Khan wins Bill Gates kudos for anti-polio efforts

Khan wins Bill Gates kudos for anti-polio efforts

PESHAWAR: Prominent philanthropist and Microsoft cofounder, Bill Gates, has appreciated Pakistan Tehreek-e-Insaf (PTI) Chairman Imran Khan’s efforts for eradication of polio in Khyber Pakhtunkhwa and tribal areas of Pakistan, Media reported Wednesday.

“I’m encouraged by your personal commitment to eliminate this disease in Pakistan. Your strong leadership comes at a critical time in our global efforts,” said Gates in a letter to PTI chief.

“Your direct engagement and your leadership are essential to ensuring a polio-free future for all of the children of KP, FATA and Pakistan and your work will have global reach and recognition,” writes Gates who is chief of his Bill & Melinda Gates Foundation, one of the main contributors for polio eradication initiative in Pakistan.Media

Mammograms don't reduce cancer death rates, study finds

Mammograms don't reduce cancer death rates, study finds

LONDON: The research, published Tuesday in the British Medical Journal, is the latest in a series of studies that question the value of annual breast X-rays for pre-menopausal women and whether too many women are being "overdiagnosed" by the popular test.

 

"We found absolutely no benefit in terms of reduction of deaths from the use of mammography," said study leader Dr. Anthony Miller, an epidemiologist at the University of Toronto's Dalla Lana School of Public Health.

 

The controversial finding is unlikely to trigger an immediate change in national screening policies, although it will enliven an already heated debate over screening. Experts have been arguing the merits of breast X-rays since 2009, when a government panel recommended that most women under 50 could safely skip the test. The U.S. Preventive Services Task Force determined that the chances a 40-year-old woman would be diagnosed with invasive breast cancer in the next 10 years was 1.44% and that her odds of dying from it were just 0.19%.

 

However, the breast cancers that strike women in their 40s are often more aggressive, and they account for about 17% of deaths from the disease, according to the American Cancer Society.

 

The ACS and the American College of Obstetricians and Gynecologists recommend annual mammograms for women beginning at age 40, and the National Cancer Institute advises women in their 40s to have the test once every year or two. The Canadian Task Force on Preventive Health Care advises women to have mammograms every two to three years between the ages of 50 and 74.

 

The British Medical Journal report, based on data from the Canadian National Breast Screening Study, argues that mammography all too often finds small cancers that would never become dangerous if left alone. Roughly half of all cancers found by mammography — yet undetected through physical examination — fell into this category, the study authors wrote.

 

The researchers examined the medical records of 89,835 women in six Canadian provinces between the ages of 40 and 59. All of the trial participants received annual physical breast examinations, while half of them also had yearly mammogram screenings for five years, beginning in 1980.

 

Over the next 25 years, 3,250 of the 44,925 women in the mammography arm of the study were diagnosed with breast cancer, along with 3,133 of the 44,910 women in the control group. In addition, 500 patients in the mammography group died of breast cancer, as did 505 women in the control group.

 

The researchers found that women who got mammograms were more likely to be diagnosed with breast cancer, but that the test did not reduce their risk of dying from the disease.

 

The research team calculated that 22% of the cancers found on mammograms were overdiagnosed. That means that for every 424 women who were screened, one received unnecessary cancer treatment.

 

The study did not address the use of mammography as a diagnostic tool, which most experts agree is valuable.

 

In light of their findings, Miller and his colleagues concluded, "The rationale for screening by mammography should be urgently reassessed by policymakers."

 

The American College of Radiology, one of the leading critics of the task force recommendations, was quick to denounce the study's conclusions. The group said in a statement that the Canadian National Breast Screening Study was "deeply flawed" and "incredibly misleading." Among other problems, the study relied on "second-hand" mammography equipment that was operated by poorly trained technicians, the group said.

 

"It would be an outrage for women if access to screening was curtailed because of the poor results in the Canadian National Breast Screening Study," said Dr. Daniel Kopans, a senior breast imager at Massachusetts General Hospital in Boston. "It has been known for years that the trial was compromised from the start."

 

The study authors said they stood by their conclusions and challenged the critics to produce data showing that mammograms reduced deaths. Other recent studies have found that advances in breast cancer treatment have eroded some of the benefits of early detection.

 

"Modern treatment is so much more effective now that the lead time gained by mammography has little impact on the outcome," Miller said.

 

Dr. H. Gilbert Welch, an epidemiologist and biostatistics professor at Dartmouth College's Geisel School of Medicine, said the study offered the highest-quality evidence yet on the prevalence of overdiagnosis.

 

"I think there's growing realization that all is not well with mammography," said Welch, who co-wrote the book "Overdiagnosed: Making People Sick in the Pursuit of Health." "People in the cancer community and the cancer surgery community are aware of the problem of overdiagnosis. They're aware that mammography was oversold, that its benefits were exaggerated and its harms were kind of downplayed."

 

In an editorial that accompanied the study, three breast cancer experts from the University of Oslo who have studied the effects of screening in Europe said Miller and his colleagues made a convincing case that current policies should be reconsidered.

 

"This is not an easy task, because governments, research funders, scientists and medical practitioners may have vested interests in continuing activities that are well established," they wrote.

 

Similar studies on mammography screening have been conducted in Europe, and critics have said that they don't apply to American women. The Canadian researchers said that their results are highly pertinent to the United States, and that their study is probably the largest we will ever see.

 

"Many people believe you do not adopt policy on the result of one trial, and yet there's not likely to be another trial like this," Miller said. "It takes too long."

Vitamin E protects against memory disorders

Vitamin E protects against memory disorders

ISLAMABAD: A joint research by Finnish and Swedish scientists has shown that the entire vitamin E family plays a role in prevention of age related memory disorders.

The latest research by the University of Eastern Finland Karolinska Institute of Sweden and some other medical research institutes showed that various forms of vitamin E plays a role in memory processes according to a report by the Finnish daily Helsingin Sanomat Xinhua News reported.

The new finding came as previous studies investigating the link between vitamin E and memory disorders usually focused only on a single form of vitamin E namely alpha tocopherol.

According to Dr. Miia Kivipelto director of the research from University of Eastern Finland vitamin E exists in eight different natural forms (fat soluble compounds) and the entire vitamin E family plays a role in protecting against memory disorders not only alpha tocopherol.

Kivipelto said vitamin E supplements available on the market usually contain only alpha tocopherol and the best sources of vitamin E are vegetable oils nuts green vegetables and whole grain cereals.

A balanced diet is the best way to obtain all the eight vitamin E from food, said Kivipelto adding that more varied diet and a healthier lifestyle could efficiently prevent memory disorders among the elderly. (APP)

First guidelines issued to prevent stroke in women

First guidelines issued to prevent stroke in women

NEW YORK: Just as heart attack symptoms may differ between men and women, so do stroke risks.

Now, the American Heart Association has issued its first guidelines for preventing strokes in women. They focus on birth control, pregnancy, depression and other risk factors that women face uniquely or more frequently than men do.

The advice applies to patients like Denise Miller, who suffered a stroke last year that fooled doctors at two northeast Ohio hospitals before it was finally diagnosed at the Cleveland Clinic. She was 36 and had no traditional risk factors.

"There was nothing to indicate I was going to have a stroke," other than frequent migraines with aura — dizziness or altered senses such as tingling, ringing ears or sensitivity to light, Miller said.

These headaches are more common in women and the new guidelines issued Thursday flag them as a concern. Miller recovered but has some lingering numbness and vision problems.

Each year, nearly 800,000 Americans have a new or recurrent stroke, which occurs when a blood vessel to the brain is blocked by a clot or bursts. Stroke is the third-leading cause of death for women and the fifth-leading cause for men. The key to surviving one and limiting disability is getting help fast, and recognizing symptoms such as trouble speaking, weakness or numbness in one arm, or drooping on one side of the face.

Stroke risk rises with age, and women tend to live longer than men. Women are more likely to be living alone when they have a stroke, to have poorer recovery, and to need institutional care after one.

Certain stroke risks are more common in women — migraine with aura, obesity, an irregular heartbeat called atrial fibrillation, and metabolic syndrome — a combo of problems including blood pressure, cholesterol and blood sugar.

General guidelines for stroke prevention currently focus on controlling blood pressure and diabetes, quitting smoking, more exercise and healthy diets.

The new ones add gender-specific advice, said Dr. Cheryl Bushnell, stroke chief at Wake Forest Baptist Medical Center in Winston-Salem, N.C. She led the panel that wrote the guidelines, published in Stroke, a Heart Association journal.

Some highlights:

BIRTH CONTROL PILLS: Women should be checked for high blood pressure before starting on oral contraceptives because the combination raises stroke risks. The risk is small but rises steeply in women ages 45 to 49. More than 10 million American women use birth control pills.

PREGNANCY: Strokes are uncommon during pregnancy but the risk is still higher, especially during the last three months and soon after delivery. The big worry is preeclampsia, dangerously high blood pressure that can cause a seizure and other problems.

"It doubles the risk of stroke later in life and it quadruples the risk of high blood pressure" after pregnancy, Bushnell said.

Women with a history of high blood pressure before pregnancy should be considered for low-dose aspirin (around 81 milligrams) after the first three months of pregnancy, and calcium supplements anytime, to lower the risk of preeclampsia, the guidelines say.

Pregnant women with very high blood pressure (160 over 110 and above) should be treated with medications, and treatment may be considered for those with moderately high blood pressure (150 to 159 over 100 to 109). Certain blood pressure medicines are not safe during pregnancy, the guidelines note.

ASPIRIN: It's usually recommended for anyone who has already had a stroke unless the stroke was caused by bleeding rather than a clot, or if bleeding risk is a concern, Bushnell said. Aspirin also is often recommended for people with diabetes to lower the risk of stroke and other problems.

A low-dose aspirin every other day "can be useful" to lower stroke risk in women 65 and older unless its benefit is outweighed by the potential for bleeding or other risks, the guidelines say.

MIGRAINES: Women are four times more likely to have migraines than men, and they often coincide with hormone swings. Migraines alone don't raise the risk of stroke, but ones with aura do. Using oral contraceptives and smoking raise this risk even more, so the guidelines urge stopping smoking.

IRREGULAR HEARTBEAT: Women over age 75 should be checked for atrial fibrillation. Doctors do this by taking a pulse or listening to the heartbeat.

MENOPAUSE: Hormone therapy should not be used to try to prevent strokes.

The new guidelines put women's issues "on the table" so more doctors talk about them, said Dr. Shazam Hussain, stroke chief at the Cleveland Clinic. "Gender does make a difference. The medical community has neglected it for some time." (AP)

US drugstore chain to stop tobacco products sales

US drugstore chain to stop tobacco products sales

CVS Caremark, America's second-largest drugstore chain, is quitting selling tobacco products at its more than 7,600 US drugstores as it focuses more on providing health care.

 

The Massachusetts-based company said Wednesday that it will phase out cigarettes, cigars and chewing tobacco by Oct. 1, a move that will cost about $2 billion in annual revenue but won't affect its 2014 earnings forecast. CVS Caremark leaders say removing tobacco will help them grow the company's business of working with doctors, hospitals and other care providers to improve customers' health.

 

CVS Caremark competitor Walgreen Co., the largest US drugstore chain, sells tobacco, as does the world's largest retailer, Wal-Mart Stores Inc., which also operates pharmacies in its stores. But Target Corp., another major retailer with pharmacies in its stores, does not.

 

Tobacco is responsible for about 480,000 deaths a year in the US, according to the Food and Drug Administration, which gained the authority to regulate tobacco products in 2009.

 

The federal government has renewed efforts to reduce the death and disease caused by tobacco use on the heels of the 50th anniversary of the landmark 1964 surgeon general's report that launched the anti-smoking movement. A new 980-page report issued last month by acting Surgeon General Boris Lushniak also urged new resolve to make the next generation a smoke-free generation.

 

Most independent pharmacies also do not sell tobacco, according to the National Community Pharmacists Association.

 

Several cities, including San Francisco and Boston, have considered or passed bans on tobacco sales in stores with pharmacies. Other places like New York City have sought to curb retail displays and promotions and raise the legal age someone can buy tobacco products.

 

CVS notches about $1.5 billion annually in tobacco sales, but it expects the $2 billion drop in revenue from phasing out tobacco because smokers often buy other products when they visit their stores. The company brought in more than $123 billion in revenue in 2012 and ranks 13th on the 2013 Fortune 500 list of biggest US companies.

 

CVS Caremark Corp. and other major drugstore chains have been adding clinics to their stores and expanding their health care focus for several years now. They've been preparing, in part, for an aging US population that will need more care and for the millions of people who are expected to gain health insurance coverage under the federal health care overhaul. Their pharmacists deliver flu shots and other immunizations, and their clinics also have been expanding the scope of care they deliver. They now help people manage chronic illnesses like high blood pressure and diabetes in addition to treating minor illnesses like sinus infections.

 

CVS Caremark has been working to team up with hospital groups and doctor practices to help deliver and monitor patient care, and the presence of tobacco in its stores has made for some awkward conversations, CVS Chief Medical Officer Dr. Troyen A. Brennan said.

 

US retail sales of tobacco, which is comprised largely of cigarettes, were about $107.7 billion in 2012, according to market researcher Euromonitor International. Less than 4 percent of retail cigarette sales come from drugstores like CVS and Walgreens.

 

The share of Americans who smoke has fallen dramatically since 1970, from nearly 40 percent to about 18 percent. But the rate has stalled since about 2004, with about 44 million adults in the US smoking cigarettes. It's unclear why it hasn't budged, but some market watchers have cited tobacco company discount coupons on cigarettes and a lack of funding for programs to discourage smoking or to help smokers quit.

Cancer cases 'set to rise by half by 2030': UN

Cancer cases 'set to rise by half by 2030': UN

PARIS: New cases of cancer will rise by half by 2030, reaching 21.6 million per year compared to 14 million in 2012, the UN said on Monday in a global analysis of the scourge.

 

Cancer deaths, meanwhile, will likely rise from 8.2 million to 13 million per year as the world's population grows and ages and more people adopt risky lifestyle habits, said the report compiled by the International Agency for Research on Cancer (IARC).

 

It took aim at Big Tobacco, saying its sales drive was "inextricably linked" to a likely surge in lung cancer.

 

Released on the eve of World Cancer Day, the report was compiled by more than 250 scientists from over 40 countries. It is the first such overview in six years.

 

World Health Organisation (WHO) Director General Margaret Chan, whose agency oversees the IARC, said the overall impact from cancer would "unquestionably" hit developing countries the hardest.

 

These nations are already grappling with poverty-associated cancers caused by infection or disease, she said.

 

Added to that will be cancers blamed on more affluent lifestyles -- high tobacco and alcohol use, eating processed foods and not exercising enough.

IARC director Christopher Wild said the focus should be on prevention.

 

"The particularly heavy burden projected to fall on low- and middle-income countries makes it implausible to treat our way out of cancer, even the highest-income countries will struggle to cope with the spiralling costs of treatment and care," he said.

 

Cancer overtook heart disease as the number one cause of death in the world in 2011.

 

New cases will likely rise to 19.3 million in 2025, with 11.4 million deaths, said Wild. By 2035, new cases would number about 24 million per year.

 

The report found a slight gender bias: 53 percent of cancer cases and 57 percent of deaths were among men.

 

In men, cancer most often attacked the lungs (16.7 percent) followed by the prostate (15 percent), colorectum (10 percent), stomach (8.5 percent), and liver (7.5 percent).

 

For women, cancer was most common in the breast (25.2 percent), colorectum (9.2 percent), lung (8.7 percent), cervix (7.9 percent) and stomach (4.8 percent).

 

There were also regional imbalances: more than 60 percent of the world's cancer cases and 70 percent of deaths occurred in Africa, Asia and Central and South America, said the World Cancer Report.

 

Measured as a proportion of the population, however, high-income countries in North America and western Europe as well as Japan, South Korea, Australia and New Zealand, had higher figures.

 

Cancers of the breast, colorectum and prostate were more typical of the industrialised world, said the report, and those of the liver, stomach and oesophagus more common in low-income countries.

China bears brunt of new cases

 

Almost half the new cases diagnosed in 2012 were in Asia, most of them in China, said the report. Europe had nearly a quarter of cases, the Americas about a fifth, and Africa and the Middle East just over eight percent.

 

But when it came to deaths, Asia's share jumped to more than 50 percent and that of Africa and the Middle East to nearly 10 percent, while the Americas' share shrank to under 16 percent and that of Europe to 21.4 percent.

 

Cancer is typically diagnosed at a more advanced stage in less developed countries, and treatment is less readily available, said the report.

 

Globally, lung cancer was the biggest killer with 19.4 percent of the total, followed by cancer of the liver with 9.1 percent and stomach with 8.8 percent.

 

The report said lung cancer was "inextricably linked to the global tactics of tobacco companies aiming to expand their sales."

 

A smoking "epidemic" was evolving in poor countries, it said, "potentially impeding human development by consuming scarce resources, increasing pressures on already weak health-care systems, and inhibiting national productivity."

 

The report said the total, annual economic cost of cancer to the world was estimated at about $1.16 trillion in 2010, "yet about half of all cancers could be avoided" through prevention, early detection and treatment.

 

Prevention includes vaccination against hepatitis B and the human papillomavirus, which can reduce cancers of the liver and cervix, the promotion of physical activity to counter obesity -- thought to be a factor in bowel and breast cancer, and tougher anti-tobacco campaigns.

‘Healthcare justice’ campaign begins in Peshawar Sunday

‘Healthcare justice’ campaign begins in Peshawar Sunday

PESHAWAR: Healthcare campaign would begin here from Sunday under which 0.8 million children would be vaccinated across the district against nine diseases including polio.

“Healthcare justice” campaign was postponed on January 26 for a week due to security fears and lack of preparations.

Peshawar administration has also imposed ban on motorbike riding for Sunday from 7 AM to 5 AM, according to the notification issued here Saturday.

Obesity among US kids starts early: study

Obesity among US kids starts early: study

WASHINGTON: Obesity among US children is largely established by kindergarten, a study said, adding that nearly half of those obese at 14 already had the problem at age five.

 

The study published in the New England Journal of Medicine also showed that over 14 percent of children enter kindergarten overweight and are four times more likely than normal weight children to become obese by the eighth grade.

 

"Although trends in the prevalence of obesity are well documented, there is surprisingly little known about new cases of childhood obesity," wrote lead researcher Solveig Cunningham, assistant professor in the Hubert Department of Global Health at Rollins School of Public Health at Emory University in Georgia.

 

The researchers used data from children who took part in a study of kindergartens in 1998 and 1999.

 

With appropriate adjustments the data sample was representative of all of the estimated 3.8 million children in kindergarten during that time.

 

"Examining incidence may provide insight into the nature of the epidemic, the critically vulnerable ages, and the groups who are at greater risk for obesity," Cunningham wrote.

 

The study showed that 14.9 percent of kids entering kindergarten are overweight. The researchers used body mass index charts from the Centers for Disease Control and Prevention (CDC).

 

The rate of obesity rises to 20.8 percent when kids reach age 14.

 

Incidence of obesity at age 14 was highest among black children (17 percent), followed by Hispanics (14 percent). The rate was 10 percent among whites and children of other races.

 

Children from the richest 20 percent of families had the lowest rates of obesity in kindergarten than those of all other socio- economic groups, the study said.

 

At all ages between five and 14, the rate of obesity was highest (25.8 percent) among the poorest children.

 

"We have evidence that certain factors established before birth and during the first five years are important. Obesity-prevention efforts focused on children who are overweight by five-years-old may be a way to target children susceptible to becoming obese later in life," 

Brain scans help predict learning problems: study

Brain scans help predict learning problems: study

STOCKHOLM: Brain scans may help identify children with learning difficulties much earlier by measuring their short-term memory capacity, according to a Swedish study published Wednesday.

 

The study by a team of researchers at Karolinska Institute, published in the Journal of Neuroscience, showed that it is possible to map the development of short-term memory capacity with Magnetic Resonance Imaging (MRI scans).

 

"It would be possible in principle to use the MR scanner to predict something about future development that cannot be predicted by psychological tests alone," neuroscience professor Torkel Klingberg told AFP.

 

"The benefit could be an early identification of children at risk of poor development so that we can give them good help intervention in time."

 

About 10 to 15 percent of children tend to have problems with learning and attention, which can be related to a deficient short-term memory -- the ability to retain information to solve a problem.

 

The scans alone are not expected to predict future learning difficulties, and Klingberg said they would be combined with other psychological tests.

 

"Until now neuroimaging has just given us pictures of behaviour that we already knew about," he said. "Now this is telling us we can use the MR scanner also for something novel."

 

The study involved a random sample of 62 healthy children and youths aged six to 20 and compared their performance in cognitive tests while being scanned.

 

They were tested again two years later, and the study found that the earlier scan could help predict how their learning abilities would develop. (AFP)

Family promise gave life to man in 31-year coma

Family promise gave life to man in 31-year coma

MURRIETA: Paul Cortez can remember the night 31 years ago as clearly as if it was last week. He had walked into the pediatric intensive care unit of Riverside County Regional Medical Center to find his 7-year-old son, Mikey, barely clinging to life.

 

Bandages were covering his little body, seemingly from head to toe. Wires and tubes attached to machines were keeping him alive.

 

Doctors told Cortez that Mikey might not make it. A drunken driver had smashed into the car carrying the boy and relatives, sending four of them, including his mother, brother and sister, to other hospitals. Four other relatives, including Mikey's oldest brother, were dead.

 

Not knowing what to do, Paul Cortez got down on his knees and, with Mikey's hand in his, made a promise to God: If his son somehow survived, whatever the condition, he and his family would always be there for him.

 

It felt strange at first because, although he is a deeply religious man, Cortez had never before asked for any favors from heaven.

 

"But he was our son," he recalled.

 

Mikey would never walk or talk again, but that didn't matter to his family. For the next 31 years, they would raise him at home, including him in every activity they could. From holidays to family vacations to high school football games, they were by his side until his death last month.

 

"I prayed to God to walk our families through this," Cortez said, his voice thick with emotion. "To help us. And he did."

 

The youngest of Paul and Roonie Cortez's four children, Austin Miguel Cortez — "but Mikey just stuck," his mother says — had always been the most gregarious and mischievous member of the family. He was a veritable whirlwind of energy and practical jokes.

 

"If you look at the pictures, they pretty much tell you the story of Mikey, because in every one he's goofing off," Cortez said.

 

In one, he's striking some sort of warrior-cowboy pose.

 

In another, he's mugging for the camera.

 

In a group shot, he's making a face.

 

And in practically every one he's sporting a big grin.

 

The family lived in Temecula, midway between San Diego and Los Angeles. In March 1982, it was little more than a picturesque backwater of rolling hills and vineyards. The beauty of the place was why Cortez had moved his family there three years earlier.

 

One day, Mikey and his relatives piled into the family car and left home to meet his father for a night out. They were traveling on a rural, two-lane road when a drunken driver suddenly barreled down on them and hit their car head-on. "No seatbelts in those days," Mikey's mother said, meaning everybody was tossed about the car.

 

Mikey, the worst injured, suffered serious brain damage. He was left in a persistent vegetative state, a condition that's like a coma but lasts much longer. People are able to perform some basic functions, but show only limited, if any, awareness of their surroundings.

 

Although Mikey would never fully emerge from that state, his father was determined to give him as full a life as possible.

 

When Paul Cortez coached his daughter Angelica and son Tony in soccer, Mikey sat in his wheelchair on the sidelines, cheering them on.

 

When Tony made his high school football and basketball teams, Mikey was at every game. One year he traveled with his family to the mountain town of Lone Pine, where he sat in his wheelchair, bundled up head to toe against the frigid winter weather while his brother played.

 

At basketball games he'd be at courtside, and at some point in every game his brother would come over and give him a hug.

 

"He was aware of things going on around him by his eye contact or gestures that he made," his father said. "He felt pain and he could feel a tickle when we tickled him and he would smile at times."

 

Like the time they put a pair of Mickey Mouse ears on his head during a visit to Disneyland. Or when a favored uncle would come into his room and he'd perk up at the sound of his voice and turn to look at him.

 

Years later, he'd do the same upon hearing his nieces or nephews say, "Hi, Uncle Mikey."

 

How much of that is simple reflex as opposed to cognitive behavior has long been debated. Dr. Paul Vespa, who heads UCLA's Neurointensive Care Unit, said there are some cases in which people largely in a vegetative state seem to recognize some things.

 

"They have a lot of impairment, but they are able to interact a little bit," he said. Giving them as close to normal a life experience as possible, as Mikey's family did, probably does help them, he added.

 

Still, there were many things Mikey could never do. He couldn't shower or dress or feed himself during the years he was rapidly growing from little boy to teenager and, finally, into a strapping, 150-pound man.

 

So his mother and grandmother did those things for him.

 

"Did it get harder?" his mother said. "No. It just got different. With a brand new baby you can do anything. With a toddler, as he gets older, you have to be more careful, putting up gates and like that. And with Mikey it was similar."

 

Because he could no longer attend school with his friends, his family found other ways to get him involved. Several times a year they took him to schools where his father gave talks aimed at impressing upon teenage drivers the pain that drunken driving exacts on innocent victims.

 

He told them how a man with a blood-alcohol level of .22, nearly three times the legal limit, had gotten behind the wheel of a car with his two young daughters and drove straight into the vehicle carrying an innocent family. The driver and a daughter died too.

 

Then he introduced them to Mikey.

 

When the talks took Cortez and his family to Florida one year for a Mothers Against Drunk Driving conference, they turned the visit into a cross-country travel adventure, showing Mikey the sites in Texas, Florida, Virginia, Massachusetts and other states.

 

Over the years, the doctors who once doubted Mikey would survive a week after the accident gave up trying to predict when he might die.

 

"The first time we were told it was one night," Roonie Cortez said. "Then it was three days. Then it was maybe a couple of months. Then three to five years.

 

"And then," she said, managing a smile, "they just threw up their hands and said, 'Who knows?'"

 

After he marked his 38th birthday a year ago, Mikey's health began to deteriorate. Eight months ago he was diagnosed with end-stage renal failure. Promise or not, doctors told the family, it was time for him to enter a facility where he could undergo kidney dialysis.

 

The family struck a deal: They would learn how to do dialysis themselves and keep him at home.

 

When Christmas Eve arrived last month, Mikey gathered with his family for a holiday portrait. Only this time there was no smile. He looked pale and weary and his eyes were closed. Three days later, he died at home, with his family at his side. He died a day shy of his 39th birthday.

 

When they got into this journey 31 years ago, his father said, the family "didn't have a clue" how they would fulfill their promise, but, yes, they would do it all again. It brought them closer together and it gave Mikey a life full of meaning with them and — with strangers.

 

"I'll tell you a story," Cortez said, pausing to brush his face as he began to choke up.

 

A year ago, he was giving a talk about drunken driving and a young woman approached him. She told him she had been one of Mikey's first-grade classmates, back when he was that vibrant little boy. She let Cortez know that over the years she and others had gotten the message of Mikey's life.

 

"And I just held on to her and we cried," he said. (AP)