Author: TarrantCounty MedicalSociety

The Zebra Is Losing Its Stripes: My Journey to Discover the Disease That Was Killing Me . . .

Feature Article

By David M. Lavine, MD

This article was originally published in the July/August 2026 issue of  Tarrant County Physician.

This article is about a personal medical journey which involves a four-year-long search to solve a problem which I hope will be an inspiration to those who read it.

The title comes from a grand rounds lecture given by Dr. Justin Grodin, a faculty member in advanced heart failure and cardiac amyloidosis at UT Southwestern.1 As the old saying goes, “When you hear hoofbeats you think of horses, but occasionally there is a zebra in the herd.” Well, my zebra is cardiac amyloidosis. When I was in medical school, this disease was hardly mentioned. Most doctors knew little to nothing about it.

My Reason
My reason for this article is personal and apparent. I could give you the detailed particulars of this disease, but suffice it to say, amyloidosis is caused by a protein misfolding/malformation which, in transthyretin amyloid cardiomyopathy (ATTR-CM), originates in the liver. The resulting amyloid infiltrates the myocardium, resulting in a thickening and stiffening of the heart muscle. The big problem is that the amyloid fibrils do their damage by concentrically thickening the muscle. The chest X-ray will not show cardiac hypertrophy, but the heart capacity is reduced, resulting in decreasing cardiac efficiency.

The most affected chamber is the left ventricle. Amyloid deposits make the walls stiff, preventing the chamber from relaxing and filling properly between beats. The next chamber most affected by the amyloid is the right ventricle impairing the right side’s ability to pump blood effectively. Because the ventricles become too stiff to accommodate blood entering the heart, pressure increases, causing the atria (the upper collecting chambers) to stretch and enlarge. This chamber enlargement leads to electrical disruption and arrhythmias such as atrial fibrillation. The more advanced the disease, the worse the outlook. The quicker the diagnosis, the more favorable the outcome.

The Journey to a Heart Biopsy
In 2021, I was beginning to have a general sense of malaise manifested by persistent fatigue and an ever-increasing intolerance to inclines. Needless to say, these symptoms were problematic. I had just retired and was looking forward to some active years. Yes, I was getting some answers for my symptoms piecemeal, but I felt a great urgency to complete this puzzle. With my medical background as an asset, I started a battery of tests. My PCP ordered an NT-proBNP biomarker. This measures the stress on your heart, which secretes a specific protein (NT-proBNP), especially during ischemic events. Normal is less than 450—mine was 1,402. What little information I could glean from the literature was sparse and, to say the least, gloomy. Survival rates were dismal. It made NO sense. I was a physically active person day in and day out.

My Quest
My pilgrimage to find the holy grail had begun. All my available sources of information created more questions than answers. As my quest for information grew, so did my sources. I even spoke with a past president of the American College of Cardiology, via a link with a medical classmate referral. A plethora of tests revealed nothing outstanding except ever-rising biomarker numbers. A follow-up Troponin level was 253, when normal is less than 47. Troponin also measures the stress of the heart following a sentinel event, but, I had never had an MI or outright cardiac failure; I was just feeling puny with an ever-decreasing activity level.

Corralling the Zebra
With no definitive answers and a situation that was getting worse, I pursued every medical connection I had. Nothing struck home, nothing was obvious, but persistence is my mantra. In Fort Worth and Charlottesville, Virginia, brilliant minds saw the discrepancies, but in over four years, found no good explanation. Even “Dr. Google” was stumped.

I Hear the Hoofbeats Coming
But the elusive mystery remained. I heard the hoofbeats and knew there was a zebra, but where was it? I had navigated a lot of “ifs and maybes” but found nothing definitive. No one could seem to explain the obvious incongruence of a 75-year-old active male and unexplained elevated biomarkers.

I Found the Zebra!
A new thought came from an old friend and internist. He had started on this journey with me in 2021. We had perused every pertinent fact and lab. After three years of continual dialogue, he queried about the possibility of my having cardiac amyloidosis. Because it was such a rare disease, 1:100,000, it seemed highly unlikely. But I wasn’t giving up . . . I was in the battle of my life. So on my next visit to my Fort Worth cardiologist, I asked if I could get a comparison echocardiogram. My last one in April 2025 was like the five previous ones. No zebras. I did ask him about the “rare” possibility of cardiac amyloidosis. His answer was definitive: “You don’t have cardiac amyloidosis.”

Despite this, in August of 2025, I got my echo report: “amyloid myocardiopathy highly suspected.”

Pulling off the Stripes One by One
Now I consider myself to be a self-educated doctor of a disease that was once considered very rare. ATTR-CM is now becoming “the disease of the month.” Jack Nicklaus, the G.O.A.T. of golf, was recently diagnosed with the same disease. He has become a spokesperson for the drug Vyndamax, the same one I am on. I’m sure many people remain to be included in this group. Thus the goal of this article . . . to educate my peers.

Epilogue
As for me, I have accumulated a fine team of super specialists from Fort Worth to Charlottesville, Virginia and UTSW, Dallas. There is NO Way I am ever letting this transitioning zebra out of my sight—it took too long to find.

I am presently enrolled in Dr. Grodin’s clinic at UTSW and have agreed to participate in an intramural study that he is directing. Hopefully my numbers will help others. Also, I will continue to take super drug Vyndamax, which is a thyretein stabilizer. I also hope to enter a depleter study (Cleopattra), utilizing new technology, later this year. Research is abounding for this disease.

Last Thoughts—The Immortal Zebra May Not Be a Zebra After All
I shudder to think what might have been, had I not been so proactive, i.e., pushy. Everything I have researched is so “real time” that it is truly hard to separate the disease as part of the landscape of aging or a distortion/malformation of that landscape. If it is the latter, then hopefully growing old will be more unfettered with a diagnosis and an effective way to treat this disease.2

The Whole is Greater Than the Sum of its Parts
Once I had the results and diagnosis, I knew what was making me sick. I had caught the zebra, but as the name of this article implies, this cardiac amyloidosis may not be a zebra after all. As it turns out, I was the “poster child” for ATTR-CM wild type. This includes a plethora of musculoskeletal problems inherent in amyloid migration and infiltration. This can start with carpal tunnel syndrome (I had four procedures for this syndrome. The first release, which was endoscopic, was 20 years ago. I had a repeated open procedure, due to the same carpal tunnel symptoms, 10 years ago, obviously from continued amyloid infiltration.), ruptured bicep tendons, (I had two) and atrial fibrillation, which is resistant to cardioversion and ablation. This ultimately ended up with a pacemaker placement a year ago.

Finally, a heart biopsy in October of 2025 confirmed it. I would encourage you to look at the varied and sundry well-known end-organ systems of this not-so-rare disease. It may start with a simple carpal tunnel syndrome and work its way through the musculoskeletal complex and end with a definitive myocardial biopsy.

Early diagnoses, to confirm or negate, is as simple as getting a Congo red stain after a carpal tunnel, trigger finger, or residual cartilage disc diagnosis, as they are a few of the related conditions. A blood serum electrophoresis (SPEP) study is also important, or a 24-hour urine collection if you are considering a differential diagnosis.

My medical background (plastic surgery) afforded me contacts in the medical community. There is no doubt that I am here today and writing this article because of my medical connections. I hope and pray my education has been an enlightenment to you.

Please remember our Hippocratic Oath: “I will use my power to help the sick, to the best of my ability.” The life you save will be one grateful patient. It may even be your own.

References:

  1. Justin Grodin, Cardiac Amyloidosis: The Zebra Is Losing Its Spots, presentation, February 1, 2019.
  2. I gathered this information from a number of personal communications, including those with the Amyloid Cardiology Specialist Department of Cardiology, The University of Virginia Medical Center; Amyloid Cardiology Specialist, Health Resources, Heart & Vascular Specialists; Amyloid Cardiology Specialist, Department of Cardiology, UT Southwestern Medical Center; Amyloid Webinars ARC (Amyloid Research Consortium); the Amyloidosis Foundation Facebook page; and Mackinzie’s Mission.

Women’s Mental Health: The Barriers to Access

The President’s Paragraph

By Cheryl Hurd, MD, TCMS President

This article was originally published in the July/August 2026 issue of  Tarrant County Physician.

This May, I had the privilege of presenting at a workshop with psychiatric colleagues regarding women’s mental health at the annual meeting of the American Psychiatric Association. We had strong attendance and a robust discussion. But given all the questions from our audience members, it became evident to me that this is a topic deserving of additional outreach, and not just to fellow psychiatrists. However, I had a dilemma . . . a draft deadline and multiple PowerPoint slides with all the information. After a couple of hours of trying to gather everything into a cohesive article to present to you all here, I decided to seek the assistance of AI. I dumped everything I had into Copilot, gave it about four dozen or more prompts, and it coalesced all my work. I still had to edit extensively; who knew that Copilot was so fond of run-on sentences?! The following has been further edited by the people who help maintain the decorum of our Tarrant County Physician journal.

Women’s mental health is as much an access issue as a diagnostic one. Across clinical settings, it is common to see:

  • Depression
  • Anxiety
  • Trauma-related conditions
  • Perinatal Mental Health Challenges
  • Emotional strain associated with:
    • Caregiving responsibilities
    • Financial hardship
    • Discrimination
    • Chronic disease

Whether these concerns are recognized, disclosed, and treated is often shaped by social context, such as current physical environment and cultural and/or historical aspects of different communities. Insurance, transportation, childcare, translation services, stigma, community trust, and local behavioral health capacity all affect timely care. Women in underserved communities are at particular risk for late diagnosis and interrupted treatment because social determinants of health and health system barriers often converge. And national mental health workforce shortage areas remain widespread.1

Underserved care is not found in a single setting but is a condition of limited access that can exist anywhere. A woman may live in a rural county with the closest psychiatrist being a long drive away. Another woman may live in an urban neighborhood with multiple hospitals yet still face long waits, unaffordable copays, language barriers, and fragmented referral pathways. In both settings, available services may not be truly usable. Women may present late, rely on urgent care, or disengage when treatment plans fail to account for barriers such as housing instability, caregiving demands, or work schedules. For physicians, treatment planning must address not only diagnosis and severity but also whether follow-up is realistic.

Rural and urban settings pose different challenges. In rural practice, barriers often include distance, limited specialist supply, service closures, privacy concerns, and broadband gaps that weaken telehealth. In urban settings, the problem is often system complexity: long wait times, fragmented care, uneven service distribution, insurance limitations, and cultural or linguistic mismatch between a patient and their physician. These differences require different responses. Rural physicians may depend more on collaborative care, telepsychiatry, and cross-system referral relationships, whereas urban physicians may focus on reducing handoff failures, improving navigation, and integrating behavioral health into primary care or women’s health clinics. Rural counties fare worse than non-rural counties on measures of clinical care and social determinants of health,2 and shortage designations affect both rural and urban areas.1

Perinatal mental health is critically important, but risks change across the lifespan. Anxiety, depression, trauma exposure, eating disorders, self-harm risk, intimate partner violence, caregiving stress, chronic illness, loneliness, grief, and cognitive concerns may present differently at each stage of life. In underserved communities, unstable housing, food insecurity, discrimination, limited preventive care, and delayed treatment can intensify symptoms and complicate care. A useful clinical framework goes beyond symptom checklists to assess safety, functioning, social stressors, and barriers to follow-up.
Routine screening is one of the strongest opportunities to improve women’s mental health care, but only when paired with a workflow that supports action. In women’s health, primary care, and perinatal settings, screening can identify depression, anxiety, trauma-related symptoms, and safety concerns before they escalate. A positive screen should trigger a risk assessment, a discussion of treatment options, a referral or warm handoff when indicated, and a plan for monitoring response and adherence. Routine screening for depression and anxiety is recommended in well-woman, pre-pregnancy, prenatal, and postpartum care. Standardized instruments and systems for timely assessment, treatment, and follow-up are also recommended.3

Care models should reflect practice realities rather than assume one solution fits all. In rural settings, telehealth can reduce travel burdens and extend specialty access, especially when supported by audio-only options and coordination with local primary care. In urban settings, access may improve more through shorter referral loops, stronger safety-net capacity, co-located behavioral health services, and language-concordant care. Telehealth is most effective when patients have the privacy, reliable connectivity, digital skills, and device access needed to use it. Underserved communities may also benefit from multiple telehealth formats, including phone-based care.4 At the same time, rural telehealth continues to face setting-specific implementation barriers.5

As you can see, addressing women’s mental health requires a layered, setting-specific approach. Trauma-informed, culturally responsive care is essential. In rural settings, physicians may need to offset workforce shortages and distance through collaborative care and telehealth-enabled consultation. In urban settings, the priority is often reducing fragmentation and improving access within systems that may appear resource-rich but remain difficult to navigate.
Ultimately, the central question is not simply whether a patient lives in a rural or urban area, but whether she can obtain timely, acceptable, and practical care. That requires early identification, realistic care planning, and systems that coordinate between screening, referral, and treatment. For physicians, the implication is straightforward: overcoming social barriers is part of the care plan, not peripheral to it.

“Healing takes time, and asking for help is a courageous step.” —Mariska Hargitay

References:

  1. Health Resources and Services Administration, “Health Workforce Shortage Areas,” accessed June 30, 2026, https://data.hrsa.gov/topics/health-workforce/shortage-areas/dashboard.
  2. W. B. Weeks et al., “Rural-Urban Disparities in Health Outcomes, Clinical Care, Health Behaviors, and Social Determinants of Health and an Action-Oriented, Dynamic Tool for Visualizing Them,” PLOS Global Public Health 3, no. 10 (2023): e0002420, https://doi.org/10.1371/journal.pgph.0002420.
  3. American College of Obstetricians and Gynecologists, “Screening and Diagnosis of Mental Health Conditions During Pregnancy and Postpartum,” Clinical Practice Guideline, June 2023, https://www.acog.org/clinical/clinical-guidance/clinical-practice-guideline/articles/2023/06/screening-and-diagnosis-of-mental-health-conditions-during-pregnancy-and-postpartum.
  4. U.S. Department of Health and Human Services, “Telehealth for Underserved Communities,” August 20, 2024, https://telehealth.hhs.gov/documents/Telehealth_for_Underserved_Communities_08-20-24.pdf.
  5. Rural Health Information Hub, “Rural Telehealth Toolkit,” last modified June 8, 2023, https://www.ruralhealthinfo.org/toolkits/telehealth.
  6. Centers for Disease Control and Prevention, “Social Determinants of Health,” last modified May 16, 2024, https://www.cdc.gov/public-health-gateway/php/about/social-determinants-of-health.html.

Beyond the Desk: Where This Work Really Happens

Project Access Tarrant County

By Kathryn Keaton

This article was originally published in the May/June 2026 issue of  Tarrant County Physician.

Over the past month, much of our Project Access work did not take place at a desk.

It began at a conference hosted by Texas A&M Fort Worth where we presented alongside other professionals on the role of Medical-Legal Partnerships in addressing barriers to care. The conversation focused on collaboration and how healthcare, legal, and community-based organizations can work together more effectively to support patients navigating complex systems. PATC had the honor of presenting what we are doing to combat barriers in our session, “When Noncompliance Isn’t the Problem: Addressing SDOH in Indigent Populations.”

Presenting at the Medical-Legal Partnerships Conference

Later in the month, the setting looked very different.

At a church gym in Arlington, a group of participants gathered for “Financial Confidence Starts Here,” a new endeavor within our Salud en tus Manos initiative. Led by a certified financial coach, the session focused on practical, real-life strategies: managing expenses, prioritizing financial obligations, and navigating the challenges that arise when a health issue disrupts income or stability.

These two settings—a professional conference and a community-based classroom—may appear unrelated. In practice, they are closely connected.
It is easy to assume that nonprofit healthcare coordination happens primarily behind the scenes through referrals, scheduling, and documentation. Those components are essential, but they represent only part of the work required to ensure that patients not only access care but are prepared to successfully complete it.

Teaching the “Financial Confidence Starts Here” class

Increasingly, we are seeing that what happens outside of traditional clinical settings has a measurable impact on what happens within them.

At the conference, conversations were centered on systems and how partnerships can reduce barriers and improve access at a structural level. In the classroom, those same barriers were discussed from a different perspective: how they are experienced in daily life. Participants asked practical questions about managing bills, handling unexpected expenses, and making decisions when financial and health challenges intersect.

Together, these experiences reinforce a consistent reality: access alone is not enough.

Patients benefit from care when they are prepared to engage with it—when they understand how to communicate with their providers, how to manage the logistical and financial aspects of treatment, and how to navigate the systems surrounding their care. Building that level of readiness often happens outside the exam room.

For our volunteer physicians, this work matters.

Patients who arrive with greater confidence, clearer understanding, and fewer external barriers are better positioned for efficient, effective visits. Time can be spent on clinical decision-making rather than navigating preventable obstacles. The work happening in community and professional settings ultimately supports the care delivered in clinical ones.

With PATC patients at Salud en tus Manos

For our funders, this work is equally important.

Initiatives like Salud en tus Manos continue to evolve in response to what we are seeing in the community. Expanding into teaching financial literacy through “Financial Confidence Starts Here” reflects a growing recognition that financial stability is closely tied to health outcomes. When patients are equipped with practical tools and knowledge, the impact of donated care is strengthened—appointments are kept, treatment plans are completed, and outcomes are more sustainable.

At Project Access Tarrant County, we remain committed to both.
The coordination of specialty and surgical care is and will always be central to our mission. At the same time, our work increasingly includes engagement in spaces that extend beyond traditional healthcare settings, whether through professional collaboration or direct community education.
Much of our work does happen behind the scenes.

But some of the most important work happens far beyond in conference rooms where ideas are shared, in classrooms where confidence is built, and in conversations that ensure when a patient finally sits in front of a physician, they are ready to fully engage in their care.

And that is where this work truly happens.

Everybody Bleeds

The Last Word

By Hujefa Vora, MD, Publications Committee Chair

This article was originally published in the May/June 2026 issue of  Tarrant County Physician.

Most days, practicing medicine feels less like a profession and more like peacekeeping, holding together a small, fragile space where people can set everything else aside for a moment. By the time patients walk through my doors, they’re not just dealing with symptoms. They’re bringing the weight of their lives with them—their stressors, their opinions, their hopes and their fears—everything they’ve been hearing and arguing about outside. What I try to do, at least as I see it, is quiet that noise long enough for something real to happen between us.

Every day, I sit across from people who arrive with more than just physical complaints. They come in with thoughts and prayers—feelings shaped by conversations at home, stories on the news, and what they read online. Politics has a way of creeping into everything now, especially into places it doesn’t belong. What used to be simple conversations—“What hurts?” or “How can I help?”—can suddenly feel heavier, weighted by the world. Questions about treatment or cost become about fairness, about the system, about whether anyone is really listening.

That’s when I try to ground things again, quietly. Because in my exam room, it doesn’t matter if you’re Republican or Democrat, an immigrant or a fifth-generation American citizen, liberal or conservative, Christian or Muslim. Those labels may matter outside, and I know they shape people’s lives, but in this space, they are meaningless. In here, you’re a person, a human being who doesn’t feel well or who’s worried, and you came for help. That’s where we start.

Most people feel that shift, even if they don’t say it. There’s often a moment when the tension softens—shoulders drop, voices relax. The world outside doesn’t disappear, but for a few minutes, it stops being the center of everything.
Still, I see how worn down many of my patients are. There’s a shared fatigue that shows up again and again. It comes from feeling like nothing really changes. New laws, new leaders, new debates—but the same problems remain. Healthcare is still complicated. Costs are still high. Getting care can still be difficult. From their perspective, it can feel like everything ends up being the same.

And I understand why. From my side, I’m trying to treat each person as an individual while working within a system that doesn’t always allow for that. There are rules, approvals, and limits that shape what I can offer. Insurance determines which tests are covered. Policies affect which treatments are available. Sometimes I have to explain why something that makes sense medically doesn’t align with what’s allowed. That’s when I see it—that subtle shift. It’s the moment when a patient starts to feel less like a person and more like just another case moving through the system. Like they’re all the same. That’s when trust can begin to slip. And once that trust slips, everything else becomes harder.

So I push back against it, as gently as I can. Sometimes that means slowing down, asking one more question, or taking a little extra time to explain. Sometimes it means acknowledging frustration instead of trying to fix it right away. People can tell when they’re being rushed. They can also tell when someone is actually trying to understand them. Because the truth is, they’re not all the same. Every patient has a different story, different concerns, a different way of experiencing illness. Even when two people have the same diagnosis, it never means quite the same thing to them.

And yet, there is something that connects all of them—and all of us. It’s something I come back to when the room feels tense or distracted. I remind myself that everybody bleeds when they’re cut. It’s obvious, almost too simple, but it’s true. No matter who someone is or what they believe, they all share the same vulnerability. They all come in hoping for answers. They all feel uncertainty when something isn’t right. They all experience that quiet anxiety while waiting for results or sitting alone before I walk in. Pain doesn’t care about politics. Illness doesn’t ask about background. Hope and fear are universal. That’s the common ground I try to hold on to.

Keeping the peace in my office doesn’t mean ignoring differences. It means not letting those differences take over. If they do, they get in the way of care. My responsibility is to bring the focus back to the person in front of me and what they need in that moment. Sometimes that means gently redirecting the conversation. Sometimes it means listening without reacting. Sometimes it means allowing a moment of silence before continuing. I can’t fix the larger system from inside this exam room. I can’t make healthcare simple or fair in every way it should be. And I can’t resolve the political arguments people bring with them. But I can do something that always matters. I can make sure the person sitting in front of me feels seen. I can remind them—through how I listen and respond—that they’re not just another name on a chart. I can give them a moment where they’re treated as an individual, not as part of a category or a political debate. I can slow things down. I can explain what I know and be honest about what I don’t. I can give them space to ask questions. And sometimes, that’s enough to break through that feeling that everything is blending together. Because even if the world outside feels divided, loud, and confusing, this space can still be different. It can still be a place where people feel recognized, even if only for a short time. In here, the focus is simpler. In here, what matters most is the person in front of me—their story, their fear, their hope. And in our exam rooms, no two people are the same. This is the Last Word.

Advancing the Future of HIV Care in Our Community

Public Health Notes

By Kenton K. Murthy, DO, MS, MPH, AAHIVS
TCPH Assistant Director & Deputy Local Health Authority

This article was originally published in the May/June 2026 issue of  Tarrant County Physician.

The Preventive Medicine Clinic (PMC), the oldest Ryan White HIV clinic in Tarrant County, has served the community continuously since its founding in 1991. In 2026, Tarrant County Public Health marks a significant milestone—35 years of delivering comprehensive HIV care, prevention, and patient support through this foundational program. In recognition of this milestone, PMC is undergoing a strategic transformation aimed at expanding access, enhancing quality, and delivering care in a more cost-effective and sustainable manner.

This evolution calls for a new identity—one that reflects not only where we have been, but where we are going. Today, we introduce Thrive Health. People living with HIV are no longer simply surviving; with the right care and treatment, they are thriving, and our new identity is meant to reflect this new era of care.

But we are not simply a rebrand; we are also entering a new phase focused on integration, innovation, and system-wide collaboration to address a persistent challenge: HIV incidence remains steady, and in some populations, is increasing. This moment calls not only for recognition of past success but for decisive action moving forward.

The Ryan White System of Care in Tarrant County
The modern HIV care system in the United States is built in large part on the foundation of the Ryan White HIV/AIDS Program, administered by Health Resources and Services Administration, an agency of the US Department of Health and Human Services. First established in 1990, the program was named after Ryan White, a young hemophilia patient who became a national advocate for HIV awareness after facing significant stigma and discrimination.

This program was designed to address a critical gap by ensuring access to HIV care for individuals who were uninsured or underinsured during a time when treatment options were limited and outcomes were poor. Over time, it evolved into a comprehensive system of care that supports medical treatment, medications, and essential support services.

Today, the Ryan White HIV/AIDS Program represents a multi-billion-dollar federal investment, with annual national funding of approximately $2.6 billion, supporting care for more than half of all people living with HIV in the United States. It has been widely recognized for achieving some of the highest viral suppression rates of any federally funded healthcare program.

In Tarrant County, Ryan White funding supports a coordinated network of clinics, including Thrive Health and other regional partners, delivering comprehensive care that includes HIV primary medical services; antiretroviral therapy management; rapid-start treatment for newly diagnosed patients; PrEP (pre-exposure prophylaxis) and PEP (post-exposure prophylaxis) services; case management; mental health and substance use care; oral health; pharmacy support; laboratory monitoring; and assistance addressing housing and transportation. Through this integrated model, HIV has been transformed into a manageable chronic condition, with significant improvements in life expectancy and reductions in transmission.

Local Epidemiology: A Growing HIV Burden in Tarrant County
Unfortunately, in Tarrant County, as in other parts of the United States, the burden of HIV continues to grow. In 2022, it was estimated that approximately 6,715 individuals were living with HIV in Tarrant County. By 2026, that number has risen to an estimated range of 7,500 to 8,000 individuals.
This increase is multifactorial and reflects a number of factors:

Ongoing HIV transmission

  • Improved survival due to effective antiretroviral therapy
  • Population growth within Tarrant County
  • The downstream effects of the COVID-19 pandemic, which disrupted routine healthcare delivery, reduced access to HIV testing and prevention services, and contributed to delays in diagnosis and linkage to care

Collectively, these factors highlight the persistent gaps in prevention and access that must continue to be addressed by healthcare and public health experts.

Why Continued HIV Screening Matters
Despite advances in treatment, HIV remains a significant public health concern. Routine screening is critical because early diagnosis allows for immediate initiation of therapy, leading to improved individual outcomes and reduced transmission through viral suppression. At the same time, a substantial number of individuals remain undiagnosed or are diagnosed late in the course of disease.

Tarrant County Public Health’s Disease Surveillance, Outreach, and Prevention (DSOP) team plays a central role in HIV and STD control efforts. Their work includes conducting field-based testing and outreach in high-risk populations, performing partner services and contact tracing, and leading comprehensive contact investigations for newly diagnosed HIV and syphilis cases. In addition, DSOP facilitates linkage to care for newly diagnosed individuals and actively works to re-engage patients who have fallen out of care, while collaborating closely with clinicians and epidemiologists to monitor trends and improve outcomes.

In addition, for several years, a key success in Tarrant County has been the implementation of opt-out HIV screening at JPS Emergency Department. This innovative program has led to the identification of numerous new HIV cases and has improved linkage to care at Ryan White outpatient clinics.
Building on this success, Tarrant County Public Health, in collaboration with the Tarrant County HIV Administrative Agency and key physician leadership from JPS, is actively working with other local hospitals to expand opt-out HIV screening across emergency departments throughout the region, with the goal of standardizing testing practices and improving early detection across multiple healthcare systems. These initiatives, if successful, could improve early detection of HIV and treatment of people living with HIV, thus helping to stop the spread of this disease.

Thrive Health: A Transformational Model for Integrated, Cost-Effective, High-Value Care
The transition from PMC to Thrive Health represents a deliberate transformation aligned with Tarrant County Public Health’s broader effort to become a more efficient, high-performing public health system. The previous clinic identities no longer fully reflected the scope or impact of services being delivered, and the 35-year anniversary provides an appropriate moment to evolve into a more unified and forward-looking model.

This transformation is driven by a focus on improving operational efficiency, returning to a physician-centric model of care, and optimizing the use of existing staff to increase patient throughput and enhance care delivery. At its core, the redesign is aligned with the Triple Aim of Healthcare—improving quality, expanding access, and reducing costs.

From a quality perspective, Thrive Health is expanding preventive services, including increasing vaccination rates—particularly among HIV PrEP patients—and incorporating routine Pap smears for eligible women in the STD clinic who have not been screened within recommended intervals. From an access standpoint, the move toward a team-based care model is expected to increase patient volume and reduce barriers to care.

In parallel, several targeted care initiatives are being implemented. A Rapid Restart Program is being developed to identify patients who have been out of care for six months or longer, with coordinated efforts from front desk staff, patient navigators, and case managers to reconnect these individuals to care and to overcome barriers. For appropriate patients, providers will review prior records, order necessary labs, and facilitate expedited re-initiation of antiretroviral therapy, including the use of home-based care teams when appropriate.

Alongside expanded vaccination efforts, preventive care is being strengthened through the integration of cervical cancer screening. Thrive Health is initially focusing on high-risk populations such as patients on PrEP before scaling to broader clinic populations. Together, these initiatives represent a shift toward a more proactive, population health-driven model of care.

Launching the Tarrant County HIV Care Collaborative
While Thrive Health celebrates 35 years of service in Tarrant County, we recognize that this work cannot be done alone. Our success and longevity is built on strong partnerships with fellow Ryan White HIV providers, including JPS Healing Wings, CAN Community Health, and AIDS Healthcare Foundation.

To further strengthen these collaborations, Tarrant County Public Health is launching the Tarrant County Ryan White HIV Care Collaborative—a first-of-its-kind initiative bringing together Ryan White providers across the region. This collaborative will serve as a platform for regular discussions on local HIV trends, ongoing education in prevention and treatment, and enhanced coordination of care across systems. A central priority will be improving linkage-to-care efforts through closer integration with DSOP and epidemiology teams.

Together, this unified approach represents a critical step toward reducing HIV transmission and improving health outcomes across Tarrant County.

Looking Forward
Thrive Health’s legacy demonstrates that coordinated HIV care works. However, continued innovation, collaboration, and system redesign are essential to meet the evolving needs of our population.

The future of HIV care in Tarrant County will be found in collaborations that deliver high-value, patient-centered care that allow individuals to lead healthy, fulfilling lives. By working together, we can move closer to ending the HIV epidemic—one patient, one system, and one collaboration at a time—because when we work together, we thrive.

Beating the Stigma: The Challenges in Treating Substance Use Disorders

President’s Paragraph

By Cheryl Hurd, MD, TCMS President

This article was originally published in the May/June 2026 issue of  Tarrant County Physician.

By the time you all read this article, I hope you will have had a chance to listen to some of Tarrant County Medical Minute’s many interesting podcast episodes. I recently had the privilege of being invited as a guest on the podcast (you can find my episode here), which TCMS launched in 2025. It was fun, and I also found it to be an opportunity to continue to highlight mental health and advocacy. As I’ve mentioned before, mental health is marginalized and stigmatized but so essential to overall health. I appreciated the opportunity to talk about this on the podcast, fulfilling one of my promises to speak openly about mental health issues.

So, today we are going to talk about an even more stigmatized mental health issue—substance use disorders. They are far more common than many of us realize. According to the Substance Abuse and Mental Health Services Administration in their National Survey on Drug Use and Health in 2023–24, nearly 48 million Americans age 12 and older, or about one in six people, meet criteria for a substance use disorder in any given year.1

Texas mirrors this national statistic. Alcohol use disorder accounts for the largest proportion, followed by drug use disorders involving marijuana, stimulants, opioids and more. State‑level estimates from the National Survey on Drug Use and Health indicate that roughly one out of seven Texans meets criteria for a substance use disorder each year.2 While this is slightly lower than the national average, it still represents millions of people across our state whose health, relationships, and economic stability are affected. In a state as large and diverse as Texas, the collective impact of these conditions is substantial: it affects healthcare utilization, workforce participation, public safety, and even community well-being.

For physicians, this data shows what is already evident in clinical practice. Substance use disorders frequently coexist with chronic medical conditions, complicating diagnoses and treatments while increasing the risk of poor health outcomes. For legislators and policymakers, the numbers highlight the scope of the issue and the importance of continuous investment in prevention, early identification, evidence‑based treatment, and long‑term recovery support. And for the general public, the message is both sobering and illuminating: substance use disorders are common, treatable medical conditions, not moral failures or character flaws.

Substance use disorders do not exist in isolation. National data consistently demonstrates high rates of co‑occurring mental illness as well.1 This overlap reinforces the need for integrated approaches to care that address the whole person rather than fragmented systems that separate “mental health” from “substance use.” The stigma surrounding substance use disorders mirrors the stigma that has historically marginalized mental health conditions—just as depression and anxiety were once dismissed as weaknesses rather than illnesses, substance use disorders continue to be judged rather than treated.

Stigma remains one of the most powerful barriers to care. It delays seeking help, discourages honest conversations between patients and physicians, and shapes policies that emphasize punishment over treatment. When individuals fear judgment, they are less likely to disclose substance use concerns, less likely to engage in treatment, and less likely to experience recovery. This is true no matter what walk of life you stem from, no matter what profession you are in. Reducing stigma is thus a clinical, ethical, and public health imperative.

Texas‑specific health data further illustrates the downstream effects of untreated substance use disorders, including alcohol‑related hospitalizations, drug‑related overdoses, and preventable deaths.2 Even when prevalence rates are slightly lower than national averages, the absolute number of affected individuals places significant strain on healthcare systems and communities. These outcomes are not inevitable; evidence‑based prevention strategies, timely access to treatment, and sustained recovery supports have been shown to reduce morbidity, mortality, and costs.3 The key is that these initiatives have to be adequately funded and broadly accessible.

It is essential to treat substance use disorders as seriously and compassionately as other chronic illnesses. This includes speaking openly about prevalence, acknowledging the role of stigma, and advocating for systems of care that are based on scientific evidence rather than outdated assumptions. If one in six Americans—and one in seven Texans—are affected, then nearly every family, workplace, and community has a stake in how we respond. As physicians, policy advocates, and community leaders, we have both the opportunity and the responsibility to lead with data, compassion, and transparency. By reframing substance use disorders as the common, treatable health conditions they are, we can achieve these goals of reducing stigma, improving access to care, and improving the health and well-being of the populations we serve.

For physicians, the message should be clear: substance use disorders are common and addressing them as part of routine medical care should be best practice. Screening and brief, non-judgmental conversations about substance use should be normalized in our clinical settings. How we ask and how we respond do matter. Framing substance use disorders as treatable medical conditions like the evidence shows will increase patient disclosures, increase their engagement in treatment, and ultimately lead to their trust in us. We must lead the shift from judgment to treatment by insisting that substance use disorders are met with evidenced based care, equitable insurance coverage, and our compassion—not silence or shame.

“We, as a culture, have not fully acknowledged how much help is needed. The only real shame is on us for not being willing to speak openly. For continuing to deny that mental health is related to our overall health. We need to start talking, and we need to start now.”
– OPRAH WINFREY

References:

  1. Blaire Bryant, Naomi Freel, and Emily Steckler, “SAMHSA Releases New 2024 Data on Rates of Mental Illness and Substance Use Disorder in the US,” National Association of Counties, July 28, 2025, https://www.naco.org/news/samhsa-releases-new-2024-data-rates-mental-illness-and-substance-use-disorder-us.
  2. “Substance Use Disorder Statistics,” Drug Policy Facts, accessed May 4, 2026, https://www.drugpolicyfacts.org/node/4476.
  3. Johanna Bellon et al., “Association of Outpatient Behavioral Health Treatment With Medical and Pharmacy Costs in the First 27 Months Following a New Behavioral Health Diagnosis in the US,” JAMA Network Open 5, no. 12 (2022): e2244644, https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2799220.
  4. Substance Abuse and Mental Health Services Administration, “National Survey on Drug Use and Health (NSDUH): 2023 National Releases,” SAMHSA, accessed April 1, 2026, https://www.samhsa.gov/data/data-we-collect/nsduh-national-survey-drug-use-and-health/national-releases/2023.
  5. Substance Abuse and Mental Health Services Administration, “State Estimates of Mental Health and Substance Use,” accessed April 1, 2026, https://nsduhweb.rti.org/respweb/estimates.html.
  6. Li-Tzy Wu, He Zhu, and Udi E. Ghitza, “Multicomorbidity of Chronic Diseases and Substance Use Disorders and Their Association with Hospitalization: Results from Electronic Health Records Data,” Drug and Alcohol Dependence 192 (2018): 316–23, https://doi.org/10.1016/j.drugalcdep.2018.08.013.
  7. Lauren R. Ray et al., “Combined Pharmacotherapy and Cognitive Behavioral Therapy for Adults With Alcohol or Substance Use Disorders: A Systematic Review and Meta-analysis,” JAMA Network Open 3, no. 6 (2020): e208279, https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2767358.

Understanding Before Access: Why PATC Is Measuring Health Literacy More Intentionally

Project Access Tarrant County

By Kathryn Keaton

This article was originally published in the March/April 2026 issue of  Tarrant County Physician.

At Project Access Tarrant County, we have always believed that the “access” in our name involves more than seeing a specialist—it also includes comprehension. A growing body of research confirms what community health organizations have long observed: Health literacy is directly tied to healthcare utilization, outcomes, and cost.

Health literacy, as defined by Healthy People 2030, is “the degree to which individuals have the ability to find, understand, and use information and services to inform health-related decisions and actions for themselves and others.”1 PATC is uniquely positioned to help our patients improve health literacy not just for their PATC service, but also for their future lifetime of healthcare.

A 2025 systematic review found that limited health literacy is consistently associated with higher healthcare costs, increased hospitalizations, and greater emergency department use—all areas PATC aims to reduce in Tarrant County.2 Literacy is not a secondary social factor; it is a healthcare variable. Health literacy influences how patients navigate outpatient, inpatient, emergency, and digital health systems (even more so in immigrant populations)—and PATC is changing how we approach this issue in our patient base.

Moving Beyond “High School or Not”
Historically, many healthcare systems—including safety-net organizations—have captured each patient’s education level in broad terms. Emerging research shows that education level alone does not reliably predict a patient’s ability to understand medical terminology, consent forms, referral instructions, or post-procedure care plans. Studies have demonstrated that even patient-facing surgical materials are frequently written above recommended reading levels.

A decade ago, the AMA and National Institute of Health recommended that medical materials be written at an eighth grade or below reading level,3 but today, most experts agree that material should be written at a sixth grade or below reading level.4

When written information assumes advanced comprehension, patients are placed at risk of misunderstanding critical instructions. Just last year, a PATC patient almost canceled her vital surgery because she mistakenly thought she was instructed to stop her diabetes medication for a full week leading up to her surgery. She had enough health literacy to question those instructions, but not enough confidence to question their accuracy.

To respond more intentionally, PATC is refining how we capture and evaluate education and health literacy across our patient population.

What We’re Changing

  1. Narrowing our educational ranges
    Rather than broad categories, we now collect more targeted education data. This allows us to examine patterns in referral completion, adherence, and communication preferences.
  2. Identifying whether education occurred inside or outside the United States
    Educational systems vary widely across countries. A high school diploma earned abroad may reflect a different exposure to English-language healthcare terminology or system navigation. Recent national research examining health literacy by Hispanic ethnicity reinforces this nuance.5
  3. Implementing SAHL evaluations for each adult patient

PATC is incorporating the Short Assessment of Health Literacy (SAHL), a validated screening tool created in 2010 by Health Services Research that directly measures a patient’s ability to recognize and understand common medical terms.

Unlike education level, SAHL evaluates functional comprehension—an essential factor in specialty care navigation. The tool is curated in both English and Spanish, with other languages available.6

Why Literacy Directly Impacts Care
Health literacy affects:

  • Medication adherence
  • Chronic disease management
  • Completion of specialty referrals
  • Understanding of pre-procedure instructions
  • Post-surgical recovery compliance

Systematic reviews across multiple countries show that lower health literacy is associated with delayed care, increased acute utilization, and poorer chronic disease management—even in universal healthcare systems, insurance coverage alone does not eliminate access barriers.7

For uninsured patients navigating specialty referrals—often involving multiple providers, consent forms, preparation instructions, and follow-up plans—comprehension is foundational. When literacy gaps are not identified, missed appointments may be labeled as “noncompliance.” In reality, they may reflect confusion, fear, or uncertainty.

Connecting Data to Our Broader Health Literacy Efforts
Importantly, PATC’s shift is not just about collecting more data. It strengthens and informs our broader health literacy initiatives, including:

  • Simplifying written instructions
  • Evaluating readability of patient-facing materials
  • Reinforcing clear text-based communications (CareMessage)
  • Informing topics for future Salud en Tus Manos curriculum
    Literacy is not just a patient issue—it is a system design issue. By measuring literacy more intentionally, PATC can ensure that communication strategies match patient needs.

    Access Requires Understanding
    Healthcare systems are becoming increasingly complex and digital. Artificial intelligence tools, online portals, and automated communications can enhance access—but only if patients can understand and use them effectively.

Access to care is not complete when an appointment is scheduled. It is complete when a patient understands what that appointment means—and what to do next.

By refining how we measure education and incorporating validated literacy screening, PATC is strengthening the foundation of specialty care coordination—because access begins with understanding.

References:

  1. Office of Disease Prevention and Health Promotion, “Health Literacy in Healthy People 2030,” Healthy People 2030, U.S. Department of Health and Human Services, accessed March 12, 2026, https://odphp.health.gov/healthypeople/priority-areas/health-literacy-healthy-people-2030.
  2. Francesca Tusoni et al., “What Is the Impact of Health Literacy on Healthcare Costs? A Systematic Review and Evidence Synthesis,” BMJ Open 15, no. 12 (2025): e108816, https://bmjopen.bmj.com/content/15/12/e108816.
  3. Patrick J. L. Fitzgerald et al., “Readability of Patient Education Materials on the American Association for Surgery of Trauma Website,” Journal of Surgical Research (2014), https://pmc.ncbi.nlm.nih.gov/articles/PMC4139691/.
  4. Cheryl A. Tucker, “Promoting Personal Health Literacy Through Readability, Understandability, and Actionability of Online Patient Education Materials,” Journal of the American Heart Association 13, no. 8 (2024): e033916, https://www.ahajournals.org/doi/10.1161/JAHA.124.033916.
  5. Athena K. Ramos et al., “Health Literacy by Hispanic Ethnicity and its Association with Healthcare Experiences, Self-rated Health, and Quality of Life,” Journal of Immigrant and Minority Health (2026), https://doi.org/10.1007/s10903-026-01848-5.
  6. Shoou-Yih Daniel Lee et al., “Short Assessment of Health Literacy—Spanish and English,” Health Services Research 45, no. 4 (2010): 1105–1120, https://doi.org/10.1111/j.1475-6773.2010.01119.x.
  7. R Schönegger, C Von Reibnitz, and Hans-Peter Wiesinger, “Health Literacy and Healthcare Utilisation in Universal Healthcare Systems: A Systematic Review,” European Journal of Public Health 35, no. 4 (October 2025), https://doi.org/10.1093/eurpub/ckaf161.1476.

The Evolving Challenges in Medicine: A Look at the Long-term Impact of the COVID-19 Pandemic

Public Health Notes

By Catherine Colquitt, MD, TCPH Medical Director

This article was originally published in the March/April 2026 issue of  Tarrant County Physician.

The opportunities, rewards, and privileges of practicing medicine are many, but the pressure of practice can at times be stressful or overwhelming. Our colleagues straining to cope may be reluctant to report or seek treatment for depression, anxiety, or substance abuse disorders. Many of these conditions have been exacerbated by the COVID-19 pandemic and its aftermath.

Tarrant County Public Health (TCPH) has for many years offered chronic disease self-management programs which host lay group support programs customized to each participant’s needs. These are facilitated by a trained lay leader with input from the rest of the support group and are tracked to mark progress on the journey toward successful chronic disease self-management, including anxiety, depression, and obsessive-compulsive disorder, among other chronic conditions. However, many physicians and other healthcare workers already feel too over-extended to participate in a time-consuming peer support program such as TCPH offers.

While healthcare worker (HCW) burnout is lower now than at the height of the COVID-19 pandemic, HCW burnout and stress have not returned to the pre-pandemic baseline according to most sources, including a large study of Veterans Health Administration (VHA) HCWs surveyed annually in 140 VA Medical Centers from 2018 to 2023. In response to survey data, the VHA implemented “several system-level programs to revise organizational practices and policies” to reduce or mitigate burnout. These include reducing workloads by hiring more staff, increasing telehealth and telework options, and introducing “whole health practices” in employee healthcare in which much attention is directed at mitigating the mental health impact of medical conditions and stressors at work or home affecting VHA employees.1 

Scientific Reports released a study evaluating anxiety
and depression among HCWs two years after the COVID-19 infection began. A remarkably high percentage (50.8 percent) of their sampled HCWs reported “long COVID,” which authors defined as “persistence of multi-system symptoms for more than twelve months, including fatigue, shortness of breath, brain fog, depression, and anxiety.” The authors used PHQ-9 and GAD-7 scales to assess anxiety and depression in HCWs two years after COVID infection (higher scores indicate more instances of anxiety and depression, while lower scores indicate fewer). They found that students had the highest PHQ-9 and GAD-7 scores, with doctors, nurses, and administrative staff reporting lower PHQ-9 and GAD-7 scores. Authors concluded that “policymakers and healthcare administrators should consider optimizing mental health support systems,” including “implementing regular mental health screenings, providing personalized psychological interventions, offering counseling services, reducing work-related stress, and promoting the use of mental health assessment tools to improve the psychological well-being” of healthcare workers, especially students and those who have long COVID.2 

Center for Infectious Disease Research and Policy summarized a Morbidity and Mortality Weekly Report study of US HCWs surveyed online in 2022 and 2023 in which 26 percent of participants “reported symptoms of mental illness but only 20% sought treatment during the previous year, mainly because of difficulty getting time off from work and worries about confidentiality and cost.” HCWs were surveyed using PHQ-2 and GAD-2 tools and cited work stress, burnout, inadequate staffing, greater workload or job demands, fear of COVID-19, and COVID-19 misinformation as their leading stressors.3 

Like our patients, we physicians escape through connections to our chosen online communities, but perhaps we should more often step out of our comfort zone to ask a colleague how they are doing in a manner which suggests that we really care to know, and this might lead to a colleague expressing concern for our well-being as well. Who among us is at risk for self-harm? According to actuarial data, the typical physician at risk is 45 years old; Caucasian; amid some marital discord or divorced, separated, or single; self-treating with alcohol or drugs; a “workaholic”; and a risk-taker. Our hypothetical colleague may also have chronic pain or some other serious medical comorbidity, is concerned about a looming change in status (financial, professional, social) and may be frankly overwhelmed by the increasing demands of work. Our colleague will likely also have access to medications or firearms with which to act.4,5,6

Psychiatric concerns in physicians are often left unaddressed until far advanced just as we often under-diagnose psychiatric conditions in our patients. Furthermore, we may fear the possible professional repercussions of asking for help with a psychiatric illness, opening ourselves up to the scrutiny and judgment of physician health programs, credentials committees, colleagues, or lawyers.

It is my personal hope that we will all use our training, honed by the COVID-19 pandemic, to minister to those suffering and in pain in the ways unique to our healing arts. COVID-19 has changed us all in ways we don’t yet fully realize.

References:

  1. Debra C. Mohr et al., “Burnout Trends Among US Health Care Workers,” JAMA Network Open 8, no. 4 (2025): e255954, https://doi.org/10.1001/jamanetworkopen.2025.5954.
  2. Lin Zhang et all., “Anxiety and Depression in Healthcare Workers 2 Years After COVID-19 Infection and Scale Validation,” Scientific Reports 15 (2025): Article 13893, https://doi.org/10.1038/s41598-025-98515-w.
  3. Mary Van Beusekom, “1 in 4 US Healthcare Workers Report Mental Distress During COVID, Survey Suggests,” Center for Infectious Disease Research and Policy, January 20, 2025, https://www.cidrap.umn.edu/covid-19/1-4-us-healthcare-workers-report-mental-distress-during-covid-survey-suggests.
  4. Latoya Hill et al., Physician Workforce Diversity by Race and Ethnicity, Kaiser Family Foundation, July 22, 2025, https://www.kff.org/racial-equity-and-health-policy/physician-workforce-diversity-by-race-and-ethnicity/.
  5. Daniel Saddawi-Konefka, Christine Yu Moutier, and Jesse M. Ehrenfeld, “Reducing Barriers to Mental Health Care for Physicians: An Overview and Strategic Recommendations,” JAMA 334, no. 10 (2025): 987–995, https://doi.org/10.1001/jama.2025.12587.
  6. Hirsh Makhija et al., “National Incidence of Physician Suicide and Associated Features,” JAMA Psychiatry, published online February 26, 2025, https://doi.org/10.1001/jamapsychiatry.2024.4816.

I am a Doctor. . .

Feature Narrative

By Sergio Sanchez Zambrano, MD

This article was originally published in the September/October 2025 issue of  Tarrant County Physician.

Recently, while evaluating annotations by a young medical student for potential publication in our journal, I objected to the fact that the author was referring to herself as a “provider.”

I do not know of ANY other profession as altruistic and generous as that of being a doctor.

I manifested my respect to the medical student for her generosity and the extent of her altruism. At that time, a Christmas present given to me by my wife came to mind—a copy of a poem written by Robert Louis Stevenson from Scotland (November 13, 1850–December 3, 1894). It is called “Eulogy of the Doctor.”

Robert Louis Stevenson’s prose is unique and needs no additional commentary; hence, I will simply “copy and paste.”

Eulogy of the Doctor

There are men and classes of men that stand above the common herd the soldier, the sailor, the shepherd not infrequently, the artist rarely, rarelier still the clergyman, the physician almost as a rule.. He is the flower of our civilization and when that stage of man is done with, only to be marveled at in history he will be thought to have shared but little in the defects of the period and to have most notably exhibited the virtues of the race. Generosity he has, such as is possible only to those who practice an art and never to those who drive a trade: discretion, tested by a hundred secrets; tact, tried in a thousand embarrassments; and what are more important, Herculean cheerfulness and courage. So it is that, he brings air and cheer into the sick room and often enough, though not so often as he desires, brings healing.

There is nothing else that I could add other than encouragement to all the doctors, young and old, to remember that we are not providers. We are DOCTORS.

I am just saying . . .

The Winter Blues

President’s Paragraph

By Cheryl Hurd, MD, TCMS President

This article was originally published in the March/April 2026 issue of  Tarrant County Physician.

As I was first writing this article, we were facing our usual “once a winter” storm with freezing temperatures, snow, and ice. Despite our best preparations, Texas just does not have the infrastructure to maintain business as usual during significant winter storms. Honestly, up to this point, it seemed like a pretty mild winter. And then the front came through with howling winds, record low temperatures, freezing rain that turned to sleet, and barely any snow, though some did fall. People stayed indoors in the warmth, but many I am sure enjoyed some “winter sports” with sledding on trash can lids and attempts to build snowmen.

However, it didn’t take long before people started feeling cooped up and wanting to get out. Thanks to telehealth, my clinic was able to provide care for patients during the following week while we awaited sunnier days and above-freezing temperatures. Patients were already mentioning that they felt a dip in their mood and lower motivation. Friends, family, and acquaintances over the years have sometimes mentioned things like this when the winter sets in. It happens only now and again, when people may want to stay home but still are interested in their usual activities. This is not seasonal affective disorder, a serious variant of clinical depression that often requires professional treatment. This is a fairly well-known phenomenon called “winter blues.” NIH-funded researchers have been studying both of these conditions for decades.

Patients were . . . mentioning that they felt a dip in their mood and lower motivation. Friends, family, and acquaintances over the years have sometimes mentioned things like this when the winter sets it. . . . This is a fairly well-known phenomenon called “winter blues.”

The winter blues tend to occur in colder and more northern (or southern if south of the equator) areas because it is a reaction to reduced sunlight and the changes of the season. Yet it can happen anywhere when the weather turns “dark and dreary.” According to the University of California-Davis Health, people still continue to function while experiencing a mood dip, minimal sadness, fatigue, and less motivation.1 These feelings are usually mild and temporary, which is different from seasonal affective disorder. According to Dr. Matthew Rudorfer, an NIH mental health expert, the winter blues can be linked to something specific, like holiday stress or loss.2

What should we do or recommend if we or those around us have the snowy doldrums? It may seem obvious, but simple things like getting outside (dress appropriately!), opening your blinds/curtains for more ambient light, being social, and getting physical (the Jane Fonda kind, not the Mike Tyson kind) are all ways to get past this. The kids have it right—go sledding, have snowball fights, make a snow (or ice) man . . . and enjoy some hot cocoa when it’s time to relax. Because the seasons always change, and spring is on the way! Well, technically, in Texas, it’s already here.

References:

  1. UC Davis Health, “Seasonal Affective Disorder, Winter Blues and Self-Care Tips to Get Ahead of Symptoms,” Cultivating Health (UC Davis Health Blog), November 29, 2023, https://health.ucdavis.edu/blog/cultivating-health/seasonal-affective-disorder-winter-blues-and-self-care-tips-to-get-ahead-of-symptoms/2023/11.
  2. “Beating the Winter Blues,” NIH News in Health, January 2013, https://newsinhealth.nih.gov/2013/01/beating-winter-blues.
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