Society website and So that's EPCMS.com And you can always go to YouTube.com with YouTube.com to search for it.

There you have used word the El Paso Physician, and when you do that, the nice thing is that you'll see this show, but you also see you'll see last year's vaccine show.

You'll see shows that are specific on what you like.

So just type in there what it is that you would like to see.

And you can see all of those there.

And also you can always ask a question of the El Paso County Medical Society and you're welcome to email them at info@epcms.com And if there's a question there, if we can answer it on the show the next time, if it's pertaining to that show, we'll do that.

And if not, there will be a doctor that will get back to you on the question that you have.

And that's super important because the El Paso County Medical Society is very committed to helping the public answer questions.

There's always like free information from the docs, and I love that.

And so that is a thing.

So again, if you have a question, feel free to call the El Paso County Medical Society or email them at info@epcms.com .

Thank you so much for joining us.

I'm Kathrin Berg and this has been the El Paso physician.

Good evening.

I am Dr. Alison Days past president of the El Paso County Medical Society.

The El Paso County Medical Society has put on the El Paso physician TV program for the last 26 years in conjunction with some of our local health care partners.

Topics over the years have included colon and breast cancers, healthy lifestyle issues, public health interest stories, vaccines, and many, many more.

These programs are archived on kcostv.org, epcms.com and on YouTube you may access the programs at any time on these websites.

If you have questions on tonight's topic, please reach out to epmedsoc@aol.com we will try to get your questions answered in a timely manner by an expert in the field.

This program showcases local specialists, and it is with great pride that we are able to present this educational opportunity to you.

Every month.

A big thanks goes out from the society to all of our specialists who have been able to give their time as speakers on this program and to the El Paso community members who have welcomed us into their lives for all of these years.

Thank you again for tuning into the El Paso physician tonight.