THE EXAMINER

Volume 17, No. 6 June 2009C

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Robert E. Bush Naval Hospital

“Serving with Pride and Professionalism”

You have the right toexpress your concerns

about patient safety and qual-ity of care.

There are several avenuesopen to you:

* Through the ICE web-site.

* Through the NavalHospital Customer CommentCards.

* The Hospital’s CustomerRelations Officer at 760-830-2475, or any of the CustomerRelations representatives inthe hospital’s clinics.

Or Directly to the JointCommission via:

E-mail atcomplaint@jointcomission.org

Fax:Office of Quality Monitoring630-792-5636

Mail:Office of Quality MonitoringThe Joint CommissionOak Renaissance BoulevardOakbrook Terrace, IL 60181

http://www.med.navy.mil/sites/nhtp/pages/default.aspx

An Award Winning Publication

Naval Hospital Twentynine Palms Awarded Accreditation

By demonstrating compli-ance with The JointCommission's national

standards for health care qualityand safety, Naval HospitalTwentynine Palms has earnedThe Joint Commission’s GoldSeal of ApprovalTM.

Founded in 1951, The JointCommission seeks to continu-ously improve the safety andquality of care provided to thepublic through the provision ofhealth care accreditation andrelated services that support per-formance improvement in healthcare organizations. The JointCommission evaluates andaccredits more than 15,000health care organizations andprograms in the United States,including more than 8,000 hos-pitals and home care organiza-tions, and more than 6,800 otherhealth care organizations thatprovide long term care, assistedliving, behavioral health care,laboratory and ambulatory careservices. An independent, not-for-profit organization, TheJoint Commission is the nation’soldest and largest standards-set-ting and accrediting body inhealth care.

Captain Don C. B. Albia,Commanding Officer, NavalHospital Twentynine Palms,stated, “By going through theJoint Commission accreditation,we are actually saying thatwe’re willing to do more thanthe minimum to meet govern-ment regulations and that theextra step we take ensures quali-ty and a safe patient environ-ment. The recent attainment ofthis accreditation validates thehigh quality and safe patientcare we are delivering to ourbeneficiaries and it sets us apartfrom other community hospitals

in terms of status and excel-lence.”

“Above all, the national stan-dards are intended to stimulatecontinuous, systematic andorganization-wide improvementin an organization's performanceand the outcomes of care,” saysMark Pelletier, R.N., M.S.,executive director, Hospital

Programs, Accreditation andCertification Services, The JointCommission. “The communityshould be proud that NavalHospital Twentynine Palms isfocusing on the most challeng-ing goal -- to continuously raisequality and safety to higher lev-els.”

The Joint Commission con-

ducted an unannounced, on-siteevaluation of Naval HospitalTwentynine Palms 12 through16 January 2009. The accredita-tion award recognizes NavalHospital Twentynine Palms’dedication in complying withthe Joint Commission’s state-of-the-art standards on a continu-ous basis.

“We sought accreditation forour organization because wewant to demonstrate our com-mitment to our patients safetyand quality care,” saysCommander Ramona Nixon,Joint Commission Coordinatorfor the Naval Hospital. “Weview obtaining JointCommission accreditation asanother step toward achievingexcellence.”

Nixon spoke of her pride in astaff whose members ask whatneeds to be done to be accredit-ed by The Joint Commission.“In addition, they appreciate theeducational aspect of the surveyand the opportunity to interactwith the team of surveyors.”

She called the accreditation,“proof of an organization-widecommitment to provide qualitycare on an ongoing basis.”

By Tyler PattersonTriWest Healthcare Alliance

Today’s net-savvy TRICARE beneficiariesuse the Internet to manage their health caremore than ever, but it doesn’t take a comput-

er wiz to navigate the convenient features onwww.triwest.com.

And the best part is that users get to pick the timeand place that’s convenient. Here are just a few ofthe tools available online to make managing yourhealth care even easier:

Online Account RegistrationWest Region beneficiaries who register for a

secure www.triwest.com account can update otherhealth insurance information, access copies ofclaims explanations of benefits (EOB)...especiallyhelpful during tax season... change address infor-mation and more. Visit www.triwest.com/benefici-ary and click the “Register Today” button to getstarted. TriWest does not share your informationwith outside parties.

What’s New on www.triwest.com

Continued on page 7

Metabolic syndrome isdefined as: a group ofrisk factors linked to

being overweight or obese thatincrease your chance for heartdisease and other health prob-lems such as diabetes andstroke.

The five conditions listedbelow are metabolic risk factors

for heart disease. A person candevelop any one of these riskfactors by itself, but they tend tooccur together. Metabolic syn-drome is diagnosed when a per-son has at least three of theseheart disease risk factors:

1. A large waistline. This isalso called abdominal obesity or“having an apple shape.”

2. A higher than normal

triglyceride level in the blood(or you’re on medicine to treathigh triglycerides -- or bad cho-lesterol). Triglycerides are atype of fat found in the blood.

3. A lower than normal level ofHDL cholesterol (high-densitylipoprotein cholesterol or goodcholesterol) in the blood (oryou’re on medicine to treat lowHDL).

4. Higher than normal bloodpressure (or you’re on medicineto treat high blood pressure).

5. Higher than normal fastingblood sugar (glucose) (or you’reon medicine to treat high bloodsugar). Mildly high blood sugarcan be an early warning sign ofdiabetes.

Other factors that can con-tribute to metabolic syndrome

are diets high in meat, fried foodand diet sodas. Diet sodas makeyou crave calories from othersources and can cause over eat-ing rather than help you cutcalories. Also, people who suf-fer high levels of stress aretwice as likely to develop meta-bolic syndrome for many rea-sons including the fact thatstress causes changes to yourblood sugar levels.

Tobacco use also increasesyour risk of metabolic syn-drome.

Tobacco use1. Makes you crave starch and

fat - a large waistline.2. Raises your triglyceride lev-

els - a higher than normaltriglyceride level in the blood.

3. Lowers your HDL level - alower than normal level of HDLcholesterol.

4. Gives you high blood pres-sure - higher than normal bloodpressure (or you’re on medicineto treat high blood pressure).

5. Doubles your risk of dia-betes and blocks the release ofinsulin - higher than normalfasting blood sugar (glucose) (oryou’re on medicine to treat highblood sugar).

Call Health Promotion andWellness at 830-2814 for moreinformation on tobacco cessa-tion. If you are interested inmedications to help you quittobacco, contact your primarycare provider.

2 -- The Examiner -- June 2009

Published by Hi-Desert Publishing, a private firm in no way connected with the Department of Defense, the UnitedStates Marine Corps, United States Navy or Naval Hospital, Twentynine Palms under exclusive written contract withthe Marine Air Ground Task Force Training Command. The appearance of advertising in this publication, includinginserts or supplements, does not constitute endorsement by the Department of Defense, the United States MarineCorps, the United States Navy or Hi-Desert Publishing of the products or services advertised. Everything advertisedin this publication shall be made available for purchase, use, or patronage without regard to race, color, religion, sex,national origin, age, marital status, physical handicap, political affiliation, or any other non-merit factor of the pur-chaser, user or patron. If a violation or rejection of this equal opportunity policy by an advertiser is confirmed, thepublisher shall refuse to print advertising from that source until the violation is corrected. Editorial content is preparedby the Public Affairs Office, Naval Hospital, Twentynine Palms, Calif.

Commanding OfficerCaptain Don Cenon B. Albia, MSC, USN

Executive OfficerCaptain Bruce Laverty, MC, USN

Command Master ChiefHMCM (FMF) Kevin Hughes, USN

Public Affairs Officer/EditorDan Barber

Public Affairs AssistantSK1 Kimberly Blain-Sweet

Command OmbudsmanLacy Richey

Care Line 830-2716Cell Phone (760) 910-2050

The Examiner welcomes your comments and suggestions concerning the publication. Deadline for submission ofarticles is the 15th of each month for the following month’s edition. Any format is welcome, however, the preferredmethod of submission is by e-mail or by computer disk.

How to reach us...Commanding Officer Naval HospitalPublic Affairs OfficeBox 788250 MAGTFTCTwentynine Palms, CA 92278-8250Com: (760) 830-2362DSN: 230-2362FAX: (760) 830-2385E-mail: d.barber@nhtp.med.navy.milHi-Desert Publishing Company56445 Twentynine Palms HighwayYucca Valley, CA 92284Com: (760) 365-3315FAX: (760) 365-8686

Tobacco and Metabolic Syndrome Risk Factors Explained

Here’s To Your Health...

Skin Cancer and Sun Screen

Your skin is the largest organ of your body and it is constantlyrenewing itself throughout your life. Skin protects us fromheat, light, injury, and infection and stores water and fat. It

keeps itself moist and intact to the best of its ability but sun, heat,dryness and chemical exposure works against your skin to damage itand dry it out.

We need some exposure to sunlight for Vitamin D production, how-ever, over exposure to the sun leads to skin cancer, premature agingof the skin and wrinkling. Also, over the age of 50 our skin doesn’tmake as much vitamin D as it used to, putting us at risk for vitamin Ddeficiency.

Skin cancer is the most common form of cancer with over one mil-lion Americans every year being diagnosed with skin cancer andalmost 10,000 dying from it. Half of all Americans who live to age 65will be diagnosed with some form of skin cancer. UVA and B radia-tion from the sun is the leading cause of skin cancer, however UVCradiation from sun lamps and tanning booths also cause skin cancer.Cases of skin cancers are more likely to occur where there is brighterand stronger sunlight such as nearer the equator or at high altitudes.In other words, here in the high desert!

Ninety percent of all skin cancers develop on the face, neck andarms where sun exposure is the greatest. Those individuals at highestrisk for skin cancer are those who have light skin, hair and eyes, afamily history of skin cancer, chronic exposure to the sun, a history ofbad sunburns early in life, or have lots of moles or freckles. However,everyone is at risk of skin cancer, no matter how dark ones’ skin orhair.

Skin cancer growths occur when normally dividing skin cells beginto grow abnormally. UV rays damage the DNA of skin cells and caus-es them to reproduce abnormally. Once a cells’ DNA is damaged, thedamage is permanent and is replicated over and over until an abnor-mal patch of cells is seen on the surface of the skin. There are over100 different types of skin cancer, depending on what layer of theskin they are found and what types of skin cells are affected.

In fact, the damage to your skin only needs to be 1 mm deep or thesize of this “-” to cause damaged cells which then find their way intoyour blood stream. Once these skin cancer cells find their way to yourblood stream you can develop skin cancers in any organ of your body.

What to look for - * Patches of skin that tend to bleed or ooze, * Open sores that don’t heal, * Patches that have an irregular shape or edges to them, * Patches that have varied colors in their pigmentation, * Growths larger than the width of a pencil eraser,* Patches that have a scaly, crusty or bumpy appearance to the sur-

By Martha Hunt, MA, CAMFHealth Promotion and WellnessRobert E. Bush Naval Hospital

Continued on page 7

By Kristen WardTriWest Healthcare Alliance

Depression can strike any-one, but the symptomscan be dramatically dif-

ferent between men and women.

Signs and Symptoms

According to the NationalInstitute of Mental Health, near-ly 20 million people are current-ly dealing with depression.Service members who may havebeen exposed to traumaticevents during their deploymenthave a higher risk for develop-ing depression or post-traumaticstress disorder (PTSD).

Common symptoms for menand women include feelings ofsadness and hopelessness, sleep-ing problems, weight gain orloss, having trouble thinkingclearly, isolation or feelings ofguilt.

Differences may include:Men...* More willing to acknowl-

edge the physical symptoms ofdepression such as fatigue, irri-tability, sleeplessness

* May engage in more riskybehaviors such as driving reck-lessly or getting in fights

* Are more irritable and angry,especially in relationships

* Abuse alcohol or other sub-stances

* Are more likely to completesuicide

Women...* More willing to acknowl-

edge feelings related to depres-sion such as sadness, worthless-ness, and excessive guilt

* More likely to have an anxi-

ety disorder* More willing to admit to

problems and seek help* Are more likely to attempt

suicide, but less likely to com-plete it

Treatment is Available

The good news is that thereare effective treatments fordepression. Women tend to seekhelp for depression, while menare more likely to deny theirsymptoms or not even recognizethem. However, help is avail-able for everyone through TRI-CARE.

The first step is to take a self-assessment questionnaire ofdepression symptoms. This isavailable atwww.triwest.com>Beneficiaries>BehavioralHealth>Depression>PatientHealth Questionnaire.

For scores greater than 10, orif these symptoms have madenormal activities very difficult,it may be a good idea to sched-ule an appointment with yourdoctor.

Active duty service members(ADSMs) should always seekcare first at a military treatmentfacility, when available. ADSMsmust have a referral from theirprimary care manager and haveprior authorization from TriWestbefore seeking behavioralhealthcare services outside thebase clinic. ADSMs enrolled inTRICARE Prime Remote maycall TriWest at 1-888-TRIWEST(874-9378) to help obtainauthorization for civilian behav-ioral health care.

Family members are eligiblefor eight behavioral health carevisits each fiscal year (Oct. 1-

Sept. 30) without pre-authoriza-tion from TriWest. If a familymember receives care beyondthe original eight visits, theywill need authorization fromTriWest. Beneficiaries can findat a network provider atwww.triwest.com>Beneficiaries>Provider Directory.

Help at Home

In addition to the self-assess-ment questionnaire and addi-tional benefits information,TriWest’s Web site www.tri-west.com has numerous self-help resources. Available at nocost via streaming video or as a2-DVD set, this series offersadvice from behavioral healthexperts who are also combatveterans and military familiesthat have coped with effects ofPTSD. Find it atwww.triwest.com>beneficiaryservices>behavioral health>HelpFrom Home.

While you’re there, find arti-cles, brochures and links toadditional resources on a varietyof topics spanning from chil-dren’s behavioral issues to deal-ing with depression or suicide.Find it atwww.triwest.com>beneficiary>behavioralhealth>Depression>Self HelpResources.

Additional sites to visitinclude:

* Military OneSourcewww.MilitaryOneSource.com

* National Institute of MentalHealth www.nihm.nih.gov

* National Foundation forDepressive Illness www.depres-sion.org

* After Deploymentwww.afterdeployment.org

Welcome Aboard toour newOmbudsman Ms. Tina Ruth!

Tina brings an exciting future forthe Robert E. Bush Naval HospitalOmbudsman Program. She has 8years of volunteering experience andher time as volunteer for Naval Medical Center Newport, RI and theUSS PORTER (DDG-78) will be very beneficial to our NavalHospital Twentynine Palms families.

Tina has been a military spouse for 20 years and has been stationedhere in Twentynine Palms for the last 2 years. According to her, themost exciting aspect of being an Ombudsman is the opportunity tohelp families new to the area to find the information they need. Also,more importantly is the privilege of supporting the needs of familiesof deployed and non-deployed Sailors.

For anyone new to the area, or in need of contacting the NavalHospital Ombudsmen for any reason, please see how you can do sobelow.

* Leave a message on the Careline at 760.830.2716.If you have a question or concern that is not an emergency.* Cell phonesLacy Richey 760-910-2050Tina Ruth 760-910-2046For questions or concerns that are more urgent or for a quick reply.* Send an email to lacy.richey@med.navy.mil or

valatina.ruth@med.navy.milFor resource requests, local information, or questions.As your Ombudsmen, we are here for you and have direct and

immediate access to the Commanding Officer and the CommandMaster Chief, Naval Hospital, Twentynine Palms for matters requiringtheir involvement or help.

We are confidential resources for you, and are obligated to reportlife-threatening situations to the Command. Rest assured, though, noinformation shared with us is ever made public.

The Examiner -- June 2009 -- 3

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Ombudsman CornerDepression in Men and Women: What’s the Difference?

Life’s Lesson...

It’s frustrating whenyou know all theanswers, but nobodybothers to ask youthe questions!

4 -- The Examiner -- June 2009

Super Stars...

Lt. Murat Grigorov, Physicianat the Adult Medical CareClinic, receives a Navy andMarine Corps AchievementMedal.

HM1 Alex Escobal, Laboratory Dept., takes the oath during hisrecent reenlistment ceremony.Cmdr. John Crabill, Physician

in the Family Medicine Clinic,receives his Qualification asFleet Marine Force Officerfrom MAJGEN T. D.Waldhauser, CommandingGeneral First Marine Division.

CS3 Matthew Delarosa,Nutrition Management Dept.,receives his first Good ConductAward.

LT. CMDR. Jessica Colwill,Physician in the OB/GYNDept., receives a Navy andMarine Corps CommendationMedal.

CS1 Leonardo Deguzman,Nutrition Management Dept.,receives his fifth Good ConductAward.

Lt. Matthew Green, a Nurse inFamily Practice, receives aNavy and Marine CorpsAchievement Medal.

Melinda Carlisle, a civilian RNin the OB/GYN Dept., receivesa 5-year Federal Length ofService Award.

Lt.j.g. Shelley Griffith, Public Health Officer in the PreventiveMedicine Dept., takes the oath during her recent promotion ceremo-ny to her current rank.

HN Anita Guanucocalixto,Pediatrics Dept., receives aFlag Letter of Commendationand her first Good ConductAward.

Lt. Cmdr. Marion HenryGeneral Surgery Physicianreceives a Navy and MarineCorps Achievement Medal.

Fawn Morocco, TAD Clerk,receives a Federal Length ofService Award for five years.

Lt. Randy Heninger, NurseMidwife, receives a Navy andMarine Corps CommendationMedal.

The Examiner -- June 2009 -- 5

Lt.j.g. Allistair McLean, Head, Information Management Dept., getsnew collar devices pinned by Cmdr. Jeanmarie Jonston, Director forAdministration, left, and Capt. Don C. B. Albia, CommandingOfficer, right. McLean recently transferred to the Medical ServiceCorps from Surface Warfare.

Lt. Cmdr. William Warner,Physician in the OB/GYNDept., receives a Navy andMarine Corps CommendationMedal.

Kathleen Mulvihill, CentralAppointments, receives a 10-year Federal Length of ServiceAward.

Lt. Cmdr. Dondria Smith-Hollies, Primary Care Clinic,was selected for the SeniorNursing Excellence Award byher peers in celebraion ofNurses Week held last month.

Lt. Rivka Weiss, PediatricsClinic, was selected for theJunior Nursing ExcellenceAward by her peers in celebra-tion of Nurses Week held lastmonth.

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Rear Admiral William Roberts, Medical Corps Director in the Chiefof Naval Operations Office administers the oath during the recentpromotion ceremonies for Lt.j.g. Gregory Abernathy and Lt.j.g. JimFrancisco. Both Nurses who serve in the hospital’s EmergencyMedicine Department were promoted to their current rank lastmonth. Rear Admiral Roberts was on a visit to the hospital here.

HM3 William Worthley, MainOperating Room, receives hisfirst Good Conduct Award.

By Diane MayerTriWest Healthcare Alliance

If you or a loved one is facedwith a terminal illness, hospice

care is available from TRI-CARE.

Hospice is a concept of caredesigned to provide comfort andsupport to patients and theirfamilies when a life-limiting ill-

ness no longer responds to cure-oriented treatments. All TRI-CARE beneficiaries are eligiblefor this benefit.

The goal of hospice is toenable patients to continue analert, pain-free life and to man-age other symptoms so that theirlast days may be spent with dig-nity and quality, surrounded bytheir loved ones. Hospice caretreats the person rather than thedisease; it focuses on quality oflife rather than length of life. Itprovides family-centered careand involves the patient and thefamily in making decisions.Care is available for the patientand family 24 hours a day,seven days a week. Hospice carecan be given in the patient'shome, a hospital, nursing home,or private hospice facility. Typesof care provided may include

Babies cry, that is a fact oflife. Sometimes care-givers get frustrated

when the baby won’t quit cry-

ing, sometimes frustratedenough to want to shake thebaby.

Shaken baby syndrome is a

type of inflicted traumatic braininjury that happens when a babyis violently shaken.

A baby has weak neck musclesand a large, heavy head.Shaking makes the fragile brainbounce back and forth inside theskull and causes bruising,swelling, and bleeding, whichcan lead to permanent, severebrain damage or death. Thecharacteristic injuries of shakenbaby syndrome are subduralhemorrhages (bleeding in thebrain), retinal hemorrhages(bleeding in the retina of theeye), damage to the spinal cordand neck, and fractures of theribs and bones. These injuriesmay not be immediately notice-able. Symptoms of shaken babysyndrome include extreme irri-tability, lethargy, poor feeding,breathing problems, convul-sions, vomiting, and pale orbluish skin. Shaken babyinjuries usually occur in chil-dren younger than 2 years old,but may be seen in children upto the age of 5 (NationalInstitute of NeurologicDisorders and Stroke).

In comparison with accidental

traumatic brain injury in infants,shaken baby injuries have amuch worse prognosis. Damageto the retina of the eye cancause blindness. The majority ofinfants who survive severe shak-ing will have some form of neu-rological or mental disability,such as cerebral palsy or mentalretardation, which may not befully apparent before 6 years ofage. Children with shaken babysyndrome may require lifelongmedical care (National Instituteof Neurologic Disorders andStroke).

As you can see, it’s veryimportant to take all measurespossible to prevent this form ofchild abuse. Our Labor andDelivery Deck, DesertBeginnings, has a program thatreaches out to mothers, fathersand other close family membersand friends to increase aware-ness and provide coping skillsfor caregivers.

In order to ensure that as manynew parents as possible receivethe information, records arereviewed and the number of par-ents trained is compared to thenumber of deliveries each

month. If numbers drop, theymake positive changes toincrease the effectiveness of theprogram.

This is what ProcessImprovement is all about.Selecting a program, problem orprocess that is very important toa particular area and looking atit to make sure it is effective. Ifflaws are found in the process,the process is revised. Thenmonitoring ensures that the newchanges are effective.

From Oct 08 -- Feb 09, onlyone mother did not receiveShaken Baby SyndromeTraining. The program works.

Process Improvement workswhen the Unit/Departmentfocuses on identifying and prob-lem solving issues that areimportant to them. I encourageyou, no matter who you are, tolook closely at how you do busi-ness. If you keep ‘stumbling’over processes and have to dodouble work to get the job done,bring it up with your supervisor.A look at how business is beingdone now and strategies tosmooth out the process canmake life a lot easier.

6 -- The Examiner -- June 2009

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Process Improvement of the Month...

Preventing Shaken Baby SyndromeWhat is Shaken Baby Syndrome? How important do you think it is to prevent Shaken Baby Syndrome?

By Lt. Cmdr. Sharon YokleyOrganizational Performance Improvement CoordinatorRobert E. Bush Naval Hospital

Your TRICARE Hospice Benefit

Continued on page 7

The Examiner -- June 2009 -- 7

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Appointment ReportingOnce registered at www.triwest.com, beneficiaries can report their

specialty care appointment dates online. Previously, a beneficiary hadto call TriWest to report this information. Now they can simply log in,access their authorization and referral information and enter theirappointment date in just a few easy steps.

QuickAlertRegistered www.triwest.com users enjoy another perk: QuickAlert,

TriWest’s notification system for authorizations, referrals and EOBs.QuickAlert can be set to alert you by e-mail or phone when an author-ization or referral has been processed for your account. You’ll stillreceive notification by mail in approximately one week, but you cansave time and schedule specialty care sooner with QuickAlert!

ePayBeneficiaries can automate their TRICARE Prime enrollment fee

payments with TriWest’s ePay. Sign up at www.triwest.com/epaytoday, choose a payment method (allotment, electronic funds transferor credit card) and never worry about late payments again.

“TRICARE 2 You” Online LibraryThe “TRICARE 2 You” Online Library hosts TriWest’s all-new

streaming TRICARE benefit videos, current and archived articlesfrom the “TRICARE 2 You eNewsletter” and a slew of links andresources to help answer your frequently asked TRICARE questions.Visit it today at www.triwest.com/t2u.

Healing 2gether Online“Healing 2gether Online” (H2O) is TriWest’s comprehensive online

resource for wounded, ill or severely injured service members andtheir families and caregivers. Find information and resources to helpyou use your benefits at www.triwest.com/h2o.

Don’t wait until tomorrow to start saving time by managing yourhealth care online; register at www.triwest.com/beneficiary today andsee just how easy, secure and convenient it can be!

What’s New on www.triwest.com...

face of them, or* Growths that itch or are tender and painful.Sun screen works by blocking out some, but not

all, of the UVA and B rays. Sun screen does notprotect against UVC radiation. The higher the SPFvalue, the greater the protection from burning. Usea sun screen that blocks both UVA and UVB radia-tion as they both cause skin cancer and burning.UVA rays cause damage deep into the skin whileUVB rays damage the surface layers. Exposure toUVA and UVB radiation has also been associatedwith non-Hodgkin’s Lymphoma and with eye can-cers, specifically on the cornea and the conjunctiva(the white part).

If you will be in the sun more than 15 minutes,wear sun screen with an SPF value of 20 or greater.Older adults should always use a sun screen withan SPF of 30 or higher. Apply sun screen at least30 minutes before going out into the sun and re-apply every 2 to 3 hours.

Since sun screen alone is not 100 percent effec-tive against the damage produced by UV rays, takeother protective measures as well. When outdoorsin the sun, wear hats, sunglasses, light colored,loose fitting clothing, full length pants and socks toreflect the heat and allow your skin to breathe.Check all areas of your skin surfaces regularly forany changes. If you can’t see a certain area of your

skin, use mirrors or get a friend to check foryou. Call your doctor if you have patches ofskin or growths on your skin that bleed or

change shape or color. If you have a family historyof skin cancer, alert your doctor and watch yourskin carefully for changes.

Drink plenty of water and other replenishing liq-uids (not alcohol or caffeine) to help your skinsweat and cool itself. Avoid the sun between 10 amand 3 p.m. whenever possible as the suns rays arethe most damaging. You can burn even on a cloudyday as 80 percent of the sun’s rays still penetratethrough clouds.

Teach your kids early about the dangers of thesun as most skin damage occurs before the age of20. Never use sun screen on infants less than 6months of age as the chemicals in sun block areabsorbed directly into their body and may irritatetheir skin. Rather keep them out of direct sun andalways make sure they are covered with hats andbaby sunglasses.

Damage from the sun is cumulative over yourlife span and builds up over time. The DNA dam-age you received from that sun burn when youwere a teen is still with you and will never goaway. The best protection from skin cancer is toavoid direct exposure of your skin to the sun.When that is not possible, use sun screen to helpreduce the absorption of UV rays and the DNAdamage that results. You only have one skin, wearit well.

Skin Cancer and Sun Screen...Continued from page 2

Continued from page 1 nursing care, medical equipment and supplies,medications, counseling, and medical social servic-es. Room and board is not a covered hospice bene-fit when a patient is in a facility such as a resthome and the care is custodial.

The patient, their primary care manager (PCM),or a family member can initiate care as long as thepatient’s DEERS information is current. There isno paperwork for the beneficiary to complete toobtain hospice services. It is the responsibility ofthe hospice to submit the documentation necessary

to obtain authorization for care. There are four levels of hospice care:1. Routine home care2. Continuous home care -- more nursing care

than routine home care3. General inpatient hospice -- care in a hospice

facility for symptoms that cannot be controlled athome

4. Inpatient respite care -- up to five days permonth to give families a rest from caregiving.

For information on the hospice benefit, pleasevisit www.triwest.com/beneficiary or call 1-888-TRIWEST (874-9378).

Hospice Benefit...Continued from page 6