Health Journal

Stand Tall

‘Tis the season—again.  It’s almost autumn, which means it is time for things to start falling down.  Unfortunately, statistics show that when the weather turns colder, the risk of humans falling down increases, especially in ice and snow.  We all need to be reminded of the risks, because none of us are exempt; none of us are invincible. 

**

“I thought I was invincible,” my 74-year old neighbor said after he fell, when I asked him why he thought he could climb a ladder.

He has Parkinson’s disease, which makes it very difficult for him to move.  He said he wanted to prove to himself he could still do it.  That’s when he fell.

I don’t have Parkinson’s, and I’m 20 years his junior.  I know I am not, yet I sometimes, too, think I am invincible. 

This time, thankfully, he recovered.  He has had other falls.  Coupled with a previous ankle surgery, his Parkinson’s makes it very hard for him to even walk.  He knows the risks.

My husband, who is not yet 60, missed our bottom step a few months ago, which sent him crashing into the wall at the bottom of the stairs.  He is okay, mercifully, but my antique mirror he crashed in to is not. 

I didn’t make him stay in the doghouse for long, because I was glad he wasn’t hurt.  It could have been so much worse. 

A friend who is 14 years my junior required ankle surgery after she fell down her stairs.  Her dog got underfoot.  She was laid up and off work for several weeks. 

It can, and does, happen to anyone of any age.  As a general rule, the younger the person is who falls, the less serious and long-lasting is the damage.  Children can sustain multiple falls when they are playing, and it doesn’t seem to affect them.  They get up and go, unfazed.  Adults most often don’t fare that well.

**

The word “mindful” has been a buzzword for several years.  Many people have probably tuned it out, because that is what happens with humans.  When a word becomes familiar from multiple repetitions, we tend to tune it out, and not fully consider its meaning. 

We all use the word “mindless” at times to describe someone else’s—or our own—actions.  It is a fitting word, because, indeed, we are not using our minds at that moment.  We do something silly or make a mistake, and we say it was “mindless.”  Mindful, then, means that we are using our minds.  We pay conscious attention to what we are doing, thinking through each step.  We focus on the task at hand, being “mindful” of what we are doing, not “mindless.”

Nearly all falls could be prevented if we were simply more “mindful.”  Falls are accidents, and most accidents in general could be prevented if the party/parties involved payed closer attention to what they were doing. 

It sounds simple, I know, but these points are important to consider:

  • focus on what you are doing.
  • Watch each step. 
  • Look around you, scan for obstacles—like the dog that caused my friend to fall.  Animals, as much love as they bring us, and as much as they don’t mean to, can cause us to fall if they get underfoot.
  • Oxygen tubing is another fall risk.  If you use oxygen and have a long hose attached to the tank, be aware at all times where the hose is.
  • Household clutter is responsible for many falls.  Objects in your path are easy to overlook, thus causing a fall.
  • Throw rugs, as much as they add to the floor in our homes, invite disaster.  Consider removing them. 
  • Watch the stairs—my husband likely wouldn’t have missed the bottom step if he had watched.
  • Don’t believe for one second—like my neighbor did—that you are invincible.  None of us are.  Don’t climb the ladder or carry that heavy basket of laundry downstairs.  Find someone to help.    Be smart about your activities. 
  • Winter is approaching, which is when falls increase exponentially.  Don’t venture out if you don’t have to.  If you do, be sure to wear shoes with adequate traction.  You can also attach rubber crampons to the bottom of your shoes with short spikes to increase traction. 
  • Even if you don’t think it is icy, double check.  My father-in-law fell on his patio because, even though it wasn’t predicted, there was a thin coat of ice on the grounds and especially raised surfaces like a patio.  Fog can freeze and become slick.
  • Vertigo/balance issues plague many of us, and increase the fall risk.  Be aware of this, and if you are struggling with either, be very careful, slow down and visit with your medical provider about what can be done to improve these conditions.  It may require medication changes, physical therapy or other means.  When getting up in the night to use the bathroom, be extremely cautious, because this is when these problems seem at their worst, on top of the darkness, and perhaps clutter and/or pets that may be in your way. 
  • Enjoy alcohol sensibly, and realize it can impair judgment, and can compound balance issues. 
  • High heels can indeed be fashionable, but there’s nothing more in-style than smart, comfortable shoes that provide maximum stability and ease of motion.

**

Thirty-two thousand people die annually in the United States alone from falls.  Thousands more deal with the aftermath that may linger on, never fully resolving itself.  Another neighbor’s 99-year old mother fell last week, breaking her hip and her wrist—another risk as the person attempts to break the fall on the way down.  Now, she is confined to a skilled nursing facility, and her daughter cannot visit due to the COVID pandemic.  It could have been prevented so easily—she was simply trying to pivot, turning to get something in the kitchen, and her feet didn’t turn as smoothly as she thought they would. 

**

Mercifully, my neighbor didn’t break anything when he fell.  He received an exam from his doctor, as well as x-rays.  His doctor admonished him to NEVER walk anywhere without his walker, or at least a cane.  At first, he said he would follow his directions 100%.  Today, one week later, I found him tinkering in his shop, his cane across the shop on the other side.  He couldn’t find it at first.  I read him the riot act, reminding him he truly IS NOT invincible.  He smiled and didn’t say anything. 

**

Most falls occur when the person is mindless while walking or moving.  Take just one extra moment to be more mindful, be aware, and think about your movements.  You are not invincible, and neither am I.  Certainly, my neighbor is not. 

Slow down, and enjoy the ride.

Words Of Medical Wisdom

It’s been on the news for months.  COVID seems like a word that’s been around forever, but only since late last year when it was identified as COrona Virus Disease, thus, COVID.  Because it was identified in 2019, it is COVID-19.  It has become, unfortunately, a household word.

Many other terms we use in COVID-speak are acronyms.  The Centers for Disease Control are known as the acronym CDC.  The World Health Organization is WHO. 

So many of the words and terms used in medicine are used without complete understanding of what they mean why we use them.  Knowledge is power, so to empower yourself in your own health care, knowledge of medical terminology is helpful. 

My day job is that of a medically-based SLP—speech language pathologist.  I am a.k.a. an ST, a speech therapist.  I work with PTs—physical therapists, and their assistants—PTAs, OTs—occupational therapists, as well as their assistants known as COTAs—certified occupational therapy assistants.  We provide tx—treatment, which is not to be confused with rx—a prescription or other treatment. 

We work with many people who have had a CVA—cerebrovascular accident—which is better known as a stroke.

Many people have “mini-strokes, which are TIAs—transient ischemic attacks.  Transient because they are typically there and gone, and ischemic, because it is a blockage vs. a hemorrhage.  Ischemic and hemorrhagic are the two main kinds of strokes. 

Unfortunately, after a CVA, many people end up in the ICU—the Intensive Care Unit.  Newborns who require intensive care, or who are born prematurely are taken care of in the NICU—neonatal intensive care unit. 

It is a good idea to be trained in CPR—cardio-pulmonary resuscitation, which can save someone’s life in the event of a heart attack.  If a person doesn’t wish to be resuscitated, they can have a DNR—do not resuscitate order on file in the event they are hospitalized and would prefer not to be revived.  Often, this is the choice when a person knows they are nearing the end of their life.

Specialized end-of-life care to ease the process of dying is provided by a hospice.  They focus on pain relief and making the person’s remaining time as comfortable and meaningful as possible, often with a spiritual component to treatment if the person wishes. 

The basic nature of many medical words can be deciphered by looking at the root of the word:

  • Cardio: the heart
  • Derma/Dermo:   the skin
  • Encephalo/Encephala:  the brain
  • Gastro:  the stomach
  • Hemato/Hemata:   blood
  • Osteo:   bone
  • Pulmon/o:  lungs

The beginning or ending of the medical term may also provide meaning, as indicated by the common prefixes and suffixes:

At the beginning of the word:

  • A-, an:  lack of, without
  • abnormal, difficult or painful
  • poly-:many, multiple
  • pseudo-: false or deceptive, usually in appearance
  • retro-backward or behind.

Then, at the end of the word:

  • ectomy:  surgical removal
  • itis:  indicates inflammation
  • lysis:  destruction, breaking down or decomposition
  • ology:  the study of a certain area
  • pathy:  disease or the disease process
  • plasty:  surgical repair
  • Some terms are discussed as an opposite to another:

    Benign is non-cancerous, while malignant indicates cancer.

    Chronic refers to a persistent condition that recurs, while acute indicates a condition that begins abruptly with a short duration.  It may or may not be severe. 

    An inpatient is a patient who has been admitted to the hospital for at least one night, while an outpatient is a patient who comes for a medical treatment or service, then returns home the same day. 

    **

    If you have read much medical literature lately, it seems there are a few buzzwords—besides coronavirus– that are getting a lot of attention.  Inflammation is one such word, and it refers to often painful, especially as a reaction to injury or infection.   It is thought to be your body’s fight against harmful things such as toxins, injuries or infections, as an attempt to heal itself.  When cells are damaged, your immune system springs to action, releasing chemicals that create this response.  Chronic inflammation, however, is a concern that has gained wider medical recognition recently, as it can have detrimental effects in the long term. 

    Unfortunately, as the Baby Boomer generation ages and continues to increase the lifespan, there are more diagnoses that these people have that compound their health problems.  Comorbidities are the multiple health woes that the Boomers—those born between 1946 and 1964—have, which are often obesity, heart disease, diabetes and other common diagnoses that, when they co-occur, create compounded health risks.

    Doctors, their assistants and nurse practitioners are often referred to in modern medical terminology as providers. 

    Outcome is a term that means pretty much what it says:  the end result of a treatment, procedure or plan of care.  Hopefully, it fulfills the goal that was set forth, as the highest level of function or good health possible in any given situation as the hope from the beginning. 

    Sepsis is a term that has been around for some time, but deserves to be understood.  Septicemia, or simply septic are all terms that indicate a life-threatening complication of an infection.  Chemicals are released in the bloodstream to fight an infection, triggering inflammation throughout the body.  It can cause multiple organ system failure, or even death. 

    **

    Modern healthcare offers every indication that it will continue to become more sophisticated, and with this evolution, there will be more information and more terminology.  Keeping yourself educated about those terms that describe yours and your loved one’s health is important in your quest for the most optimal level of good health you can have.

    HTYH:  Here’s to your health!

We All Need Each Other

There is nothing I can tell you about the Coronavirus that you don’t already know.  There are no recommendations, no information, advice or statistics that may surprise you. 

We have all heard it all.  We know the drill. 

I could reinforce how much most of us don’t like to wear masks.  However, I will add another dimension to this:  as a speech/language pathologist (a.k.a. speech therapist), the masks create another literal and figurative layer to the communication problems I work with. 

I can’t complain, however, I am not a health care hero on the front lines.  I am not saving any lives.  Those who are, are indeed wearing the mask, plus a face shield, plus gown, gloves, and all manner of PPE (personal protective equipment) that I do not have to wear. 

I only have to wear the mask, so for that, I am grateful. 

Greater than that, however, is this:  the forced isolation and the decrease in social activities has created an unnatural environment for human beings, because we are meant to stick together, not stay apart.  And, we are meant to see each other’s faces in full when talk in person.

I am not insinuating that the masks and social distancing, as well as the isolation and quarantines are not necessary, because they are.  I truly understand they are necessary right now, and perhaps for a long time to come. We all need to listen to the experts, and adhere to these guidelines.

I am suggesting strongly that, as a speech therapist, having had many years of experience with people with communication disorders, it is a struggle to fight their way out of the isolation that communication problems inevitably bring with them.  For 26 years, this part of my career has broken my heart.  Now, with the forced isolation, it breaks my heart for so many more people, not just those with communication problems.

To take a look around in public, the sight of many people wearing masks is a strange one indeed.   The sight of medical personnel in hospitals and clinics with their PPE enhances this otherworldly perception.

This is reality as we know it right now.  We must all do whatever we can to play our part.

But this can be hard, and I don’t mean that in the sense that you may not agree with the recommendations, and you may not like them.  It is hard in the sense that we are all living in a strange new world, and none of us know what the future holds. 

This creates stress that is unlike any other stress most of us have ever experienced. 

I am including myself in this. 

When I express to people who know me well that I feel an almost ever-present state of low-grade anxiety regarding the COVID world we live in, some people are surprised. 

“You seem so happy-go-lucky,” several of them have told me, as if I am immune to these kinds of feelings.  I tell them because I need someone to talk to about it, because I know they likely understand.  I reach out because I need to, because I need them to hear me, even if I may seem immune to this kind of stress and anxiety.

I am not, and you likely are not either.

So right here, right now, I am giving you permission to feel this new breed of stress and anxiety, and to find someone to talk to about it.  I have, and it has made all the difference.  And it will continue to make a difference with our mental—and physical—health.

**

We all know that stress does not lie “out there,” it is within each of us according to our own personal perceptions of any potentially stressful situation. However, it is safe to say that the current state of our country and of the world is causing stress for most people.  In some shape or form, it is altering life as each of us knew it, and likely not in good ways. 

As we know, it is increasing social isolation.

Isolation, especially among older adults, poses an extremely high risk of increased stress.  In itself, isolation is not necessarily a negative thing. Some people do prefer to be alone, so this is not stress-inducing.  For most people, however, it is.  This loneliness causes stress, and this stress has been documented to lead to multiple health issues, including dementia, heart disease and stroke.  It also exponentially increases the risk of depression, which increases the risk of suicide.  It has been theorized that it may rival the risks posed by smoking, obesity and physical inactivity.

This brings some hard questions:

In the face of COVID isolation restrictions, how can we eliminate or decrease this stress? 

How can nursing homes and other long-term medical care facilities create a safe environment for visitors to decrease the isolation among this vulnerable group?

How can we connect seniors with others using technology if they are not technologically prepared with a computer or device, as well as the ability to understand how to use programs that allow them to connect?

Among younger adults, how can we return to some semblance of the normal social outings/social interactions we enjoy that is so important for our mental health, as well as our outlook on the future? 

Will we ever get to go to concerts or sporting events with hundreds/thousands of other people?

Is there hope for planning a trip for vacations?  They, too, are necessary for mental health.

What if I get sick with the virus?

There are no easy answers here.  But again, we are all in this together.  Most of us are feeling this pain.  Like I have done, I encourage anyone who is feeling significant stress to reach out and talk to someone about it.  Chances are they are feeling it too, even if they don’t say it.  The sooner we find ways to decrease the anxiety and stress, the less chance our physical health will be affected.

Besides reaching out to a friend or family member, who likely are the first contacts, it is important to consider a visit with your medical provider about this.  They should be aware of the impact this may be having on your physical health, and they may have medical solutions. 

Speaking with a trained counselor is a resource that should also be considered.

Ensure that you are doing all you can to take care of your physical health, including adequate sleep, water intake, good nutrition and regular exercise.  This will not only boost your mood, it will help keep your immune system at its best. 

It has been reported from many sources that alcohol intake has increased since this pandemic started, and overeating is another way some people choose to dull the pain. Be aware of these red flags, and if you think you may be abusing food or alcohol to decrease the pain, be sure to seek out help.   Most importantly, remember there is no shame in asking for help for these difficulties, or any others.

If you have loved ones who continue to be under increased isolation precautions due to advanced age or previous medical conditions, be aware that they may be silently suffering.  Reaching out to them with phone calls, handwritten cards and visits through the window may make all the difference for them.  If you have the technological skills, they may need help implementing avenues to video chat.  As a plus for you, doing these gestures for someone else may very well boost your level of optimism as well. 

Remember:  We are all in this together, and we all need each other.

How To Be Old

Most of us hesitate to let others know how old we are.  There is some unspoken taboo against divulging our age, and an even greater distaste for growing older.  The adage It’s better than the alternative is true, but most of us don’t analyze that statement.  Age is somehow correlated with advanced decline, despite the fact that many people age in a positive manner.

**

I met “Lillie” in her home last week.  She is 97 years old and lives alone, with minimal paid   assistance with housekeeping.  Her son lives nearby, and has lunch with her several times a week, and visits at other times, too.  She is otherwise independent.

I met her as a home health patient.  I am a speech-language pathologist, serving several settings including home health.  I was called to see her because her doctor wanted her to receive swallow therapy after she reported to her that she had a little bit of difficulty swallowing sometimes.  She didn’t think she needed much help, but she agreed.

She didn’t need much help indeed, but I was able to offer a few strategies and further increase her awareness of the fact that, at 97, the swallow process had slowed down just like many other processes of the human body.

She had already guessed this, and started making those changes before I arrived. 

I must admit I was a bit skeptical when I was dispatched to her house.  I recall thinking: “At age 97, I don’t know what I can do for someone who likely won’t respond well to new ideas, and suggestions that perhaps she should make some changes in her habits.”

In my 26 years of practice, I don’t think I’ve ever misjudged someone’s character so poorly by what I saw on paper. 

She greeted me at the door with a friendly smile.  I could easily see that 97 years had nothing on this woman.  I could sense she hadn’t missed a beat, and likely was in superior cognitive health as well. 

“Here,” she said.  “You can sit across from me in this chair.  I usually sit here because this cushion helps my back pain.  I guess I’m lucky, because that’s about the only pain I deal with.” 

I sat down across from her, and it didn’t take long for me to realize I was in the company of someone truly exceptional, someone I hadn’t ever met the likes of in my 26 years of practice. 

As I do with the elderly patients who appear to have unlocked the secret to successful aging, I tuned in to all she had to say.  I could see she had it figured out. I want to be like these people when I grow up, so I am in a prime field to glean this kind of valuable information.  When I see it is appropriate and welcomed, I engage them in conversation regarding their apparent defiance of the aging process.

For myself, I welcome age.  I just celebrated my 54th birthday, and I am fortunate to be in good health.  I try hard to keep myself healthy, and I want to know every little bit of information to add to my arsenal to continue to age successfully, so people like her are a wellspring of good information and advice.  I don’t hide my age, and I encourage others to embrace the process.

It quickly became obvious that she knew the secrets that are not really secrets at all, just the things we all know we need to do to maximize our health, but perhaps don’t.

It was also quickly obvious that she treats age as a gift, even though she has lost two husbands, having cared for them both until they passed.  Every day, she knows, is a gift.

She spoke of another woman who lives nearby whom she recently found out about.  This woman is 105 years old, and still going strong.

“I think I’m going to find her number and call her,” Lillie said.  “I want to know how she does it.”

I had no words to respond to that.  Clearly, she doesn’t realize that she, too, is already doing it, and doing it well.

“I take the daily paper, but only for the crossword puzzle, the word search, sudoku, and the jumbled word puzzle.  There’s not much else in it,” she said.

“I like to read,” she said, holding up a small paperback novel.  It didn’t appear to be large print.  “I love these.  I have a little group of people who love to read and we trade books back and forth.  I have read many of these several times, but if you wait awhile between readings, it’s new again.”

Lillie was simply telling me about the things she enjoys doing—reading, puzzles, not realizing that these are the things that keep the brain healthy, the cognitive activities I recommend for nearly all my patients to keep their brains fit.  Clearly, these activities are keeping her brain fit.

“We know how to be young,” Lillie said.  We know how to act, what to do and what to think.  “But we don’t know how to be old.  There are no guidelines past a certain age.”

“I know that as we age, we can get stubborn.  I told my kids to tell me if I’m doing something wrong, I don’t want to be set in my ways.  Please tell me if I’m doing something wrong.”

I sit in rapt attention as this woman continues to give away the secrets.  I am here to do a job, however, so I do need to ask her a few questions.

“Do you drink enough water?” I ask.  This is a routine question for all my patients with voice and/or swallowing problems. 

“Yes,” she says. “I am sure to drink two or three glasses in the morning, a glass with lunch, and the rest in the afternoon.  I don’t drink any in the evening, because I don’t want to get up more than once in the night to use the bathroom.”

She continued to tell me her healthy eating habits.

“When I see someone who is healthy, I always wonder, how are they eating?  That tells a lot. I limit beef, chicken and fish,” she said.  “I like to buy organic vegetables, too.  I believe pesticides are overused, and I want to keep them out of my body.”

I always want to know about how they exercise, so I asked her.

“I stretch every morning and every night.  I used to do yoga, now I do a few stretches to stay limber.  And I do Tai Chi to help with balance,” she said.  I am not surprised.

“I used to love to dance with both of my husbands.  We danced a lot.  That kept me going.  I liked to ride a bike when I was younger, now I have a stationary bike in the basement.”

Clearly, her health habits are stellar for a person even half her age.  Besides tending to her physical health, she also realizes the importance of connecting with others.  Besides seeing her son several days each week, she keeps in close touch with her daughter and all her grandchildren.  As I was preparing to leave, her phone rang.  She had already ignored one other call, and after checking the caller ID, she said, “It’s my granddaughter in Norway!” 

At that, I ended the session, and told her to take the call.  That was more important than me continuing to absorb her inspiration.  When she reached to answer the phone, her cat, who had been snuggled up in her lap, jumped down.  Lillie told me earlier in the visit that her cat was great company for her.

**

I remain in awe of Lillie.  I will see her several more times, and she will likely continue to practice her stellar health habits.  She will likely call the 105-year old woman to see how she does it, even though, in reality, she is already doing it.  She will likely continue to work the crossword puzzle every day, and will drink plenty of water daily.  She will most likely eat little meat and organic vegetables, and she will keep on reading novels.  She will keep stretching every morning and every evening. She will spend as much time with her family and friends as she possibly can, and she will continue to accept the companionship of her cat. 

This is how Lillie does it—she knows how to be old, even though she says she doesn’t.  Perhaps we should all take a cue from her.  Even if it is just adopting one of her good habits, or lessening one of your own bad habits. 

It’s never too late to change. 

The Power of Speech

In these days of face masks, it can be hard to speak clearly, and it can be hard to understand someone who is speaking to you.  Even in the best of settings, communication can still be hard.  Even without a face mask during the COVID-19 crisis, speech sometimes doesn’t come out like it should, and it isn’t heard as it was intended to be heard. 

Most of us—including myself—take communication for granted.  You would think that, after 26 years as a speech therapist, that I wouldn’t take it for granted.  Yet, I still do. The two-way street of speaking and listening, the give-and-take of verbal exchanges is a complex process.  Most of us produce speech effortlessly, without thinking, and most of us can hear others when they speak to us.  Speech flows from the speaker, then the listener understands and responds. 

Except when it doesn’t flow, and the listener can’t understand and respond.  Like when both parties are wearing face masks. 

**

Every May, my profession observes Better Speech and Hearing Month.  It is part of our professional duties to share insight and awareness, and to educate others in how to achieve optimal communication.  This year, when face masks have become the new normal, the meaning of clear communication is heightened. 

My goal is to provide information on how to take care of one’s voice, how to preserve one’s hearing, how to communicate best with someone who has a communication deficit.  I will also speak of maximizing swallow function and swallow safety, as that is a significant portion of my work. 

These topics are timeless and always relevant to good health.  I will reiterate what I tell my patients, my friends, my family, and anyone who will listen. 

  • Drink enough water.  In the treatment of voice disorders, drinking “enough” water is rule #1.  The vocal cords are among the first tissues of the human body to show signs if there is any level of hydration.  “Enough” is defined as:  half your body weight in ounces daily.  And, if you consume caffeine (like I do, I never tell anyone they have to quit), add that much more water to that figure, as caffeine has a dehydrating effect. If you are drinking nowhere near this amount, remember that anything closer to that amount is progress.  Drinking enough water is good advice for anyone with or without voice disorders, unless your health care provider has advised you otherwise. 
  • Engage in deep breathing exercises to maximize vocal function.  Expanding your belly as you breathe in is the goal as you breathe in through the nose and out through the mouth.   And, in these days of COVID-19, be thankful for the ability to breathe easily if you can.  Many people suffering with the disease cannot.
  • If you are a smoker, PLEASE consider giving it up.  The negative effects of smoking on the human body are well known, but it also affects vocal quality. 
  • Vocal abuse is an issue for people who overuse their voices, including singers, teachers and public speakers.  Excessive, repeated strain on the voice can cause short-term or permanent damage. 
  • If you must be exposed to loud noises on the job, or perhaps you are using power tools or a lawnmower, wear ear protection.  It is well-documented that repeated, excessive noise damages hearing.  The music going in your ears via earbuds must also be kept at an acceptable volume. 
  • Most of us eat too fast—myself included.  I have many patients referred to me by their health care provider with complaints of choking, or other signs of swallow problems.  Often, after we determine no physical cause, it becomes clear that they are eating too fast and/or taking bites that are too large.  When they simply slow down and report back to me, the swallow problem is often “cured.”  It does take awareness and discipline, but, just like most other physical functions, swallowing ability decreases with age due to muscle weakness and an overall slowdown of the whole process.   I often use the analogy that “you are clogging the drain.”  We all know what happens when too much is sent down a drain too quickly.  The same thing often happens when we eat too fast.  Of course, your health care provider should be informed of these problems, but start by slowing down your rate of intake and the bite size, and see what happens.  One simple, yet difficult strategy is to put your fork or spoon or finger food down between bites.  Chew the one in your mouth thoroughly, swallow it, take a small sip of water if you need to, perhaps swallow again, then pick up the utensil or finger food for the next bite.  We fail to savor and fully enjoy the bite in our mouths if there is another one waiting to be shoveled into the mouth while we are still chewing.  Again, I am guilty of this, too.  Simply try slowing down when you eat. 

**

If we haven’t already, we should all offer gratitude toward our doctors and nurses not only for their valiance and dedication toward treating and healing patients with COVID-19, but for all they do, all year, every year.  Hospital week was observed earlier this month, and National Nurses Day was observed on May 6th as well.  Better Speech and Hearing Month is observed during the month of May as I noted above, and please consider my professional advice given above as positive steps toward good health every day of every year. 

**

My brother-in-law is profoundly hearing impaired, but he leads a full and productive life as a person who communicates by reading the speaker’s lips.  He is struggling in this new era of face masks in public, as they cover the speaker’s lips.  Whether or not we realize it, many of us rely upon facial cues when we are speaking in person with someone to clarify a message.  With the speaker’s mouths covered, we rely upon the eyes, which do help in the communication process, but not as much as the facial expressions made by the mouth. 

My parting advice to you is this:  if you are still able to communicate well in these face mask times, be grateful.  If you know your communication partner struggles with hearing and understanding, please offer a repetition, a written message or other functional form of communication. 

Above all, please take good care of your voice, your hearing, your lungs and every other body part—whether or not they help you communicate.

Thank you doctors, nurses and hospitals today, and every day.

The Language of COVID-19

It is a strange, new world out there.  And by out there, I mean I hope you are all staying at home as much as possible.  We all must do our part; this we all know. 

News-TV offers a non-stop, progressive, constantly updated news stream regarding the latest statistics:  new infections, new guidelines, new research, and, unfortunately, new deaths.  As I write, the numbers continue to rise, our nation—and the world—has not yet seen the peak. 

So, keep doing all the right things.  You know what they are.

What you may not know is the new language that is being spoken, printed and used regarding the novel coronavirus. 

So, let’s start there.  The coronavirus is actually a family of viruses that have been around for years; they were first identified in the mid 1960’s.   The one affecting the world now is a new strain, thus the word novel has been added.   Most of us have heard of the SARS virus that struck in the early 2000s ; its technical name is SARS CoV.  This novel coronavirus sweeping the world is known as SARS CoV-2.

Animals can be infected with coronaviruses, and those viruses can evolve to make people sick as well, thus creating a new coronavirus.  Researchers have determined this was how the COVID-19 virus originated. 

So why is it called coronavirus?  Because corona is the Latin word for “crown,” and under a microscope, the virus has crown-like spikes on its surface. 

And why is it called COVID-19?  CO for corona, VI for virus, and D for disease.  Hence, COVID.    “19” was added because it was identified in 2019.

Several acronyms have been used frequently in the news, with the CDC being one of the most common.  The Centers for Disease Control—CDC—is the leading national public health institute in the United States, and it is part of the Department of Health and Human Services.  Its primary home is in Atlanta, Georgia, and its primary functions are research and education to promote public health protection. 

The World Health Organization—WHO—is located in Geneva, Switzerland.  It is an agency of the United Nations, specializing in worldwide public health—much like the CDC, only on an international level. 

The terms “endemic,” “epidemic,” and “pandemic” can sometimes be defined loosely, and may be more fluid as diseases change.  In general, however, the differences are listed below:

Most of us are familiar with the term “epidemic.”  Backing up, lets first define “endemic.”  A disease is said to be “endemic” if it is localized to a certain, relatively small area, or to a certain group of people.  A good example is malaria, which is endemic to parts of Africa.  It is also used to describe certain plants or animal species that are specific to one area.

“Epidemic” is used to describe a widespread occurrence of an infectious disease in a particular community at a particular time.  We have all heard of the flu epidemic that travels through your house, your town or perhaps your region.

“Pandemic” is the word we have, sadly enough, become very familiar with.  Consider a pandemic an epidemic that can—and does, as we have seen—travel worldwide.  Remember the letter ‘p’:  the pandemic has a passport to travel worldwide.

**

PPE is another acronym we have heard a lot about recently.  “Personal protective equipment” refers mainly to the gear necessary for medical personnel to do their jobs, while at the same time protecting themselves.  Face masks and shields, gloves, gowns and other bodily coverings that cover faces, hands and clothing are considered PPE.  They are necessary for medical personnel to shield themselves from transmission of the virus, although sometimes it cannot be prevented.  As you have likely seen on the news, there are “novel” forms of PPE being used, including home-made cloth masks, use of plastic normally used for garbage bags or other purposes being used to cover one’s body for protection.  The international shortage of PPE has prompted this creativity. 

The simple surgical face mask is the one most commonly seen and used.  It protects the wearer from larger droplets, splashes or sprays or other hazardous airborne fluids.  It also protects others from the wearer’s respiratory secretions.  It fits relatively loosely, and does not require a seal check.   Therefore, there is room for secretions to spread in and out of it, thus not guaranteeing safety.    The home-made versions are likely less protective than these, but any covering is helpful.  The N-95 respirator is called as such due to the fact that it filters out at least 95% of airborne particles, large ones as well as the smaller ones that the basic surgical mask may not shield the wearer from.   It requires a specific fitting and seal check each time it is donned.  These respirators are in a greater shortage at this time, which explains why they are not more widely used.

A ventilator is a complex medical device that provides mechanical ventilation when a person is not able to breathe well enough independently to sustain life.   There has been a shortage of these nationwide, as they are all too often required to sustain the life of a person with severe COVID-19.  In decades past, the term “respirator” and “ventilator” have been used interchangeably, but contemporary terminology draws this clear distinction between the respirator described above as a high-tech mask, versus the ventilator, which is a complex mechanical device that can save a person’s life by providing artificial respiration.  The ventilator requires that a tube is inserted into the patient’s airway in order to mechanically provide in-and-out respiration.

**

Social distancing needs no definition.  Isolation is the simple, precautionary act of separating yourself from most other people, which is what most of us are hopefully doing when we are not at our essential jobs, or performing essential tasks such as going to the grocery store.  Quarantine is a more strict affair, whereby you carefully separate yourself from others if you have been exposed to the virus, or if you have been diagnosed with the virus and do not require hospitalization.   Using disposable dishes, washing your own laundry separately in hot water and drying in a hot dryer are recommended.  Using extreme caution and washing hands frequently cannot be stressed enough.

**

Corona does mean “crown.”  We may all feel as if it is indeed a ruler wearing a crown right now, dictating our every action.   There will come a time when the worst is passed, and we will come out rulers of our own lives once again.  It will likely be a new world with new rules and recommendations, but as a group, humans are up to the challenge.  We will meet it, too, just as we have met the COVID-19 challenge.    Until then, keep doing your part.

THE GIFT OF AGE

“One life on this earth is all that we get.  Whether it is enough or not enough, and the obvious conclusion would seem to be that at the very least we are fools if we do not live it as fully and bravely and beautifully as we can.” –Frederick Buechner

I am not ashamed to print that I will soon be 54 years old, or perhaps I should say 54 years young.  I’ve already bought myself a little gift.  It sits in wait in a little box.

Age is a gift.  The old adage that “It’s better than the alternative” is so true, but not that simple, because none of have experienced the alternative.  So, while we are here, it behooves each and every one of us to suck all the nectar out of this one life we are given.

**

My sister turned 60 last month.  She is well-known by almost every one in her small town of approximately 1100 people, which explains why there were several hundred people at her party.  We tried to make it a surprise, but she’s too perceptive to pull that off.  Plus, about a month before her birthday, she started planning her own party, thinking there was nothing in the works.  When that was thwarted by vague comments from her family, she knew something was brewing.  She didn’t care, just so there would be a celebration, and there was indeed.  She savors every moment of every day, even the not-so-good ones.  She truly knows the gift of age.  I try to keep up with her, and short of planning my own party, I think I do a pretty good job.  We have experienced enough loss within our family to know that in just one second, everything can change.  Therefore, savoring every moment is what we have learned to do. 

**

Although I will review some basics later, this is not a lecture on why you should take care of your body as you age, and how to best do it.  I have already written about that.  It is meant to make you think twice before you complain about adding another year to your age.  I shouldn’t lecture, however, because I wasn’t always proud of my age.  So, if you have some work to do before you can shout your age from the mountaintops, I must say I have been there.

**

I have worked as a speech-language pathologist since 1994, with the last 21 years spent working with adults.  Many of my patients have had strokes, some have had head injuries, others were diagnosed with brain cancer, or many other diseases/disorders that can cause speech/language/swallow problems.

When I was preparing to turn 40, I was bemoaning the onset of my new decade.  Shortly after my birthday, a patient was sent to me who turned me around, never to complain about my age again.  She was 39 years old, had just given birth to her 6th child, and suffered a massive stroke.  She lost most function on her right side. 

That was a powerful lesson.

Then, ten years later, I celebrated my 50th birthday in grand style, complete with a party.  Several months later, another lesson came my way.  A man who was just a few months younger than me became my patient.  He had an incurable disease, one that slowly took away all function.  He died several months after his 50th birthday. 

Perhaps I needed to be reminded of The Lesson.

**

“Old age ain’t no place for sissies.”  –Bette Davis, actress

Perhaps you’ve heard that one before.  I am old enough to have an idea of what it means.  Increased aches and pains, decreased flexibility, a decrease of some functions, loss of energy and general fatigue are the main changes I have noticed.  None have kept me from enjoying life, but I know all these and more are to be expected, even with careful attention to healthy habits.  Given these maladies, I must say they are worth the wisdom I have gathered as I age.  If I could go back to any age, I wouldn’t do it.  Knowing who I am, what I want, how to navigate this crazy world, and how to love nearly everything about it is worth adding another digit to my age.

I look forward to (almost) every minute of every day of yet another trip around the sun.  It is the best gift I get every year. 

**

In my work, I am privileged to meet many remarkable patients and their family members who seem to be aging gracefully, welcoming the gift of each new year.  If it feels appropriate, I often ask them if they have any secrets to aging so well.  Their answers typically fall into two categories:

1:  “I stay physically active.”

2:  “I do what I like to do, and I keep my brain busy.”

To me, this translates very simply into this:  Exercise your brain and body.  Given these two broad bits of advice, I would like to add the following tips.  You have likely heard them all before, but they all bear repeating.  Sometimes, hearing the same thing in different words can make a greater impression.

1:  Sleep is vital to good health.  Multiple studies confirm this, as does the fact that with enough sleep, we all feel better.

2:  Drink enough water.  Our bodies—and brains—are made of primarily of water.  As a speech-language pathologist, voice therapy is in my scope of practice.  Hydration is essential to vocal health, as well as overall physical health.  “Enough” water is defined in my profession with this formula:  half of your body weight in ounces daily.

3:  Get regular checkups, and listen to your body.  Find a medical provider you are comfortable with. 

4:  Even simple exercise such as walking daily can make an incredible difference.  Ask anyone who exercises regularly, and they will tell you that without it, their quality of life is compromised. 

5:  Use every tool in the shed to find happiness.  It’s out there, but it may take effort.  If you need to forgive someone to find it, remember that forgiveness isn’t about the other person, it’s about freeing yourself.

**

My patients have shown me time and again that life can indeed change in just one moment.  Losses in my life have confirmed this.  If you have the opportunity—and most of us do—get out there and make the most of every day.  Your age makes no difference, except in your mind.

The bonus is this:  your physical health will improve, too.  Studies have shown that optimistic people tend to be healthier. 

Congratulations.  You have just set in motion a positive force, one that will continue to carry you more smoothly as you travel around the sun another time. 

And, whenever your birthday happens to be, Happy Birthday to You. May you have many more. 

Stroked

Consider this:  every major organ including the heart, the kidneys, the liver, the skin and many other tissues—except the brain—can be transplanted.  At this point in medical technology, there is no brain transplant.  Mercifully so, as the brain is truly what makes each of us unique.  To have someone else’s brain would make you a different person indeed. My hope is that modern medicine doesn’t progress that far. 

So, the brain you have is the brain you will keep.  If the brain suffers a blow externally, a brain injury typically causes symptoms that require extensive rehabilitation.   As a speech therapist, I have worked with multiple patients who requires brain rehabilitation after a closed or open head injury.  Other therapists—physical and occupational—typically comprise the rehab team to treat head injuries. 

A stroke, however, can be considered a brain injury inflicted from the inside.

I had been working with strokes as a speech therapist for twenty years, when I decided it was important to know just why we call it a “stroke.”  Since I am the professional who works with language disorders after a stroke, I realized it was my job to know why we use this word.

I looked online, and two different sources told me the same thing:  as far back as 500 years ago, when, in just one moment, a person experienced sudden physical changes we now know as a “stroke,” it was said they were stroked by the hand of God.  The technical medical term is cerebrovascular accident, or CVA.

Today, while it still causes mysterious symptoms that we now know more about, its sudden onset and resulting deficits may seem a mystery in their own right.

A heart attack is a term widely known and understood.  In an attempt to make a stroke more universally understood, it is sometimes called a brain attack.

There are two types of strokes, both of which cause an interruption to the blood flow to the brain, which can cause death to brain cells in minutes:  hemorrhagic, whereby there is bleeding inside the brain, and ischemic, which is bulging of a vessel without bleeding.  Typically, the hemorrhagic stroke is more severe. 

**

If you’ve seen one stroke, well, then you’ve seen one stroke.”

Movies and television would have us believe that all strokes cause slurred speech, drooping facial muscles and loss of saliva, as well as one leg and/or arm that doesn’t move very well.  In some cases, this is true.  In many others, the stereotype is not accurate.  I have seen hundreds of strokes in my career, and no two have been identical. 

The brain is the master computer of the human body.  In the brain, all those wrinkles, folds, worm-looking surfaces and crevices are expertly crafted and finely tuned to complete highly specialized functions.  Each area has a specific function, and the damage is determined by where the stroke occurs. 

If the right side of the body is weakened by the stroke, then the damage to the brain has occurred on the left side of the brain.  Conversely, if the weakness is on the left side of the body, then the stroke has occurred on the right side of the brain.    Other strokes can cause weakness over the entire body.

Perhaps you have heard of a TIA, or a “mini-stroke.”  A Transient Ischemic Attack is a minor stroke with symptoms that quickly resolve, lasting perhaps only a few minutes. It may or may not show up on testing.  It is transient because it is typically there and gone, ischemic (vs. hemorrhagic) because it doesn’t bleed out, and yet it is an attack because is certainly is an assault on the body and the brain, and it is a serious medical issue as well.  It may be a warning of a more severe stroke to come, and should not be ignored.

**

There are several major risk factors for stroke, including: 

  • high blood pressure
  • high cholesterol
  • diabetes
  • smoking
  • increasing age—especially over age 55
  • illicit drug use
  • some forms of oral contraceptives
  • men have a higher risk of stroke than women, but women are usually older when they have a stroke, and are more likely to die from a stroke than a man.
  • African Americans have a higher risk of strokes than people of other races

**

If you suspect you, or someone with you may be having a stroke, this acronym may help you realize the need for medical attention:  FAST

F: facial drooping

A:  arm weakness

S:  speech difficulty

T:  Time to call 911

Prompt medical attention is imperative, even if you are not sure if a stroke is occurring.  There are some strokes, that, if treated within the first three hours, can be reversed at least in part by the use of a drug called tPA.  Again, it is imperative that medical attention be sought in the first three hours, but always as soon as possible.

There are other symptoms besides those in FAST, including confusion, vision problems in one or both eyes, a sudden, severe headache which may include vomiting, dizziness, or altered consciousness, trouble walking.  

There are a few disorders that can mimic symptoms of a stroke, including seizures and migraine headaches.  The most important thing to remember if you are having any of the above symptoms is this: 

None of these symptoms should be ignored.  Seek immediate medical attention.  And always, always take good care of your body—and your brain.  It’s the only one you will ever have. 

**

Autoimmune Disorders

Every year, at about this time, there is a lot of talk about immune systems—there should be, it is cold and flu season.

Imagine your immune system as your own personal army.  They are always on guard, ready to defend your health from any outside force that may try to make you sick.  At this time of year, that is primarily colds and flu. 

This army is comprised of dedicated soldiers, an army that has the best interests of your health as its only focus.  It fights off invaders at all costs in whatever ways it can, whenever it can.  Unfortunately, as most of us know, sometimes the battle is lost, and we succumb to a cold or the flu, perhaps even pneumonia.  Our immune systems, however, rebound, and we become well again.  After the illness, our immunities are wise to that invader, and they know better how to defend against a repeat illness—at least, in the short run. 

This “army” that defends your health should be treated just as you would treat a dedicated group of foot soldiers.  They require rest, good nutrition, adequate hydration and stress relief—all those things you need for yourself as well. 

Now, consider for a moment, this scenario:  there is a mutiny, and these soldiers turn on you.  They begin fighting for the opposing force.  Their job was to defend you against the invaders, but instead, they have joined them.  They have become traitors. 

Autoimmune disorders are essentially that:  your immune system turns on you.  The causes are generally unknown, some run in families and some may be triggered by infections or other environmental factors. 

There are many different autoimmune disorders, and still more that are being researched as possible autoimmune disorders.  A partial list follows of the most common:

  • rheumatoid arthritis
  • systemic lupus
  • inflammatory bowel disease—includes Crohn’s disease and ulcerative colitis
  • multiple sclerosis
  • type one diabetes
  • Guillain-Barre syndrome
  • psoriasis/psoriatic arthritis
  • Addison’s disease
  • Graves’ disease
  • Sjogren’s syndrome
  • Hashimoto’s thyroiditis
  • myasthenia gravis
  • celiac disease

The list goes on and on, and, unfortunately, on.

Each disorder has its own list of symptoms, but in the early stages of many of the disorders, these signs are common, and should be brought to your medical provider’s attention without delay:

  • fatigue
  • achy muscles
  • swelling and redness
  • low-grade fever
  • trouble concentrating
  • numbness and tingling in the hands and feet
  • hair loss
  • skin rashes

There are multiple additional symptoms for each specific disorder.  For example, type one diabetes also causes extreme thirst and frequent urination.  Some disorders have symptoms that come and go—such as multiple sclerosis.  A period of symptoms is called a flare-up, and when the symptoms are gone, it is referred to as remission.

Type one diabetes is an example of an autoimmune disorder with symptoms the do not go away.  This disorder requires injections of insulin or an insulin pump in order to maintain physical functioning. 

Unfortunately, I have recently become too familiar with this disorder.

Previously known as juvenile diabetes, this disorder typically does strike in childhood or young adulthood. 

My niece, who is now 19, was diagnosed with type one diabetes at age 17.  She was experiencing extreme thirst, frequent urination, fatigue, and general malaise.  A blood sugar test was the first tip-off, and the diagnosis soon followed. 

Her life, since then has been a difficult journey.  However, without the daily measuring and injecting of insulin she now relies upon, she would not survive.  She is learning the ropes, and this is her new normal.  She has strong family support, and a wonderful endocrinologist—a doctor specializing in disorders of endocrine glands and hormones, and a positive attitude.

**

An important realization for anyone who has an autoimmune disorder, or who is close to anyone with this disorder, is to realize that while there are no known cures, these disorders could not have been prevented, and medical researchers are continuing to work toward improved treatments as well as cures. 

Other important facts to take away include:

  • There are more than 80 different types of autoimmune diseases.
  • Autoimmune diseases are relatively common.
  • They can be genetic.
  • Autoimmune disorders are NOT allergies.
  • They can take years of trial and error to be diagnosed. 

**

The human immune system is a wondrous thing.  If yours is keeping you well, be sure to be grateful.  If not, keep taking care of your army, this can only help.  And, most importantly, keep hanging in there, and be kind to yourself. 

THE FLU VACCINE  101:  WHAT YOU NEED TO KNOW

You know the drill:  wash your hands, get enough sleep, stay away from sick people, eat right, reduce stress, and, of course, GET YOUR FLU SHOT!

What you may not know, are some of the important details of the flu vaccine.

But first, consider your immune system an army.  It is a built-in infantry of soldiers ready to defend your health, no matter what it takes.  They give their all to protect you from the enemy lurking out there, waiting to make you sick.

But like human soldiers, they need to be well-taken care of in order to perform to the best of their abilities.  They need to be well-rested, fed well, given ample water to drink, and allowed to some time to rest and relax, as well as getting enough sleep.  Giving all your bodies those things will allow your army to fight their hardest to keep you healthy. 

Ask any first-year teacher and they will likely tell you they are spending the first year of their teaching career fighting one malady after another.  Every cold and virus that the children bring to school, the teacher likely picks up.  In each successive year, however, the immune system recognizes these invaders, and has a strategy ready to fight them off. 

Now, consider the flu vaccine an advance warning of the enemy’s strategy.  You’ve been given their playbook, and now your body knows how to fight them.  Your body knows the plan of attack with the flu vaccine, and it knows exactly how to counter their attack. 

**

Along with the holidays, it is the flu season.  The flu, no matter what time of year, getting the flu is no fun, not a gift.  Flu season is in full swing across the country and getting a flu shot is the most important precaution against getting the flu.  While it is not a guarantee that you will not succumb to the virus, it is the best defense. 

And, it’s not too late.  If you haven’t already gotten your flu vaccine, you still have time.  It is always recommended by the end of October, but it’s never too late.  Getting vaccinated in July or August may be too early, and may reduce resistance to the flu virus when it hits peak season.

**

In 1938, Jonas Salk and Thomas Francis developed the first vaccine against flu viruses.  These first vaccines were used to protect soldiers in the U.S. military against the flu during World War II.  These early vaccines were not as purified as present-day vaccines, and they were known to cause fever, aches and fatigue.  People mistakenly thought these vaccines caused the flu, because the impurities caused symptoms that were similar to those of the flu.

In 1952, Jonas Salk used his experience in the development of the flu vaccine to develop the polio vaccine.  Imagine, for just one moment, if polio had not been eradicated.  Now, imagine how much worse the flu virus would be without Francis and Salk’s research and efforts to improve public health. 

**

According to the Centers for Disease Control (CDC), these important points about the flu vaccine need to be known:  (www.cdc.gov)

  • While there are many strains of the flu virus, the vaccine guards against the most common 3-4.
  • A goal of researchers in the near future is to develop a vaccine that would cover all strains.
  • Anyone over six months of age should get the flu vaccine.  Babies under six months of age are at risk as well, but it is not recommended under six months.
  • Pregnant mothers should also be vaccinated.  This may also decrease the risk of the baby getting the flu.
  • Anyone caring for the baby should vaccinated.
  • It is especially important for health care workers and anyone who cares for another person to get vaccinated.
  • Even if a person does get the flu after a vaccine, there are data to suggest that their symptoms are milder.  In addition, it has been shown to greatly reduce the risk of a child dying from the flu.
  • It is imperative that those in high risk groups be vaccinated, including:  young children, pregnant women, people 65 years and older, and anyone with a chronic health condition such as asthma, diabetes, heart/lung disease.
  • There are very few people who should not get the flu vaccine, mostly due to allergies to gelatin, antibiotics, or other ingredients in the vaccine.  Egg allergies have been a cause for concern in the past.  Visiting with your health care provider about any allergy concerns is advised.  This topic is also covered on the CDC website listed above.
  • Flu vaccines are offered in multiple, easy-to-access locations.  Your health care provider can offer a vaccine, but they are also available in health departments, pharmacies and urgent care clinics.  Some workplaces offer vaccines, as do some college health centers.
  • An annual vaccine is recommended because the immunity declines throughout the year, and will not protect as well.  Secondly, the flu virus changes, and each year’s vaccine is designed to target the newest strains of the virus.

**

The word “influenza,” which we have shortened to “flu,” has its origins in Europe in the 1700’s.  It was thought that a person’s health was influenced by the stars or other astrological factors.  This line of though then evolved to “influenza del freddo,” meaning “influence of the cold.” 

It is indeed prevalent in the colder months.  No matter where the word came from, the flu vaccine is always a good influence.  Be sure to get yours. 

‘TIS THE SEASON

It’s that time of year again.  Fall continues to fall, which is bringing us ever closer to the first big holiday of the season:  Thanksgiving.  With it comes family, food, festivities and fun.  Then, about four weeks later, many people celebrate Christmas.  One week after that, we welcome the New Year. 

After that, then, and only as a matter of personal opinion, are the three longest months of the years.  The festivities are over, the decorations are packed up—or are overdue to be packed up if they aren’t already.  And, if you live in the Midwest and many other parts of the United States, Old Man Winter takes up his annual residency.  If you like winter, then you are in luck.  If not—like me, it is a tough time of year.

The holidays can be a joyous time of year for many people, and I hope it is for you, too.  However, the few months after can be time of reckoning for some people.  The family is gone and the party is over.  Perhaps you spent too much money on them for gifts and festivities, and you have new debt.   This can equal new stress.

Finally, and for purposes of this post, if you are like many of us, you may have one more post-holiday stress to deal with:  weight gain.  I certainly hope you don’t ever have that concern, but if you do, I want to provide some ideas and tips that are simple and easy to implement in order to prevent this before it becomes a problem in January, February and March. 

It is important to realize that nearly every human fights an internal battle between what we want, and what we know is best for us.  Too often, the human brain acts as a toddler, throwing a fit if it doesn’t get its way.  The good news is that like toddlers, it often responds positively to structure and discipline.

The brain loves patterns, loves to go down a familiar road.  At the holidays, most of us have made a habit of partaking of many kinds of good food, and likely over-indulging.  This is the default mode, and it is the path of least resistance.  It is the most familiar route, so we simply take it, because it is easy, and the path is well-worn. 

The key is to change the way we think about it.  Approaching the holiday table with a clear-cut intention to change our old patterns is the first step.  Fixing this intention in our minds, telling ourselves I am going to eat a normal amount of good food, I will not overindulge.  And, I will enjoy small amounts of the food that may not be quite as good for me. Eating the goodies is good for the soul, provided they are in small amounts.

Much like you would fix a small plate of goodies for a toddler, you need to fix yourself a small plate first in your mind, then on your real plate. 

Beginning this practice ahead of the holidays allows you time to get used to smaller portions.  At mealtime when you dish up your plate, simply put a few less bites on your plate.  If you are not satisfied after the meal, after giving yourself a few minutes to resist, then return to the serving bowl.

Along these lines are a few other suggestions to practice before the holidays:

  • Leave a few bites on your plate at the end of the meal.  Most people were taught not to waste food, but it will certainly look better left on your plate than accumulating on your hips and stomach.  In time, simply taking smaller portions will become easier, and there will be no waste.
  • It takes a few minutes for your stomach to register that you are indeed full, and then communicate it to your brain.  Giving yourself about five minutes to sit and decide if you really do need more is important.  Walking away from the table will decrease the temptation to take more right away.
  • If you are feeding small children, resist the temptation to clean their plates if they don’t.  Trust me, as the mother of grown sons, I can attest that this is not necessary to be a good parent!
  • If you are eating out, ask for a box as soon as your meal arrives, and pack half of it.  Most restaurant meals are large enough to provide two meals.  Take the other half for lunch the next day.  Or, if you are eating with someone you are comfortable enough with to split the meal, consider ordering one entrée.
  • So, that brings us back to the holiday table.

  • Fill your plate with vegetables first, and after you have finished those, then go back for the not-as-nourishing food.
  • If you are bringing something to the party, make a vegetable tray with your favorite vegetables so that you will have this defense.
  • Drink a large glass of water 5 minutes before you partake.  This will help with hydration—obviously, but it will likely fill you up a bit.
  • If you are hankering for sweet stuff, or more of it after you have already eaten it, try eating a pickle, an olive or some other bitter food.  The bitterness often cancels out the craving for sweets.
  • Eating a small square of dark chocolate may satisfy your craving for something sweet.  It contains less sugar than milk chocolate, and typically doesn’t leave you craving more.
  • Getting enough sleep is an important defense in controlling your appetite.  Studies have shown that the hormone ghrelin increases in production when you are tired.  It is known as the ‘hunger hormone.’
  • Chew twice as long as you normally would.  This slows down your rate of intake, and allows you to relish the same amount of food with equal enjoyment as if you took more.  Also, saliva production increases as you chew, and this aids digestion.
  • Above all, be sure to enjoy yourself.  Eating good food you enjoy is one of the greatest pleasures in life.  In my work as a speech/language pathologist with adults in the medical setting, I also provide therapy for swallowing disorders. I often have to restrict or forbid food intake altogether.  In the most severe cases, a feeding tube is required for nutrition and hydration when the swallow muscles are not strong enough to swallow safely and protect the airway from food and liquid “going down the wrong way,” as we all do once in a while.  With many of my patients, this happens too often, and they cannot safely swallow.    It is heartbreaking.

    If you have the ability to swallow safely, and I hope you do, please be grateful for the gift that it is, and exercise the swallow muscles with small bites and sips.  Again, be sure to enjoy the good food of the season—within reason.

    HAPPY HOLIDAYS TO YOU

Hospice And Palliative Care

There are many mysteries in life.  Perhaps the greatest one is what happens after life.  It is uncharted territory; it is the unknown.  Beliefs regarding what happens after we die are as individual as each person who holds them, and they will be respected in this post.  But that’s not what this post is about.

Our culture is largely a death-denying one.  Most people don’t like to think about, talk about or plan for death.  We prefer to think perhaps, that we, as well as our loved ones, may not have to deal with this eventuality. 

It’s easier that way.

**

Statistics show that approximately 90% of all deaths in America occur after an illness of some length.  Only 10% of the population dies as a result of a sudden event, such as an accident, heart attack or stroke.  This translates into nine out of ten people having some time to prepare for the impending eventuality of their own death. 

I work in the medical field as a speech-language pathologist, a.k.a., speech therapist.  I have worked in nearly every setting, including inpatient acute, inpatient rehab, outpatient rehab, home health, long-term care and private practice. I have treated many diagnoses, with the most frequent being stroke, head injury, brain cancer, Parkinson’s disease and dementia, to name the most common.  There have been multiple others. 

While there are many moments of victory in my work, occasions that I have been privileged to guide the patients on their journey to regain their ability to communicate and/or swallow, many occasions have not ended so happily. Often, the patients I have treated have not been able to regain these or any other functional abilities, and have succumbed to their diagnosis. 

Often, the option of hospice care was introduced. 

In order to quality for hospice care, a person’s physician must certify that their diagnosis will likely not allow them to live for longer than six months.  While not even the most skilled and intuitive doctor can predict this timeline, these are guidelines they follow from their past experience. 

In some cases, the patient may not live this long.  In other cases, they may live longer.  In even more unique situations, some patients “graduate” from hospice care, no longer expected to die within this six-month period.  Others remove themselves from this care in order to continue to receive aggressive medical treatment to work toward recovery.

While in hospice care, the goal is not to ignore the patient’s medical needs.  Rather, its purpose is to allow the patient to receive less intensive and perhaps less invasive treatment, and focus not on cure, but on pain relief if necessary, while maximizing their comfort and quality of life in the time they have left.  It can be seen as an acceptance of their limited time left, with hospice staff aiding them in making the most of this time. 

I recently treated “Brenda,” a patient I had been acquainted with for about a year.  She had required therapy for swallowing problems as part of her multiple diagnoses.  She resided in a facility, and I saw her initially for home health visits there, providing strategies to allow her to swallow more safely.  She was eventually hospitalized for another diagnosis, and released.  Within a week, she was re-admitted for treatment for another of her multiple diagnoses.  She continued to have swallow problems, and I re-evaluated her.  She was at risk for aspiration (food and liquid going into the lungs), and required a pureed diet with liquids thickened to honey consistency. 

She was not happy about this, and neither was I.  I don’t like to take away the pleasure of eating and drinking one’s favorite foods, but in order to keep her swallow safe, it was my ethical and professional responsibility to recommend this. 

This diet and liquid recommendation continued to be a major issue for her, and I understood.  At this point, and like many of my other patients, eating and drinking one’s desired foods and liquids is likely the greatest pleasure they can still enjoy. In addition, she had begged the doctor to release her, but she required more hospital care.  She was also facing the prospect of kidney dialysis, a regularly scheduled procedure that greatly reduces quality of life, and very few people are able to discontinue regular dialysis treatment—typically 3-5 times per week.  Her other diagnoses did not bode well for her long-term health past six months, and the doctor visited with her about hospice care.

Her family was supportive, but she initially declined.  After a few days, however, when she was able to receive more information and have more time to think about it, she decided to accept hospice care.

“I don’t want to come back here.  And I want to eat whatever I want to eat,” she said.  Hospice care would allow this.  She now receives regular visits from a hospice nurse to maximize her comfort and quality of life. 

I need to go visit her.

**

Medicare and most insurance policies cover hospice care. It is recognized as an essential element of health care.

**

My mother was a hospice volunteer.  She would visit patients in their homes and help the agency with other duties.  She died suddenly almost twelve years ago, and we designated the hospice as one of the memorials.  Having had experience with dying people, and having the inspiration from her, I decided that when I felt strong enough to become a volunteer myself, I would—in her honor, and for myself as well.  So, I did.  For about five years, I, too, visited hospice patients in their homes through our local hospice. 

It is not a volunteer opportunity suited to everyone, but I felt it was suited for me during that time.  I no longer volunteer there, but it was a positive experience. 

**

While there are inpatient hospice centers that allow for patients to receive care in a facility—typically to determine the most appropriate pain medication regimen, or to give their caregivers a respite, most hospice care is provided in the patient’s home—which sometimes is a nursing home or other facility. It allows them to feel most comfortable in their most familiar setting. 

Hospice care includes, but is not limited to:

  • pain management
  • providing caregiver instruction on how to care for the hospice patient
  • provides medication and medical equipment
  • assists the patient and family with emotional, psychosocial needs and, if desired, spiritual needs as well.
  • while not provided extensively, physical and speech therapy are sometimes provided to maximize quality of life, not to rehabilitate the patient.
  • provides respite for caregivers, with nurses and/or volunteers sitting with patient to allow them to take care of their own needs.

**

While both hospice and palliative care focus on reducing pain and maximizing quality of life, palliative care has an additional element, and is defined as: An approach that improves quality of life of patients and their families who are facing life-threatening illnesses through the prevention and relief of suffering/pain through early identification, as well as assessment and treatment of the pain and the diagnosis/diagnoses causing it.

The main difference is that while palliative care does provide relief from pain and suffering, and attempts to maximize quality of life as hospice does, it also provides treatment as an effort to cure or reduce the symptoms of the long-term illness, while hospice does not attempt to cure.  Hospice recognizes that the diagnosis/diagnoses will likely limit the patient’s life to six months or less, and no active treatment is provided.

Palliative care became a formally recognized subspecialty in 2008, and is also provided in the home, but can also be provided in a short-term hospital stay.  In larger hospitals with well-developed programs, there is a specially appointed care coordinator who oversees the patient’s plan of care, helping to keep all the providers going in the same direction. 

Studies have shown that when such support exists, patients typically fare better in the short and the long run, requiring fewer hospitalizations and/or ER visits, and improved health overall, staying more independent and feeling better at home.

**

It has been said that suffering in life is inevitable.  We have all experienced some degree of pain in our lives, either emotional, physical or both.    It is how we manage it that makes all the difference.

Hospice and palliative care are designed to manage physical pain, as well as the emotional and psychosocial pain that accompanies it.

Life and death are uncertain.  Hospice and palliative care are sure things.  If you, or a loved one would benefit from either, please contact your health care provider.   Suffering may be inevitable, but managing it will improve your quality of life.

Fall Prevention

It’s no joke.  The “I’ve fallen and I can’t get up” line has been used and abused as humor since its inception in the late 1980’s as a television advertisement for a personal emergency alert system.

I will confess right here, that age 23 in 1989 when it came out, I participated in the joke as well.  But it’s really not funny anymore, and it should never have been funny in the first place, to me or anyone.

I see the aftermath every day at work.  I am a medically based speech/language pathologist, and many of my patients—all adults—are being treated in the rehabilitation gym because of a fall.  Many people sustain a head injury as they fall, thus incurring cognitive and memory problems, and thus, requiring my treatment.

I see it at work, and lately, it has been present all around me at—literally.  One week ago, we received a call from our 71-year old neighbor who had fallen on his bathroom floor and had laid there for a few hours.  He wanted his wife to wait at least until 7:00 a.m. to call us on a Sunday, which she did.  The call came in at the stroke of 7:00.  We went over, and helped him up.  He refused medical treatment.  His gout was acting up again he said, and his feet were swollen and not able to bear weight.

Today, as I do every week day, I check in on my 74-year-old neighbor before I leave for work.  He has Parkinson’s disease, and his wife leaves for work several hours before I do.  It had been several weeks since he had fallen, but just ten minutes before I arrived, he fell when he tried to pivot too quickly.  He said he was fine, and didn’t hurt himself. 

Our friend’s father didn’t fare so well.  Joe moved his parents from 500 miles away to be closer to him and his sister, their only children.  They found a nice apartment, and decided to take a springtime trip back north to see old friends.  They stopped about halfway, and never made it further than that.  His dad fell on a curb simply stepping up, and broke a hip.  He has been in a rehab facility and  hasn’t been able to return home since, and they are now moving into an assisted living facility.

**

Fall will soon be upon us, which makes it a perfect time to increase awareness of falls and their prevention.  The only falling any of us see should be the beautiful leaves from the trees.  Fall, of course, is our precursor to winter, which always sees an increase in falls due mostly to ice.  So, once again I am on a soapbox to preach fall prevention, because nearly 100% of falls can be prevented.

**

Approximately 32,000 people die annually in the United States as a result of falls.  The vast majority—about 29,000 of these people are over 65 years old.  There are many injuries as well that are not accounted for in that figure.  One in four adults 65 and older report falling at least once annually. 

The 85-and-older population demographic in the United States is the most rapidly growing segment of our population, as the lifespan continues to increase.  Therefore, these numbers will likely grow as well. 

**

Any person of any age can sustain a fall.  At one end of the age spectrum are children, who are more likely than younger adults to fall due to their higher level of physical activity and lack of safety awareness.  Most falls with injuries, however, do involve older adults.  Age, in itself, is a risk factor for that reason.  Other risk factors include:

  • decreased physical activity
  • side effects of medication
  • loss of balance—common with aging
  • poor mobility
  • decreased cognition
  • decreased vision/decreased depth perception
  • unsafe physical environment—fall risks present include clutter, pets, oxygen tubing, poor lighting
  • poor adherence to medical advice to use a walker or cane
  • alcohol or other substance abuse
  • inner ear disorders
  • vertigo
  • low blood pressure causing lightheadedness upon standing
  • attitude of invincibility—“It won’t happen to me.”

…and many more.

Any and all of us are at risk, but again, older adults—65-plus– are the most common age group to experience falls.   Age brings with it a natural slow-down of movement, and we should respect that change.  At age 53, I am already feeling this.  I exercise nearly every day and remain in good physical shape, but I can feel the change, so I work with it, instead of fighting it.  I used to bound up and down the stairs—we have two sets in our home—without using the railing.  I no longer bound, and I always use the railing.  When I am walking downstairs to the laundry room and my arms are full of laundry, I am sure to lean against the wall, and take it even more slowly.

I know I am not immune to falls. 

A fellow speech therapist who is not yet 40 fell going down her stairs last year, and was laid up and off work for several months.  Her dog got under foot as she went down the stairs.

It can happen to any one of any age, at any time, for multiple reasons.

Now that I have sufficiently laid the foundation for the why and how it happens, lets cover the most important topic:  how to prevent falls.

First of all, please know that none of us are immune.  As I pointed out, it can happen to anyone.  Given that, here is what you can do to prevent falls, perhaps with a little help from your provider and/or other medical professionals:

  • Review medications to check for any side effects that may contribute to a fall
  • Keep measures in place to monitor blood pressure
  • Participate in screenings either in your home, a facility or a public place to assess for fall risk factors
  • Engage in regular exercise, including community-based programs/classes that enhance balance, such as yoga and Tai Chi.
  • Proper use of assistive devices such as a walker or a cane
  • Installing and using grab bars in the shower/bath.  A raised toilet seat or armrests are helpful
  • Ensure adequate lighting—especially places like the basement or garage, that may not be lit up.  Most people get up at night to use the bathroom, so ensure adequate night lighting as well.
  • Wear sensible shoes with good traction.  This is especially important in the wintertime, as the fall risk multiplies on snow and ice.  Attaching crampons—rubber nets with short spikes that stretch across the bottoms of your shoes—may be a good idea if you know you will be on questionable outdoor surfaces in the winter.  My father-in-law fell last winter when there was a surprise freezing fog.  It wasn’t predicted, and he simply stepped outside and hit the slippery spots and went down.  If there is any chance of this in freezing temperatures—predicted or not—take an extra moment to “test the waters” by hanging on to something as you run your foot over the surface you intend to walk on.
  • Be aware of and clear all possible physical factors in your home environment, such as clutter and throw rugs.  Always keep your eyes on any pets that may get in the way, as well as oxygen tubing that may wrap around your leg.  Be aware of stray electrical cords as well.

A word to caregiving family members who may be frustrated because your loved one needs to adhere to this advice, but doesn’t take it from you:  don’t take it personally.  This is nearly a universal phenomenon, as almost 100% of patients don’t like to hear the advice from their spouse/partner/family member.  Ensuring that the medical professional lays down those laws to them may help when you remind them of what they need to do.

For those who have difficulty ambulating and/or getting up and down in/out of a chair, a gait belt is a very simple and handy tool.  It is a strong canvas belt that can be easily wrapped around the upper abdomen and buckled to allow someone to assist with these transfers and/or ambulation by hanging on to it, and gently pulling up and lowering down.   These are available at most pharmacies and online.  

**

Just prior to finishing this post, I checked in on my neighbor.  He had fallen once again yesterday.  This time, he laid there for about 30 minutes, and was forced to scoot himself to a point where he could reach something to help pull himself up.  He was home alone, and he is now scuffed up on his head and arm from the fall, but no major injuries—this time.

 “I happened in one second, for no reason,” he said. 

That’s usually how most falls happen. 

He has received home health physical, occupational and speech therapy in the past, and I encouraged him to ask his doctor about it again.  If a person qualifies as “homebound,” through the doctor and home health agency, they can receive home health therapy—not around-the-clock caregiving—for several sessions per week.  It is covered at 100% by Medicare and some insurance companies.  Ask your provider if you think you are in need, and may qualify. 

Have a great fall, and enjoy the beautiful autumn.  The falling leaves will soon be splendid and beautiful.  Please aware that a fall can happen to you in any season, but your chances of preventing it are much greater with a little thought and effort.

Keep Moving To Stay Young

“Some people drink from the fountain of youth, others merely gargle.”

The legend lives on. 

Ponce de Leon, a Spanish explorer, likely offered the most popular account of the supposed miracle fountain, although there are other accounts throughout history and throughout the world.  Not surprisingly, none of the accounts have been supported by historical or archaeological evidence. 

The city of St. Augustine, Florida, is home to the Fountain of Youth Archaeological Park, where Juan Ponce de Leon was supposed to have landed, according to promotional literature.  For just $18, you, too, can tour the park and take a sip of the fabled rejuvenating water.  Many people still do. 

If only it were that easy. 

**

This post is part informational, part inspirational.  You have likely heard all the information before, but good advice bears repeating.  You may have been inspired before, but since we all need all the inspiration we can get, I will offer you more.

We all know the importance of taking good care of our health for optimal aging.  So much of the basic foundation of healthy aging lies in our own hands. 

  • Healthy food in moderate amounts
  • Water in adequate amounts daily
  • Enough sleep
  • Stress reduction
  • Social contact
  • Regular medical checkups, followed by following doctor’s orders.

You already know all this.  You already know how important each starred item above is.  Yet, most of us—myself included—long for an easier way.  An easy, cure-all, much like the Fountain of Youth.  Many of us try easy fixes, “magic” pills.

But there are no truly magic pills, just like there is no fountain of youth.

 Most of these “easy” ways don’t do much good for our long-term health, youthfulness and longevity.  The fundamentals listed above are among the best ways. 

I purposely left off two of the most important factors in taking care of one’s health, because I wanted to focus on them here.  Two more healthy habits that, when practiced faithfully, can make the difference between aging well, or not aging at all. 

Which, of course, can also mean the difference between life and death.

**

I am 53 years old/53 years young, depending on how one looks at it.  I like to write, and I want to do more of it in my life, so I keep busy with creative writing and a few side gigs like this monthly post.  I enjoy it, it makes me feel good mentally and physically.  It is good for my brain.

My day job is that of a speech/language pathologist.  I have worked in the field for 25 years, with the last 21 working with adults.  My patients have various diagnoses, but among the most common are stroke, head injury, voice deficits, brain/throat cancer and Parkinson’s disease.  These diagnoses bring so much heartbreak to life, so much to work on in rehabilitation, often alongside physical and occupational therapy. 

I have the opportunity to meet many people in my work, many patients and their families and friends.  So many of these patients are profoundly inspirational to me; so many of them are truly resilient people.  Their rehabilitation process has made them more determined to live a healthy life, because any of the diagnoses that bring them to me can be experienced by someone who has taken good care of their health, as well as someone who hasn’t.

I am always fascinated by the patient who looks and acts a decade or two younger than they actually are.  Because my work involves communication, I typically don’t hesitate to engage them in a discussion about how they take such good care of themselves.

By and large, their answers fall within these two responses:

1:  I stay active.

2:  I do what I enjoy doing.

Number one translates into “I keep my body moving,” which is the essence of keeping the body fit.

Number two translates into: “I engage in activities that keep my brain moving,” which the essence of keeping the brain fit.

It can truly be that easy—and that hard.

Finding the motivation to engage in physically and cognitively stimulating activities can be the hardest part.  Getting started, getting up out of the chair or getting out of the funk can be the greatest challenge. 

But once you start moving the body and/or the brain, it is so much easier to keep it moving.  Many people—myself included—wait for motivation to strike us before we act.  In reality, motivation comes from doing, not waiting.  Once we get started, the energy starts to flow—both physically and mentally. 

It is a well-known proven fact that physical activity keeps the body healthy.  It is becoming more well-known that positive mental activity keeps the brain healthy.  There is an increasing amount of research coming out that suggests a link between depression with dementia later in life.  This may surprise some people, but to me, it makes perfect sense.  If the brain is not stimulated and worked in a positive manner, it faces a greater risk of illness later in life, just as the body faces a greater risk of illness if it is not positively stimulated.

In a bonus, buy-one-get-one-free kind of deal, sustained physical exercise has been proven—hands down—to fight and/or prevent depression.  Moving the body keeps the brain moving and healthy.  If the effects of exercise could be bottled up into a pill, many researchers have noted, it would fly off the shelves as the best-selling, safest, most natural medication of all times—not just for depression, but for good health overall.

There’s the magic pill. 

Plus, both physical and cognitive activities you enjoy sustain themselves:  if you enjoy them, the feel-good aspect keeps on going after you made the initial effort.  And if it is a really good match, you may have a hard time stopping.  Find a hobby you enjoy, spend time doing it, and don’t feel guilty about it.  You are worth it.

Finding activities you enjoy—both physical and cognitive—may take some time.  Give yourself that time.  If you don’t like running, take a walk.  If you don’t like biking, then take a yoga class.  The same is true for brain exercises.  Even activities that may seem purely for fun—I’ll use the example of jigsaw puzzles, because that is what I enjoy—keeps my brain working, too.  Reading is a never-fail activity.  Crossword puzzles keep our word-finding abilities sharp, which is a skill that declines with age, and often declines sharply with my stroke patients.

If you have the means, traveling is an excellent way to keep the brain wide open, and physical activity on vacation always seems less of an effort.

**

We should all be so grateful for our health-care providers.  They are there when we need them, and they provide expert, loving care.  But if we keep our brains and bodies moving like we know we should, we can give those providers a break they so deserve by staying healthy, and needing their services less. 

Of course, those extra years you add on to your life will make up for fewer visits now in your younger years…

Private Matters

Privacy has always been the right of the patient in any medical setting.  No unauthorized person or entity has ever had the right to access medical records.  However, it was not as stringently enforced until the Heath Insurance Portability and Accountability Act  (HIPAA) was enacted in 1996.  This gave patients much more legal ground to stand on if they felt their medical information was compromised, shared, or used in any other way except for their best interests in their plan of care. 

Many medical providers and entities are legally bound by HIPAA rules, including:

  • doctors and nurses
  • clinics
  • hospitals
  • chiropractors
  • pharmacists
  • dentists
  • nursing homes
  • physical, occupational and speech therapists
  • medical social workers
  • health insurance companies
  • company health plans
  • psychologists
  • Medicare and Medicaid

Clearly, if a medical professional discusses your situation with friends, family, or anyone who is not directly involved in your care, this is a breach of medical confidentiality.  However, there are many other situations that can play out that may compromise the security of your medical information. 

Consider the following scenarios, and decide which ones are an illegal violation of your medical privacy:

A:  Your doctor greets you in a restaurant near other diners, asking you if you are feeling better.  She goes on to say that your tests came back normal.

B:  Two nurses are talking at the desk in front of patient visitors.  One says to the other, “That lady in room 122 lives close to you on Spruce Street—do you know her?”

C:  A physical therapist recalls a patient from a previous hospital stay several years ago.  He is not currently treating the patient, but looks up her information online to see why she is in the hospital this time. 

D:  A secretary leaves a patient file open on the counter where other outpatients can see it.

E:  All the above.

The correct answer is E:  all the above are HIPAA violations. 

**

HIPPA is the Health Insurance Portability and Accountability Act which was enacted in 1996.  While it is a complex code of rules that govern the transmission of private health information between providers and insurance companies, most of us are most familiar with the aspect of the Act that governs our rights to privacy.  Other objectives of the Act were designed to combat waste and redundancy, as well as to fight fraud and abuse in the health care system. 

You may tire of signing forms that indicate your understanding of these privacy policies, but they are in place to protect your private information and your security. 

Most medical personnel are dedicated to preserving your privacy at all costs.  Most do not intentionally disclose your information for their personal gain, although there are some cases whereby medical information such as your Medicare number may be sold for illegal monetary gain. This unfortunate circumstance is not the focus of this article, but as a rule, NEVER GIVE OUT YOUR MEDICARE OR INSURANCE INFORMATION TO A PERSON OR ENTITY YOU ARE NOT FAMILIAR WITH.  If you ever feel that a situation isn’t on the up and up, it may not be.  Trust your gut, and withhold this information.  Check out the source who is requesting it.  You have nothing to lose but your personal medical security.

If you feel that the security of your private information has been compromised, you have the right to proceed with action against the party in question.

The Department of Health and Human Services maintains their website with a section dedicated to health information privacy.  www.HHS.gov extensively covers the procedures for filing a complaint online, but also offers directions for filing a complaint in writing. 

Anyone who files a complaint is legally protected from retaliation from the provider in question.

Most larger hospitals have a privacy officer.  Smaller offices and practices may not have such a department, but they will have a contact person who can provide you with information regarding the actions you need to take if you are interested in filing a complaint. 

Privacy regarding your medical matters and records is an important aspect of health care.  You have the right to the degree of privacy you desire, and if you feel you are not getting it, check out the website maintained by Health and Human Services noted above, or talk to the privacy officer of the practice, if there is one.  You are free to bring up your concerns to any staff member if there is not an officer. 

You are the patient, you are the customer.  You have the right to privacy, so don’t hesitate to make sure you get it.  

Speak Up For Good Health

Communication is a two-way street; a two-sided coin. The receptive half is what goes in—usually by someone speaking to you, and the expressive side is your response.  Every human relationship depends upon communication in order for the two parties to interact and understand each other.  Family relationships, romantic relationships, work and business relationships all depend upon each party expressing themselves, and understanding what the other half expresses.

This is no different in your relationship with your health care provider.  And, unlike the other relationships listed above, your life may depend upon clear communication with your provider. 

After you have taken good care of yourself, the next most important thing you can do is to express yourself clearly to your provider, and to make sure they understand what you have to say.  This can be difficult in any human relationship, but in this relationship, it is also your right to be heard and understood, and to receive the medical care you need.

In this age of electronic medical records, many of us feel slighted by the computer. Many people report feeling ignored when the provider has their head buried in the screen.  This is not an ideal set-up, but as always, there are two sides to every story. 

The pressure to complete documentation in a timely manner is very real for providers, and some may feel they have no choice but to type while you talk.   This is tough for both sides, and there are no easy answers.  Most providers have sharpened their ability to listen and type at the same time, even if it feels as if they are ignoring the patient. 

If you are the patient, and you have more than one reason you are visiting the provider, you may need to prioritize those reasons, and ask for their undivided attention when you are telling them about that particular concern. 

“I know you have to keep documenting during the visit, but it is very important that I can have your attention while I tell you about…” An approach such as this may make it easier for both of you to take a moment to ensure shared understanding.  Acknowledging the pressure they work under may help put both of you on the same page.

The simple, yet complex act of listening can begin the healing process.  Showing empathy, warmth and concern helps the provider and the patient to relax and open up to a mutual understanding. 

Writing concerns down in a prioritized order is a very effective guide for the patient to initiate, and maintain an assertive manner during the visit.  This also helps the provider to understand the most important issue, and perhaps, which ones could wait for another visit, if the primary concern is a serious issue that will likely take up a considerable amount of time.

In addition, taking note of these variables of your situation may help:

  • Does it come and go, or is it always present?
  • Is it seasonal?
  • Is it affected by the time of day?
  • Does stress bring it on or make it worse?
  • Is it more pronounced when you are tired?
  • If there is pain, what is the rating on the 1-10 pain scale?

At the end of the visit, a simple reiteration of the patient’s concerns in prioritized order is an effective way to ensure that effective communication has indeed taken place.

“’I just want to repeat my most important concerns, and make sure I understand what you told me,” is another effective tactic.  Repeating back the advice and recommendations that provider gave ensures that you understood what they said.

Writing down your concerns is a very effective tool, as mentioned above.  Keeping a journal of your symptoms, doctor visits and changes in your condition helps to keep the information sorted in your mind, and provides a written history if you need to look back to recall certain information. 

Taking a family member or friend along to take notes during the visit is helpful, as it may be hard for you to recall all the information later to write it down.  They may also keep you accountable to speaking up about things you may want to leave out, provided you have already shared that with them.   Again, keeping a bound journal is the best way to keep an accurate record of your health history.  Electronic recordkeeping may work well for the patient too, but simply writing by hand is the most effective.  

Maintaining a separate written calendar of appointments and symptoms is an excellent way to provide a timeline of your care for future reference, as well as a means for the provider to see what other medical professionals you have visited, and when. 

Asking about side effects of prescribed medications is another important step in understanding your plan of care.  Your provider can explain these possibilities, and the pharmacist can, too.  Don’t hesitate to ask. 

***********

Sitting on crinkly paper in a loosely fitting gown in a sterile examination room doesn’t exactly allow for you to feel assertive and comfortable when you are the patient.   We all know this, but do try to remember that this is old hat for the provider.  They have seen it all, and there isn’t much that will surprise them.  Your modesty is your guarded right, but being mindful that this brief encounter in compromised conditions is necessary for your health. 

Finally, you are the customer.  If you truly feel that you could find a provider who listens better, treats you with more respect and seems more attuned to your medical needs, then you have the right to look elsewhere.  Good bedside manner is but one quality among many that are important in a provider, but it is the one that makes you feel well taken care of. 

Effective communication in the medical setting is your right.  As well as exercising for good health, be sure to exercise this right. 

Summer Safety

Ahh, summer.  It is upon us once again.  No matter how old we become, most of us still carry around that feeling of freedom; at least a little bit of the notion that our worries are a bit lighter, and that, perhaps, we are invincible, just like we were when we were kids out of school for the summer.

As we age, however, we realize, through time and experience, that perhaps none of us are invincible like we once thought we were.  This awareness, when used in our favor, can help us prevent injuries, illness and accidents—and hopefully a trip to the doctor or ER.

We have likely heard most of this advice before, but it all bears repeating.  Some tips below, however, may spark new awareness that you may not have had before.  If one accident, injury, or—in the worse case scenario—death can be averted, then any repetition will have been worth it.

Perhaps, like I did while researching, you may learn something new that may come in handy sooner or later.

Preventing sunburn is a priority for most people.  Most of us know, but again, hearing it one more time doesn’t hurt:

  • The strongest sun rays are bearing down between 10 a.m. and 4 p.m.  Avoid these times, if possible.
  • Use a broad spectrum sunscreen, one that protects against UVA and UVB rays.  The higher the number, the better. Reapply every few hours.
  • Sunscreens really do expire.  Just ask anyone who has used a bottle of sunscreen that was too far outdated.
  • The most severe cases of sunburn may cause an extremely uncomfortable condition known as Hell’s Itch.  Also known as Fire itch or Devil’s ant itch, it has been described as if fire ants are biting at the affected skin.  During the healing process, the itch is deep and throbbing, and may keep a person awake at night, persisting for days as it heals.

Swimming in pools, lakes and at the beach always carry a drowning risk.  Know your abilities, and respect them.  If you are in charge of small children, know their limitations.

  • Always wear life jackets while boating.
  • If you are driving the boat, remember that drinking alcohol while driving a boat carries risk just as drinking while driving a vehicle.
  • Water sports such as skiing and tubing require the use of lifejackets.  If you are engaging in these sports, drinking alcohol greatly increases the risk of injury.
  • If you own a pool and you have small children, or are hosting small children at a party, double and triple-check to make sure the area is secured to prevent small children from wandering into the pool area unattended.  Four children die daily in the United States as a result of drowning.

Those “invincible” teenagers may pose greater injury/accident risk during the summer:

  • Teenage employment may create unfamiliar situations for the working teen, thus increasing the risk of injuries.  Talk to your teenager about this risk, and if the employment setting does not educate their employees on safety as some independent places of employment may not, discuss this with your teen, and with the employer, if possible. Farming accidents are a prime example.
  • If they are at home while you, the parent, are at work, they may cook more meals for themselves.  Kitchen safety with appliances is an issue to cover as well.
  • The teens who stay out at night are at increased risk for personal safety issues, especially females.  As much as they may roll their eyes at you, make sure they are aware of their surroundings, and hold them accountable to curfews.

Spending more time outdoors in the summer carries some unique risks as compared to months with cooler temperatures:

  • Playgrounds are utilized more in the warmer months.  Check for safety with swings and other moving equipment.  Make sure the material under the equipment is designed to cushion falls.  Metal equipment—especially slides—heats up exponentially during the summer, thus increasing the risk of burns.
  • Insects such as ticks and mosquitoes are prevalent in the warmth.  Checking for ticks after being outdoors is recommended.  Better yet, if you are headed to a wooded area, wear a lightweight shirt with long sleeves and socks that are tucked in to the pants.  Wearing light colors also lets you visually spot the ticks earlier.
  • Mosquitoes are attracted to some fragranced body products, including lotions, cosmetics and hairspray.  They like to attack bodies that like to eat refined sugar, but tend to stay away from bodies that eat a lot of garlic.
  • Heat stroke is very real, and more common that you may know.  Overdoing it in the sun while not staying hydrated can bring this on.  Outdoor workers and those who engage in sports practice or exercise in the heat are especially at risk.  Remaining hydrated by taking frequent drinks BEFORE you feel the thirst is important.  Drinking drinks with electrolytes such as Gatorade is recommended along with water.   For many people, their tolerance to the sun and heat is diminished after a heat stroke.  Older adults who may lack sufficient air conditioning in their homes are at increased risk as well.  Infants and small children, as well as the older adult may have less ability and awareness to protect themselves from the risk, so be aware of their safety if they are in your care.
  • Outdoor barbecues and picnics are common, as are potato salads, and other dishes that are typically made with mayonnaise.  If you are taking a dish to an outdoor party, substitute a dressing without mayonnaise.

Travelers on the roadways increase in the summertime.  Stay smart about it:

  • Before embarking on a long trip, make sure the vehicle has been properly maintained.
  • NEVER leave kids or pets in the car alone, even for a moment.
  • Carry a first-aid kit in the car.
  • Texting while driving, of course, multiplies the risk exponentially—just like drinking alcohol while driving.
  • Bedbugs are very real, and they really do bite.  It is no joke.  If you are staying in a hotel, check the beds before you settle in.  They like to hide in crevices, so lift up the sheet and check along the seams of the mattress.  They only come out at night, so they are good at hiding.  They like to ride along, so be sure not to take any home with you.  Place your bags in the bathtub while you check.
  • Buckle up.  Your chances of survival are 9/10 with seatbelts, and, conversely, 1/10 without.  I prefer the better odds. You wouldn’t be reading this article if I hadn’t buckled up in 1988.

 

 

 

***

 

None of us are invincible–not the teenagers, not the adults.  Stay safe and healthy in the sun during your summer adventures.

HAPPY SUMMER TO YOU

 

 

 

Start With Easy

The long winter is mercifully over, and spring is springing. We are now several months into the new year, and as the trite saying goes, How time flies.

Many of us made New Year’s resolutions several months back. Perhaps a few of us can even recall what they were, and even fewer can proudly say they have kept their resolve and met these goals.

I am not one of the latter. I hope you are.

Observation, as well as solid research bears this out: Most of us begin with grand aspirations to make sweeping changes for the New Year, and a fraction of us actually do make those changes. Most of those changes, it turns out, are related to improving one’s heath. Among the most common goals include:

  • Lose weight
  • Eat less
  • Exercise more
  • Stop smoking
  • Get more sleep
  • Stress less

These are all noble and worthwhile goals. The majority of us could benefit from reaching these goals, but so few do. Why is that?
Because we are human. Because we have been living in a patterned, habituated way that created the excess weight/out-of-shape body/smoking addiction/poor sleep/excess stress.
And habits, as we all know, are hard to break.

**

The human brain is the most complex organ in the human body. It is Command Central, responsible for the functioning of every other organ and body system. It is the only major organ that cannot be transplanted. And, it is one of the organs most easily improved upon with the owner’s effort. Current research also bears out the idea of brain plasticity: that the brain can indeed change and improve, against what years of former research indicated.

It responds well to patterned behavior: anytime an action is repeated enough times, whether it is eating too much, smoking, reacting poorly to stress or maintaining a sedentary lifestyle, it creates a path, a trail in the brain for the human who owns the brain to follow down again and again, until it becomes the path of least resistance. And, coincidentally, humans love the path of least resistance.

Compare it to the cattle trails in the pastures of the Midwest. The cattle walk the same path repeatedly, until the trail is worn into a rut, and getting out seems almost impossible. Stepping out of this rut requires effort; walking within the rutted trail requires very little.

Inside that trail, however, the cows are missing out on verdant fields of green outside of the trail.

Humans are missing out on greener pastures, too. There are grand and glorious fields of green waiting for us outside the trails we have made in our minds, the trails we created from repeating the same action again and again, the trails that keep our habits going strong.

But it seems so hard; it seems to require so much effort to make those changes. Let’s take the example of the person who needs to exercise more, which is most of us. Most of us would benefit from at least a half-hour of exercise each day. But half an hour? That thought keeps us firmly planted on the couch, in front of the television, probably with a bag of chips close by. Plus, who really has time for that? Never mind that those who think this—again, most of us—waste much more time that it would take to exercise in front of that TV, or on our phones or whatever.

So, let’s make it smaller and easier. Let’s start with just 5 minutes. As smart as the human brain is, it can be easy to fool as well. Just as you might with a toddler, tell your brain We’re only going to do this for five minutes. You can walk for five minutes.

And your chances of getting up off the couch and out the door are much greater than if you insisted on that thirty minutes of walking.

So, you got up, and got moving. Two minutes pass, then three, and gee, this isn’t so bad. I feel like walking more. But just five more minutes for a total of ten. I can do ten. No wait, this feels really good. I think I can make it for fifteen or twenty minutes…

And you are off. You are working toward that goal.

Here’s the funny thing about humans and their brains. We think that in order to complete a task, whether it is taking a 30-minute walk, unloading the dishwasher, sorting that pile or bills or finishing that novel, that we must wait for inspiration to arrive. Surely it will; it’s on its way, so we decide to sit and wait for it to arrive.

But until we get moving toward the goal, it doesn’t move toward us. If you are like most humans—and likely you are, getting started on the dreaded task actually brings the inspiration to continue it and eventually achieve it.

Action begets action. It takes the actual getting started to bring the inspiration to you. It will meet you halfway, or perhaps it will only require you to give a third. The important thing to remember is that it will likely wait for you to initiate.

Leaving behind the pack-a-day cigarette habit likely feels daunting, so let’s start with the pack minus one for the first week. This may take a bit longer, but again, it is moving in the right direction, something you weren’t doing before.

Need to drink more water? Start by adding just one more 8-ounce glass daily for this week. You can certainly do that, and it won’t make you feel waterlogged like if you drank as much as you know you needed to do.

Need to drop a few pounds? Most of us do. If diets haven’t worked—and most don’t, try simply eating less of the same foods:

  • Put your spoon, fork or sandwich down between bites.
  • Chew each bite thoroughly. It will make you feel more full, more quickly.
  • Drink a glass of water a few minutes before mealtime. You likely need to drink more anyway, and it will fill you up a bit.
  • Before you take that second helping, step away from the table for just a few minutes. It will distract you, and you may realize you didn’t want it anyway.
  • Don’t deny yourself the good stuff, simply take a smaller dessert.

**

Changing old habits can indeed be hard work. Simple, small steps like those listed above make a large task seem easier.

How do you eat an elephant? One bite at a time. Break the goal down into small steps, and you will have more success. You are the captain of your ship with your health, and you can turn it around. Many other people have, and you likely have what it takes to make the changes that will bring you better health. They likely struggled just as we all do, but they likely took smaller, easier steps.

The New Year isn’t new anymore, but spring is. New life is growing all around us. Consider turning over a new leaf as the leaves come on the trees.

It’s never too late to make a resolution for better health.

A Balancing Act

Consider this: The average height for an American woman is about 5 feet, 4 inches, and the average man is 5 feet, 9 inches. The average shoe size for women is 8.5 and 10 for a man. Now, think about how small—in relative terms—the foot is compared to the body it holds upright.

It really is quite a feat—no pun intended.

To add to that, most human bodies are able to make sudden movements, turns and twists, perhaps even inversions, as some people can stand on their hands or on their head and return to an upright position with little difficulty.

Some people, that is. Not all of us.

We use the word “balance” in many contexts, often without thinking about it. We use it a way that is more figurative; there really is no balancing of any physical object in these meanings.

“I need to find balance in my life.”
“My checkbook needs to be balanced.”
“We should all eat a balanced diet.”

Physical balance, however, is a key element in good physical health, and for all other aspects of health as well.

The vestibular system is yet another wondrous system of the human body. It has the greatest responsibility for the maintenance of balance and spatial orientation, and it is located within the inner ear. If you have ever had an inner ear infection, you will likely remember very clearly how it feels when this system goes awry. Dizziness and possible nausea are the most common complaints.

The cerebellum, which sits at the base of the brain, is the neural structure that receives this feedback and commands the body to move accordingly.

The eyes work in tandem with the vestibular system, providing accurate feedback to the cerebellum to determine how and when to move the body.

Except when they don’t.

Motion sickness is a common malady, resulting from a mismatch between what the eyes see and what the vestibular system reports. When there is no physical movement, but the eyes sense movement, the sensation of being carsick, seasick or airsick results.

Like most other systems, the vestibular system requires stimulation in order to develop. Which explains why children enjoy being spun, twirled, pushed high in the swing, turned upside-down on a carnival ride and many other shake-ups that most adults don’t enjoy. Our vestibular systems are fully developed, and cannot tolerate the stimulation that children’s typically can.

I once had a co-worker who delighted in spinning around in her swiveling office chair. She said she felt her vestibular system was not yet fully developed, which, as a female in her late thirties, was not a common thing. It used to make me almost dizzy to simply watch her do it, which was likely that mismatch I wrote of above. My eyes saw movement, but my body didn’t feel it.

Perhaps, as an adult, simply reading this and imagining how it must feel could bring on a bit of dizziness. As young adults, most of us reach a sweet spot, a zenith of vestibular function where everything seems perfectly balanced. Then as we age, something changes—as so many things do with age. Our balance may seem off; we may feel a little less stable on our feet.

Which bring me to the point: balance is not always granted, and we need to act accordingly.

In the United States alone, 32,000 people die annually as a result of falls. Thousands more are injured, and must deal with the aftermath: broken bones—most likely hips with the elderly, and wrists, as we all attempt to catch ourselves as we fall. Head injuries are common, as the head is at risk for being struck when a person falls.

Age often brings a decrease in balance, as with so many other functions. The risk of falling increases with age, but remaining proactive, preventive and positive is key to avoiding falls. As with nearly all accidents, they can be prevented. Awareness of risk is the first step:

  • Obviously, stay off the ice in the wintertime. If you must get out, be sure to have help. Falling in all age groups increases exponentially on ice.
  • If you have pets in your home, know where they are at all times. If they have a tendency to get underfoot, increased vigilance is necessary.
  • If you use oxygen, make sure the tubing is not wrapping around your feet.
  • Don’t pivot too quickly.
  • Use the stairway railings.
  • When getting up in the night to use the bathroom, sit on the edge of the bed for a moment to make sure your equilibrium is sufficient. Sometimes the nighttime is harder, due to having been lying down, asleep, and the darkness as well.
  • Keep your pathways clear of clutter.
  • Throw rugs, while beautiful, increase the risk of falling. Be aware of this risk, and make sure your feet clear them if you have them in your house.
  • Wear smart, comfortable, low-heeled shoes.
  • If your doctor or physical therapist has recommended use of a cane or walker, be sure to use it.

If you suffer from a balance disorder of any kind, it is best to have your medical provider evaluate it, as the causes can be varied. Age can indeed decrease your balance, but there are many other factors as well.

**

The human brain is the most wondrous computer. As Command Central of the human body, its structure and placement are carefully engineered to maximize safety and function.

Imagine the brain as a tree. Its trunk is the brainstem, and the leaves hold the different lobes of the brain. The functions most important for survival are nestled deeply in the brainstem. Heartbeat, respiration, swallowing and consciousness are among the functions located deep in the brainstem where there is less chance they can be damaged by accident. Balance is located just above that in the cerebellum, at the base of the brain. In order to function as the upright creatures we are, this ability is heavily insured with its placement at a relatively low level. Without the ability to stand upright and move accordingly, we cannot function as we were designed to do.

In so many ways, life is a balancing act. Make your balance the best act possible.

Knowledge Is Power

In the attempt to take control of one’s health care, the maze of medical terminology can be overwhelming. Many terms are used that are part of a complex medical language that a lay person may never master fully.

Many acronyms and abbreviations are used as well. Some are clearly understood by the patient, others are used with a general understanding. Some are not understood at all.

Knowledge is power. Knowing what these acronyms and abbreviations mean will help you understand yours or your loved one’s diagnoses, recommendations and prognosis. Some are used by medical staff without awareness that the patient and family may not know what they mean, and may not want to ask.

Some of the simpler, more common ones include: BP—blood pressure. This will certainly be measured in the ICU—Intensive Care Unit. It will likely be measured by an RN—Registered Nurse, or an LPN—Licensed Practical Nurse. They will likely also measure your I&O—Intake and Output—all you take in, and all you put out. If you cannot take anything in PO—by mouth, then you are NPO—nothing by mouth. You may have an NG tube—nasogastric tube—in your nose to provide hydration. You will probably have an IV, intravenous tube in your arm or hand as well to administer fluids and liquid medication. In prolonged cases of NPO, a PEG tube—Percutaneous Endoscopic Gastrostomy tube may be inserted into the stomach to allow fluids, medications and liquid nutrition to be provided when swallowing is not possible due to decreased consciousness or difficulty swallowing.

Perhaps you suffer from sleep apnea. You may use a CPAP, or Continuous Positive Airway Pressure machine, which delivers just that: continuous, positive airway pressure to allow you healthier sleep.

As we age, most of us suffer from STM loss—Short Term Memory loss. With advancing age and some diseases that accompany it, LTM loss—Long Term Memory loss is a factor, as well as STM loss. If this memory loss prevents someone from remaining in their home safely and independently, they may move to an ALF—Assisted Living Facility. With advancing healthcare needs, someone may require help in a SNF—skilled nursing facility, which is—in most cases– the same as a NH—Nursing Home.

We all strive to perform WNL—Within Normal Limits, or at least WFL-Within Functional Limits. If this is a challenge in one’s home, a person may receive HH-Home Health nursing and/or therapy services. Those therapists may be a PT—Physical Therapist and their assistant—PTA, and/or an OT—Occupational Therapist and their certified assistant—COTA, and/or an ST—speech therapist, a.k.a. (also known as) an SLP—speech/language pathologist. There are no speech therapy assistants utilized in the medical field.

Just like doctors and nurses, these therapists work with multiple diagnoses, including: CVA—cerebro-vascular accident (a.k.a. stroke), and TBI—Traumatic Brain Injury, which may be caused by an MVA—motor vehicle accident. They will likely review the H&P—History and Physical—written by your doctor, before they initiate their POC—plan of care. They may also provide e-stim—electrical stimulation—to rehabilitate muscles.

When injury or illness causes pain, a TENS unit—Transcutaneous Electrical Nerve Stimulation—may be used to relieve pain.

If you have had a CVA/stroke, it is generally classified as one of two types: ischemic or hemorrhagic. An ischemic stroke is the most common type, and is caused by a blood clot that blocks a blood vessel to the brain. A hemorrhagic stroke is caused by the rupture of a blood vessel in or on the surface of the brain, bleeding into the surrounding tissues.

A minor stroke is also known as a TIA, or Transient Ischemic Attack. These “mini-strokes” generally resolve without any intervention, but may portend a full-blown stroke in the future. The symptoms are generally temporary, and may or may not show up on imaging tests. They truly are transient—here, and gone. If you feel you may have experienced one, however, seeing your health care provider is a MUST.

The term “stroke” dates back at least 500 years. When, in those primitive medical times, it was truly a mystery when a person’s actions, interactions, speech, strength or level of consciousness suddenly changed in a matter of mere seconds, it was attributed to “the stroke of God’s hand.” We have kept the term “stroke” since then.

Nearly all of us have had an X-ray of some sort. But why is it called “X”? In 1895, a German physics professor named Wilhelm Roentgen was experimenting with cathode rays in discharge tubes, when he discovered an unidentified radiation emerging from them. He labeled it “X”, and it eventually was labeled X-Roentgen ray, and thus was shortened to “X-ray.”

It is very important to know CPR in order to possibly save someone’s life. Cardio-Pulmonary Resuscitation training is offered through Red Cross, and other qualified institutions as well. Before your s/s (signs and symptoms) of a heart attack, you may also have SOB: shortness of breath. If your heart condition warrants, you may require a CABG, or “cabbage” in hospital lingo: Coronary Artery Bypass Graft. An EKG—electrocardiogram—monitors heart function.

As well as having X-rays, you may have been tested with a CT or “cat” scan. This stands for Computerized Tomography. An MRI is short for Magnetic Resonance Imaging, and a PET scan is the acronym for Positron Emission Tomography.

Most of us have heard of the FDA, the Food and Drug Administration, the branch of the government that oversees food and drug safety. The CDC, the Centers for Disease Control attempt to do just that through education, prevention and research. The NIH—National Institutes of Health—are another part of the US government, consisting of over 20 different divisions, each dealing with some aspect of health, and are generally research-based.

**

Ideally, none of us would ever have to become familiar with any of these acronyms, abbreviations or terms. We would all stay healthy, and not have to speak or understand this language. Most of us, at one point, will see one or more of these printed in our medical history.

The American Medical Association (AMA) is an organization of American physicians. It also stands for Against Medical Advice. We can all prevent this one from appearing on our charts by simply following our healthcare provider’s advice and orders.

The A-B-C-Ds of Medicare

Signed into law in 1965 by the Social Security Administration, Medicare began its coverage in 1966.  This health insurance plan will turn 53 years old this year, covering more than 55 million adults over age 65, as well as some adults under 65 who are disabled, suffer from end stage renal disease, or amyotrophic lateral sclerosis (Lou Gehrig’s disease).

President Lyndon B. Johnson signed it into law, and former president Harry S. Truman was issued the first card.  In 1965, the budget allotted $10 billion for this coverage, and about 19 million people signed up for coverage.

No longer part of the Social Security Administration, Medicare-along with Medicaid (an insurance plan for low-income citizens), is covered by the Centers for Medicare and Medicaid (CMS).

********

Medicare consists of four parts:

  • Part A:  hospital insurance which is mandatory.  It covers hospital stays of up to 60 days at 100%, as well as skilled care in a nursing facility, home health care—nursing and therapies, NOT personal assistance—as well as hospice care.  Most people receive Medicare A free of any premiums.
  • Part B:  outpatient insurance which is optional.  Typically, it covers such expenses as doctor visits, outpatient therapy, x-rays, chiropractic care, certain vaccinations and other services.  There are premiums to be paid for Medicare B, which, in 2019, is 135.50 per month under a certain level of income.
  • Part C:  this is an option that allows enrollees to receive their services in a capitated style vs. fee for service.  It sets a price that is paid to a practitioner that agrees to cover costs for a designated period of time, whether or not the enrollee utilizes their care.
  • Part D:  initiated in 1997, this is the prescription drug plan approved and regulated by Medicare, but administered through multiple private health and pharmacy companies.

Let’s get to know a few medical scenarios and how Medicare may cover:

  • You are hospitalized with a stroke.  It pays for covered costs for the first 60 days, except for the deductible.  If you go to a skilled nursing facility for rehabilitation after this, it will cover the first 20 days at 100% if you show progress toward your goals set forth by nursing and therapies.  After that, it is covered at 80% if you continue to make adequate progress for up to 100 days.
  • You then return home from the skilled nursing facility, and you need further physical therapy as an outpatient.  Medicare B covers 80% of the Medicare-approved amount.  When you receive these therapy services from a participating provider, your coinsurance amount is 20% after you meet your deductible.  In 2019, this deductible amount is $185.

And what it doesn’t cover:

  • You require further care in a nursing facility after your stroke.  Your therapy has ended because your progress has not been adequate to further qualify you for Medicare A.  No form of Medicare covers this long-term care in a nursing facility.  The majority of Americans (60%-plus) living in long-term care facilities are enrolled in Medicaid, which covers this cost.
  • You also need new hearing aids, and new glasses.  Medicare does not cover any of these expenses.

***

Medicare is a multi-faceted, complex and sophisticated program of health coverage for seniors and those under 65 with certain disabilities.  It was initially met with some resistance when it was introduced in 1965, much like the Affordable Care Act (Obamacare) has been resisted in its implementation.  Critics were certain it would never work and would never endure for the long term, but it has 52-plus years of staying power since its implementation.

Prior to its creation, it was determined that a system of health insurance for the elderly would have to be funded by those who had not yet reached that age, because of two reasons:  1)  the elderly have more health issues and need to spend more of their money on health care, thus reducing money available for insurance, and 2) the elderly are typically not working as much as younger people, and don’t have as much flexible income.  Thus, the idea of withholding a Medicare tax was created, and it has survived the test of time.

 

If you are a Medicare recipient, you likely know all this information, and much, much more.  If you are not yet a recipient, you will one day know it.  Regardless of which group you are in, you may not know the following facts about Medicare:

  • More than 55 million Americans rely on Medicare for health care coverage.
  • Enrollment in Medicare A is mandatory.  If you choose not to, then you must repay your social security benefits if you are receiving them.
  • If you work past age 65 and are receiving health insurance from an employer, you can choose to delay receiving this benefit.
  • Once you enroll in Medicare, you can no longer make contributions to a health-savings account.
  • Higher incomes may mean paying higher Medicare premiums. In 2018, these income levels were lowered, thus creating higher premiums for income levels that were not affected prior to last year.  If your income level changes, these higher premiums can be appealed.
  • In general, Medicare offers more coverage choices than many employer plans.
  • While it does not typically cover dental care or glasses, it does cover durable medical equipment such as walkers, wheelchairs, canes, hospital beds, glucose monitors and patient lifts.

***

As a not-for-profit agency, Medicare has one goal:  to keep seniors and disabled people healthy, and out of the hospital, and hopefully remaining in their homes.  Several of their provisions illustrate this very well:  When an enrollee requires nursing and/or therapy care in their home, Medicare pays at 100%.  For certain diagnoses, if patients return to the hospital with the same diagnosis that exacerbated after returning home, hospitals face large fines and penalties.  Their goal is to ensure that proper medical care was administered before the patient is discharged.

Medicare fraud has, unfortunately, captured too many headlines in the last few years, and they work tirelessly to reduce this travesty.  Preventing such fraud helps Medicare keep their costs low, allowing them to keep premiums low and benefits high, ultimately keeping enrollees healthy.

Ten thousand Baby Boomers reach the age of 65 every day in the United States, which qualifies them for Medicare.  This “boom” is indeed booming, and this increase in enrollment will continue to challenge the program.  However, it continues to grow strong into its 50’s, and would likely make President Johnson proud to see the strong health care program it has become.

There is a wealth of information online regarding all aspects of Medicare.  Please consult their official website at www.medicare.gov.

And please, do all you can to keep yourself healthy, no matter what your age.  Health and happiness go hand in hand, and Medicare wants you to stay in your home in good health—and in happiness.

Back to Basics

Tis the season for holiday cheer.  The season for hope, joy and peace.  The season for merriment among family and friends.   It truly can be the most wonderful time of the year.

On the other side of this beautiful, brilliantly shiny coin is holiday stress.  In our efforts to ensure that all this cheer does indeed arrive in good time and in good measure, we bring stress upon ourselves.  We don’t really mean to, it typically arrives as a normal by-product of all this preparing, shopping, sending cards, baking, cooking, cleaning, planning and attending parties, and generally placing pressure on ourselves to over-achieve to a standard that no one—except ourselves—holds us to.

Yet we do it.  Year after year.  It brings us joy—mostly.

Except when it doesn’t.  I hope you are in the group that experiences nothing but sheer joy, with little or no noticeable stress.  If you are not in that small group, then keep reading.  Perhaps the following can take away even a little bit of stress.

Because stress, as we all know, is the enemy of good health.

**

Most of us—myself included—have been known to neglect the most valuable, most foundational steps that must be taken before anything else can be expected to work right.  Most of us tend to forget that the building blocks of health are quite simple, and can be improved—at least a little bit—for most of us.

A friend of mine recently lost a family member to cancer.  She said their family had attended grief support groups, which have been invaluable and life-saving for them, and for many bereaved people.  She made the comment that the group leader reminded them of some very simple, yet frequently overlooked steps that should be taken if one is to attempt to rebuild their lives after a loved one dies.  It seemed she and her family had forgotten about these basics.

Many of those same simple steps are the same ones we should take to avoid holiday stress.  Just like in times of grief, we may overlook the most basic tools we have in our hands to make ourselves feel better.

The simple steps are as follows:

  • Get enough sleep.  If it is hard to sleep, go to bed early, practice relaxation, take naps and don’t apologize for sleeping.  The caveat to this is that if you find yourself sleeping too much, you may be more tired and/or depressed.  Please be aware of that sign, and act accordingly.
  • Drink enough water.  As a medical professional, I frequently recommend increased water intake.  “Enough” is defined as half of your body weight in ounces daily.  Anything closer to this than where you are now is considered progress.  The only exception to this is if you have been advised by your doctor the limit fluids.
  • Stay connected to other people.  The power of human interaction cannot be denied.  We are wired to be social, and while this may sound contradictory, those holiday gatherings should be enjoyed primarily as precious time together, not an occasion to stress about unimportant details. If, however excess contact brings you excess stress, you likely know when you need to be alone.
  • Practice moderation.  Denying yourself delicious foods can be counteractive, just as overindulgence can.  Beating yourself up with guild after indulgence never does any good.  Just pick yourself up and start over.   Somewhere in the middle is always the best place.
  • Move your body.  There has never been a study that denied the benefits of moderate exercise.  A simple walk, a yoga class, a workout at the gym or a run in the brisk winter weather is good medicine.  It has been said many times that if the benefits of exercise could be bottled and sold, it would fly off the shelves.  Taking the time and making the effort are indeed more difficult than swallowing a pill, but the payoffs are worth it in the end—and sometimes even during!
  • Examine your expectations.  If you are placing unrealistic expectations on yourself to throw the perfect party, send out the perfect cards with the perfect pictures, buy the perfect gifts, prepare the perfect foods…you will likely come up short.  In most cases, you are the one placing the most pressure on yourself to achieve these expectations, so you are the one who can change them.  If anyone complains, enlist their help.
  • Anticipate that stress is not completely unavoidable, and plan accordingly.  Schedule an hour in between activities for a nap, or some other relaxing activity.*Make a list of what brings you the deepest joy.  If any of the stress-inducing activities do not support the things on your list, consider letting them go.  It’s not worth the stress you associate with them if they don’t make you happy.
  • Be aware that the shorter amounts of daylight and/or gray days can legitimately bring us down.  Seasonal Affective Disorder –SAD—is a very real thing.  If you think you may be affected by this, try to get outside during the day if the sun is shining, consider getting light exposure through a light box, which your doctor can tell you about.  Be sure to contact your physician if you feel you are suffering from this lack of light exposure in the winter.
  • If you typically have conflicts with family members during the holidays anticipate that more will be likely.  Resolve not to attempt to resolve them in the presence of the entire family during this time which is supposed to be joyous.   If these difficulties arise, consider simply stating:  “Let’s take care of this another time.”
  • Your gift-giving habits/gift wrapping do not have to be on par or exceed anyone else’s.  It is not a contest.  You can give yourself permission to choose not to give someone a gift, even if they gave you one.  Some people choose to give more material gifts than others.
  • Don’t forget intangible gifts.  Spending time with someone is one of the greatest gifts we can give.  Take someone to dinner, or cook for them.  Ask them out to a movie or concert.   Offer to babysit for someone’s children or care for elders they care for so they can have time out.  Offer an apology.  Forgive someone.  Forgiveness comes with a bonus:  it benefits you more in the end.  It’s the gift that keeps on giving.

**

We celebrate the holidays because they are meant to bring us joy, and often times, they do.  Sometimes, though, when they don’t, we lose sight of how we can go back and start over by thinking about what we can do differently.

Stress, as we all should be aware of by now, can adversely affect our health.  It increases blood pressure and decreases our self-care abilities.  Our bodies respond in many negative ways.  If we don’t harness the stress and it persists, the patterns continue, and the bottom line is that our health is compromised.  Most doctors will inquire as to your stress levels to determine how it impacts your health, because they know how it can negatively impact your health.

**

Happy Holidays.  Enjoy the celebrations, and don’t let them overwhelm you.   Take care of yourself, and most of the other details will take care of themselves.  Be kind to yourself this holiday season.  You deserve it.  It’s the most basic gift you can give yourself, so that you can give the gift of joy to others this holiday season.

 

 

Thanksgiving Day Every Day

“Gratitude is the sign of noble souls.”—Aesop

“Gratitude is not only the greatest of virtues, but the parent of all the others.” Marcus Tullius Cicero

“The thankful receiver bears a plentiful harvest.” –William Blake

“The essence of all beautiful art, all great art, is gratitude.” 

Friederich Nietzche

It’s that time of year again.   We gather with family and friends, we prepare and consume delicious food, enjoy fellowship and (hopefully) the day, or perhaps a long weekend off work.

There are no commercial expectations one is pressured to engage in, nothing we are told we need to buy besides the ingredients for this delicious food—or perhaps a dinner out.

This fall festival is a favorite holiday for many.  Its spirit is simple:  count your blessings, and appreciate them.  Hopefully, we can all say we fulfill this expectation on this day.

But shouldn’t we do this every day?  Shouldn’t we, perhaps, try harder to keep this spirit alive all year?

The answer is yes, and the reason is simple:  it’s good for you, and good for the rest of us, too.  Practicing gratitude has the power to turn bad into good, dark into light, strife into peace.  And, recent research has revealed that it is good for our physical health.

It is simple, yet complex.  It’s easy, yet hard.  Which is likely why most of don’t do it enough.

**

While it is hard to quantifiably measure, many studies have attempted to measure the effect that gratitude has on mental and physical health.  Measuring gratitude itself is hard, and comparing the results to a control group may be tricky as well.  However, the research bears out a common theme:  practicing gratitude, choosing to see the positive in every situation, and realizing our blessings are associated with lower levels of illness, lower self-reports of stress, increased amounts and quality of sleep, improved relationships in our families, at work and in our social circles, and increased feelings of good will toward our fellow humans.

Sound too simple?  Or perhaps too flimsy and without proof?  Go ahead and have doubts, but here is the bottom line:  it makes you feel good without any side effects, so why not?  Also:

  • It doesn’t cost a thing.
  • Your feelings of increased peace will be impossible to keep to yourself. It’s a good kind of contagion.
  • It is your choice, so why not choose the positive?

And while you are at it, do an online search for the health benefits of gratitude.  You will be pleasantly surprised, and perhaps even motivated to be grateful.  One of the most widely cited research project appears here:  https://www.psychologytoday.com/us/blog/what-mentally-strong-people-dont-do/201504/7-scientifically-proven-benefits-gratitude

**

One year ago today, I was involved in a minor auto accident.  No one was hurt seriously, which was the thing I was most grateful for.  However, there was a lingering darkness about it that hung like a cloud above me.  I had to find a better way, so I changed the way I thought about it:

  • Nobody died.
  • It wasn’t my fault.
  • The other driver had good insurance, and she was sincerely apologetic.
  • My beloved car was crunched in the back, but it was drivable.
  • I got a rental car while it was being fixed.
  • My minor but lingering neck pain could have been a lot worse.

I decided to be thankful instead of angry or upset.  I decided to see the good in a situation that initially felt like a bad situation, but I changed it in my mind, and I was better for it.  I like to think I was better for others, too, not harboring any resentment, anger or holding a grudge.

**

Exercise is essential for good health.  However, it is a commitment of time and energy.  If its benefits could be bottled and sold, it has been theorized, they would fly off the shelves.  Motivation for exercise can be hard to come by.  You may feel tired.  You may not feel you have enough energy, enough time, enough warm clothes in this cold weather.

Reframing these thoughts can help:

  • “I am thankful that I can move my body.  Some people don’t have that ability.”
  • “I am grateful for a free hour.  I could watch television, but I will be thankful that I have this choice on how to spend my time.”
  • “The great outdoors are a beautiful gift of nature.  I will get out and enjoy them.”

Turning the negative into the positive provides a better outcome.  It is your choice; no one can force you to be pessimistic.  And, the best bonus of all is this:  you will, very simply, feel better.

**

Thanksgiving is meant to be enjoyed with family, friends, food, fellowship and fun. Enjoy all these aspects of Thanksgiving, and hopefully, many more.

After the holiday is gone, and the leftovers are all eaten, remind yourself to keep the spirit of gratitude alive.  If you practice it regularly—just like exercise—it will make you feel better—just like exercise.  It can turn a bad day into a good one, a gray mood into a bright one, and is easily shared.

Acknowledging the positive things in your life in writing has also been shown to enhance the benefits.  This practice of keeping a gratitude journal holds you accountable to recognizing something by putting it in writing.  It also serves as a reminder when you re-read your past entries.

Again, it is your choice.  You can choose to see the goodness in your life, or you can stay blind to it.  You have nothing to lose but negativity.

Thank you for taking the time to consider gratitude, and Happy Thanksgiving.

 

Take Care While Giving Care

“You need to have a daughter. They are the ones who take care of you when you get old.” –Author’s mother, to me when I was expecting my second son. I never did have a daughter. She didn’t need care at the end of her life.

One of the greatest, most meaningful jobs one can have comes with little or no pay, and sometimes little appreciation. It typically requires that one puts their own needs and their life in general on the back burner in order to take care of someone else.

A caregiver is typically underpaid or unpaid, and often not recognized as the angel they are. Without them, another human being would not be able to function very well, if at all. Yet, their praises go mostly unsung, and they just keep on working.

Lifespans in America continue to increase. The Baby Boomer generation is aging, and often the Boomer’s parents are alive and continue to age as well. There are varying definitions of the “Baby Boomer” generation, but it is roughly defined as those born between 1946 and 1964. The post-war increase in births has accounted for a significant increase in the population of that age group which, in 2018, include those between the ages of 54-72. While this generation has generally been credited as having healthier lifestyles than their parents, the sheer numbers provide a challenge to our medical system, and for those who need care as well. As mentioned, lifespans continue to increase, so many parents of Baby Boomers are alive and require increased medical care and/or caregiving.

Complicating this phenomenon is the fact that many Boomers had their own children later in life in order to pursue professional goals that became more easily reached in the post-war economy. Therefore, as they raise their own children, their parents require help as well. This “sandwich generation” faces challenges in providing care to both their children and parents as well.

While there are millions of caregivers for children in need of care as well, this will focus mainly on caregiving for adults.

Caregiving may very well be one of the most rewarding, most unrecognized, most fulfilling, most underpaid/unpaid, most important and most thankless job one can have. Paradoxically, it can be all those things at once.

An informal caregiver is typically a family member or a loved one, and is typically unpaid. A formal caregiver is typically paid to provide care in the person’s home or a long-term care facility. While paid caregiving is undervalued, under-recognized and typically underpaid, this will focus mostly on those who are unpaid caregivers, those who are typically family members or loved ones.

It is estimated that within the last 12 months, 34 million caregivers have provided unpaid care to an adult age 50 or over. Approximately 15 million of these 34 million caregivers provide care for someone with Alzheimer’s or another form of dementia.

As with my mother’s sentiment expressed in the opening statement, most caregivers are female. However, in my medical career that has included hundreds of home health visits, I have seen unparalleled care given to my patients by their sons, husbands and other male family members.

I told my mother I would have good daughters-in-law. So far, I have one who is stellar, and she is a nurse practitioner. So far, so good.

Caregiving is required for both physically and mentally disabled people. For many, their conditions continue to progress, making caregiving an increasingly harder task.

It is typical to see very little attention paid to the caregiver when the person receiving care is obviously in dire need. “Care for the caregiver” is a concept that is often overlooked, but is gaining ground in our society. There are support groups organized specifically for the needs of the caregiver, and to offer support for those who are also living their lives with their primary responsibility in taking care of a loved one.

In my home health and outpatient visits as a speech therapist in the rehabilitation setting, it is the norm—almost certain—that the patients will take advice from a therapist or other medical professional before they will take the same advice from their caregiver, which is most often the spouse. I assure the caregiving spouse that it is human nature for the person receiving care to take the same advice from a professional, but not from them.

It is a difficult position for the caregiver, but this assurance that the vast majority of people I work with demonstrate this is at least mildly comforting. To have their efforts and suggestions met with disagreement and sometimes disdain is disheartening for the caregiver, who typically goes above and beyond to take care of their loved one. So, to the caregivers who have experienced this, please know you are not alone, and this is typically—and unfortunately—the norm.

There are plenty of grateful people receiving care as well, and they need to be recognized, too. Keep up the good work!

To the person receiving care:

  • make a regular effort to say “thank you” to you loved one taking care of you

  • be specific in your praise: examples include “I appreciate how you always put lots of ice in my water as I like,” or “I know you sacrifice your needs for mine, and I appreciate that more than you know.”

  • Allow your caregiver time to do what they need to do. If your immediate needs are met and you are safe to be alone for a few hours, keep your promise to follow whatever rules are in place while they are gone, with the most important one likely being: no getting up alone.

  • If volunteer caregivers or paid caregiving is available as respite care for you while your loved one/caregiver is given time to meet their needs, allow this person a chance to prove themselves. Tell them you appreciate them, and tell them your life stories while they are there with you. You could likely entertain someone with your past experiences.

    • To the caregiver:

      • Don’t feel guilty or inadequate if you would like to have regular time to yourself, time off to take care of yourself. Just as in an airplane, you must put the oxygen mask on yourself before you can assist anyone else. If you aren’t able to meet your own needs, you will struggle to help someone else meet theirs.

      • Seek out potential respite care. Some support groups offer free/low cost caregiving as respite for you to take time off, which you have undoubtedly earned.

      • Ask your physician, senior center, area agency on aging, hospital/hospice or consult online sources for possible support groups or systems for your specific situation.

      • Online social media groups exist to support others like yourself through the internet. Check Facebook or do a Google search for online support.

      • Sometimes your most basic physical needs are neglected, especially sleep. Being well-rested can make the difference between darkness and light in one’s heart. Good nutrition and plenty of water are important, too. Don’t forget sunshine and fresh air.

      • Don’t be afraid to reach out to other family members, even—especially–your children—if it is their other parent you are taking care of. Often, other family members think they don’t need to offer help because you appear to have it all under control. They may think they wouldn’t know how to meet the needs of the person who needs care. Keep it simple, and assure them they could do it.

      • Simply saying “I need help” is not admitting a weakness. The same woman—my mother—who told me I needed a daughter (not necessarily true) also spoke these wise words: “Asking for help is a sign of strength, not weakness.” (Very true.)

      • To those close to the caregiver: Offer your help with caregiving. Offer to give them a few hours to themselves while you take over caregiving to give them a break. Assure them their loved one is in good hands, and make sure they are. Practice gratitude for the fact that you are able to help.

        Care for the caregiver. It is so very important. Make sure that if you are giving care, that you are indeed taking care of yourself.

Fall Prevention 101

There isn’t anything that can be said about this topic that hasn’t already been said; that you probably haven’t already heard—many times. There’s no new research, no new findings, just the same old stuff.

But it bears repeating, so it will be repeated right here. Right now. Again. It really cannot be said too much, because the numbers haven’t gone down. The statistics haven’t changed.
Approximately thirty-two thousand—that’s 32,000–people die each and every year in the United States alone as a result of falls. That’s 32,000 too many, because by and large, nearly all of them could be prevented.

Prevention. Such a nice word. It has a ring to it. It sounds positive, like something each and every one of us would eagerly practice if we were just shown how. It sounds like something we would all rush out and engage in, because we all believe in it. Except most of us don’t—engage in it, that is. Even though we believe in prevention.

It sounds like something that could shave off millions of dollars in medical costs to our society, mostly through Medicare.

The proof, however, is in the pudding. Most of us don’t follow the simple rules we are aware of, and we most likely don’t seek advice that we don’t already know about in order to keep from becoming a statistic. We tend, as humans are wont to do, to think we are invincible. “It won’t happen to me.”

And then it does. In any number of ways, it can happen to you. Here are some common and not-so-common ways that falls can occur:

  • slipping on ice
  • falling down stairs
  • falling up stairs.
  • missing the last step and plunging forward
  • falling due to alcohol indulgence or other drug effects
  • falling off a treadmill
  • falling in the bathtub or shower
  • tripping over a throw rug
  • tripping over a pet
  • tripping over oxygen tubing
  • tripping over clutter
  • dizziness caused by medications
  • getting up in the night to use the bathroom with no lights
  • getting up and experiencing balance problems
  • getting up and sleepwalking
  • rushing to get somewhere
  • failure to heed the advice from a medical professional to use one’s walker or other safety recommendations to ambulate.
    • In most of the above contexts, the fall takes place in the home, which is statistically where most falls occur. Specifically, the kitchen and bathroom are the two most common places where falls occur.

      All of us know what it means to fall, but it is officially defined as:
      “an unintentional event that results in a person coming to rest on the ground or another lower level.”

      There are three phases to a fall:
      1: an event that displaces the body’s center of mass beyond its base of support
      2: failure to maintain upright posture to correct this displacement
      3: the impact of the body on environmental surfaces

      The human body is amazing on so many levels. So many abilities are wondrous, and we typically take them for granted. The ability to keep our bodies upright—adult bodies are typically between five and six feet tall—on our feet, which are relatively small in comparison to the size of the rest of the body, can somehow support and balance the rest of our bodies to keep them upright. Not a small feat—pun intended.

      The most common injuries reported from falls are fractures, namely hip, wrist, arm and pelvis. Attempting to break a fall with one’s hands is a reflexive response while falling, thus accounting for the wrist and arm fractures.

      A potential serious effect is a head injury. Unlike fractures, head injuries typically don’t completely heal. Most people who experience head injuries are left with lingering deficits that may lessen over time, but don’t typically ever return to “normal.” In the most severe cases, the person bears little resemblance to the person they once were. Some family members and loved ones of such victims report: “The old person died, and a new one is here in their place.”

      Just in case this information isn’t sobering enough for you to practice prevention, here are more facts from the Centers for Disease Control (CDC) https://www.cdc.gov/homeandrecreationalsafety/falls/index.html :

      • One in four people over 65 fall each year, with less than half telling their doctor
      • Falling once doubles your chances of falling again
      • One in five falls causes a serious injury, such as a head injury or hip fracture
      • Three million people are treated in emergency departments for falls
      • 800,000 people are hospitalized each year because of a fall
      • 95% of hip fractures are caused by falls, mostly falling sideways
      • Falls are the most common cause of traumatic brain injury (TBI)
      • In 2015, Medicare/Medicaid paid for 78% of the $50 billion medical tab for falls
        • Being aware of the above factors and keeping them in mind will increase your chances of fall prevention. In addition, consider these tips:

          • do strength and balance exercises
          • have your eyes checked
          • add grab bars in shower or tub
          • add more lighting to your home
          • use the handrails on stairs for stability
          • make sure your winter shoes have adequate traction
          • consider purchasing crampons: covers for your shoe soles with short spikes for increased traction
          • believe that you are not invincible or immune, because none of us are
            • Being careful, mindful and aware of risks is the best advice for anyone and everyone, because anyone and everyone can experience a fall. They are more common in the 65+ population, but they can occur at any age.

              Fall is once again upon us, so let’s keep fall a positive word: fall in love with the beautiful fall colors, but please don’t fall down.

              Instead, simply slow down. It’s much easier to enjoy the beautiful fall colors that way.

Mother Knows Best

Apparently, it has reached epidemic proportions. I see it almost every day in my work, and now it is affecting my own family. My two sons, ages 18 and 21 are suffering the effects as well.

However, just like some of the patients I treat, they brought it on themselves.

I am talking about something that sounds so benign, but yet has so many possible negative side effects: eating too fast.

I am a medically-based speech language pathologist, a.k.a. speech therapist. My day job consists of treating adults with speech, language and swallowing deficits, usually due to a stroke or some other diagnosis, but sometimes the swallowing problems have no apparent diagnosis, no reason they should exist. Except that since I have been in business for over 20 years, I have it figured out: often, the swallow problem is caused by eating and swallowing too fast.

Choking is the most obvious risk, but other risks include poor digestion, stomach pains and pneumonia. The social aspect of frequent coughing and choking cannot be denied.

On my off-hours, I love to write. I love to share information that may make your life easier; your health better, which is why you hear from me every month. I try to keep it simple, relevant, readable and applicable to your life.

Chances are, if you are among the 95% of people in the general population–I have deduced –that eat too fast, then you likely have, or will have this problem down the road.

Let me save you a lot of future heartache, stomachache, coughing/choking, complaints of swallow problems to your doctor followed by possibly unnecessary evaluations, and perhaps weight gain or loss, and let me share some professional advice with you that I am offering for free.

Here is your free medical advice, with no strings attached, no risk of causing harm to anyone: slow down and take smaller bites and sips while you eat.

I wish I could distill this into a pill, offering it as a cure for so many swallow problems I encounter in my work. I wish it were as easy as popping a capsule, and voila! Problem solved! I wish it didn’t take any lifestyle changes on your part, because as a fellow human, I know how hard it is to change bad habits and replace them with good ones. Most of us are conditioned to believe that we need a pill to solve our problems. Maybe not so with this one.

First, let me make it abundantly clear: If you have a swallow problem that is preventing you from swallowing safely as evidenced by coughing, choking and/or difficulty getting food and/or liquids to go down, you need to consult your doctor. Your first strategy—after this move—should be to take a look at your swallow habits.

Do you eat too fast? Take large bites? Are you the first one done at most meals? Do people tell you that you eat too fast—even if you don’t want to hear it? These are all red flags and should be considered in light of your swallow difficulties.

I am in no way trying to take away from the legitimacy and seriousness of swallow problems caused by stroke, head injury, Alzheimer’s disease, Parkinsons’s disease and myriad other diagnoses that do cause medical swallow problems. There are many such diagnoses that cause swallow problems, and I have likely treated them in my 24 years of practice. They are very real and need to be medically addressed. Please, if you feel you are suffering swallow problems due to any of these issues, or perhaps another medical issue you are experiencing, see your doctor. He or she will refer you to a speech-language pathologist if necessary. Difficulty swallowing may indicate a deeper problem, and it should be medically addressed.

I encounter this habit in a considerable number of swallow patients that are referred to me. In the absence of any other cause, many times it can be attributed to the patient’s habit of eating too fast, and/or taking large bites. If they don’t first volunteer it, I often ask them this pointed question: “Do you think you eat too fast?” And in the majority of cases, their answer, sometimes delivered rather sheepishly, with the head down in a quiet voice, is “yes.” Most people are willing to admit it to me when they likely won’t acknowledge it with a family member who points it out.

So, I am asking you to simply think about it. Like so many other habits we possess, we don’t know we possess them. We are not aware of our patterns of behavior, even though they may be glaringly obvious to others. Just think about it.

**

My two sons, my husband and I recently took a 3,100 mile road trip. It was mostly joy, but travel involves a lot of togetherness, and perhaps too much closeness. Inside a car together, many personal issues become family issues.

Such was the case with one of my sons. Being in a small, enclosed space like a car made it quite obvious that someone had an issue with gas. He explained that he typically has it most of the time, and has simply become used to it. His friends likely had, too. The three of us in the car with him, however, didn’t want to get used to it.

We discussed possible causes, covering potential causes such as food intolerance/allergies. He was not aware of any, nor was I as his mother.

At our next stop, we had a pizza lunch. It became apparent to me that he was eating too fast. I guess as his mother, I had become used to his rate of eating as well. I normally only worry about this when it causes choking. However, I knew of another young man with the same problem. A friend of mine was one of his teachers, and she complained of this to me. She gently explained to him this possibility. He observed himself objectively while eating, changed his patterns to slow down, and resolved the issue.

Long story short, my son did the same, and has had less of a problem. We were all thankful for the remainder of the trip, and since then as well.

My other son followed suit with his older brother, and was a champ in changing the same habit. After another pizza lunch—he ate nice and slow–he made this comment to me: “You mean my stomach can always feel this good after eating pizza?” As 6’4” 200-pound eighteen-year-old boy, he has seen his share of pizza meals.

This may seem too simple, too easy a fix for what appears to be a big problem. With a few small changes in your eating habits, however, you may be saved any more current swallow and digestive problems, and from more of the same problems later in your life.

As we age, most body functions slow down, including the swallow process for some people. If you spent your life eating quickly with no problem, it may just catch up with you later with age. I am just over 50 years old, and I can see this already. Coupled with the habit of eating quickly, this combination of advancing age and quick eating can cause problems.

Most people who maintained a busy work schedule did not have a long period of time for lunch. A prime example is teachers. I think they have, on the average, about 17 minutes to eat their lunch. Many years of eating lunch quickly is not easily undone after a teacher retires. Many other professions are the same way. Again, the first step is to take a step back and just look at your habits.

How does one go about changing this habit? Just slow down sounds too easy, but that is the goal. To accomplish this goal, I am offering the following strategies that I offer many patients—again, free of charge. They are all good bits of advice for anyone to follow, no matter what age or what swallow complaints you have.

  • Take bites that are about half the size your normal bite.
  • Put your spoon or fork down between bites. If it is finger food or a sandwich, do the same. Chew thoroughly and slowly. Swallow, and swallow again if you feel the need. Only when that bite has fully cleared you mouth should you pick up your fork and take another bite.
  • This extended period of chewing produces more saliva. Saliva, which has a bad rap for being “gross,” is actually a wonder fluid. It is filled with digestive enzymes that aid digestion. It is the lubricant that helps food pass through the mouth, throat and esophagus. Without it, we’re stuck—literally. So the more saliva, the merrier.
  • Sit down for this one: place a small table mirror in front of yourself while you are eating, preferably alone or with those closest to us. Seeing ourselves eat as others see us eat can be incredibly eye-opening, and hard to swallow—pun intended. I recommend this to many patients, but I have yet to try it myself. It can be a rude awakening.
  • Take a 5-10 minute break before taking another helping. This short respite may just be enough time for your stomach to catch up to your willpower, convincing you that you really don’t need to eat any more.
  • Minimize distractions during eating. Try not to watch television and focus on how you are eating, at least for the period of time necessary for you to fully become aware of your eating patterns.
  • Speaking of TV, be aware of where your TV is placed if you do watch it while eating. Many televisions in this age are affixed onto the wall above eye level. This requires that you tilt your head back while eating and swallowing, which can invite swallow problems. Keeping your head straight or a bit tucked down is the safest way to swallow.
  • If you struggle swallowing pills, make sure you are taking them one-at-a-time. Consider taking them with a thicker liquid like tomato juice, as the increased weight of the liquid helps carry the pill down. Some people have good luck taking their pills with applesauce or pudding.

**

Again, please contact your health care provider with any swallow problems you have. The first medicine you should take for this problem, however, is to make sure you aren’t eating too fast—just like your mother told you not to. She always knows best.

And if your mother happens to be a speech-language pathologist who treats swallow problems, then you’d better really listen—just ask my children.

Stroked by the Sun

**Drink plenty of water before you go out.**

**Wear light-colored clothing.**

**Avoid the hottest afternoon hours outside.**

**Drink plenty of water while you are in the sun.**

**Make sure there is shade available.**

**Wear loose-fitting, breathable clothing.**

**Drink plenty of water after being in the sun.**

You have likely heard all this advice before regarding summer heat safety.  It may go in one ear and out the other, just like your mother saying, “eat your vegetables.”  You know it is important, but “it won’t happen to me…”

***

Heat stroke—also known as sun stroke–is real, and it is really dangerous.  It strikes those who are not prepared nor fit to be in the intense heat, and its effects may last throughout the rest of the affected person’s life.

In the most extreme cases, it can take one’s life.  This is serious business.

In the Midwest, winters are brutally cold, and summers are extremely hot.  The range of temperatures we experience from the climax of summer to the dead of winter are extreme.  We all know how important it is to protect ourselves from danger in the cold winter.  It is equally important to protect ourselves in the summer.

Most of us have our favorite seasons.  For many, those are spring or fall.  For some, however, the extreme cold and extreme heat are the most favored.   For those of us who find comfort in the heat, we may be drawn to the outdoors in the heat.  Call us crazy; I am including myself here.  I adore the heat, I crave it; I love the intensity.  I know how important it is to be careful.  I know that I need to drink lots of water before, during and after heat exposure.  I know when the most intense times of day are.  I know not to over-exert myself during those times.  I know to get the outdoor physical movement done such as yard care, gardening and exercising done in the early morning or early evening hours.

Still, I know I have to be careful.  I know I cannot be overconfident. I am not invincible; neither are you. We I have to remember the warning signs, including:

  • Hyperthermia:  body temperature of at least 105 degrees, in combination with disorientation and lack of sweating.  If the person is exerting themselves in the sun, it may be extreme sweating vs. lack of sweating.  This is NOT to be confused with an illness with a fever caused by other factors where extreme heat from the sun is not involved.
  • Before the heat stroke, signs of heat exhaustion are present, including:  dizziness, headaches, weakness and mental confusion.
  • Substances consumed before the heat stroke that increase risk include:  alcohol, caffeine and other stimulants, as well as certain medications.
    • Be aware, and take it easy in the sun.

      **

      Exertional heat stroke is caused by excess physical activity with insufficient cooling.  Athletes working out in the heat of the day, outdoor laborers, military personnel with heavy gear, or first responders such as fire fighters or EMTs are especially at risk.

      The elderly and the very young are at increased risk.  People at each end of these age extremes should be monitored closely when outdoors in the heat.  Chronically ill people also have a greater risk of developing symptoms.

      In the United States, approximately 600 people die each year from heat stroke.  Among those who survive, many report chronic and lingering symptoms long after the heat stroke is resolved.

      Heat stroke is also a risk for animals.  Pets and livestock can also succumb to the heat, so precautions should be taken to prevent overexposure to heat for animals, including NOT leaving them in the car alone in the heat.

      **

      Tragically, many helpless children die as a result of a parent leaving them in a hot car.  Most are small babies/children strapped in a car seat and forgotten.  Sadly, some are intentionally left in a hot car while a parent runs and errand or tends to some other personal activity, lacking the knowledge that the car will indeed become too hot for the child.  Additionally, there are reported cases of children climbing into a parked, unlocked car and succumbing to the heat.

      Awareness of this risk is crucial.  It is recommended that if your routine does not include dropping your child off, and your child is in the back, place a valuable item that you will remember to take inside—your phone or a purse—next to the child so that they will not be forgotten.

      **

      Treatment should ALWAYS involve alerting Emergency Medical Services (EMS) immediately.  While waiting for help to arrive, taking measures to cool the person is important, including:

      • moving the affected person to a cooler area
      • remove clothing to aid cooling
      • applying cold compresses or towels or bathing them in cold water.  Wrapping them in wet towels could delay cooling, as it may act as insulation.
      • immersion in cool water or a cool shower is considered the best treatment in general, but care must be taken if the person in unconscious or barely responsive.  This may take the efforts of several people, with care taken to hold the person’s head above the water.

      **

      Perhaps the term “cool” has a positive connotation in our language because of the importance of staying cool physically.  Being “cool” is apparently a good thing to be—especially in the summer heat.

      STAY COOL.

The Skin You’re In

It can be dry.  It can be smooth.  It can be dark.  It can be light.  It can be pale.  It can be calloused or blotchy.  It can be freckled or scarred.  It can be tattooed or sunburned.   It can be considered the container for the human body.

No matter what it looks or feels like, it is always this:  the largest organ of the human body.

Summertime is sun time.  Most of us expose much more skin in the summertime than in the winter, mostly for comfort and coolness, but also for sun tanning.

In American culture, tanned skin is generally seen as a positive thing.  It hasn’t always been this way, however, especially for women.  In earlier days, this was seen as less than feminine, and it was not desirable for women.

A sun tan, while often looked at as a sign of health, is actually a sign of already-damaged skin.

The term “redneck” has its origins in sun tanned/burned skin.  An outdoor manual laborer was typically wearing a t-shirt, which created a sunburn on the back of the neck.  Thus, a “redneck.”

******

With the increased sun exposure in the summer, skin care safety becomes increasingly important.

We have all heard it before:

  • wear sunscreen
  • wear a hat
  • wear long sleeves and pants
  • wear lip balm with sunscreen in it
  • stay out of the sun during peak hours, if possible (10:00 a.m. to 2:00 p.m.)
  • re-apply sunscreen frequently
  • put sunscreen in out-of-the way places, like the tops of your ears
  • drink lots of water when you are in the sun
    • At the risk of sounding like a broken record—or your mother, or both, it bears repeating:  all of these tips are important to prevent sunburn and/or permanent skin damage.

      When my son was about four years old, we not only put sunscreen on him, we told him what it was.  To him, however, it was “skin scream,” which is exactly what your skin will do if you don’t use it.

      *****

      There are several acronyms commonly used with sunscreen:

      • SPF:  Sun Protection Factor
      • UVA:  Ultraviolet A rays
      • UVB:  Ultraviolet B rays

      Both UVA and UVB rays damage the skin, with continuing research to bear that out.  Both penetrate the atmosphere and play an important role in premature aging of the skin, damage to the eyes and skin cancers.  They also reduce your immune system strength.  Most sunscreen labels spell out the coverage for each kind of ray, but broad spectrum on the label means it covers both.

      While using sunscreen, there are several important factors to keep in mind:

      • The lower the number, the less protection offered.
      • Experts recommend using nothing lower than 30.  The numbers may be misleading as the claims that they let you stay in the sun for a certain amount of time can be hard to measure.  So, a safe bet is to use a number at 30 or higher.
      • Re-apply often.  Every 2 hours is recommended.
      • No sunscreen is water-proof or sweat-proof; thus, the recommendations to re-apply after 2 hours.
      • Babies younger than six months should be kept out of the sun.  The use of sunscreen is not recommended for them due to potential skin reactions.
      • It is increasingly being disproven that “most” skin damage is done at an early age, as was once thought.   It is a cumulative effect, much like smoking.  The sooner you change the negative habit, the more good it will do you.
      • Clouds block only about 20% of damaging rays, so sunscreen is necessary on cloudy days too.
      • Darker-skinned people are at risk as well, and often, their cancers go undiagnosed or ignored because of the idea that they are not at risk.
      • Light-skinned and light-haired people are, of course, at high risk.

      *****

      Summertime, of course, is peak season for sun exposure.  However, sun exposure in other seasons should not be ignored.  Spring, fall and winter bring on their own breed of sun exposure, depending upon the activity.

      • Snow sports create a need for sunscreen on exposed areas like the face and lips.
      • Using sunscreen while traveling to unfamiliar climates should always be a rule.
      • Exposure through a car window to the arms can add up.  Be aware of this as you drive throughout the year.
      • Many facial moisturizers have sunscreen, and should be used daily, year-round.

      ****

      Many of us have an attitude of invincibility toward sun damage, and skin cancer may be the furthest thing from what we think is possible.  None of us, however, are exempt from the risk.  Be wise, and slather it on generously and frequently.Use sunscreen so that your skin doesn’t scream.

The Gift of Communication

Imagine being in a foreign country, all alone, and you don’t speak or understand the language.  The sense of isolation and frustration would likely overcome you.  You couldn’t meet your needs, nor could you connect with any other person there.

Like most of our abilities, communication is one we don’t think too much about.  We simply speak, listen, think, formulate a response and speak again.  It just happens.  We communicate, we interact; we connect.

Except when we don’t.

Sometimes, it’s not so easy to speak, listen, formulate a response or speak again.

Sometimes, any one or all of these abilities are impaired.  These amazing abilities of your amazing human body are not to be taken for granted, but often, they are.

I am guilty, too.  I take mine for granted.

**

Like every other ability, our amazing human bodies provide us with the capacity and power to engage our brains and muscles to create desired actions.  In turn, we achieve desired results.  In terms of communication, we engage.  We connect.  We express ourselves to other human beings.

Most of the time, we don’t even think about it.  If we couldn’t connect, we would feel isolated and alone, misunderstood—or not understood at all, and frustrated.

**

So let’s think about it.

Let’s consider for a moment that hundreds of muscles have to engage in perfect timing in order to speak a single word.  We have to breathe in, push that air back out and up through our vocal cords, on through our mouths, shape our mouths using our lips, tongue and jaws in order to create the sounds of our language.

Then, after we have spoken, we have to listen.

We have to engage our sense of hearing, pay attention, decode the sounds we hear and make sense out of them so that we can turn around and do it all over again with our response.

**

We recently celebrated Nurse’s Week.  They deserve more honor and respect than any of them will ever get. Hopefully, they are recognized for the amazing work they do.

The month of May also brings recognition to these very abilities we have just covered:  Better Speech and Hearing Month is observed every May.

Most of us don’t engage in behaviors that endanger any of these abilities, such as overuse of vocal cords by screaming, listening to loud music or NOT wearing ear protection when we are exposed to loud sounds.  Most of us know better, and we act accordingly.

Unless we don’t.

So, if you need to be reminded of those very things that your mother always told you to do—or not do, then I’m here to do it:

  • Don’t abuse your voice by straining it.
  • Don’t turn your music up too loud.
  • Use ear protection when you are using loud machinery such as a lawn mower.
  • Practice good oral hygiene in order to keep those sparkly whites sparkling.  You’ll need them not just for chewing, but for speaking effectively as well.
  • Brush your teeth.  You don’t have to floss all your teeth every day, just the ones you want to keep.
  • Drink enough water every day.  Whether or not your mother knew it, this is essential for good vocal cord health, as well as good overall health.
  • You have two ears and one mouth.  Listen twice as much as you talk.  Listening is more powerful than speaking.  We learn by listening.  We learn nothing by talking.
  • When you do talk, however, be sure to face your communication partner and make eye contact.  Ensuring that you have their attention can make the difference between effective communication and a missed message—and perhaps some hard feelings.
  • Be aware of background noise.  If you have music or the television in the background, this may distract from the other person’s ability to hear you.  Wind, traffic and any other external noise can be a factor as well.
  • Be aware of your communication partner’s hearing ability.  If they have difficulty hearing, you may need to adjust your volume accordingly.
  • Use those teeth you brush at least twice daily to chew your food slowly and thoroughly.  Your stomach will thank you.
  • If you are using earbuds/earphones, don’t turn up the volume too loud.  This sound is piped directly into your ears, and it can cause great damage if too loud.
  • In the right amounts, ear wax is a blessing.  It catches dirt and foreign materials—like bugs—before they can get into your ear.  And for the love of your mother, don’t stick a Q-tip or any other pointy swab into your ear.  If your ear is blocked with wax, let a medical professional deal with it.  Don’t risk injuring your eardrum with a swab.
    **

Imagine again being in that foreign country where you don’t speak or understand the language, and nobody there understands yours.  You would be totally disconnected from the human group.

Communication—speaking, listening, understanding and responding–allows us to be a part of the human group via this amazing connection.  Be grateful for it.  Be aware of the gift that it is.  Appreciate it and exercise it in socially appropriate ways while you have it.  Like all of our amazing abilities, it may not be there forever.

Giving—And Taking Care

A 76 year-old man and his 72 year-old wife who had a stroke.

A 41 year-old mother and her 15 year-old son who had a head injury.

A 22 year-old woman who recently graduated college and her 82 year-old grandmother with dementia.

A 71 year old-old woman and her 43 year-old daughter-in-law with Parkinson’s Disease.

A 59 year-old man and his 82 year-old mother who recently fell and fractured her hip.

***********

Caregiving is an important job, no matter who is providing the care, and who is receiving the care.  At some point in many people’s lives, there comes a time when a person needs help completing tasks such as bathing, dressing, moving from chair to bed, dispensing medications, cooking/eating and paying bills.

This need can arise from multiple causes, such as illness, injury, surgery, stroke, broken bones, and dementia.  Any of these—and many others—can render a person incapable of taking care of some or all of their needs, either temporarily or permanently.

Caregiving comes in many forms; comes in many different types of relationships and many different kinds of adults and disabled children.

 According to AARP, 43.5 million American adults provided unpaid care to a child or an adult with an illness or disability in 2017.   Of those, 34.2 million provided this care to an adult age 50 or older.

The majority—82%–care for one adult.  Fifteen percent care for two adults, and 3% care for three or more adults.

A significant percentage—15.7%–provide this care for someone with Alzheimer’s or some other form of dementia, including dementias caused by drug or alcohol abuse, multiple head blows or repeated strokes.

Unpaid caregiving, which is also called informal caregiving, is a job that is under-understood, under-appreciated, and under-compensated.  It is a necessary job, but not one recognized by our society for the value it provides.

Paid caregiving is recognized as a job, whether it is provided in a person’s home, or within a facility.  Unfortunately, for the work that is performed, it is often not compensated well enough to maintain a sufficient workforce, or quality of character of the caregiving employee.

Caregiving is a hard job, regardless of whether it is paid or not paid.  It can be part-time, or 24/7.  It can be temporary, or permanent.

Always, it is a necessary component of the world of work, but a more necessary component of humanity.  We all need each other at different times in our lives to make it through.

The high cost of caregiving is often measured in personal terms.  The caregiver, because our society doesn’t fully recognize the value of this service, does not receive a sufficient level of recognition or status in order for the value of this work to be felt by the caregiver. In addition, if caregiving is provided in the home, it is typically a job that isolates the caregiver from others, leaving them with no peers to interact with.

If the caregiver is a family member, and there are other family members who do not provide regular caregiving for their loved one in need, the level of work and commitment necessary on the part of the caregiver is often underestimated, and misunderstood by some of the other family members.  If they do not perform the regular caregiving tasks, they may not fully understand the depth and complexity of the tasks necessary to make it all work.

The routines, the appointments, the likes and dislikes, the triggers and the non-verbal messages are all important parts of the big picture, all parts of the process of understanding the needs of the person in care.

The redemption for the caregiver is this:  despite the hard work, the personal sacrifice, the pain and lack of attention to their own needs, the rewards are beyond description.  Having spent that time and effort to care for their loved one, the sure knowledge that they did all they could to help them through is the most rewarding payment available.  For most people who provide care, this is payment enough.

**

“I was so surprised.  They just showed up with a meal, with a crew of three that could outshine any professional service.  They cleaned my house, did the laundry, set my pills out for the next week, sorted the mail and baked cookies for me. 

Beth, a 71 year-old woman recovering from surgery in her home.  Her friends simply showed up to help her take care of these needs.  They didn’t ask her what she needed; they made a plan and carried it out.

Many people who need such help won’t ask for it.  And, when asked by well-meaning friends and family members “What can I do to help?” won’t ask for such specific needs to be met.  Which means, of course, that often times it is appropriate and most beneficial to anticipate their needs, and make a plan to fill them, just as these three above did.

This is also known as caregiving.  It is not a regularly scheduled commitment, but it is giving care to a person in need.  There are likely people in our lives who would benefit from such care, and simply showing up with a plan would very likely be a great gift for them.

Most caregivers are women.  Women are known to be more nurturing than men, but this is not always the case.  Many men provide tender, loving care to a spouse, parent or other loved one.

Most people who are providing regular care likely don’t attend to their own needs.  Often, a caregiver suffers psychologically or medically, as care giving is very taxing. If you know a person who provides regular care to another person, consider offering your time and effort to take care of the person in need to give the caregiver a break.

If you are the caregiver, it is important to recognize and realize your own limitations.  If your health—physical or otherwise—is being compromised, don’t be afraid to speak up in order to have your own needs met.  Care for the caregiver is an under-recognized need, and in order for you to continue to provide care, you must take care of yourself.  If you have accepted the role of caregiver, but know you simply are not capable of meeting the needs of your loved one, you must find an alternative form of care.  If you are not able to sleep due to the needs of someone else, or if you are not physically able to complete the tasks necessary such as transfers and bathing, then it is not in their best interests for you to continue, as much as you want it to be.  Seek out extra care, or perhaps placement in an assisted living or nursing facility.  As humans, we all have limitations, and it is important to recognize them.

Taking care and giving care are parts of life that most of us experience at one time or another.  Helping someone recover from an illness, injury or surgery is a gift that may one day give back to you.

Sometimes, too, the best care we can give is simply listening, and holding someone’s hand.

 

 

Re-New Year’s Resolution: Spring Restart

The first day of spring is upon us.  According to the calendar, the season is changing, and will soon herald the imminent arrival of green grass, tree leaves, and blossoms of all sorts.  It is a New Year for nature.  Winter is winding down, and although there could still be more snow here in the Midwest, the light at the end of the winter tunnel is shining bright.

Renewal is a good thing.  Nature depends upon it.  Every 365 days, Mother Nature starts over, and shows her stuff.  And it’s good stuff.

Perhaps the advent of spring would be the time to make resolutions, better, perhaps, than in the dead of winter.

If your New Year’s resolutions are a thing of the recent past, then consider a jump re-start.  Consider trying again.  Think about a second chance to make those resolutions stick—maybe a bit modified so that they will stay stuck.

**

The vast majority of New Year’s resolutions involve improving one’s health.  Among the most popular:

  • Lose weight
  • Exercise more
  • Stop smoking
  • Reduce stress
  • Get more sleep
  • Drink more water
    • If any of these sound familiar to you, then you are not alone.  Most of us have at least one area of our health that could stand to be improved.

      If, like the vast majority of the population who did indeed make resolutions, yours are already broken, then consider a renewal.  Chances are, though, if they didn’t work the first time, then they probably won’t work the second time around.

      So let’s try something different.  Let’s break it down into small, manageable bites.  The smaller the bite, the better.

      Let’s take the exercise resolution.  If your goal is to walk 30 minutes a day, and you are currently walking zero, let’s start with one.  Just one minute.  That may sound pointless, but it will build upon itself.  The next day, walk for two minutes.  The next day, three, and on and on.  Adding just one minute daily will make it seem less of an effort, but it will help you reach your goal.

      If you want to start with more than one, consider beginning with the day of the month:  if it is the 10th, then walk 10 minutes.  If it is the 17th, then walk 17 minutes.  You get the idea.  And every day, add one more minute to coincide with the day of the month.  Sounds simple and perhaps a bit silly, but having this external monitor, this accountability factor has helped many people succeed.

      And speaking of accountability:  having another person to buddy with is an incredible motivator.  If you commit to someone to meet them at the gym or the park at a certain time, you will be much less likely to forego your exercise.  If you have a willing buddy, but your schedules don’t mesh, consider a daily check-in by phone or text to hold each other accountable.

      The same can be done with weight loss.  If you are accountable to someone else to avoid, let’s say, bad carbs, and you know you must report to them as such, you will be better able to keep your resolution.

      If smoking is your bad habit to break, another smoker would likely understand more than someone who doesn’t smoke how hard it is.  However, if your goal is to reduce/eliminate cigarettes, and theirs is to commit to exercising, you can set up your plan accordingly.  The main idea is to have someone besides yourself to be accountable to.  Most of us humans are weaker when we are trying to do it alone.

      Drinking more water is perhaps a resolution that should be made more than it is.  The vast majority of us could stand to drink more water.  Set a goal, and add an ounce daily until you reach it.  Fill a measured pitcher daily with your set amount, and add to it daily.  Just be sure to drink it!

      Water can be boring to many people, and this may keep many of us from drinking enough.  Many of us substitute colas—both diet and regular—that have zero value for our bodies—less than zero, actually, as they can be quite harmful.  If sodas are your downfall, consider carbonated water.  If you drink pop in a can, find it in a can.  Same for a bottle.  Sometimes the carbonation is enough to provide the thrill, and it’s without all the chemicals.

      Our human brains are incredibly complex, but they can be easy to fool, too.  Simply holding a cold can and feeling the fizz—even though you consciously know it is not a soda—can be enough to satisfy the craving when you are trying to quit.

      If it’s sleep you need more of, your brain responds well to tricks there too.  Going to bed earlier, of course, is a no-brainer.  Adding to that, is the routine you normally go through.  If you shower, brush your teeth, climb into bed and read a book every night around 11:00, just do the same thing a bit earlier.  Your brain responds to these external cues, and tells your body it is time to shut down.

      The importance of reduced screen time at bedtime cannot be understated.  The light from screens of your television, computer, phone or other device emit light rays that are stronger than normal light, and alert your brain that it is time to stay awake, because it is so bright.  Our brains respond to daylight and night, and act accordingly in their sleep and wake cycles.  Soft light for reading is best, and complete darkness is best for sleep.  Screen light at bedtime keeps your brain stimulated longer than normal light, and your awake time increases.

      Increasingly, studies are showing the importance of adequate, quality sleep for good health in the short and long run.  Our culture may not reinforce this, but the joke is on our culture:  poor and inadequate sleep cause poor health, not to mention poor mood, reduced mental acuity, fatigue, and increased risk of accidents.

      **

      Bad habits are hard to break, and good ones are hard to start.  Many people however, have done both, and with the right tools, so can you.  Each of us has unique gifts and weaknesses, but as humans, the vast majority of us respond to these simple suggestions:

      1:  Take small steps toward a larger goal.

      2:  Consider an accountability buddy.

      3:  Recognize your patterns/habits, and make small adjustments to “trick” your brain into changing them.

      Good health is a gift, but it is our birthright as well.  We have more power to effect change in our health than we may think, but it does take thinking, followed by effort.  Change is hard, but changes toward good health are important.  You hold the power, so use it wisely.

      HAPPY SPRING, AND HAPPY RE-NEW YEAR!

Not Your Type

Imagine having to tell yourself to breathe in and breathe out, every single time.  Or, perhaps you had to pump your own heart.  Or, maybe you have to inject insulin into your body several times daily so that you can produce glucose, which is essentially fuel for every activity of your body.  And, if you didn’t fulfill these functions, you would certainly die.

The first two scenarios are absurd, of course.  Your body automatically does this rhythmically, all day, every day.  24/7, 365.  Your heart beats an average of 60 times per minute, and you breathe in and out without thinking about it around 20 times each minute.

You do, however, have to consciously eat good food to fuel your body.  Then, miraculously, your body takes that food, stores and uses the sugar to make everything work.  This happens with the indispensable help from the hormone insulin, which is the catalyst for energy production in your body.  Without it, you would have no energy for any activity, including your heartbeat.  It is to your body what gas is to your car.  As with any hormone, its job is that of a chemical messenger:  it tells other body processes to occur.

In Type One diabetes, the pancreas ceases to produce insulin.  This happens slowly, over a long period of time, until it reaches a breaking point.  When this point is reached, the person experiencing it typically begins to experience several of these many symptoms:

  • extreme thirst, even when drinking more fluids
  • more frequent urination
  • increased appetite, often accompanied by weight loss
  • fruity odor on the breath
  • drowsiness or lethargy, possibly stupor or unconsciousness
  • sudden vision changes

These symptoms should never be ignored, and are cause for immediate medical attention.

The previous name for Type One diabetes was Juvenile Diabetes, because its average onset age is 14, but ranges from early childhood through early adulthood.  It can, however, be diagnosed at any age.

PLEASE DO NOT IGNORE THESE SYMPTOMS.

Type One diabetes is known as an autoimmune disease, a disease that results when the immune system of the body recognizes the good cells as invaders, and begins to attack itself.  Its cause is unknown, but current research suggests a combination of genetic and environmental factors.

“I didn’t feel good for quite awhile.  I was tired all the time.  Then, I started to get real hungry, so I ate more, but I lost weight.  Then, I got thirsty and drank a lot more.  I went to the bathroom a lot more too.  One day, I realized I was having trouble seeing as good as I usually do, even with my glasses. I knew something was wrong.”        

–Lydia, age 17 and recently diagnosed with Type One diabetes.

Lydia’s daily routine will now consist of pricking her finger at least four times daily to measure her blood sugar, and injecting insulin into her leg, arm or stomach up to 4 times daily, depending on her blood sugar.  This will happen every day for the rest of her life.  She must replace the insulin her body no longer makes with injections, or she will not survive.  She did not cause this disease to occur by eating poorly, or by making any other unhealthy choices.  It simply happened.  While research is ongoing, there is no cure.

Other important information about Type One diabetes:

  • 1.25 million Americans live with it, including 200,000 people younger than 20.
  • One million adults live with Type One diabetes.
  • 40,000 people are diagnosed annually in the U.S.
  • Between 2001 and 2009, there was a 21% increase in prevalence (existing cases), and it is expected that there will be 5 million people in the U.S. with Type One diabetes by the year 2050.
  • $14 billion is lost annually in the U.S with related health-care costs and lost work income.

 

*There is no cure.

It is important not only to know the symptoms outlined above, but also to realize this:  it cannot be prevented.  It is not acquired by poor lifestyle choices, such as low activity and consuming unhealthy foods.

Type Two diabetes, however, is an entirely different diagnosis, and the distinctions between them are crucial:

  • In Type Two diabetes, insulin is made by the body, but not used properly.  It builds up in the bloodstream, thus causing high blood sugar.  It cannot get to the body’s cells in order to be used as it should be.
  • Lack of exercise and being overweight are the two most common causes, but not everyone falls into these categories.
  • There may be no symptoms before diagnosis.  Type Two diabetes is typically diagnoses in adulthood, but increasing numbers of children are being diagnosed with Type Two.
  • It can typically be prevented or delayed by eating the right foods—typically lower carbohydrates, exercising regularly and maintaining a healthy weight.
  • Type Two diabetes accounts for 90-95% of all diabetes diagnoses.

 

TYPE TWO DIABETES CAN TYPICALLY BE PREVENTED.

**

Being aware of the symptoms of Type One diabetes is crucial, and may be life-saving.  This awareness expedites the diagnosis, and the sooner the treatment begins, the better.  Without the treatment, life is threatened.  Continued vigilance is necessary throughout one’s life in order to maintain proper blood sugar levels.

Again, there is no cure, but research is ongoing.

**

Being aware that Type Two diabetes is generally preventable is crucial as well.  Healthy lifestyle choices and remaining active are the two most important factors in prevention of Type Two diabetes.  While certain factors may predispose some people to Type Two diabetes, it is manageable through diet, unlike Type One.

These predisposing factors include:

  • 45 years of age or older
    genetics
  • high blood pressure
  • as a woman, having had gestational diabetes during pregnancy, or giving birth to a baby weighing over 9 pounds.
  • certain ethnicities are at higher risk:  African-American, Alaska native, Native American, Asian American, Hispanic or Latino, or Pacific Islander-American.

**

“I really hate that I have Type One diabetes.  I will have it for the rest of my life.  I am learning how to live with it, and I am feeling stronger.  Many other people live with it, I can too.  My mom gave me a shirt that says: ‘PROUD OWNER OF A USELESS PANCREAS.’ I will make the best of it.      Lydia, quoted earlier regarding her diagnosis.

**

 

May neither Type One nor Type Two be your type.  If you are diagnosed, however, please know your life can be lived to its fullest, just as many people with diabetes continue to live theirs.

 

Good Health in Bad Weather

Ahh, spring and summer.  That glorious time when the sun basks us in its warmth and healing powers, all of nature is green, cold and flu season is over, the days are longer and we come out of our partial hibernation.

But it’s not yet spring or summer.  It is winter, and for better or worse, for love or hate of the cold, it is here.  The holidays are over, flu season is in full tilt, and as I write, the snow whips and swirls in the blizzard-force winds outside.  It is beautiful, but it is also cold.  The sun is breaking through, but the temperature is still below 20 degrees.

Baby, it’s cold outside.

And we may feel cold inside as well.

The holiday cheer has dissipated into a January routine, perhaps has left us with a few unwanted pounds and may have inadvertently left us with a case of the winter blahs as well.

Our resolutions may already be shattered, only a few weeks into the New Year.

But there is hope.  Knowing the seasons will change soon again may give us a boost.  Knowing the sun and the warm will be back may help.  Until then, however, we may need help to get back into a positive groove.

There is help.

There is hope, but there is also work to do.  Roll up your sleeves, and consider any or all of these suggestions to keep your health a priority in this New Year.

  • Enlist a friend to hold you accountable to any resolutions.  Having someone check on you to hold you to your word may be what you need to push you through.
  • Get enough sleep.  Our predecessors went to bed when it was dark, and got up when it was light.  We, too, may need a bit more sleep in the winter months.
  • Even if you don’t think you need it, drink water.  In the colder months, we may forget that our bodies need to be fully hydrated, even when we may not produce sweat.  A good guideline to strive for is this formula:  drink half of your body weight in ounces daily.  This is an ideal amount, so anything closer to it is progress.  Most of us don’t quite get there, but adding a bit more can only help.
  • Replace sodas or alcoholic drinks with seltzer water or flavored, carbonated water.  This may be all you need to trick your brain into believing you are partaking of the good stuff, when, in fact, it may really be good for you.  The carbonation and the cold may satisfy your craving.
  • Schedule your annual physical, dental exam or other examinations that are due every few years.  Get it on your calendar, and you are committed.
  • If you normally take a summer vacation, it’s not too early to start thinking about it, and perhaps making decisions.  Having this set gives you something to look forward, which can be a huge morale booster.
  • Many gyms or rec centers have winter sign-up specials to get your year off on the right foot.  Having an indoor facility to go to will take away the “it’s too cold to exercise outside, so I just won’t” excuse.
  • Getting an exercise buddy helps.  If you are accountable to each other to meet at a certain time, you will likely honor that, and continue to encourage each other to complete each workout, and come back for more.
  • Treat yourself—and take your buddy along—to a coffee date or lunch date at least once a week to reward yourselves.
  • DO NOT assume you are invincible on ice.  If you are still bound to get outside for any reason, respect the ice.  You are no match for it.  Stay indoors, and, if you have to miss just one or two appointments or exercise sessions, the loss is worth the risk.  Anytime you leave your home and there is even a slight bit of ice, be AWARE!  And, unfortunately, the older we get, the more our balance is compromised.  This is especially important on ice.
  • Consider online or television exercise videos.  PBS has some, as does Amazon and Amazon prime if you pay for the premium service already.  YouTube is another good source, simply log on and search for your desired activity (www.YouTube.com).  It’s always free with internet service.
  • Our hands can be dangerous carriers.  They pick up germs from places you may not realize, such as:
    • public pens, such as those at the bank—bring your own
    • restaurant condiment bottles
    • public restroom soap dispensers
    • our own cell phones/devices—clean them frequently

Our homes may not be a safe haven from germs.  Our family members may be sick, or may simply bring home germs from other places.  Be aware of all surfaces in your home that are frequently touched, including counters, remote controls, refrigerator door handles and all door handles.

Be sure to wash your hands frequently anywhere you are to reduce risk of transmission to yourself, or anyone else.

*The blues like to prey on us in cold weather.   The days are short, the sun is limited, and the weather may not be very friendly.   If you are prone to feeling down in the winter, be aware you are not alone.  If you can’t shake the winter blues, consider reaching out for professional help, or to a support group or a trusted friend.    It is a sign of strength to ask for help.


Very soon, spring will be springing.  The green will reappear, the days will get longer, the temperatures will rise, and the air will smell fresh.   Nature always makes this promise, and never fails to deliver.  Hang in there—winter is a part of the deal, and spring will be that much more sweet when it does arrive.

No matter what the season, be good to yourself.

Healthy Holiday Habits

“I can resist anything but temptation.”   –Oscar Wilde

Too much of a good thing is wonderful.”    –Mae West

It is time once again.  The holiday season is upon us; the time of year when the most delicious foods show up in the ads, in the stores, in the restaurants, in the office, at the parties, and on our table.

The time of year when we typically eat more than usual.

The time of year when exercise is most important, but given our busy-ness in preparing for the holidays, coupled with colder weather, we may not get out and move our bodies like we should.

The time of year when the foods are about twice as caloric as the normal foods we eat.

The time of year when eating is a social activity as much as it is an activity to sustain us.

And all of this is okay, all of this is expected.  The key lies in moderation.

All things, as the saying goes, in moderation.

**

You have most likely heard all this before.  There are no earth-shattering, magical tips that haven’t been tossed out there before.  Sometimes, however, re-reading something you already know, or seeing the same idea printed in different words can strike a chord within, and make it stick; make it make more sense.

Sometimes, taking a step back and realizing that you are not alone in your struggles can help.  If you were, none of these tips would have been printed anywhere.   Knowing nearly every other person celebrating the holidays struggles too can make you feel not so alone.

Sometimes, too, hearing it in a positive tone can give you the confidence to believe that you actually can resist temptation.

These tried-and-true ideas have been around for a long time, and they can be implemented according to your individual needs.  Take what works for you and tailor it to your needs and your weaknesses.

Remember:  you are not the only one struggling, and you CAN resist—unlike Oscar Wilde.  And, perhaps Mae West’s quote should not be applied to holiday food intake.

As with any attempts to change any habits, being aware of them is typically the best place to start.  So many of us indulge mindlessly, so take a moment to step back and increase your awareness:

  • Check to see if you are actually hungry.  Many of us simply eat because it is there.  Step back and think about it for a minute or two before you indulge.
  • Slow down.  You will eat less in the same amount of time if you simply reduce your rate of intake.  Put your spoon, fork, or finger food down between bites.  Thoroughly chew each bite, savor it in your mouth before you swallow it, and then swallow again.  After that, then you can decide if you need more.
  • Keep a food diary.  Sounds like a chore, but it may be the best eye-opener to make you realize just how much you are taking in.
  • Focus on eating, and nothing else.  Don’t watch TV, talk on the phone, read or engage in any other activity that may distract you from realizing how much or how quickly you are eating.
  • Just like your mother said, don’t talk with food in your mouth.  Most of us are guilty of this.  It’s gross, but somehow marginally socially acceptable.  This takes you awareness away from how much or how fast you are eating as well, and poses a higher choking risk.
  • Fill up on vegetables and other healthy snacks before you hit the higher calorie foods.  Better yet, bring a vegetable tray to the potluck, usually there aren’t too many of those.
  • Drink a large glass of water before you plan to eat.  This is not only good for you, but will help to fill you up so you eat less.
  • Speaking of drinking water, the recommended amount is half your body weight in ounces, with equal amounts added for what you consume in caffeinated beverages because they have a dehydrating effect.  This sounds like a lofty goal, and most of us have a long way to go to get there, but anything closer to this is progress.
  • Instead of high-calorie sugary and/or alcoholic drinks, consider seltzer water.  Either plain or flavored, the carbonation and possibly the taste just might trick your brain into thinking you are indulging in something forbidden when you are not.  It actually counts toward your recommended water intake.
  • Chew gum.  Suck on a mint.  If you are craving sweets, eat a pickle or something else bitter.  It should kill the craving.
  • Better yet, brush your teeth.  Pick up a few inexpensive, disposable toothbrushes with toothpaste already on them to make it easier to brush, and subsequently easier to resist.
  • Enlist the help of a friend.  Setting goals with someone adds the element of accountability.  It’s too easy to be accountable only to yourself, most of us cheat and tell ourselves little—or big—lies in order to get what we want.
  • This friend can also be your exercise buddy.  Knowing someone is depending on you to show up for a walk, run or yoga class can be the determining factor that actually makes you show up and do the work.
  • Don’t try to lose weight during this season, simply maintain your current weight.  That is quite possibly setting yourself up for failure.
  • If you have a picture of yourself from earlier days that motivates you to eat less and/or exercise more, by all means get it out and look at it frequently.
  • If you are eating in a restaurant, chances are your portions are much more than you actually need.  Ask for a to-go box when your food arrives, and pack up half right away.  You will be less likely to eat it all if it’s already boxed up, and you have another meal ready.
  • Watch your portion sizes at the table or the party buffet.  Taking just a little bit less of the heavy stuff can make a big difference.
  • If you overeat at one meal, don’t kick yourself.  Simply move on, and eat less at the next meal.

And now one you may not have heard…

  • There are apps for your cell phone and other devices that track calories.  If you use other apps, simply search and find, or better yet, ask a teenager for help.  There are many out there, and some will likely be better suited for you than others.

Above all, enjoy.  Eating is one of the greatest pleasures of life.  Just make sure you to do it in moderation.

Give it Up—Join the Great American Smokeout

Every year on the fourth Thursday of November, Americans gather with friends and family to partake of a Thanksgiving feast, and to celebrate family, fellowship and gratitude.  We can’t do it alone; celebrating Thanksgiving by oneself is not a great way to observe the day.

One week prior to that day, on the third Thursday of November, Americans who smoke are urged to gather—at least in spirit—with other smokers to try to give up smoking—at least for one day.  It is best not to try to do it alone; relying on support from others is often more successful than trying to quit alone.

The Great American Smokeout is sponsored by the American Cancer Society.  In 1970 in Randolph, Massachusetts, Arthur Mullaney asked people to give up cigarettes for a day, and donate the money they would have spent on cigarettes to a local high school scholarship fund.

Bear in mind that during this era, smoking was very common, and secondhand smoke was not seen as a violation of a non-smoker’s clean air.

The idea took off, and by the late 1970’s, it was an annual tradition.

Research and statistics prove that support is essential for quitting and maintaining a healthier lifestyle by staying away from smoking. We know that people experience greater success rates with their efforts when they have support from others in the forms of the following:

  • Encouragement, support and positive feedback from family and friends
  • Telephone hotlines dedicated to smoking cessation
  • support groups/online support groups

Other important recommendations include:

  • Nicotine replacement products
  • Prescription medicine to lessen cravings
  • Counseling
  • Alternative activities to promote health such as exercise groups to fill time and energy formerly devoted to smoking
  • Combining two or more of these activities increases success

Many non-smokers and former smokers use this day to promote awareness of the health risks of smoking, the social and hygiene liabilities, and to show smokers that there is life after smoking.   In addition, it is seen as a day of heightened awareness to further non-smoking causes such as more firm tobacco laws, decreased teenage smoking, increased tobacco taxes and improvement of non-smoker’s rights such as more widespread non-smoking areas in public facilities and places of business.

“My dad smoked in the house for my first 18 years.   None of us liked it, but in the 70’s, we didn’t know how bad it was.  Plus, he was the dad, and you didn’t question it. 

When I went to work in the school system, and kids would come to school smelling like cigarette smoke, I felt so bad for them.  Then, I realized I was one of those kids who smelled like cigarette smoke.

Dad had serious health issues when I was in my 20’s, and finally gave up smoking.  It is never too late.  I always worried he would develop lung cancer, but he didn’t.”

****************************************************

Many former smokers will tell you their senses of taste and smell improve after they quit.  When they smell it on others, it may even be repulsive, knowing they smelled like that for a long time.

Some former smokers will tell you they haven’t missed it once.  Others will tell you they want to smoke every day, and it is hardest when someone around them smokes.  It is an addiction for many, and addictions are sometimes something one must find a way to manage forever.

Nearly all of them will tell you they feel better, have more energy and have a better self-image when they quit smoking.

**

Simple, tried-and-true tips like the ones below are always important to try:

  • Finding replacement habits is known to help somewhat.  Keeping one’s hands busy with something is often a good strategy.  After years of holding a cigarette, the habit is still there, wanting to be fulfilled.  Holding a bottle of water is probably the best replacement.
  • Chewing gum or keeping breath mints is a good replacement for the oral sensation that is missed after one quits smoking.
  • Over-the counter nicotine replacement therapies are available, including gums, lozenges, sprays and patches.
  • Online resources and telephone hotlines can be found by an online search for groups like “Nicotine Anonymous.”
  • Finding what your strongest triggers are is an important step in beating the habit.  If you typically smoke when you get home from work, make alternate plans such as going out for afternoon tea, taking a walk, or calling a friend or family member.
  • Enlisting the help of a buddy who also needs to quit is a very good idea.  Being accountable to another person to change old habits or form new positive ones can make all the difference.  If you know someone else is depending on you, it may be the tipping point that keeps you going until this new pattern becomes an ingrained habit.  This works for exercising or other healthy lifestyle changes as well, including dieting.

**

Be nice to yourself when you are making this lifestyle change.  If it doesn’t work the first time, try trying again.  Be persistent.  Change takes time and sometimes multiple efforts.  It may be one step up and two steps back sometimes, but if you know in your heart of hearts that you can and should make this change, keep that foremost.  Keep telling yourself you can do it.  Many other people have made this change, and there is nothing different about you that would keep you from doing it too.

Go ahead.  Be a quitter.  You won’t regret it.

Kindness as Medicine

Your doctor is likely the central figure in your healthcare.  Along with his or her team of nurses and other medical staff, you are likely grateful for all of them for the care you receive.  You know you wouldn’t be as healthy as you are without them.


Your family, friends and perhaps spouse or partner are likely the central figures in your happiness.  Along with an extended family and perhaps an extended circle of friends, you are likely grateful to them for the companionship you receive.  You know you wouldn’t be as happy without them.

Time and again, multiple studies have borne out the important link between good health and strong social connections.  The more connected we are, the greater the chance we are healthy.  Married people live longer; this has been documented in many studies as well.

We all need each other.  We need our doctors and nurses.  We need our families and friends.  We need our children and our spouses or partners.  We even need those people out there we don’t know.  We depend on the rest of society to fill the needs we can’t fill ourselves, from farmers who grow our food to teachers who educate our children, from grocery store personnel to automakers.

Any of us who think we can make it on our own likely haven’t tried.

So what does this have to do with our health?  If we do it right, social interaction has a lot of benefits for us.

Humans are wired to be social.  We are supposed to be interdependent.  We are designed to have social relationships, and when we do, we are better for it.

None of us would be here without a relationship between our parents.  Then, as a baby, we were cared for by our parents.  Human infants are the most helpless of all creatures; we require the most care and nurturing of any species.   Cattle and horses are born standing up and ready to move.  They still need care, but all other species are much less dependent than humans when it comes to requiring care from other creatures in their species.

We need our families to teach us language and social skills.  We need our friends to show us we are loved by someone other than those who have known us since we were born.  Without this interaction, loneliness takes over.

As we age, we develop our own unique personalities and styles of interaction.  Ours are likely different from everyone else’s; that is what makes us unique.  It is what makes the world go round, as the saying goes.

With these differences can come conflict.  Realizing that our way is simply that:  our way, and others have their own way too is a crucial step to interacting in peace and harmony.  There’s no good guy, no bad guy, just differences.

Respecting these differences is crucial for our society.  We must get along with others whose opinions and styles of interacting may not hurt us, but may not please us either.

Let it be.


Kindness is a virtue. It is also a necessary part of human interaction.  Kindness is a force that benefits not only the recipient, but the giver as well.  Perhaps it benefits the giver on an even deeper level.

Consider the recent spate of natural disasters that have befallen our country:  Hurricanes, earthquakes and most recently, wildfires.  Thousands of people who were not directly affected volunteered their time, energy and money to help out those who were directly affected.  They gave unselfishly, and asked for nothing in return.  Most volunteers get what they want out of the volunteering situation:  a sense of satisfaction for having helped someone who was in need.  They feel fulfilled, and the victims feel the care and support they provided.

A recent interview with many of these volunteers produced a unified answer along those lines:  they volunteer because it makes them feel good.  They connect with those who are suffering, and both sides come out of it feeling better.

They needed each other.

More profoundly, the recent mass shooting in Las Vegas has highlighted the best of human interactions in the worst of times.  Multiple stories of strangers helping victims surfaced in the days after the tragedy.  These thousands of people who, only moments before the shooting, were unified only by their love of country music, came together to help each other in this horrific crisis. It was seemingly instinctual.  Some of them sacrificed their own safety to provide safety for others, some of them sacrificed their lives.

They needed each other.

Many of us will likely never provide that kind of life-saving assistance.  At least not on that level.

Every day, however, we all have the opportunity to provide kindness in our everyday interactions.  It can be the simplest of gestures, but it means more than we likely know.  Finding these opportunities doesn’t take much looking; it can be so very simple.  Consider these chances to make a difference:

  • Smiling at a stranger.
  • Holding the door for the person behind you.
  • Letting someone else go in line in front of you.
  • Bringing someone’s newspaper to their porch from the sidewalk.
  • Paying for someone’s meal in line behind you.
  • Sending a thank you note—on paper—in the mail for the last gift you received.
  • Sending a kind note for no particular reason.
  • Thanking a soldier in uniform for their services and sacrifices.
  • Babysitting your neighbors kids so they can have a few hours alone.
  • Delivering baked goods to someone who is struggling.
  • Sending a sympathy note to someone grieving, no matter how long ago it was.
  • Compliment a child on their manners in public so the parents can hear.
  • Visit a nursing home and ask to see someone who doesn’t get much company.
  • Bring your pet to that nursing home—with their permission.
  • Buy a cheap bouquet of flowers and take it to someone in the hospital.
  • Let that car creep in line in front of you in the traffic jam.

There are thousands more, just keep your eyes open for the opportunity.

If kindness were practiced in a very specific way, at least one time each day, by every person, the world would change–for the better.  We would be happier, and for the purposes of this post, healthier.  Happier people are healthier.

Start with you—today.  Share the kindness in small ways throughout your day.  You will feel a lift in your heart, and the world will be a tiny bit healthier for it.

Fall

“It’s not the fall that gets you, it’s the landing.”

Ahh, fall.  It’s almost that glorious season when the weather cools and the trees take on beautiful hues of orange, red and yellow.   But that’s not what we’re discussing here.  After the fall season comes winter, and that’s when outdoor falls rise precipitously.

Indoor falls in one’s home, however, are the leading cause of injury and loss of independence among those over 65.

Let’s just get the ugly facts out first, and then discuss it more:

  • 420,000 people worldwide die annually as a result of a fall.
  • 32,000 of those are in the United States.
  • Falls kill three times more people than guns in the U.S.
  • Falls are the leading cause of death by injury in those over 60.
  • The average hospitalization cost after a fall in 2012 was $34,000.

All of us have fallen at one time or another.  We trip, we slip on ice, we stumble on a throw rug, we sit up too fast and become lightheaded, we experience vertigo and simply fall to the floor or ground.   We miss a step, fall off the curb or fall in the shower.  We trip over a pet, or get up in the night and don’t turn on the light when we should.  The causes are many, the results are typically more narrow.

With age, the risk of a broken hip increases in direct proportion to advancing age.  One’s reflexes are slower, and the ability to break a fall with the hands decreases.  The younger the person, the greater chance the fall is broken by the hands.  This can lead to broken wrists, but this injury is typically less life-altering and shorter term than broken hips.

The risk of head injury is ever-present.  Striking one’s head on the way down on furniture or other objects, or striking it on the floor upon impact remains one of the greatest risks, and one of the top potential long-term injuries.

Other injuries are always possible.  Broken ribs, arms or legs are frequent results of a fall.  Extensive bruising is common as well.  Lacerations often happen on the way down, too.

The human body is a wonder of balance.  How an adult of five feet tall or greater can stand and balance on two feet that are relatively small in proportion to the rest of the body above it is truly an engineering wonder.  But it works—usually.

The inner ear is the center of balance.  When it is not functioning properly, one’s balance is affected, and the risk of falling increases.  Dizziness, vertigo and light-headedness can multiply a person’s risk of falling.  If you feel these symptoms, consult your healthcare practitioner.

Overindulgence in alcohol at any age can affect one’s balance:  moderation and caution are key.

The best treatment for a fall is prevention.  There are many simple things that can be done to decrease fall risk, including:

  • wearing shoes with good traction and low heels.
  • Arrange furniture to create clear pathways.
  • Avoid piling up extraneous objects—newspapers, books, boxes, etc—that may be in your path.
  • Choose a carpet pattern that highlights the edge of steps.
  • Use handrails whenever present.  If you do not have sufficient rails in your home or the entrances, have them installed.
  • Install grab bars in your shower if you don’t already have them, as well as traction sheets in the tub.
  • Place bright colored tape with traction strips on the steps.
  • When using a stepladder, make sure it is fully opened with both spreaders firmly locked.  Heed the warning on the top:  This is not a step!
  • Keep the paths well lit, especially at night when getting up.
  • Eliminate throw rugs.  If you must keep them, use double-stick tape or rubberized sheets on the bottom to secure them.
  • Learn to use recommended mobility aids such as a cane or walker. Listen to your doctor or physical therapist when they tell you to use them!
  • Furniture surfing” doesn’t take the place of a cane or walker.  Grabbing on to chairs and couches as you navigate your house is inviting risk.
  • Be sure the chair is squarely behind you before you sit down by placing both hands firmly on the armrests and lowering yourself slowly into the chair.
  • Ask for help when walking outside on ice.  Place crampons (spiked, rubberized webs that cover the shoe bottom) on your shoes for extra traction.
  • Be aware of pets that may be underfoot.
  • If you rely upon oxygen through a tube, be sure the tubing doesn’t become tangled in your feet.  Typically, there are many feet of tubing that lead to the tank, and they can become easily entangled.
  • Forget invincibility.   Falls can and do happen to anyone at any age.

**

Stay safe and be careful.   Enjoy the beautiful fall weather and resplendent colors in nature.  Keep fall a beautiful thing, not an accidental thing.

 

A Sense of the Senses

There is a single-sensory experience coming our way in a few days that has received international attention.  It is an experience that is truly a once-in-a-lifetime experience.

It is the total solar eclipse.

By the time you read this, it may be over; you will likely have already viewed it.

You looked at it with your eyes, hopefully with the recommended glasses.  You will likely never forget it.  Your visual memory of this spectacular event will last until the day you die.

All because you saw it with your own eyes.

Your eyes, your windows to the world.

**

If I could have chosen to be blind or deaf, I would have chosen to be blind, because if you are deaf, you are cut off from everyone else.”  Jeanne, author’s aunt, who was blinded at age 18 months in 1935 due to retinal blastoma—cancer of the retina.

 

“If you had to choose between being blind and being deaf, which would you choose?”  Author’s recollection of fourth-grade girls questions between each other.

I remember choosing deafness.  Vision, to a 10 year-old girl, seemed to be of paramount importance among the senses.

Brad, the author’s brother-in-law, disagrees.  Brad has been profoundly hearing-impaired since he was two when he was apparently deafened after a severe illness.  He compensates by reading lips, and staying in the game.  He doesn’t miss out on any family or social interactions.  He doesn’t let his hearing impairment keep him out of the game of life.  It is as if he has no handicap at all.

**

Most of us are fortunate to have all of our five senses intact.  We may wear glasses; there is a smaller chance that we may wear hearing aids.  Total blindness like with Jeanne, and almost-total deafness, as with Brad, is extremely rare.  Our sight and hearing likely serve our needs; they are both functional.

An even more remote possibility is that our sense of smell is impaired, or absent. (Known as anosmia.)  Among those who struggle with this loss, many report a sense of depression at the loss of the sense of smell.  Those of us who can smell—the vast majority—don’t realize how important the sense smell is to one’s quality of life.

Most of us have experienced a temporary loss of smell due to a cold or sinus infections.  Permanent loss of smell is typically caused by certain medications, diseases such as Parkinson’s Disease, Multiple Sclerosis and hormonal disturbances, head trauma, cocaine use, nasal polyps, head/neck radiation, and old age.

A loss of smell not attributed to a cold or other temporary condition warrants a medical examination.

**

Our skin is the largest organ of our body.  Essentially, it is the container for our bodies.  Its receptors provide us with the sense of touch.  We can tell the difference between hot and cold, rough and smooth; deep and light pressure.  Multiple medically-based research projects have established the need for human touch in order to flourish as humans.  Its healing powers are not to be taken lightly.

When our skin is burned by the sun or other means, when it is cut or scraped or otherwise injured, the sense of touch can be a liability if it causes pain.  This pain, however, is an alerting system to let us know our bodies may be in danger.

Taking care of our skin is likely something we don’t think about much.  However, the basics are most important here:

  • Use sunscreen when out in the sun.
  • Keep lotion on your skin if it appears dry, especially in the winter.
  • Drink plenty of water, it makes the difference between healthy skin, and dry, irritated skin.
  • Be aware of any changes in a wart, mole or sore, or note the appearance of new ones.  Get regular checkups from a dermatologist, or have your provider examine your skin regularly.

**

When our sense of smell is affected, our sense of taste likely is too, as they are closely related.  When this sense returns to normal, we realize what a gift it is.

Eating delicious food is a great pleasure of life.  For many older people, this gift is the last remaining pleasure when most other abilities are affected.  As we age, the taste buds tend to decline in their strength, with the sweet taste bud persisting long after the others have dulled their ability to taste.

This explains why many older people will eat primarily sweets, and little else.  If you are a caregiver for such a loved one, a trick to enhance their other food is to simply sprinkle a bit of sugar over their plate, given they are not diabetic, or otherwise averse to sugar.

People with swallowing problems often require their food to be pureed into a smooth texture.  This alteration requires that liquid is added to blend the solids, which may change the taste a bit, but mostly changes the texture.   Those of us who eat regular foods don’t realize the great pleasure of texture in what we eat.

In addition, this changes the sight of food, which likely decreases the pleasurable aspect as well.

  • The crunch of potato chips.
  • The feeling of the small balls of tapioca in our mouths when we eat the pudding.
  • Sinking our teeth into a big, juicy steak.
  • Crunching an apple.

These pleasures are often taken for granted, but enhance the great pleasure that eating provides us.

Eating slowly, savoring each bite by putting your spoon/fork or sandwich down between bites is sage advice for all of us, as we tend to eat too fast and not enjoy our food as much as we possibly could.  The pleasure is there for our taking, if we simply take our time and enjoy it.

**

We all know the danger in exposing our ears to loud noises.  Taking precautions with loud machinery such as a lawnmower or a power saw is important.  Ear protection was not always in vogue, nor was it recommended in the last half-century with the advent of power tools and machinery.  It certainly is recognized and encouraged now.

If you or your children listen to music through ear buds with a personal listening device, it is important to keep the volume at an acceptable level.  This direct onslaught of sound into your ears must be monitored to avoid ear damage.

If you are a parent, your children may need your encouragement to realize this.

**

When the temperature drops during the total solar eclipse on August 21st, you may feel the drop in temperature on your skin, thus through your sense of touch.  Your vision, however, is the primary sense that will allow you to experience this once-in-a-lifetime event.

If you are blessed with good vision, take a moment to offer gratitude for this amazing sense.   When everyone is oohing and aahing, your sense of hearing will enhance this experience.

When you eat your next meal, enjoy the smells, the taste and the feel of the food in your mouth.

Our five senses are truly gifts—treat them as such.

Heat Stroke: Summer Sun Sensibility

“I used to be able to work all day in the summer heat.  During harvest, I gave it my all in the hundred degree-plus temperatures, and I felt great, just a little tired at the end of the day.   Then, about ten years ago, I had a heat stroke.  I overdid it, and now I cannot tolerate the heat.  After it hits about 85 degrees, I can’t stand it.  I haven’t been able to tolerate it since.”

                                                                             —Stuart, 62 year-old farmer

Heat stroke takes a toll now, and later.  It is a brutal attack on the body, and the body may never be able to tolerate heat again, just as Stuart said above.   Just as the winter cold can cause permanent damage through frostbite, the summer heat can wreak havoc on the rest of your life.  For a small percentage of those who experience heatstroke, they will never know, because they don’t live through it.

The most heartbreaking cases of heat stroke—also known as sun stroke—are those cases when small children or babies are left in a hot car and forgotten—until it is too late.  Between 1998 and 2011, at least 500 children in the Unites States died while trapped in a hot car.  Seventy-five percent of these children were two years old or under.

In more recent years, there have been media campaigns to increase awareness of this horrific situation, which typically occurs when the parent deviates from their normal routine, and forgets that the child is in the back.  Perhaps the parent/caregiver typically doesn’t take the child to day care, but did on this particular day.  This is typically unintentional, and the ensuing heartbreak may or may not result in legal action against the parent/caregiver.

Some of these cases are due to a parent/caregiver assuming that it is safe to leave a child for a short period of time in the car.

It is NEVER safe to leave a child in a car alone.  EVER.

When the outside temperature is 70 degrees Fahrenheit, it can quickly exceed 120 degrees if it is parked in direct sunlight.

Another highly publicized situation that has captured more recent media attention is the plight of athletes practicing in high temperatures.

This extreme exertion, coupled with lack of proper fluid intake can be a recipe for disaster.  When heavy clothing and padding is added—such as the case with football players—this trifecta can and does prove deadly.

As with the recent campaigns to keep children out of hot cars, there has been increased media attention paid to this tragic—and preventable–aspect of sports practices and games.

**

Heat stroke is defined as hyperthermia with a body temperature greater than 105.1 degrees as a result of environmental heat exposure, as opposed to a fever due to illness.   Lack of relief and regulation from this heat also plays a role, as when not enough fluids are consumed, and relief is not provided in the form of removal of extra layers of clothing or equipment, such as in the case of football players with padding, and firefighters with heavy gear.    It is not to be confused with a cerebral stroke involving a blockage or hemorrhage in the brain.  Rather, it is called a “stroke” due to the sudden outcome, such as when one is struck by an object.

**

Common sense plays a big role in prevention of these and every other kind of heat stroke.

  • Find a new way to alert yourself to a child who is typically not in your care and needs to be dropped off.  Put your cell phone or purse next to the car seat so that these will be reminders.
  • As always, but especially if you are outdoors in the heat, drink plenty of water.
  • If it feels too hot, and you don’t have to be in it, don’t go outdoors.
  • If your child is an athlete, advocate for a change in practice times, duration, or other changes that will make it safer for the athlete.

**

More specifically, the following measures should be employed as prevention:

  • Drink fluids often, and especially before you are thirsty.
  • Monitoring the color of urine.  Dark yellow may indicate dehydration.
  • Wear lightweight, light-colored clothing.  Loose-fitting clothing and hats, both with ventilation to allow the body to cool naturally are best.
  • Block out sun and other heat sources.
  • Avoid beverages containing alcohol and caffeine.
  • Know signs and symptoms of heat-related illnesses.

**

The early signs of heat-related illness include:

  • dizziness
  • mental confusion
  • headaches
  • weakness
  • young children may have seizures

 

As the heat-related illness progresses into heat stroke, the following symptoms are more common:

  • 105.1 degree or above body temperature
  • throbbing headache
  • red, hot and dry skin.
  • nausea and vomiting
  • rapid, shallow breathing.
  • muscle weakness or cramps
  • lack of sweating
  • unconsciousness

All the above symptoms require immediate medical attention, summon emergency help and proceed with the following treatment to lower the body temperature as soon as possible:

  • move the affected person to a cooler area, if possible
  • remove clothing
  • bathe person in cold water or apply cold compresses
  • if person is unconscious, great care and extra help must be taken if immersed in water

**

The summer heat is heavily upon us.  Knowing the risks and ensuring adequate levels of hydration for yourself are vitally important.  If you are a caregiver for a child or a person who cannot monitor this for themselves, it is imperative that you monitor them as well.

Following your instincts and common sense is a necessity in the heat, just as it is in the cold weather.

Against previous, commonly-held notions, heat stroke does not typically come and go without leaving its mark.  As noted in the opening quote, its effects can and will likely linger long after the acute symptoms have resolved.  For an extremely small percentage, it can be fatal.  It is a small percentage, but keep in mind it can indeed be fatal.

**

Summer is here for some time, and will continue to deliver its hot blow every summer after this one.  Summer can be safely and sensibly enjoyed.  Just don’t forget to pay attention to the signs of heat stroke.

Better yet, pay closer attention to prevention.

Foodborne Illness

“We had about 350 guests at our wedding.  It was a beautiful day in late May, and we had a full roast beef dinner with all the trimmings served in the evening.  A great time was had by all, and then we took off the next day for our honeymoon in Mexico.  These were pre-social media and cell phone days, so we had no idea…

When we returned home, we found out that about three-fourths of our guests became ill with vomiting and diarrhea from foodborne illness within the next few days.  It was short-lived and bearable for them, but, of course, they all wondered if we were sick.  Montezuma’s revenge is always a danger too in Mexico, so our dear friends and family were concerned for our gastro-intestinal welfare while we were honeymooning. 

Perhaps it was the greatest wedding gift of all, but we didn’t get sick after the wedding.  We still feel terrible that so many of our guests did.”

**

Even though America’s food supply is among the safest in the world, there are still approximately 48,000 cases of foodborne illness annually.  This equates to one in 6 Americans experiencing such illness each year, which result in 128,000 hospitalizations, and approximately 3,000 deaths.

Summer is peak season for foodborne illness.  There are two reasons:

  1. Outdoor cooking activities increase, especially camping.  Such activities do not typically provide the safety controls that a kitchen provides—especially thermostat controlled cooking, refrigeration and washing.  Then, the food is presented and consumed outdoors in the higher summer temperatures
  2. Bacteria grow faster in warmer temperatures.

Outdoor barbecues and potlucks typically involve food sitting out in the heat.  Measures can be taken to control the temperature even when sitting out, but greater care and vigilance must be exercised in order to do so.

When eating at an outdoor potluck or barbecue, be aware of the temperatures of perishable food, and what their ideal temperature should be if you were eating them indoors when they were freshly prepared.

Ideally, perishable food temperatures between 40 and 140 degrees should be avoided.  Hot food should be kept hotter than 140 degrees, and cold food should be kept colder than 40 degrees.

Refrigeration decreases the multiplication of bacteria, and freezing further slows, or even stops this growth.  However, when food is thawed, the bacteria can become active again.  Thoroughly cooking food kills the bacteria.

**

The good news is that most healthy people have immune systems that can fight off any bad effects of food that is compromised.  Just as our immune systems do their best to fight off viruses and other illnesses, so too do they fight food-borne illnesses.  Therefore, people seldom get sick from them.

There are certain groups of people who are more at risk for food-borne illness, including:

  • infants and children
  • pregnant women and the fetus
  • older adults
  • people with weakened immune systems

Not only are these groups more at risk, they are also more likely to demonstrate more severe symptoms and complications.

**

The most common symptoms of food-borne illness include:

  • vomiting
  • diarrhea
  • abdominal pain
  • fever
  • chills

These symptoms may range from mild to severe, and can last from a few hours to a few days.

If any of the following symptoms are present, a healthcare provider should be consulted immediately:

Signs of dehydration, including:  excessive thirst, infrequent urination, dark colored urine, lethargy, dizziness or faintness.

In infants or young children, this may include:  dry mouth and tongue, lack of tears when crying, no wet diapers for 3 hours or more, high fever, unusually cranky or drowsy behavior, sunken eyes, cheeks or soft spot on the skull.

Another sign of dehydration in people of any age is when their skin does not flatten back to normal right away after being gently pinched and released.

  • prolonged vomiting that prevents keeping liquids down
  • diarrhea for more than 2 days in adults or more than 24 hours in children
  • severe pain in the abdomen or rectum
  • a fever higher than 101 degrees
  • stools containing blood or pus/black and tarry stools
  • nervous symptom symptoms, including:  headache, tingling or numbness of the skin, blurred vision, weakness, dizziness, paralysis
  • Signs of Hemolytic Uremic Syndrome (HUS), an extremely rare disease that mostly affects children younger than 10 years of age.

Most symptoms are temporary, but the most severe that require medical attention can cause lifelong, chronic health problems, so it is best to get immediate help.

**

As with any illness, prevention is always the best medicine.  Properly cleaning, handling, cooking and storing foods are the best strategies:

  • Keep cold foods cold and hot foods hot.  Refrigerators should be set at 40 degrees or lower; freezers at 0 degrees.
  • Perishable foods left at room temperature for more than two hours are at greater risk.
  • Wash all fruits before eating.
  • Fruits should be cleaned on the outer skin before they are being cut, even if the skin is not being eaten.  Dragging a clean knife through a watermelon can introduce all manner of germs from the outer rind into the edible flesh.
  • Scrub firm-skin vegetables with a brush under running water before cooking or eating raw.
  • Separate raw meats from other foods to avoid cross-contamination from the juices and residue.
  • Wash hands before and after handling foods.
  • Wash utensils and surfaces before and after food preparation in hot, soapy water.

**

As with any illness, being aware of the symptoms and when to seek medical attention is important.

This summer, when enjoying outdoor cooking and dining, keep these precautions in mind.  Again, prevention is the best medicine.

**

Luckily, most of us can fend off foodborne illnesses with our healthy immune systems.  If we succumb, they are typically not severe, but be aware of the symptoms listed that require medical attention.

Most minor cases don’t last long, and are a mild illness.  The marriage described at the beginning, however, has lasted 23 years—so far.

Better Hearing and Speech Month

You have likely engaged in multiple conversations today. You spoke, your communication partner spoke, you spoke back, they spoke back, and on it went. You expressed yourself with speech, they listened. They expressed themselves with speech, you listened with your amazing hearing ability. Back and forth it went, and you likely didn’t give it a second thought.

**

Like most of our abilities, communication is a phenomenal process. It is a two-way street, with information going in, and information going out.

The receptive aspect of communication consists of all modes of taking in information—including reading and other visual skills, but this post will focus on the ability to hear.

The expressive aspect of communication consists of all modes of putting out information—including writing and gesturing, but this post will focus on the ability to speak.

**

As I write, my 17 year-old son is engaging in one his favorite hobbies: target practice. He fires, and he fires again. On and on, and every time I hear the loud gun, I am taken aback for a moment. It is loud and clear in my ears even inside the house, so for him, that sound is magnified.

My brothers used to fire away just like he is doing. It is a time-honored interest among many teenage boys. In 2017, however, there is one big difference: my son wears ear protection. My brothers didn’t.

Neither did my dad, who was exposed to loud machinery as a farmer, back in the pre-cab days. He paid the price with decreased hearing as he aged.

Neither did my husband, who was exposed to loud equipment as a builder for the last 30 years. He now wears ear protection, but he is paying the price for all those times he didn’t.

**

Forty million is a large number. When it represents a group of people, it is a considerable segment of a population. In America, it represents the number of people who experience a communication deficit, either with expression through speech or reception through hearing.

Most of us simply open our mouths, and the words come out effortlessly. Our brains have already processed what we want to say, and the process is in motion. The end product is our speech.

The beginning is typically in response to our communication partner’s expression, or as a beginning of a conversation. It typically continues to be an exchange, a give-and-take, allowing each half of the conversation to express their ideas, hear the other person, and respond accordingly.

All this seems effortless—until it isn’t.

Those 40 million Americans have difficulty in speaking or hearing—or both. It is not effortless for them. In response to this struggle for a significant part of our population, the American Speech-Language Hearing Association (ASHA), designates the month of May as Better Hearing and Speech Month. In this effort to increase awareness of communication deficits and to help preserve them in others, a campaign is launched to bring attention to communication, both for those who struggle, as well as those who do not.

Making the general population aware of the many ways that communication can be preserved, or improved upon if it is deficient, are the goals of this campaign.

And there are many.

As the previous examples illustrate, protecting our hearing is of paramount importance. It wasn’t always, but the passage of time has taught many valuable lessons for people like my father the farmer and my husband the builder.

Another considerable professional group is musicians: the industry has come to realize the damage done to professional musicians hearing ability, specifically those who perform loud concerts. They, too, wear hearing protection now, not then.

Loud music can harm anyone’s ears as a listener; this cannot be ignored. As I type, I am listening to my favorite music on my tablet through headphones. I do enjoy it to a nice loud level, but I try to practice what I preach and keep it at a safe level. When I exercise, I wear ear buds to listen to my iPod. I keep the volume at a safe level then as well. This intensively directed music into one’s ears can cause even more damage, since it is so strongly concentrated directly into the ears.

“Listen to your buds.” This is the name of the ASHA campaign that is aimed specifically at children to increase their awareness of the need to keep the music at an acceptable level when listening through headphones or earbuds when using personal listening devices.

For more information regarding this campaign, see www.asha.org/buds.

**

Technology continues to move fast, and texting on cell phones has become a preferred mode of communication. I have likely sent scores of messages today, you probably have too. Speaking into the phone to use the talk-to-text function is a capability that was unheard of even ten years ago; speech recognition is no longer exclusively a human function.

I don’t understand it, I just use it. But I do try to appreciate it.

**

As mentioned above, there are ways to preserve or improve our communication. And, in honor of Better Hearing and Speech Month, here are some general ideas to improve communication, both expressive and receptive:

  • Be aware of your communication partner’s hearing status–especially with the elderly. Speaking a bit louder, slowing down and facing anyone who has trouble hearing can make the difference between understanding and NOT understanding.
  • Monitor your volume as you speak. Perhaps you are too loud, or maybe too soft. Don’t hesitate to ask your communication partner if your volume is appropriate for your interaction.
  • Speak to and respond to children as they develop their speech.
  • Discourage children from over-using their voices, such as yelling on the playground.
  • Drink plenty of water. It keeps the vocal cords supple and in good working order.
  • As mentioned earlier, protect your ears! Use ear protection when necessary.
  • Be aware of background noises when communicating: music, conversations between others, television sounds, traffic, wind, fans household noises and any other source that may interfere with others hearing your speech.
  • Understand that if a person has difficulty expressing themselves with speech, it does not necessarily mean they cannot understand you. This assumption is a travesty against those who are fully intact in their ability to understand, but suffer deficits in their expression due to a stroke, brain injury or brain cancer, some progressive diseases and other causes as well.

**

For further information about Better Hearing and Speech Month, go to the American Speech-Language Hearing website at www.asha.org. If you are interested in finding out more about how communication disorders can be addressed by a licensed speech-language pathologist and/or audiologist, consult this website as well.

Affordable Care Act: Then and Now

On health care reform, the American people are too often offered two extremes—government-run health care with higher taxes, or letting the insurance companies operate without rules. I believe both of these extremes are wrong.” –Barack Obama, one week prior to Election Day ’08.

From its earliest beginnings through the present, the Affordable Care Act, commonly referred to as “Obamacare,” has experienced a noteworthy journey.

As a new president, Obama’s first step toward a new and revised national health insurance plan was the convening of a health summit between doctors, insurance companies, drug companies, consumer advocates and lawmakers.

“The status quo is the one option that is not on the table,” said President Obama. Clearly, the winds of change had begun to blow.

From its earliest beginnings through present day, here is a condensed history of the Affordable Care Act:

    • MARCH 2009: President Obama appoints our very own Kansas governor, Kathleen Sebelius, who has shown that she is willing to take on the insurance industry, as head of Health and Human Services. She also heads the White House Office for Health Reform.
    • JULY 2009: Democrats in the House reveal their 1,000 page plan for health care overhaul. President Obama’s ally and House Speaker Nancy Pelosi states: “When I take this bill to the floor, it will win.” The various committees of the House begin voting on provisions and closely examining the details.
    • AUGUST 2009: Many lawmakers return to their home states to find much concern and worry over “Obamacare.”
      “Americans are shell-shocked by the many changes in the first eight months in Obama’s administration,” one lawmaker states.
    • NOVEMBER 7th 2009: By a 220-215 vote, the House approves its version of health care reform. Only one Republican voted in favor.
    • DECEMBER 24th, 2009: Majority agreement in both chambers of Congress, with the Senate approving its overhauled version in a 60-39 vote.
    • JANUARY 2010: In President Obama’s first State of the Union address, he assures Americans that the health care overhaul will “protect every American from the worst practices of the insurance industry.”
    • FEBRUARY 2010: President Obama calls a bipartisan health care meeting for both Democrat and Republican leaders, stating “the Democratic and Republican approaches to health care have more in common than most people think.” Also, Anthem Blue Cross of California informs many of their members that their premiums will increase by 39%. As the White House and Congress investigate this announcement, Democrats increase their resolve to bring about positive change.
    • MARCH 21ST 2010: The House okays the Senate’s plan in a 219-212 vote. All Republicans voted against it.
    • MARCH 23RD 2010: President Obama signs the Affordable Care Act into law. “We did not fear our future. We changed it.” Millions of uninsured Americans will now be insured through the insurance marketplace—called exchanges—and Medicaid coverage is expanded.
    • SPRING 2010: Kansas’ own Kathleen Sebelius is appointed to the newly created office to build the insurance exchanges as a function of the Health and Human Services department she manages.
    • JUNE 2010: The first major provisions of the Affordable Care Act go into effect. Adults with pre-existing conditions can join temporary high-risk pools.
    • JULY 2010: Healthcare.gov launches. The enrollment function is not yet added.
    • SEPTEMBER 23RD, 2010: More provisions go in to effect:
      *dependent children can remain on their parent’s policies until age 26
      *no lifetime limits on coverage
      *no pre-existing exclusions for those under age 19
      *insurers are barred from requiring co-payments for preventive care and
      vaccinations.
    • JANUARY/FEBRUARY 2011: The Centers for Medicare and Medicaid—CMS—take over responsibility for building the insurance marketplace.
    • SEPTEMBER 2011: Health insurance companies must disclose any rate increase greater than 10% to the general public.
    • NOVEMBER 14TH 2011: The Supreme Court hears arguments against Obamacare brought by 26 states and the National Federation of Independent Business, arguing that some elements are unconstitutional.
    • JUNE 28TH, 2012: The Supreme Court upholds the constitutionality of
      the major provisions of the Affordable Care Act.
    • OCTOBER 1ST, 2013: Health Insurance Exchanges are scheduled to open, with the policies going into effect January 1st, 2014. The site crashes after a relatively small number of shoppers attempt to create accounts.
    • JANUARY 1ST, 2014: Most of the components of the Affordable Care Act go into effect, including:
      *prohibition of denial of coverage to adults with pre-existing conditions
      *large employers are required to provide coverage to those who work at
      least 30 hours/week
      *small businesses that provide coverage are given tax breaks
    • NOVEMBER 2016: Donald Trump is elected president, with a major campaign promise to “repeal and replace” the Affordable Care Act.
    • MARCH 2017: “Obamacare is the law of the land,” says a defeated and disappointed Paul Ryan. GOP leaders failed to win over Republican conservatives and moderates, and they accept defeat of their proposed American Health Care Act. The Affordable Care Act lives on.

**

With an eye to the future, the following provisions are set to become part of the Affordable Care Act:

    • JANUARY 2018: All existing health insurance plans must cover preventive care and checkups without copays.
    • JANUARY 2020: The Medicare Part D donut hole coverage gap will be phased out.

From its beginnings with President Obama’s early presidency through the present and likely the future, the Affordable Care Act is now widely regarded as the most sweeping health care reform in decades, and appears to be here to stay.

Those Shoes are Made for Walking

My grandma started walking when she was 85.  She’s 92 now, and we don’t know where she is.”

Spring is springing.  The birds are starting to sing, the trees and flowers are waking up, and winter will soon be behind us once again.

It’s time to get outside.  Time to enjoy the fresh spring air, feel the sunshine again, and take in the nature outdoors.  Move your body.  Take a walk.  Take many walks.

If you are already a regular walker for exercise, give yourself a pat on the back.  This is the simplest form of exercise, and the most natural.  Our bodies are designed to move. Our legs are designed to move our bodies from one place to another by walking.   By design, we are supposed to walk.  Keep walking.

If you engage in some other form of regular exercise, you too, deserve a pat on the back.  Whatever that form of exercise is, however, consider adding a walk to it.

If you do not regularly exercise, then this is written for you.  Please consider becoming a walker.  Just think about it.

It is widely recognized in the medical community that exercise in general is a wonder drug.  It the most reliable preventive treatment for obesity, high blood pressure, depression and anxiety, heart health and helps in preventing virtually every disease.  If its benefits could be bottled and sold, it would fly off the shelves.

So why don’t more people engage in walking and other forms of exercise?  Because it is the path of most resistance, and humans want the past of least resistance.  Because it takes time and energy.  Because it takes changing habits.  All the above are hard, and humans, in general, want easy.

**

Walking is the most natural, most basic, simplest form of exercise.  It doesn’t take any special equipment, except for a sturdy, well-cushioned pair of shoes, which you may already have.  It doesn’t take any special training, and it doesn’t take a gym or a membership to one.  There are no machines you must learn to use.  There are no special talents you must possess.

If you are fortunate enough to have good health that allows you to walk, then there are no reasons for not moving your legs.  Among the many reasons given by many people for not engaging in a simple form of exercises are the following:

  • “I’m tired.”
  • “I’m too busy.”
  • “I don’t feel like it.”
  • “I’m waiting for the motivation to come.”

For the purposes of this article, none of the above stated reasons will be considered legitimate reasons, and will be countered by the following:

  • “Regular exercise/walking will give you energy.”
  • “People make time for what is important to them.  Take a look at how you spend your time.  If you are in front of the television for a few hours every day, then this is important to you.”
  • “Even those who exercise regularly don’t always feel like it.  The feeling sometimes comes after you get started.”
  • “Motivation doesn’t just arrive.  The more you work toward something, the more you feel it coming.”

Special consideration is given to those with chronic pain conditions, as this is a delicate situation that is sometimes aggravated by exercise.  Working with an exercise professional who specializes in chronic pain may help to develop a plan to minimize the pain and maximize the benefits.  Discuss this option with your doctor, or conduct research online to find solutions that other people with chronic pain have discovered.

**

Taking those first steps are often the hardest.  Before the first steps, however, you must make the decision to become a walker.  It starts in the mind.  Beginning with a positive mindset, telling yourself that you can and will do this, and it will make you feel better.  If you tell yourself that it’s too hard, and it won’t do any good, then you are most likely defeated before you begin.

So think positive.  Not just about becoming a walker, but about everything you do.  It makes everything easier.

Now comes the action, and the following ideas are tried-and true:

  • Enlist the help of a walking buddy.  Committing to another person to show up at a certain place at a certain time makes you accountable to someone else, which tends to make people more responsible than when they are accountable only to themselves.  It’s very easy to cancel out on yourself; not so much with someone else.
  • Start small.  The thought of walking only ten minutes is much less daunting than the thought of walking half an hour.  You can increase slowly over time, or increase when the ten minutes are up, and you feel great and want to keep walking.
  • Find a picture in a magazine of person whose shape you would like to have.  Cut it out and put it on your bathroom mirror.  Better yet, if you have a picture of yourself from an earlier time when you were in a shape you want to return to, post that where you can look at it every day.
  • Consider the time of day when you feel best and most ready to exercise.  For some people this is early in the morning.  For others, it is in the evening.  For others still, it may be over their lunch hour.  Keep in mind that if you are a coffee drinker, recent studies-and personal testimonies—show that coffee may help physically motivate you to exercise.   So if you drink coffee in the morning, consider walking in the morning.
  • Walking to music is a tremendous motivator.  Choosing your own music and loading it onto an iPod or other small device is an easy way to plug in.  If you are not adept with such technology, ask a teenager or younger person.  Most of them know how to work such a device and are thrilled to help.
  • Take your dog for a walk.  They will never refuse a walk.  If you don’t have one, try to borrow one.  Their owner likely will thank you.

**

So now you are moving!  You are officially a walker, and it feels great—at least it does today.  But maybe not every day.  Keep going!  And remember not every day is going to be a great walk.  However, those days that feel the worst may produce the best results.  You may realize that on those “bad” walking days, you feel even better when you are done than you normally do.

Maybe the weather is bad.  Too hot or too cold.  Too windy, or too rainy.  Keep these ideas in mind:

  • Dress in thin layers, especially in the cold.  Removing the outer layer as you warm up keeps you comfortable.
  • Cotton traps moisture if you sweat.  Nylon fabrics help keep sweat away from your body.
  • Don’t be scared away by a light rain.  If it’s not too cold, and if there is no lightning, a walk in the rain with a lightweight raincoat can be extremely refreshing.    You won’t melt.
  • Avoid lightning and ice at all costs.  DO NOT brave these elements.  You will not win.
  • If you live in a rural area, windy days can be torture.  Consider asking a family member to drive you into the wind so that you can walk back with it at your back.  Or, since most cold winds are from the north or south, try to find an east/west path.  The wind at your side it better than the wind in your face.
  • Don’t be afraid of low temperatures, as long as the windchill is not a factor.  The cold can be extremely invigorating.

Walking is truly the simplest form of exercise.  You simply walk.  However, there are some ideas that may make it more effective:

  • Be aware of your posture.  Stand tall, spread your shoulders back and hold your head high.   Tuck your tailbone in.
  • Take longer strides.  You may need to remind yourself to stretch your legs out a bit more, because you have had your standard stride length all your life, and it is an ingrained habit.
  • The more you move your arms, the more they can help carry the rest of your body.  If you pump your arms while holding them higher, this can provide a more intense workout.

Safety should always be a paramount concern.  When walking outdoors, remember the following:

  • Be aware of your surroundings.  If a strange person or situation doesn’t feel right, trust your gut and walk the other way.
  • Take your cell phone along if possible, but only for emergencies.
  • Carry a small can of pepper spray.
  • Be aware of loose animals or wild animals.
  • Try not to walk on the street.  If you have to, face traffic and stay alert.
  • Don’t text and walk.
  • If the terrain is not smooth or unknown, be sure to visually examine the next few steps in front of you so to avoid any small holes or rocks, or anything else that may trip you up.  Look up every few moments to scan your route ahead, while still being mindful of the path at your feet.
  • If it is dusk or dark, wear reflective clothing, and take extra caution to stay away from traffic.  If it is light outside, wear brightly colored clothing.  Patterned clothing in bright colors is even better.

**

Many people truly want to get out to walk, but find it next to impossible due to family obligations.  Perhaps you have a baby or small child, or you are caring for a family member who needs constant attention.  These situations make it difficult to stay committed, but these situations also call for the stress relief and good health that walking can bring.  Consider finding another person whose needs are the same, and swap caregiving, if possible.  You can do double duty for them, and in return, they will do double duty for you.  If the weather allows, and the child is old enough, pushing a stroller during a walk adds to the benefits of exercise, and the child usually loves it.

**

The first steps will likely be the hardest.  Don’t think of it as a lifetime sentence.  Think of it as just for today.  The tomorrows will follow.   Just this once.  Just get out there.

Just start.

A Healthy State of Mind

“Never mind.”

“I don’t mind.”

“He’s lost his mind.”

“Mind your P’s and Q’s.”

“It blew my mind.”

We talk about our minds without realizing it. Our minds, which can be thought of as our own personal expression of our brain, are more powerful than we realize.

If we consider our brain—the most amazing, complex and mysterious organ in our body—as the computer hardware, then we can consider the mind the software. It tells the brain what to do, how to act, when to engage. You are the master programmer of your brain, you get to decide what to tell your brain.

And, consider this: essentially every other major organ can be transplanted from a donor—except the brain. Therefore, the mind has a giant responsibility toward this most amazing organ.

**

When we are driving through a school zone, the speed limit typically lowers 10 mph. This, of course, is to protect the children from speeding cars. This is, of course, a good idea. Without us—as drivers—realizing it, it brings our attention to the kids, right where it should be. It makes us mindful of the fact that kids aren’t always mindful before they act, and we need to exercise increased caution. Our focus zones in to where it should be: the children’s safety.

Having received a pricey speeding ticket in a school zone, however, I am here to say that this reduced speed limit announced with a flashing light makes us not only mindful of the children’s safety, it makes us mindful of just how much this would hurt our wallet if we were caught.

**

“I am so careful when I eat popcorn now, ever since I broke my tooth on a hard kernel.”

“I watch my step so carefully now so that I don’t twist my ankle again when I am walking in unfamiliar places, especially at night.”

“I count out a certain number of chips and then close the bag. I ate an entire bag once without realizing it until it was gone.”

“I didn’t realize how much extra walking I could get in if I simply parked at the far end of parking lots. Those little strolls add up.”

**

These are all examples of mindfulness, whether or not we realize it. We pay attention to certain things when they are called to our attention, either in a positive or a negative way. We remember things that impact us for better or worse.

We can put this ability to work in many other ways to improve our health, but it does take a little focus. In December, the topic of this post concerned the eating habits we typically engage in during the holidays. These “habits” are so ingrained, so much a part of who we are and what we do, so much so that we call them “traditions.” This is not a bad thing. We need traditions to anchor us in our lives, to remind us of what is important in our families and our social circles. It’s only harmful if it causes long-term health problems.

After the holidays, we return to our lives in their normal patterns. These patterns do not typically include as much eating as during the holidays, but we still maintain certain patterns, certain habits. And we really don’t even think about them. We just act. We eat breakfast, lunch and dinner like we always do. We exercise like we always do—or don’t. Perhaps yours are good habits/patterns, perhaps

they are not so much. Either way, they are uniquely yours, and you likely don’t even think about them.

But maybe you should.

Maybe we should take a few moments to think about exactly how much sugar that breakfast donut has. Perhaps we should pay attention to how much sugar we add to our morning coffee. While we’re on a roll, let’s count out how many potato chips we eat with a lunchtime sandwich. If it’s French fries, take a moment and reconsider the sure knowledge that a small order would be less fattening than a super-sized order.

If you are like the average American, you likely are in a hurry, and eating it quickly. Most of us do. It is another habit most of us engage in without thinking about it. We don’t think there is any other way.

“I can’t drink coffee without all the sugar.”

“I need the sugar in the donut and coffee to get me going for the day.”

“But I LIKE the supersize fries. I won’t get full if I eat a small order.”

“I am always in a hurry; I don’t have much time for lunch, and I have to eat fast.”

For a moment, just think about what it is exactly that goes into your mouth, how fast you are eating it and why you chose to eat it. If it is a habit, realize that if it is not a healthy one, you have the power to change it, starting with how you think about it.

It’s not easy. Habits are creatures that have a life of their own. Repeating the same action day after day ingrains it into our brains, and it becomes almost like a reflex. Much like cattle wear down a path as they walk over it time and time again, you are laying down a path in your brain when you repeat an action over and over. The cattle chose the path in the pasture that is easiest to traverse, the path around the obstacles; the path of least resistance.

Humans do the same thing. We choose the path in our brains that takes the least effort. The human brain is wired to do just that. It wants the maximum output for the minimum input. This is a good thing, this allows us to develop skills and abilities that enrich our lives, and the lives of others by repetition. You are experiencing this when your dentist has to pull your tooth. He or she has likely pulled hundreds of teeth already in their career, and the “cattle trail” in the dentist’s brain is well-worn. This is a good thing for you when you are in their chair and your tooth is on its way out. You want that repetition in the dentist’s brain to serve you well, allowing for an easy extraction.

You are likely not a dentist, but you likely have skills you have honed from repetition. Again, this is a good thing; it is how the brain is supposed to work. However, it is easy to develop bad habits through repetition; the brain works the same way, good or bad.

So how does this affect your health? You make choices every day in what you eat, how much you eat and how quickly you eat it. You make choice to exercise or not, and how much, how frequently, and with what intensity. You have likely been doing the same things day after day, and you have a well-worn cattle trail in your brain. This trail may be a healthy one; if so, that’s fabulous. If not, then it’s time to re-think the habits. You have the power to make a new cattle trail in your brain. It is never too late to change.

Just think about it.

**

Our bodies are meant to move. We are designed to move our joints in order to move our bodies in simple and in complex ways. Our hips flex to move our legs, our thighs move to flex our knees in order to walk and/or run. Our shoulders flex to move our upper arms, our upper arms move our elbows in order to move our hands. It is a beautiful system, and if you are lucky enough to be able to use all your joints in a functional manner, then by all means you should. You should use them in functional ways, and if your daily routine does not include enough movement, then you should add more with exercise.

If you are not already exercising, the thought of it may not be pleasant. If you exercise regularly, then this habit is ingrained, and the rewards likely keep you doing it over and over again. Given enough regular exercise, the thought of not exercising typically doesn’t even enter the mind of the exerciser. The brain doesn’t give that option because the cattle trail is already worn well. If you ask a person who exercises regularly, they will likely tell you that NOT exercising is not an option in their minds. They have worn a path so well in their brains that they don’t even have to think about it, they just do it.

Back to the non-exerciser: Not exercising is a habit, and it too can be changed. It must start in the mind, you must start by telling your brain that regular exercise is possible and positive, and that you are capable of finding the time and energy to pull it off. Whatever it is–simple like a walk or complex like a gym workout—moving your body is always a good thing. Start small. Start slow. Just start. Start by telling yourself you can do it, and it is worth the pain. Tell yourself you have the time and the capability. Tell yourself this: “If I can just do this for a few weeks, it will become a habit—a good one.”

Just think about it.

The human brain is a powerful, awesome, mysterious and wondrous organ. You have more power than you might think to make it work even better than it already does. Just for today, focus on all decisions—large and small—that you make on a regular basis that affect your health. You may be surprised.

Just think about it.

Peace on this Earth

My monthly posts discuss a variety of health-related issues. Some discuss afflictions that affect many people, some discuss general health-care information and maintenance, some are informational, some discuss the nuts and bolts of healthcare funding and some discuss important factors such as stress. All of these posts are created to enrich your understanding of that particular aspect of health.

Fueling all these efforts to inform you about health care, however, is the deep desire that humans have to simply feel good, inside and out. In our bodies, minds and souls. That is the big idea. That is what we all want, whether it is for the long term, or a short term fix. We all simply want to enjoy the feeling of feeling good.

**

In light of these main ideas, I am going out on a limb, taking a departure from my normal posts to address, in first-person style, an issue that affects the well-being—and ultimately the health–of everyone in this country, even everyone on this planet. This issue, whether we realize it or not, does indeed affect our ability to feel good in our hearts and souls. We are all in this together, and once again, we have all been touched by yet another senseless mass shooting. This time it was a major airport in Florida.

I was scheduled to arrive at another nearby major airport in Florida the day before the shooting, but my trip was postponed. I was close to this tragedy in my heart, simply because I was supposed to be so close geographically. Because it could have been the airport I was going to, or any airport for that matter. It could have been me, or someone I love. One of my brothers is a captain for a passenger airline. It could be him someday, if the actual airplane becomes a weapon once again.

We shake our heads and wonder “When will the next one be?” “What makes people do such awful things?” “Where will the next mass shooting occur? “Who will be the next victims?” And perhaps the most difficult question of all, “Why?”

There are no answers to these questions, although we all wonder. I do, and I am certain you do too. For the vast majority of people, these heinous acts are not able to be understood. And this is a good thing. We don’t want to have the mental state that allows us to understand. We don’t want to be in these people’s minds.

Another question we all ask ourselves, if not others is this: “What can we do to keep this from happening again?” This is a tough question with no good answers, but there are a few answers worth considering. On a macro, societal level, we can remain aware. We can report any actions that are clearly questionable, or any statements made by others that suggest that this person is considering such an act of violence. Sometimes the person in question is a loved one. There are reports of parents expressing concern regarding the potential actions of their own children. As a parent myself, this must certainly be the most difficult kind of love to show for your own child. Not giving in to the denial that your child could indeed be capable of such an act is an admirable act of selflessness. It certainly must be difficult, but I commend any person who has reported such suspicions, possibly saving countless lives at the expense of the relationship they had with their child.

The same holds true for any other loved ones or acquaintances you may have suspicions about. Talk to someone else who knows them. Listen to your gut, your little voice. It is usually the voice of reason and intuition. If something about what that person said or did doesn’t feel right, it probably isn’t. Don’t ignore this feeling.

Remaining aware and not denying any obvious red flags are very important obligations we all have toward our families and society in general. Again, we are all in this together. There are likely countless such efforts made that have already thwarted outbursts and attacks that never made headlines simply because they didn’t happen—thanks to the vigilance and responsibility of people like you, normal citizens who spoke up when they had a concern.

**

So these ideas are all a given, we already knew these. Perhaps a gentle reminder didn’t hurt. Beyond the obvious precautions we can take on a larger, societal level, we can make other, smaller changes within.

Not having a window into the minds of the people who carry out these acts of terror and hatred, we can safely assume they are tortured by a complete lack of peace of mind.

We all want peace of mind. We all want to feel no anxiety or nervousness, fear or dread, delusion or lack of control. We medicate—either by ourselves or by prescription, alleviate by tuning out these thoughts and tuning in to TV or social media, or fabricate—we tell ourselves lies to ease the pain. We all suffer at least a little bit, at least sometimes. How much, and how we handle it makes all the difference.

We know our own suffering, but too often, we have no idea what someone else—even someone we think we know—is going through. They could be suffering from one or more of the Devastating Ds: death of a loved one, diagnosis, divorce, depression or disaster. They may be our waitress, nurse, neighbor, seatmate on a plane. If their actions seem unkind or unwarranted, consider that they may be going through their own troubles we know nothing of. Perhaps their mother just died. Offer them kindness instead of hostility.

Getting out of our own minds and seeing through someone else’s perspective can be a difficult thing. Realizing that we are a tiny spoke in a great big wheel, a mere blade of grass in a giant yard is a difficult thing. Humans are egocentric beings, and we focus most often on ourselves. We want what we want for ourselves, even if it means that others may suffer in the process. Too often, however, we don’t know that our actions can hurt other people.

  • Taking a step back and asking how would I feel if they did/said this to me? is a positive step toward awareness of how we are perceived by others. How, perhaps, they may feel we have hurt them, even if we didn’t intend to.
  • Sometimes, our tone of voice implies so much more than we know.
  • Sometimes, the comments we make in jest can be taken the wrong way. Remember, humor is funny because of the truth that often lies beneath the message, and it can easily be taken for truth.
  • Sarcasm can also be mistaken for truth, because it, like humor, works because of the likely truth beneath the words.
  • If we are offended or hurt by someone, there is a good chance they had no intention of hurting you, they simply were taking care of their own needs, and happened to step on your toes in the process. Look at the situation again from this perspective, and let it go.
  • Do our words contain messages that may be even mildly offensive to someone’s ethnic heritage, religion, race, orientation, political views or other personal choices and/or characteristics?
  • If the conversation involves someone who is not present, ask yourself: “Would I still say this if they were here in front of me?”

**

Enough don’ts. Now, let’s think in positive terms and see what we can actively do to help bring about peace in our own minds, other’s minds and hopefully in the world.

Consider first the example of the butterfly effect. It is a metaphor to illustrate the point that very small actions can produce very large results. The butterfly example is used to illustrate the point in scientific terms, that even the smallest motion such as the movement of a butterfly’s wings in a far-off location can affect the development, course and strength of a hurricane hundreds, if not thousands of miles away.

The same could be true for small actions from you. They could have far-reaching effects that you would likely never be aware of.

It seems that kindness is a buzzword lately, and it’s a good word to be buzzing about. Being kind to just one person in one small way can set off a ripple effect that can bring about huge, positive results. You likely have your own small acts of kindness—random or otherwise—that you like to share, but below are a few that may or may not be in your repertoire:

  • Pay for the person behind you in line, whether it’s at the coffee shop, tollbooth, or movie theater.
  • Take flowers to a nursing home. The staff won’t have a problem finding a good recipient.
  • Bake some goodies at home and give them to neighbors. Leave some in the mailbox for the mail carrier.
  • Purchase a grocery gift card and hand it out to someone in the grocery store with many children in tow, or who otherwise looks like it would put it to good use.
  • Ask your electric, phone or utilities company who needs a little help with their bill and donate towards it.
  • Ask an independent mechanic if he has a customer who needs a donation toward their car repair bill.
  • If a loved one has recently received medical care, bring food to the doctor’s office/hospital nursing unit who provided care.
  • Give young parents the gift of time and offer to babysit for an evening out. Throw in a restaurant gift card if you see the need.
  • Compliment a stranger on their clothing or beautiful smile.
  • Thank strangers for something that may seem small, like a door they held open.
  • Smile at someone who cuts you off in traffic instead of cursing them.

May these kind acts and others you engage in create ripples you may never know of.

We are truly all in this together, whether we feel connected or not. Your kindness may make the difference in someone’s day, week, month or life. Your kindness may bring them peace of mind that may change their course, just like the butterfly’s wing flapping could theoretically change the course of a hurricane, a powerful, negative force. Their negative force could be changed into something positive with your one small action.

And you may never know, but you don’t need to know. Your acts of kindness will bring their own reward to you: peace of mind. Research bears this out, but we can feel it the minute we do it. And feeling good, my friend, starts in the mind.

HOLIDAY HABITS—AND BEYOND

“I can resist anything except temptation.” –Oscar Wilde

It’s that time of year again. The holidays are once again upon us, and the time of year is rich with tradition. Decorations go up, carolers go out, shoppers show up in stores and online, and delicious holiday food appears in the office, in the magazines, on television and on our holiday tables. Too often, it ends up accumulating in the wrong places on our bodies after the holidays are over.

Instead of condemning this too-frequent result, let’s take a look at its positive attributes.

Eating is a form of social bonding. When we share good food with family and friends, we are sharing something more: community. We come together as social beings to partake of delicious treats; some nutritious, others not.

This is a good thing. This is what memories are made of.

Our senses of taste and smell have more power to imprint memories on our brains than the other senses do. The tastes and smells of holiday food can quickly take us back to a place and a time, and usually these are good memories. It is one of the great pleasures of life to enjoy tasty food, and we should not take it for granted. We should simply enjoy, and be grateful for the joy it brings us.

We should, however, keep it in moderation.

**

But what exactly is moderation? How do we define it? That’s a tough question, and the answer is different for each person. A diabetic will have a drastically different answer than a person without diabetes will. A person with food allergies will have a much different answer than does a person without.

The best answer is, perhaps this: you just know. Our bodies—and our brains—have infinite wisdom surrounding those things that are good for us, and those which are not. However, too often we don’t listen. We override good judgment and common sense and listen to emotion, desires, cravings and feelings instead of reason.

But we know. Deep down, we know.

**

At this point in our adult lives, we have many, many holiday seasons under our belts—figuratively, and literally as well. Perhaps you are in your 30’s, 40’s, 50’s or beyond. That equals decades of holiday seasons, decades of behaving in a certain way at a certain time of year. It is tradition, yes, but traditions, at their most basic form, are habits. Patterns, if you will. And these patterns can rule our lives if we let them. We have engaged in them for so long, we no longer have to think about them. We simply know that when fudge shows up in the office, we eat it. We know that we will likely have a large plate of rich foods at the office holiday party, preceded by several drinks, and followed by several desserts.

We know that we will purchase and drink eggnog throughout the season. We know that we will bake Christmas cookies with the children and/or grandchildren, and we will eat both the dough and the cookies after they are baked. We know that the neighbor brings us homemade candy every year, and they know what we like. We know we will simply eat it.

We know all this so well that we don’t have to think about it anymore. It just happens. We are on automatic pilot when it comes to these treats. We just do it.

And this is not a bad thing. It is a tradition, and traditions are good things. However, moderation should perhaps be given its due if your wisdom and intuition tell you to slow down on how much you eat; how many cookies you consume; how many drinks you drink.

Just listen, for a moment, to that little voice that may be whispering to you to Please take only one cookie, I can’t handle any more than that. One drink is enough, thank you. I know the fudge is delectable, but one small square is better than three. Please stop picking at the dinner as you prepare it; you will be full by dinnertime.

Just make a conscious effort to listen for a bit.

Our brains are infinitely wise and wondrous organs. Yours will tell you what is right, how much is enough; when to stop. You simply need to listen. For most of us, however, this breaks with our tradition of eating to excess, eating until we are miserable. Our traditions typically involve neglecting or ignoring that little voice of wisdom, and partaking until we are past the point of feeling satisfied in a healthy way.

It is possible to do both: honor traditions, and enjoy yourself. Again, it takes a little moderation in the form of listening to our bodies instead of our emotions and impulses, and paying attention to what we know is best for us. We do all know this, but too often, it is overridden.

But how? What are some simple things to remember at the moment when indulgence seems imminent? That moment when we feel we simply must have another cookie, piece of candy/cake/pie or drink?

It is hard, but it is simple too.

  • Just stop. Take a little break. Walk away from the food. Give your brain a minute to do its job of reasoning with your emotions and impulses. Tell your impulses to just wait a minute, and then you will indulge them. Treat them like a small child, because that is how they behave. They want it now. They don’t yet have a voice of reason, so you have to be that voice. See what happens. Perhaps in that one minute, your powers of reason will override your powers of impulse. Just stop for a moment and see what happens.
  • As crazy as it sounds, talk to yourself. In your head, of course. Repeat some very simple, yet positive and powerful phrases like I am happy with a little bit. I can walk away. I am stronger than this. I don’t need more. Telling yourself these positive things will dramatically increase your chances of resistance. The voice of negativity says I can’t resist. This is so bad for me but I can’t help it. One more serving won’t matter. I am weak. Here I go again. I feel the pounds going on. Listening to that negative voice will only keep you on that road.
  • Go get a large glass of water, and spend a few moments drinking it. You likely need to drink more water anyway—especially at this time of year—and it fills you up, decreasing your cravings. Snacking on vegetables or fruit will have the same effect.
  • Take a moment and think of something—however small—you can do for someone else at that moment. Perhaps you could send a kind text to a friend or family member to let you know you are thinking of them. Perhaps you could go write that check to the charity you were considering. If you are not cooking, ask the cook if you can help them cook or clean up the kitchen.
  • Go outside. Look up, look down; look around. Breathe deeply. Take in the awe and wonder of our natural surroundings. If the weather permits, walk around the block, or even further if you can. If you can’t make it that far, just walk down the driveway and back. Anything to reset your impulses.
  • Find a mirror, and first find something you like about yourself. Maybe your eyes or your new haircut. Ask yourself if this indulgence will add to, or take away from your appearance.

**

First and foremost, and by all means, enjoy yourself. This is the season of glad tidings and joy, not negativity and guilt. Don’t beat yourself up over another indulgence. Simply pay a bit more attention to those patterns, those habits that you engage in without much conscious awareness. Just take a little look and decide if you can make a small change or two, or perhaps many small changes that will make a big change in the end.

These patterns, these habits we engage in without thinking create our overall behaviors. How we live our days is how we live our lives. Each moment of every day is a part of a larger picture. If you are happy with that picture, that is great. If you are not happy with that picture, start by making very small changes, like walking away from the indulgences.

No matter how you choose to live your days, make sure it is how you want to live your life.

Be mindful of your Holiday Habits.

Have a blessed, enjoyable, healthy and tasty holiday season.

 

An Attitude of Gratitude: Health and Happiness for Thanksgiving

The holiday season is upon us, with Thanksgiving arriving near the end of this month. This holiday brings no commercial expectations with it, other than the necessary expenditures for food at the grocery store for the feast most of us consume with our family and friends.

The spirit of Thanksgiving carries a deep and meaningful message. The first Thanksgiving was a celebration of abundance, freedom, good health, peace and goodwill. These gifts still abound today, albeit in different forms, different proportions, and sometimes, different disguises. Keeping your mind tuned in to them and keeping your eyes open to them can be challenging when so many of us experience lack, sadness, poor health and sometimes, a lack of peace within and with our families. Seeing only the negative sometimes seems to be easier than looking for the positive, but when you consciously focus on the positive—even the smallest things—a sense of peace and abundance can flourish.

It’s all a matter of perspective. It is our choice to decide what we want to focus on, and whatever we focus on seems to increase—positive or negative.

There are several books that were bestsellers that chronicle individual journeys made into a life of gratitude when the author’s life seemed to have no hope. In A Simple Act of Gratitude: How Learning to Say Thank You Changed My Life, the author, John Kralik, decided to send one thank-you note a day for a year. He had little hope for change in his personal and professional life, and felt he needed to make a change. This book, published by MJF books in 2013, describes how this simple act transformed his work, his outlook on life, his mood, his health and his view of the world.

In 29 Gifts: How a Month of Giving Change Your Life, author Cami Walker, a young woman in her 30’s with severe and painful multiple sclerosis decides to give 29 gifts—mostly small tokens or gestures—in 29 days, and finds her pain decreasing, and her health and happiness increasing. (Published in 2009 by Da Capo press.)

There are many other studies reported regarding the positive effects that gratitude can have upon one’s health and happiness, and are easily accessible and readable online:

  •  The Neuroscience of Why Gratitude Makes Us Healthier/huffingtonpost.com
  • 10 Reasons Why Gratitude is Healthy/huffingtonpost.com
  • In Praise of Gratitude/health.harvard.edu
  • Be Thankful: Science says gratitude is good for your health/today.com
  • Boost Your Health with a Dose of Gratitude/webmd.com

These, and many other articles can be viewed with an online search. There is no shortage of reporting the underestimated benefits of simply cultivating gratitude.

Some of you have likely discovered these benefits already, and kudos to you. Many of us, however, need a refresher course in the importance of something as simple as saying “thank you” more often, even if it is for what seems to be a simple thing. Perhaps someone took an extra bit of time to listen to your woes, someone picked up your child from school, or brought you a bouquet from their garden. There is no shortage of reasons to be grateful to other people, and letting them know with a simple “thank you” or a handwritten thank-you note will reinforce their kindness. Note-writing is a dying tradition, but it should never go out of style. It should, in fact, always be in style and important.

Adopting an attitude of gratitude also involves personal reflection and private expression. One effective way to remind yourself of how bountiful your life is, is to keep a written gratitude journal. Setting aside a few minutes at the end of each day, or at the beginning of the day to reflect on yesterday’s blessings and writing them down is a positive practice that allows you to reflect upon all your blessings, large and small.

Some days, these blessings are easy to think of and write down. The birth of a grandchild, the family gathering for a holiday, the means to buy a new car, a child graduating from college or a clean bill of health are all large and obvious blessings. Other days, you may have to dig a little deeper. A beautiful sunset, a good night’s sleep, a baby laughing, a car that runs or a delicious piece of pie may be overlooked because they seem to be an everyday thing. Even if they are, continue to offer thanks. Remember, that which you focus on expands.

**

Practicing healthful habits during the Thanksgiving holiday may take a little extra effort, but it is always worth it. Small actions taken together can produce big results.

  • Consider starting your Thanksgiving morning with a walk, weather permitting. If it’s a bit cold for your liking, bundle up and give thanks for the ability to walk. Reflecting on your blessings first thing in the morning while you burn up a few pre-feast calories is an excellent way to start the day.
  • Limit your samples as you cook, or while you are in the kitchen watching someone else cook. These can add up quickly.
  • If you are the dessert baker, consider cutting out 1/3 of the sugar in the recipe. Most pies, cakes and other desserts call for plenty of sugar, and reducing by this amount would not cause a noticeable difference.
  • Drink plenty of water throughout the day, especially a glass before the big meal. This will likely fill you up a bit and help you eat less. Small sips during the meal are best.
  • Take smaller bites. Try a half-full fork or spoon, instead of heaping.
  • Put that fork or spoon down between bites. Chew each bite longer, savoring it and allowing it more time in your mouth. The more you chew, the more saliva you produce, and the more digestive juices you swallow, thus helping digestion.
  • Drink small sips of water between bites instead of gulps. More water dilutes the digestive juices.
  • Be aware of the extra calories that alcoholic or other holiday beverages add to your total intake.
  • Take smaller servings to start, and delay the time you would normally take for refilling your plate. It takes time for your stomach to register that you are full.
  • Take larger servings of vegetables. If the space on your plate is taken up by the healthier foods, you won’t have as much room for the foods that are heavier.
  • When eating dessert, it can be hard to stop once you’ve started in on the sweets. Taking a bite of a pickle or an olive after a small serving of sweets can help kill the craving for more. The bitterness sometimes quells the sweet craving.
  • Allow whatever leftovers you will reasonably eat in the next few days, and pack them in the refrigerator. Sending home food with guests also gets it out of your way—and your mind. Much of the food from the holiday feast can easily be frozen. If you are a guest, take minimal portions home if the host/hostess wants to send some with you.
  • Brush your teeth as soon as you can after eating. Your fresh-tasting mouth may keep you from putting more food into it.
  • Get away from the food. Go for a walk after the meal—or after a nap! Encouraging other family members to join you is a great bonding time.
  • Don’t beat yourself up with guilt if you overeat. If there is one day of the year that overeating is expected, it is Thanksgiving.
  • If you go out to eat during the weekend after Thanksgiving—perhaps on Black Friday—consider splitting an entrée or dish with your dining partner. Or, ask for a box as soon as your plate arrives, and put half of it away right away. These tricks work for every meal out, no matter what time of year it is.

**

Above all, give thanks and enjoy. If some—or all of these—suggestions fail, consider it a once-a-year indulgence. The attitude of gratitude is certainly the most important practice to engage in.

Many Thanksgiving blessings to you and your family.

THINK PINK – Breast Cancer Awareness

Every October, the breast cancer awareness campaign brings a sea of pink ribbons into public view across the nation in order to increase awareness—and hopefully early detection—of breast cancer. Since the pink ribbon’s inception in the early 1990’s, early detection rates have increased, and death rates have decreased. Survivor stories abound, and tales of incredible strength and resilience offer hope and inspiration to women and men alike.

However, breast cancer remains a formidable threat to women, and even to a small percentage of men. According to the American Cancer Society (ACS) projections for 2016, about 246,000 new cases of invasive breast cancer will be diagnosed in women, and about 40,450 women will die from breast cancer this year. While rare, this disease does occur in men, but it is 100 times more common in women.

Second only to skin cancer, breast cancer is among the most common cancers among women. About one in every eight women will develop invasive breast cancer in their lifetime

The death rate from breast cancer has been decreasing since 1989, likely due to early detection, increased awareness and better treatments. The incidence—the number of new cases diagnosed annually—began decreasing in 2000. This decrease is thought to be due to a decrease in the use of hormone therapy after menopause. The results of the Women’s Health Initiative, which likely affected the continued use of hormone therapy, linked the use of hormone therapy to an increased risk of breast cancer and heart disease.

While it continues to be the second leading cause of cancer death to women—second to lung cancer—there are more than 2.8 million survivors of breast cancer in the United States today. There are reasons to be optimistic, as trends continue to show decreased incidence and increased survival rates.
October is designated as the month to heighten awareness of breast cancer, but this awareness should not be practiced only one month each year. Being aware of risk factors—both those that cannot be controlled and those that can—is an important first step in continuing to keep the diagnosis numbers down, and the survival rates up.

RISK FACTORS

There are many women who have many of the following risk factors, but never develop cancer. Other women, unfortunately, have no other risks besides being female and aging, yet they develop cancer. Those two factors cannot be avoided, neither can certain gene changes. Other factors that cannot be changed include:

Race/ethnicity: White women have a slightly greater risk of developing breast cancer than African-American women, but African-American women are more likely to die of it. Asian, Hispanic and Native American Women have a lower risk of developing and dying from breast cancer.

Having a personal history of breast cancer: If a woman has already had breast cancer in one breast, she has a greater risk of developing cancer in the other breast, or in another part of the same breast. This is not to be confused with recurrence, which is when the original cancer returns. The younger the woman with breast cancer, the greater this risk is.

Family History: An important statistic to note is that approximately eight of ten women who develop breast cancer have no family history of breast cancer. However, women with a blood relative who has had breast cancer do have a higher risk. Having a first-degree relative—mother, sister, daughter—with breast cancer doubles the risk. Having two first-degree relatives with breast cancer can increase the risk to three-fold. In the rare cases where a father or brother has had breast cancer, a higher risk exists.

Having dense breast tissue: breasts are made up of fatty tissue, fibrous tissue and glandular tissue. Having less fatty tissue than fibrous and glandular tissue as determined by a mammogram increases the risk from 1.2 to 2 times greater.

Starting menstruation before age 12, and going through menopause after age 55. Having had more menstrual cycles throughout a lifetime exposes a woman to more estrogen and progesterone.

Previous radiation to chest: women who had radiation to the chest for other cancers such as Hodgkin or non-Hodgkin lymphoma have a significantly higher risk.

There are lifestyle factors that can affect a woman’s chance of developing breast cancer,
including:

  • Having more than one drink per day
  • Being overweight or obese
  • Decreased physical activity
  • Having children—having a first child after age 30 or not having had children
  • Use of oral contraceptives or injectable shot
  • Hormone therapy after menopause

**

CARING FOR AND SUPPORTING A LOVED ONE WITH BREAST CANCER

There are no magic words or formulas to take away the physical or emotional pain of breast cancer for a loved one. If your wife, sister, mother, daughter, friend, or anyone you care about has breast cancer, your support and positive interaction can only help.

Knowing what to do to help can be challenging. Most women hesitate to ask for help, nor will they give a specific answer if you ask them how you can help. Simply stating “Let me know if you need anything” is generally not a good idea. They will not call you to ask you to bring a meal. Being proactive, and simply telling them, “I am going to bring you and your family dinner tomorrow night. You can refuse if you like, but I really want to do this for you” is much more effective than asking “Can I bring you food?” Since their tastes may be limited or changed from treatment, be sure to ask if there is anything that is easier for them to eat, and that you would be glad to alter any recipe if that would help it be more palatable for them.

Other specific offerings include:

  • Offering a ride to treatment/doctor’s appointments
  • Taking their children for an afternoon/day
  • Taking their laundry home with you and bringing it back clean
  • Asking when the best time of day and best date for you to spend several hours cleaning her house, or simply taking care of small things she hasn’t been able to attend to around the house, like straightening, changing sheets, walking the dog, sorting the mail or washing the car.
  • Bringing her a funny movie, and offering to watch it with her.
  • Listening if she wants to talk, or simply being present if she doesn’t want to be alone.
  • If she has a hobby, and she feels up to it, bring her the supplies and offer to help.
  • Flowers always brighten the day.

Depending upon the individual, the following suggestions may be helpful:

  • Offer to arrange for her to receive a massage from a qualified therapist. Some massage therapists offer home visits, so if she doesn’t feel like going out, one may come to her.
  • If she has a clergy person she feels close to, she may like to have help arranging a visit.
  • Local support groups can offer support that is unparalleled. Finding out what groups are offered, where, when and how to get there makes it easier for her to connect with others who are struggling or have struggled like she has.
  • Taking a drive in the country or through a park.
  • The adult coloring craze is taking off because it is known to reduce stress and offers an alternate focus. Offer to bring her a book and colored pencils if she doesn’t already have them.
  • If she feels like reading, offer to go to the library or buy her the books of her choice. Libraries also offer popular books on CD, so if she prefers listening versus reading, offer to bring those to her. They can also be purchased, but typically cost more than books.
  • Be aware that many people who are diagnosed with illness of any kind are often inundated with advice from well-meaning friends and family. Trust that her plan of care between her and her medical team is what she feels is best, unless she specifically asks you for advice.

**

Remaining aware of risk factors is important for any disease, cancer or otherwise. If your good health continues, but your loved one is suffering, your awareness of their needs will help them more than you know. Many people are avoided in their times of suffering because their family and friends don’t know what to say, so they say nothing. Simply acknowledging “I don’t know what to say” or “I don’t know what to do to help you,” can break down these walls and allow for open conversation. Just being there is important—we all need each other.

May good health and happiness be yours, and may it belong to your loved ones as well.

RX SUCCESS

The majority of adults in America take at least one prescription medication. Some take many. With age, chances are you will take even more.

Medications can be life-changing, and, at best, can be life-saving. Despite side effects, most of the benefits are worth the downside, if there is one. Managing medications can seem like a daunting task, especially as the number of prescriptions you take increases. Taking them at the right time, in the right combinations and the proper dosages is of crucial importance. This, however, is just one of several important considerations.

For many people, paying for their prescription medications is the greatest concern. Becoming aware of the side effects is another. Swallowing them safely and easily—especially the larger and dry ones—can be an issue. Helping an elderly loved one, or someone who is mentally or cognitively challenged to take them properly is a concern for many.

This article will provide basic information regarding these aspects. There are tips and suggestions that can be easily implemented to maximize the safety, minimize the cost, and improve the swallow process.

Becoming educated about the various prescriptions your health care provider has prescribed for you is an important step in maximizing control over your own health. With your provider’s direction, awareness of side effects is crucial for your health and comfort. Sometimes, there are small changes that can be made that make it easier for you to obtain and consume them. Generic drugs, while in most cases are significantly cheaper, are typically a consideration. However, some may not deliver the same effective results as the name-brand drug, and your provider’s decision whether or not to prescribe a generic should be respected. The provider gains no benefit from prescribing a name-brand drug, so your health interests are always foremost when that decision is made. If, however, the generic is the only form that you can afford, you should be sure to express that to your provider.

Medicare D is the plan that covers prescription drugs. If you are eligible for the other forms of Medicare, you are likely to also be eligible for Medicare D. The multitude of private health insurance policies available on the market for those not eligible for Medicare vary widely in their coverage, so you would have to learn about your individual coverage with your insurer.

Pharmacists not only fill and dispense prescriptions, they are often an overlooked wealth of information that you could benefit from, given the opportunity to get that information from them. By scheduling at least an annual review with your pharmacist, you can gather important, and possibly life-saving information, such as:

  • Medicare D/Insurance benefits regarding medications
  •  Considerations to help you fit the cost of drugs into your budget
  • Ensure each prescribed medication is most appropriate for you
  • Review your health during the past year, accounting for any changes that may require medication adjustments.
  • Provide a liason between you and your doctor concerning your medications.
  • Education and awareness regarding side effects and drug interactions.

A relatively new invention on the market to aid in the safe, timely and appropriate medication dosage is the electronic pill dispenser. This is basically an upright canister with compartments inside to hold each of your prescriptions separately. It is programmed to dispense each pill at its appropriate time in the appropriate dosage to ensure safe administration. This electronic system prevents under- or over-dosages when it is programmed correctly. If the person taking the medications is not able to load their prescriptions into the device correctly, a caregiver should complete this task.

This dispenser is especially helpful for anyone who lives alone, depends upon themselves to take their medication correctly, and especially those who may be suffering from memory and/or cognitive deficits. People with early-stage Alzheimer’s Disease who struggle to take their medications correctly are prime users of this device. At the programmed time, the pills are released by the dispenser, and they slide out of a chute on the bottom. Typically, an alarm sounds to alert the person that the pills have been dispensed, and are ready to be taken. One caution to be aware of is this: some of the dispensers have a high-pitched alarm, which can be difficult to hear. Elderly people who suffer from age-induced hearing loss generally do not hear this high-pitched sound, as those high pitched sounds are not heard well, or at all by those with age-induced hearing loss.

Some of the more technologically advanced models allow a caregiver to log on to their computer remotely to gain access to the computer inside the dispenser, and find out if their family member or loved one has taken their medications that were dispensed. There are various other alerting systems available on some models that would then be engaged if necessary. Your pharmacist would be able to discuss this device with you to determine if it is appropriate for you or your family member/loved one. In general, Medicare does not cover the cost of the dispenser, but there may be special situations that some or all coverage is allowed, and your pharmacist would be able to answer any reimbursement questions as well. Individual health insurance policies would be consulted for coverage as well.

This device has made a tremendous difference for many people who, otherwise could not live alone for this reason. It has allowed them to maintain their independence in their own homes, which can account for a significant part of one’s outlook on their life, and their sense of autonomy.

Many people dispense their medications into a box with separated sections for each day, and some for specific times of day. This method is very inexpensive and helpful in keeping medications organized. If you or a loved one needs assistance to make sure you are putting them in the right boxes, asking for help once each week should be considered.

As we age, and/or as our parents and loved ones age, it is likely that the number of prescriptions will increase as the number of diagnoses increase. With these increased diagnoses, there is a greater chance that additional doctors will become a part of the care team. Specialists may be called upon to treat unique conditions, and they will likely prescribe more medications. Being certain that the primary care physician and the specialist are aware of the medications that each is prescribing is of utmost importance. It is a good idea to consistently use one pharmacy so that they can manage your prescriptions, but when additional doctors are added to the team, it becomes of paramount importance that one pharmacy is managing your medications. With a comprehensive list of medications, the pharmacist will be able to monitor the combinations of drugs, and keep you aware of any possible interactions between these drugs that may occur.

Keeping an up-to-date list of medications handy in your home and available for others to review is important in the event that you require urgent care, and cannot communicate to emergency medical personnel what medications you are taking. They can discern if any of your problems may be medication-related, or compounded by your medications. If you require hospitalization, having this list available is helpful to the hospital staff.

Ensuring a seamless transition with your medications from the home to the hospital for an extended stay is something not to be taken for granted. If even one medication is not included on your list as an inpatient, or if the dosages are not accurate, there can be additional health concerns or complications. Don’t assume that your medical records will be transferred with 100% accuracy, it is good to double-check the medication list.

As we age, our bodies metabolize medications differently, so it is important to check with your pharmacist to make sure that if you have been taking a prescription long-term, that the dosage is still appropriate for your age and weight, if it has changed.

Many pharmacies now describe the visual aspects of a pill on the label, such as “small round orange tablet” to make the patient more aware of what each pill should look like. Also, the diagnosis that the pill is prescribed for is often included, such as “treats high blood pressure” or “blood thinner.”

These informational aspects are helpful in keeping the patient aware of more aspects of their medications, in an effort to increase understanding and safety in dispensing.

Age brings an almost-inevitable slow-down in most of our muscular functions, and swallowing is no different. It, too, is a very muscular activity, and the process of swallowing typically slows down. If you were able to swallow a handful of pills when you were younger, or even if you still do it well into middle age, it is wise to reduce the number of pills you take per swallow. Many people consider it a badge of strength and youth to gulp a handful of pills, but it is not a safe practice. Ideally, swallowing one at a time is the best advice, but even if you reduce the number of pills you take per swallow in half, you are likely to swallow more safely.

Many people mistakenly think that tilting the head back to swallow a pill is the best way, assuming incorrectly that this aids gravity in the swallow process. The opposite is actually true. Tilting the chin down slightly as you swallow is the safest way to swallow pills. Tilting the head back to get the pills in the back of the mouth is sometimes necessary, but be sure to tuck your chin down slightly as you swallow. This may sound contrary, but trying it out with just one pill will allow you to see that it is typically easier.

There is understandable anxiety surrounding the process of swallowing a pill for many people who have had great difficulty in the past. The chin-tuck maneuver has proven to be helpful for many people. In extreme cases, grinding the pills and mixing them with a smooth solid such as applesauce or yogurt can be helpful. If, however, a medication is time-released, this is not recommended. Checking with your pharmacist before grinding medications is a wise idea.

**

Medications are meant to improve our health and quality of life. In some cases, they may even save your life. Taking them correctly and safely is an important of health care and maintenance.

ZIKA UPDATE: THE LATEST FACTS

This month, much of the world is watching the games of the 31st Olympiad from Rio de Janeiro, Brazil from the comfort of their homes. The spectators there, and especially the athletes are watching something else: mosquitoes.

The Zika virus has been in the news for most of 2016. One of the most watched countries is Brazil, as the concentrations of the mosquitoes that carry the virus are among the highest there.

The risk to athletes and spectators alike appears to be minimal, but many in both groups are taking precautions. A handful of athletes cancelled their opportunity to compete, opting to eliminate the risk of contracting the disease through a mosquito bite to keep their reproductive health foremost. Most of the athletes are of childbearing age, and because the risk is present for both men and women, their future reproduction was more important to them than competing in what may be a once-in-a-lifetime competition.

Others opted to bring mosquito nets along; some males even froze their sperm before they left as insurance.
Before the games began, there were approximately 165,000 suspected and confirmed cases in Brazil. In January, there were 8,000 reported cases in Rio alone, but only 140 new cases reported in July. Mercifully, those numbers went down in time for the Olympics, and the anticipated dread and panic seem to be less than feared in the months before the games began.

Very few of us have to worry about direct exposure in Brazil. However, a mosquito bite is not the only way it can be contracted. A pregnant woman can pass it on to her fetus in utero and during delivery, and it is sexually transmitted as well. There have also been a few cases reported to be caused by a blood transfusion.

Many media accounts have given in-depth coverage regarding the risk to a pregnant woman and her fetus. If a woman is pregnant, or may possibly become pregnant, travel to affected areas is discouraged. Because it is sexually transmitted as well, extreme caution is advised considering her sexual partner. If they have traveled to an affected area, then this must be addressed.

The virus causes microcephaly, which means that the brain’s growth is affected, and causes the brain to develop to less than its normal size, and typically cognitive and sensory development are adversely affected as well. Many of the affected babies undergo intensive therapy to stimulate their senses and development, with no guarantee that it will make a functional difference.

In Brazil alone, approximately 1,700 babies have been born to affected mothers with this condition since the outbreak of the Zika virus.

**

The name Zika comes from the Zika Forest in Uganda, where the virus was first isolated in 1947. This virus is related to yellow fever, dengue, Japanese encephalitis, as well as West Nile Virus. Prior the 2007, it was contained in a narrow geographical area in Africa and Asia. After that time, it was noted to spread across the Pacific Ocean to America, causing the outbreak that began in 2015.

The infection, known as Zika fever or Zika virus typically causes only mild symptoms. There is no specific treatment or vaccine. Rest and acetaminophen are typically advised as relief from symptoms. In extremely rare cases, Guillain-Barre syndrome may result, which attacks the nerves and causes first weakness, then temporary paralysis. Hospitalization is required, and most people recover.

The virus is spread primarily by the female Aedes aegypti mosquito, but researchers have found the virus in common Culex mosquitoes as well. The mosquitoes must feed on blood in order to lay eggs. Their lifespan is only three weeks, and the typical mosquito doesn’t travel more than 500 feet in its entire life.

**

There have been more than 1,650 cases of Zika infections confirmed in the Unites States, mostly from travel to South America and the Caribbean. Most recently, however, there have been new cases confirmed from mosquitoes in a very specific area of south Florida. The Centers for Disease Control (CDC) urged pregnant women to avoid an entire area of Miami, known as the Wynwood neighborhood where the mosquitoes were known to inhabit. As of this time, 15 people in Miami have contracted the virus locally, with 14 of them in this mile-square neighborhood. Geneticists call this a “lazy” mosquito, since it travels so little within its short life. Mercifully, this is a good thing to contain the population of affected mosquitoes.

This is the first time the CDC has ever issued a travel warning within the continental United States due to an infectious disease.

Aerial spraying for mosquitoes in underway in Miami, but it appears to be making very little difference in the extensive mosquito population. In addition—for future prevention—there are trials proposed, but not yet cleared by the FDA, for genetically engineered mosquitoes whose offspring die before reproductive maturity, which would be a significant factor in reducing the population of infectious mosquitoes.

As with any outbreak of an infectious condition, panic is never a good option. Remaining informed from reliable health and media sources, and following general and specific recommendations in place from the CDC and other trusted sources is always the best line of defense.

The following recommendations are universally offered to prevent the spread of the Zika virus:

*Prevent mosquito bites:

  • Use a repellant with DEET.
  • Wear long pants and long sleeves in areas with mosquitoes.
  • Protect children or those who need assistance.
  • Use screens on windows and doors to keep mosquitoes out.
  • Don’t leave water standing outside that may attract mosquitoes.

*Plan for travel:

  • Check travel notices through the CDC before you travel.
  • Follow recommendedprecautions for both before and after your trip.

*Protect yourself during sex: Zika is passed through sexual contact via semen and vaginal fluids. It is thought to remain longest in semen, but studies are underway to determine exactly how long it remains in all fluids, and how long it can be passed.

  • Abstain from all sexual contact—this totally eliminates the risk of getting Zika from sex.
  • Use condoms or other barriers if not abstaining.

*Build a Zika prevention kit:

  • Keep mosquitoes out of your bedroom. If it is not well screened, use a bed netas mosquitoes will bite indoors as well as out.
  • Use standing water treatment tablets to kill larvae in standing water aroundyour home, being careful to follow directions on package.
  • Use EPA registered insect repellant
  • Spray your clothing and gear with permethrin to protect yourself from bites.
  • do not spray permethrin directly on skin.

**

The Centers for Disease Control (CDC) remain the most informed and authoritative source on Zika, its symptoms, prevention and treatment. Their website (www.CDC.gov) contains a wealth of information regarding Zika.

Understanding Food Labels: Just the Facts

Good nutrition is a foundation of good health. Along with exercise, stress reduction, enough sleep and many other good habits, eating well will help us stay healthy or regain health. Eating the right foods in the right amounts can help us maintain healthy weights, which is essential for lifelong good health.

Most of us try to eat healthy foods, but knowing exactly what the terms mean on food labels can help anyone make better decisions regarding the healthful benefits—or lack thereof—of any food. There is a lot of terminology used regarding the health benefits of food, but some of it can be confusing. Some of it is purposely misleading through marketing, in hopes that the consumer will purchase, consume, enjoy and repeat—all the while thinking they are eating food that is good for them when in effect, it may not be.

Making sense of the common words used on food labels is an art and a science. Some of them are concrete terms, some are more abstract, such as “natural” or “healthy.” This article aims to provide objective information regarding the use of/meanings of terms commonly used on food labels, not to offer advice regarding your purchase/consumption of foods with these terms on the labels.

“Healthy” is likely the most vague and meaningless word that can appear on a label. It sounds good, it may make the buyer feel like they are purchasing food that is good for them, but in many cases, it is simply included on the label to increase confidence in the buyer that they are indeed purchasing “healthy” food. It must be, the buyer thinks. It says so, right there on the label. And the manufacturer makes money on that word.
The Food and Drug Administration (FDA) does not have an official definition in place to enforce the use of the word “natural” on labels. They do have an official policy issued in 1993 regarding the use of the term that states:

“FDA has not objected to the use of this term on food labels provided it is used in a manner that is truthful and not misleading and the product does not contain added color, artificial flavors or synthetic substances. Use of the term “natural” is not permitted in a product’s ingredient list with the exception of the phrase “natural flavorings.”

Recent online forums on the FDA website have asked the public for their input. Several citizen petitions were presented to the FDA to address the use of this term, one asked for them to ban it altogether. Their goal is to determine, if it is appropriate to do so, what the definition of “natural” should be, and how it should determine appropriate use of this term on labels. This online forum was closed for discussion in May of this year, and the results can be viewed at: http://www.regulations.gov/#!docketDetail;D=FDA-2014-N-1207.

**

One term that does have strict rules regarding its use is organic.
As defined by the USDA (United States Department of Agriculture), the following rules apply:

  • Organic meat, poultry, eggs and dairy products come from animals that are given no antibiotics or growth hormones.
  • This includes grass-fed beef, free-range chicken and turkey, non GMO (genetically modified organism, to be expanded upon later in this article) fed chicken eggs and milk without rBST hormone, which is a hormone that helps cows produce more milk, usually to help the farmer/manufacturer profit.
  • Organic plant foods are produced without using pesticides, fertilizers or radiation.
  • A government-approved certifier must inspect the farm for proper standards, which include processing and handling.

There are three levels of organic claims for food:

  • 1: 100% organic. Fully organic or made of only organic ingredients. Foods that qualify for the 100% organic label receive the official USDA seal.
  • 2: Organic. At least 95% of the ingredients are organic.
  • 3: Made with organic ingredients. At least 70% of ingredients are certified organic. With these foods, a USDA organic seal cannot be used, but may state “made with organic ingredients” on the front label.

It is important to realize that while any food that is organic is favorable, it isn’t necessarily a health food. Organic ice cream is still ice cream, and there are healthier choices one could make than ice cream.
It is widely agreed among nutritionists that there are some foods that have higher levels of pesticides. Known informally as “The Dirty Dozen”, the following fruits and vegetables are considered the most contaminated:

  • peaches
  • apples
  • sweet bell peppers
  • celery
  • nectarines
  • strawberries
  • cherries
  • pears
  • imported grapes
  • spinach
  • lettuce
  • potatoes
  • Conversely, the following list of 12 fruits and vegetables are considered the least contaminated:

    • onions
    • avocado
    • frozen sweet corn
    • pineapple
    • mango
    • asparagus
    • frozen sweet peas
    • kiwi fruit
    • bananas
    • cabbage
    • broccoli
    • papaya

    As a rule of thumb, the thicker the skin—such as a banana or avocado—the lower the levels of contamination. Also, if a food travels from a foreign country, such as grapes from Mexico, the greater the chance they are contaminated with pesticides in order to survive the long trip.

    Organic foods are more expensive. If your budget is limited but you would still like to include organic foods in your meals, consider the above lists. Also, remember that, unless it is a fruit or vegetable, it may not necessarily be more nutritious just because it is organic. Recall the ice cream example…

    **

    When you purchase food that is produced locally, this helps to promote environmental sustainability, and supports local producers. This is a positive practice, and, logically, should be engaged in whenever possible. However, many foods cannot be grown locally in all areas, and a higher cost may be prohibitive for some people. A rule of thumb, as with the organic contamination issue, is to purchase foods that are produced as close to you as possible.

    Whenever foods can be purchased in their most pure form, this is considered “whole.” Nothing is added; nothing is processed. There are no regulatory terms for this, but it includes fresh produce, dairy, whole grains, meat and fish.

    GMO –genetically modified organism—as it relates to this article, is a food whose genetic composition has been altered. This was referred to earlier in the article. The arguments against it are that it possibly compromises the nutritive levels, and possibly the safety of foods, as well as creating negative effects on the environment, although the credibility of the evidence against it is argued. There is much debate and disagreement over both sides of this issue, and online searches will present both sides of the argument.

    **

    There are many terms that are used on food labels, and are not dictated or controlled by the FDA, USDA, or any agency. When these terms appear on food labels, there is no concrete definition, and they are generally used for marketing. While they are positive attributes, be aware that they may not make your food healthier:

    • all-natural: some all natural foods have no nutritional value, such as certain sodas.
    • fresh: vague, ill-defined. Is it one day old? Two?
    • superfoods: certain berries such as acai and goji berries are advertised as superfoods, but there is no legal definition. This term is easily abused, and eating a variety of fruits and vegetables is the best advice most nutritionists would give.
    • energy-boosting: caffeine is frequently added to many foods and drinks to back up this claim.
    • diet: many diet drinks and foods have added chemicals and artificial sweeteners.
    • sugar-free: typically artificial sweeteners are used.
    • low-carb: read the labels to determine the exact number of carbs. ‘Low’ to one person may mean something different to another.
    • multi-grain: some grains are more nutritious than others. High-fiber and 100% whole grain breads are likely most nutritious. Check for added sugar as well.
    • antioxidants: All fruits and vegetables have antioxidants.

    **

    Eating healthy should be a goal for all of us. Determining exactly what is healthy can be a challenge, given the word salad of terminology used to describe the nutritive value of foods. Remember that marketing is a savvy science, and many of these words are used in food marketing to create a sense of eating healthy, when, in effect, the words used are used too vaguely to provide concrete information about exactly what you are eating.

    Eating well doesn’t have to be drudgery, difficult or boring. Some of the most nutritious foods are delicious, “natural,” and “healthy.” Just be sure you know what those words mean for you.
    Given that this article is meant to be informational only, without advice, one last thing must be said, and it is likely what your mother told you all along:

    “Eat your vegetables!”

Summer Skin Safety: Burns, Bites and Poison Plants

Most of us don’t realize that our skin is our body’s largest organ.  It covers every square millimeter of our bodies, and acts as a container for everything beneath it.  It performs its job effortlessly in most cases, not really asking for much.

Except when it calls for attention. Sometimes, at any time of the year, it can become irritated.  In the winter, it typically becomes dry.  In drier climates, it can remain dry all year round.   The summer season, however, presents its own unique set of challenges.

It is always advised to seek medical attention if you have concerns regarding skin conditions.

Our skin is more exposed to the sun, the elements, insects, bees and poisonous plants during the summertime.  Therefore, it is more at risk for burns, bug bites and reactions to plants—typically poison ivy, poison oak and poison sumac.

Sun protection has been a health issue that, luckily, has been heavily covered in the media.  Most of us know that we need to wear sunscreen when we are outdoors, and we need to watch our skin for new moles, suspicious spots, sores that don’t heal, and changes in existing moles.  It is highly advised to perform regular checks of our skin all over our bodies to watch for these changes, and to have someone we are comfortable with check our back and other hard-to-see places.  An annual visit to a board-certified dermatologist is ideal, as they are highly trained and experienced in the detection and treatment of skin disorders.

It has been determined that most damage to the skin by the sun takes place in our earlier years, and cannot be reversed.  As we age, we are less vulnerable to the most detrimental effects of the sun, but the exposure we have accumulated over our lifetimes remains a risk factor.  The greater the exposure, and the greater the damage in our earlier years, the greater the risk for skin problems as we age.

Fair-skinned people, and those with many moles are at the highest risk.  Those with darker skin are more protected by melanin, the pigment that causes our skin to darken.  Some people are naturally dark-skinned, no matter what their race, and others are very light skinned, with less melanin, and consequently, a higher risk for skin damage.

In addition to this risk, people who take certain medications—ibuprofen/naproxen (NSAIDS), tetracyclines, furosemide, quinolones, psoralens, thiazides and the phenothiazines—are at greater risk for sunburn, as these drugs increase the skin’s sensitivity to the sun.  Check with your doctor if you are taking any of these medications before you spend a considerable amount of time in the sun.

By the time you feel the effects of the sun, it is too late.  The burn is there, and for relief, the following remedies may help:

*Apply a cold compress to the affected areas.

*Apply a cooling gel such as aloe vera to the affected area

*Take aspirin or Tylenol to relieve discomfort and inflammation

*Avoid further exposure until the burn resolves.

You can expect peeling after the burning subsides.  A sunburn is obviously damage to the skin, but remember that even a suntan is considered skin damage.  Long-term exposure to the sun can create a leather-like and prematurely aged  appearance to the skin.

Prevention is the best approach to sunburn.  Keeping these suggestions in mind will likely reduce or eliminate your chances of sunburn:

*Avoid the sun during peak hours:  10:00 a.m. until 2:00 p.m.

*Use a sunscreen of SPF (sun protection factor) of at least 30 every day, even on cloudy days.  When swimming or engaging in other water sports, re-apply every 80 minutes, even if the label states it is water-resistant.  Apply at least 20 minutes before sun exposure.

*Avoid tanning beds, and minimize sunbathing.

*Wear a wide brimmed hat and sunglasses.

*Wear dark colors if the temperature permits.  Tighter weaves will keep rays out best.  Some nylon shirts offer sun protection—check the label and tags.

*For children under six months of age, keeping them out of the sun is the best plan.

**

Sunlight is necessary to promote plant and human growth.  Humans, however, should expose themselves sensibly.

**

Summer brings the added risk of tick bites.  In the Midwest, they are most common in the early spring to late summer.  Ticks bite and attach themselves to a host—a human or animal—to feed on blood.  Most ticks don’t carry diseases, and most bites do not cause serious consequences.  However, it is important to be aware of the risks:

*Lyme disease

*Rocky Mountain Spotted Fever

*Tularemia

*Colorado Tick fever

*Babesiosis

*Ehrlichiosis

If you have any of the following symptoms after a tick bite—anywhere from day one to three weeks after the bite—see your health care provider:

*fever

*headache

*nausea

*vomiting

*muscle aches

*rash or sore around bite

Typically, removing the tick and washing the area is all the treatment necessary.  Being certain to remove the head, as well as the body, is important to prevent an infection.  To remove the tick, medical professionals recommend:

***Use a clean tweezers.  If you don’t have one, wear rubber gloves or use tissue paper around your fingers.  Grasp the tick around the head, not the body.  Squeezing the body could force fluids into your body from its body.  Gently pull the tick straight out, do not twist it.  Place the tick in a plastic sealable bag or jar and place it in the freezer in case it needs to be examined in the future.  If you cannot remove it, contact your doctor.

Ticks are likely the most feared insect in the summer, but mosquitoes are likely the most annoying.  While mosquitoes also can carry disease, their bites can cause irritation and itching.  Using a spray to repel mosquitoes is the best defense.  Avoiding standing water, and wearing clothing to cover the skin while keeping comfortable is advised as well.

There has been widespread global concern over the Zika virus carried by mosquitoes,, which affects primarily South America.  At this time, there is not an immediate threat to the United States.   Trusted media sources will likely keep our nation apprised of any imminent danger; panic is never a good reaction.

Bee stings area also a concern for the warmer months.  Preventive measures include:

*Learn to recognize bees and other insects and avoid them.  Nests or mounds of bees should obviously be avoided.

*Bright-colored clothing and perfumes can attract bees.  Avoid them in favor of long-sleeved shirts and long pants, as well as shoes and socks if you think you may be in an area that has bees.

*Spray outdoor garbage cans regularly with insecticide.

*Make sure you have screen on open windows.

Most people can suffer through a bee sting with minimal symptoms, including:

local pain, swelling and redness.  Simply washing the area and applying antiseptic like hydrocortisone cream or calamine lotion and covering it with a dry, sterile bandage is typically treatment enough.  If the stinger is still in the skin, remove it gently.  Scrape gently if necessary, but don’t squeeze the sac or stinger.  If you are stung on the hand and are wearing rings on any of your fingers, remove them immediately in case extreme swelling occurs.

However, some people are more sensitive and allergic to bee stings.  Symptoms of an allergic reaction include, in addition to pain, swelling and redness:

*pimple-like spots

*moderate-severe swelling, versus mild swelling with a normal reaction.

*warmth of the skin in that area

More severe symptoms include:

*trouble breathing

*swelling of the face, mouth or throat

*wheezing and/or trouble swallowing

*restlessness and anxiety

*rapid heartbeat

*dizziness and/or sharp drop in blood pressure

*hives that first appear around sting as a red itchy rash, then spread.

If you know you are allergic, always be prepared with your epinephrine kit.   If you know you are going into an area that likely has bees, do not go alone.  Getting immediate medical attention is always advised after a sting if you are allergic.

**

In North America, the three most common poisonous plants are poison ivy, poison oak and poison sumac.    An online search will easily provide images of these three plants so that you can be aware of what they look like, and avoid them.  The classic “leave of three, leave them be” is good advice to heed for poison ivy.  If there are three leave on the plant in question, it is best to leave them alone.  In the Midwest, poison ivy sometimes grows as a vine, as well as a plant.

If you have been exposed, follow these steps:

*remove your clothes

*wash all exposed areas with cool running water, using soap if available.  Clean under fingernails as well.  If you are in the woods, use water from a running stream.

*If pets are exposed, bathe them as well.  They can carry the toxic element back to your home on their fur.

The most common reactions to exposure to these poison plants are:

*redness and itching of the skin

*a rash in the area of contact, often in patterns of streaks projecting from the affected area.

*the rash goes on to develop into red bumps, or large oozing blisters.

It is always advisable to seek medical attention if you have been exposed to any of these three plants, but especially if you experience any of the following:

*difficulty breathing

*severe swelling

*more than ¼ of your body is covered with the rash

*the rash is on the lips, face, eyes or genitals

*a fever develops, and signs of infections such as pus or yellow oozing fluid, and an odor comes from the blisters.

*you have been exposed to the smoke from these plants burning

**

It is always advised to consult your health care provider if you have any concerns regarding any sunburns, bug bites or exposure to poison plants, or any other skin conditions.

**

Author’s note:  As I complete this post, I am treating a burn that I received in a way that was not mentioned, but is more common during the warmer months:  I took a short ride on the back of a motorcycle while I was wearing shorts.  I wasn’t careful to keep my legs clear of the already-hot muffler, and I sustained a moderate burn on the inside of my calf as I hopped on the motorcycle as a passenger.  The foot pedal wasn’t down, and it took half a second, and the damage was done.  Please be aware that if you do choose to ride, long pants are always the best option.

**

Be good to your skin.  It is the largest organ your body has.

ORAL CARE:  PUT YOUR HEALTH WHERE YOUR MOUTH IS

Say aaahhhh.

Let’s take a look inside the most complex, wondrous and bacteria-laden portal into the human body.    There’s more than meets the eye.

Most of us, as adults, faithfully brush our teeth twice daily.  Some of us even overachieve, and brush after lunch.  We all should.  Flossing, unfortunately, is not a practice as popular as brushing.  It should be.

“Let me look into my patient’s mouth, and I can give you a general prediction of how healthy they are likely to be throughout their lifetime.”  This notion is gaining popularity among many medical professionals, but a generation ago, this would likely not have been uttered by any doctor.  The connection between a healthy mouth and a healthy body was not acknowledged.   If, as the saying goes, the eyes are indeed a window to the soul, then, the mouth is seen not only as a door into the body, but as a window as well.

The human mouth is teeming with bacteria, most of it the good kind.  The bad kinds are easily overpowered by the good ones with regular and efficient oral care—except when they are not.

**

The average adult mouth has 32 teeth, including four wisdom teeth.  This includes 8 incisors, 4 canines, 8 premolars (also known as bicuspids), and 12 molars, including the wisdom teeth, which normally come in sometime around age 18.  A person loses their “baby” teeth around ages 12-13.  Barring any accidents or decay due to lack of care, an adult can expect to enjoy their mouthful of teeth well into their senior years.   This lack of care, however, can spell an early death for adult teeth.

Among women, pregnancy is a major factor in calcium loss, which, in turn, affects the health of a woman’s teeth.  There is a wive’s tale—or perhaps it is based in truth—that a woman eventually loses one tooth for each pregnancy she experiences.    Osteoporosis, which is most common with women, is being investigated as a result of periodontal bone loss and tooth loss as well.  Clearly, women have a unique set of circumstances and situations that can uniquely affect them.

**

There is an element of the mouth that is underappreciated:  saliva.

Most of us see saliva as an unfavorable aspect of the human mouth.  This notion should be re-examined, because without it, we are stuck—literally and figuratively.  Dry mouth is a condition most of us have experienced at one time or another due to many possible factors, including medication, lack of water intake and illness.  Saliva bathes the mouth in a cleansing fluid that washes food away, allows bad bacterial to be neutralized, and it lubricates solids as we chew them in order to moisten food in order to swallow them safely.  In addition, saliva is filled with digestive juices that promote good digestion.  Therefore, chewing food for longer periods allows more efficient digestion to take place, because more saliva is produced, thus, more digestive juices are present.   Certain medications, namely, decongestants, antihistamines, painkillers and diuretics can reduce saliva flow, thus setting the stage for bacteria growth, because when saliva flow is limited, its cleansing action in the mouth is reduced.

**

Inflammation is being recognized as a contributor to many health conditions.  New research is investigating the link between the inflammation and infections that oral bacterial can cause, and how these are connected to heart disease and stroke.   The inflammation associated with severe gum disease—periodontitis—is suspected to play a role in certain diseases.  Periodontitis is also linked to premature birth and low birth weight.

Diabetes, which reduces the body’s resistance to infection, puts the gums at risk for gum disease, as it is noted much more frequently among those with diabetes.  Additional research shows that people with gum disease have greater difficulty controlling their blood sugar.

Another interesting topic of study by respected institutions is the link between early tooth loss, poor oral care and Alzheimer’s:  while it is still in the early stages of being proved with multiple research projects, it is suspected that the bad bacteria present in the mouth that takes over when oral care is not performed, eventually travels to the brain whereby it is quick to kill off neurons, thus creating a perfect atmosphere for dementia to set in.   The flip side of this stance is that poor oral care is a consequence, rather than a cause of dementia.  Further research will bear out the true cause in time, but it behooves all of us to at least be aware that this connection is suspected.

While good oral care is a good habit that is cultivated, there is one particularly bad habit that is practiced that is detrimental to oral health:  smoking.  According the Centers for Disease Control (CDC), the risk of severe gum disease is three times higher than that of a non-smoker.  Also, the nicotine in cigarettes causes blood vessels to constrict, interfering with their ability to fight infection.  When gum surgery is necessary, the recovery is more difficult and the surgery tends to be complicated by smoking.

Another habit that can adversely affect gum health is overeating.  Obesity has been linked to gum disease in several major studies, as it does appear that periodontitis progresses more quickly in the presence of increased body fat.

**

There are several unique health conditions that are directly affected by oral health, especially among the elderly.  Not only does good oral care tend to decline with age and its accompanying maladies, this general decline in health may indeed be more pronounced because of poor oral health.  In the cases of overall decline due to aging, other bodily functions such as respiration and swallowing can be adversely affected.  If a person has been diagnosed with Chronic Obstructive Pulmonary Disease (COPD), this can be exacerbated by increasing the amount of bacteria in the lungs.

If a person develops dysphagia—swallowing disorders—due to a stroke, progressive disease or general aging, bacteria can be aspirated into the lungs when the swallow process becomes weak.  In aspiration, saliva, liquids and/or foods are ingested into the lungs instead of the stomach.  If this occurs repeatedly, and if the materials that are aspirated carry bacteria from the mouth with them into the lungs, the risk for pneumonia and other infections increases exponentially.

Oral care is normally a self-care habit that is performed independently from childhood through adulthood.  There are situations, however, when a person may become temporarily or permanently unable to perform their own oral care, and it becomes of paramount importance that another person or persons be responsible for that person’s oral health.  If a person has been injured and is physically unable to perform the tasks, or if long-term illness sets in that takes aware their awareness and/or ability to perform the oral care tasks, then they must rely upon someone else to perform oral care for them.   This must be considered an important commitment to the disabled/ill person.  In aging, dementia and disability can prevent an older person from remembering to perform the tasks, and from actually performing them.  In this case, too, someone else must be responsible for this very important task.

**

Oral care may seem too simple a notion to spend much time thinking about, or analyzing one’s own habit surrounding it.  Most of us, as adults, take for granted that if we simply brush our teeth twice daily, then we will be assured of good oral health.  This is never a guarantee.  While brushing twice daily should be considered the absolute minimum, there other habits that we should all consider adopting, of we haven’t already:

  • Consider brushing in the middle of the day after lunch.  There are inexpensive, disposable toothbrushes on the market that are ready to use with a dab of toothpaste on them.  Keeping these handy allows us no excuse to slip into the restroom after lunch for a quick brush.
  • Floss DAILY.  There are no exceptions to this.  If you don’t, and then decide to floss after a long period of time, you will likely notice there is a strong smell that comes out of your mouth along with the food particles that have been stuck in your teeth.  This odor comes from the beginnings of bacteria that have been forming on those food particles.  It is not pretty, and obviously, is smells bad.  When unattended for too long, these particles become a prime breeding ground for the bad bacteria that contribute to illness.
  • Make regular dental check-ups a priority.  Twice each year is the recommended visit frequency.  If you don’t have dental insurance, the cost may be noticeable at the time, but if you consider it a form of long-term health insurance, then you can see that the benefits outweigh the cost.  Poor dental health is visible and generally not accepted well by our society as a whole.  While this is a sad reality concerning one’s looks, poor dentition, coupled with poor oral health is almost always considered a detriment in social situations.  Bad breath often accompanies poor dental health, so the added dimension of a bad odor along with the visible dental issues can be seen in a very unfavorable light.
  • Limit sugary and processed foods, and increase your consumption of fresh fruits and vegetables.  Sodas are not a good choice either, and coffee and tea can cause stains and bad breath as well.  Drinking plenty of water is crucial too, as dry mouth is a likely consequence of NOT consuming enough water daily.
  • Brush your teeth immediately upon arising, before you eat or drink anything.  The bacteria grow in the mouth overnight, creating the unfavorable taste in the mouth most mornings.  If you eat and drink before you brush, the bacteria are swallowed and ingested into the stomach, thus increasing the chances of poor heath vs. good health if the bacteria are brushed away.
  • If you get up in the night to get a drink, consider swishing your mouth out with one mouthful of water and spitting it out before you actually take the drink.  This washes away some of the bacteria that have grown, and prevents you from swallowing them.  Brushing would be most beneficial even in the night, but for most people, it is not practical.  Simply washing out the mouth with water will help.
  • Replace your toothbrush every 3-6 months, or more frequently if the bristles begin to wear, or if you have had the flu or a cold.  These bacteria may linger on your toothbrush after illness.

**

Oral care is too often overlooked as a less-than-crucial part of good health.  Researchers continue to study the link between good oral health and good health in general, with all research bearing this out:  A healthy mouth is necessary for a healthy body.  Taking the few extra minutes necessary to floss daily, or perhaps adding a third brushing to your daily routine will pay off exponentially as you age.

Smile—it will give you yet another reason to take care of your mouth, and the good health it promotes will enhance your smile in return.

HIPAA:  It’s a Private Matter

HIPAA has become a familiar term to anyone who provides or receives health care, which would include nearly each person alive. If you are the patient, you are informed of your rights prior to receiving your care.  If you are the healthcare provider, you have been instructed on the importance, the relevance and the legality of the patient’s privacy.  For the patient, it may become an annoying redundancy, but it is there primarily to protect the patient’s right to privacy.

HIPAA is an acronym standing for Health Information Portability and Accountability Act.  It was signed into law and enacted in 1996 by President Clinton.  There are five section or titles, summarized briefly as follows:

Title 1:  Protects health insurance coverage for individuals who lose or change jobs, and prevents health plans from denying coverage to individuals with specific diseases and pre-existing conditions, as well as prohibiting the setting of lifetime coverage limits.

Title 2:  Directs the U.S. Department of Health and Human Services to establish national standards for the processing and transmission of electronic healthcare information.

Title 3:  Details tax-related provisions and guidelines for medical care.

Title 4:  Further defines health insurance reform

Title 5:  Provisions on company-owned life insurance and treatment of those who lose their U.S. Citizenship for income tax purposes.

**

For the vast majority of the population, Title 2 is the only part of HIPAA that directly affects us.  HIPAA compliance term most commonly used to refer to the protection of confidential health information, whether it be through electronic, written or verbal transfer.  While it was signed into law in 1996, its full enforcement of the privacy Title for covered entities didn’t begin until April 2003.

 

With the rise in electronic medical information systems, as well as the electronic storage and transfer of such records, the possibility that confidential information may be compromised increases, as does any electronically stored and transferred personal information.  Credit card and bank account numbers are another example of highly confidential information that is stored and transferred electronically, and these systems, too, are at risk for security breaches as all of us have at least heard of, or, worse yet, experienced the nightmare of such information being compromised.

Health care information is sensitive in a more highly personal and private way.  Most of us have health information that we don’t want to be turned into general information for easy access to online.  Further, we don’t want our health care providers sharing it for inappropriate reasons.  The HIPAA laws protect our rights as patients in order to keep any information from being shared, with potential legal consequences for the medical providers who share them illegally.  These consequences typically include fines, but may also involve jail time for extreme cases.

The following examples are all illustrations of the various ways in which your privacy rights may be violated as a patient in our medical system:

  • A secretary leaves a fax detailing your private health information laying on the counter in the medical office where staff members and other patients can easily see it.
  • Two nurses are discussing the recent surgery results of a patient on their floor while they sit on an outdoor patio having lunch with others in earshot.  They use her first name and her room number, as well as the street she lives on, as this is a relatively small town and one nurse want to clarify to the other exactly who she is.
  • Your doctor approaches you when you are dining out in public with friends to ask how you are feeling since your last visit.    He asks if your condition has improved.
  • A hospital nurse sees that her neighbor has been admitted, but he is not her patient.  She has electronic access to all current records, so she logs on to his account to see why he has been admitted.
  • A doctor’s office has a “Welcome to Our Practice” board posted with the first and last names of new patients listed.
  • A doctor is relaying health information by phone to another doctor, including the patient’s name, birthdate, diagnosis and symptoms.  There are family members visiting another patient nearby within earshot.
  • An insurance company requests more than the “minimum necessary” information, and the secretary gives them confidential information that, legally, isn’t necessary for this particular insurance business interaction, which only authorized the release of the patient’s name, address, birthday and other such information.
  • A hospital housekeeper knows why her neighbor is receiving treatment from what she has overheard from the nurses and doctors talking about him.  Another neighbor asks her what she knows, and she tells her the information she heard exchanged between the doctor and nurse.
  • A nurse has logged on to a patients clinical record, and steps away from her computer for a few minutes to tend to another patient.  The computer screen can be seen by anyone standing at the counter.
  • A family member who is not authorized to receive confidential information calls to ask questions about the patient.  Without checking to see if this family member is listed by the patient as an approved contact, the nurse answers all the questions concerning the patient’s condition.
  • Without the parent’s consent, a doctor’s office releases confidential information about a minor child to another physician’s office.
  • Your child is having his broken arm cast in a procedure room of a clinic.  On the wall in this procedure room is a list of scheduled procedures for the day, including first and last names of all scheduled patients.
  • At your chiropractor’s office, are required to sign your name on a list on the counter to show you have arrived.  Your name, as well as everyone else’s, is visible to anyone who approaches the counter.

**

Any of these situations are considered HIPAA violations.  Some are blatant, some are not so obvious.   There are many gray areas, and each potential situation warrants close examination to determine, if indeed, a violation did occur.

If, as a patient, you feel your rights have been violated, you can file a complaint with the U.S. Department of Health and Human Services.  This can be filed online by logging on to HHS.gov, which is then handled by the Office for Civil Rights (OCR).  If you prefer to make the complaint in writing, you can do so with their instructions provided online.  It can also be submitted by fax. The following information must be included:

  • your name—you can request that it is not disclosed within the claim, but it must be on record in order for you to file it.
  • full address
  • telephone and email addresses
  • name and contact information of the agency in question
  • brief description of what happened
  • any other relevant information
  • your signature

If you need special accommodations due to disabilities in filing your complaint, you can make them aware of your needs and you will be informed of the help available.

Your claim must be filed within 180 days of its occurrence, unless you are able to show “good cause” for a claim past that date, such as an extended illness.

Under HIPAA law, an entity or agency cannot retaliate against you for filing a complaint.  If you feel you have experienced such retaliation, you are encouraged to report it the Office for Civil Rights (OCR).

Not all entities are required to comply with HIPAA rules, and only covered entities can be investigated.   These include most:

  • Doctors
  • Clinics
  • Hospitals
  • Psychologists
  • Physical, Occupational and Speech Therapists
  • Chiropractors
  • Nursing homes
  • Pharmacies
  • Dentists
  • Health Insurance Companies
  • Company Health Plans
  • Medicare, Medicaid and other governmental health plans

There are special circumstances under which some protected health information may be released without your consent, such as in a criminal investigation or public health crises.

**

While HIPAA is designed to protect the patient, it is not without its challenges in its attempts to keep private information private.  It is controlled and interpreted by the United States Department of Health and Human Services (HHS), not a local agency.  Therefore, an individual cannot take action against an entity such as a clinic or hospital, they must instead file a claim through HHS.  The enforcement of HIPAA is limited by shortcomings such as limited staff and expenditures in HHS.  In addition, the health care providers have been forced to hire more staff to enforce HIPAA, which increases their costs, which is, in turn, typically passed on to the patient in their billing for services.

In terms of billing, a patient doesn’t have to give their consent to have their insurance billed, which takes away the patients right to determine which claims they want their insurance company to see, as well as their right to self-pay, if they so choose.  Finally, some providers contract with other outside sources for billing and legal services.  The patient does not have a legal right to determine which outside sources may see your records.  There are signed contracts that keep the information confidential, but if there is a violation, there is little that can be done as an individual.

**

Prior to the enactment of HIPAA, there was no national law enforcing patient privacy. There were rules and guidelines, but no national policy that provided for consequences when privacy was violated.  Those were the days of less restriction for medical providers, but more risk for private health information to be accidentally or purposely shared.  In those days, you may have seen first and last names written in plain view on a board behind the nurse’s desk.  You may have heard first and last names called freely in a clinic.  Encryption was relatively unheard of in the medical setting. Your health information may have been shared with little regard for confidentiality.  HIPAA has provided for stringent laws that protect the patient from their private information being shared when it shouldn’t be.  These post-HIPAA days are here to stay, and for those of us who are patients, despite the extra paperwork, time and attention it takes, we should be thankful.

 

 

BALANCE

I’m out of balance.”

“I need to get some balance my life.”

“Find the balance.”

“We all need a balanced diet.”

“It’s time to balance my checkbook.”

 Humans are upright creatures.  We are designed to stand upright, walk around, sit down, stand back up, bend over, lay down, get up and maybe even stand posed on one foot, or stand on your head—if you are really balanced.  Most of us take it for granted—just like so many other amazing functions of our amazing human bodies.

If you are out of balance, none of these actions may be possible.  Dizziness, light-headedness, vertigo, falling and clumsiness are all signs that our bodies are not balanced.  That’s when we realize what a gift it is to be balanced.

We speak of balance so often in our lives that we hardly notice the importance of that word.  It all stems from the concept of being balanced on our feet and maintaining a sense that we are upright, and we are able to physically navigate our bodies through space and distance without falling or feeling that we are off-center.  If you have never experienced this feeling, you are among the lucky ones.  If you have, then you can relate.

It is estimated that 40% of people will experience significant balance disorders at some point in their lives.  This estimate, however, may be conservative, because there are a wide range of symptoms that can be attributed to balance disorders, and the various ways that they might be detected and reported—or not.

The symptoms may range from mild light-headedness, all the way to a complete loss of the ability to remain upright and function in our daily lives.   It can keep some people in bed or chair-bound all day, because simply walking is difficult.  In the most severe cases, a feeling of continually falling, as if falling through space or endless, multiple trap doors, is reported.   Driving is out of the question for many people, as is functioning in their work, family or social roles.  A simple turn of one’s head may make their world spin, turn sideways or upside-down, or make it impossible to visually focus.

Adding to the misery is the fact that, for most people, these symptoms can come and go, and often cannot be predicted.  These disorders may be present most of the time, or they may come in a sudden attack, often without warning. They may even be caused by something as simple as turning over in bed—a common trigger.

**

 There are many sign that a balance disorder is present, including:

  • A feeling of unsteadiness/increased clumsiness/feeling “woozy”
  • Falls/near falls/running into obstacles
  • Impaired mobility/gait
  • sensation of spinning/swaying—also known as vertigo
  • confusion/disorientation
  • reflex delays
  • headache/migraine
  • nausea/vomiting
  • fatigue/difficulty concentrating
  • visual disturbances, including nystagmus (erratic and rapid eye movement) and oscillopsia (sensation that objects in line of view, or the entire room or visual space is spinning or moving erratically).

**

According a subsidiary of the CDC (Centers for Disease Control), 4% of adults—8 million Americans—report a chronic problem with balance, and an additional 1.1%–2.4 million Americans—reported a chronic problem with dizziness.

One disorder in particular, Benign paroxysmal positional vertigo—herein referred to as BPPV—accounts for half of all reported cases in adults.   It is most commonly described as a brief, sensation of spinning that occurs when there are changes in position of the head with respect to gravity.  This sensation may be reported when rolling over in bed, getting out of bed, moving the head quickly, or looking up.  As the name suggests, it is benign and not a serious disorder in terms of health, but it can seriously affect one’s function.

The cause of BPPV can be best explained by this analogy:  The inner ear, which plays a key role in balance, has crystals floating smoothly and evenly when they are functioning properly.  Imagine a snow globe:  when you shake it up and the snowflakes float freely and evenly, all is well and beautiful. When they cluster and cease to float evenly and smoothly, it’s not so pretty.  It’s much the same in the inner ear.  If the crystals float smoothly, all is well.  If they cluster, stop moving or fall from this space, then a sensation of spinning is caused.  The information sent to the brain from the inner ear doesn’t match the actual head movement.

Other causes include:

  • An inner ear infection
  • Low blood pressure
  • Trauma—injury to the skull or a brain injury
  • Surgical trauma
  • Meniere’s Disease—an inner ear fluid balance disorder
  • Perilymph fistula—a leakage of inner ear fluid
  • Other, less common medical disorders

Balance disorders should always be examined medically.  Starting with your primary care physician, a balance disorder can be assessed, and you may be treated or referred to a specialist, perhaps an  otolaryngologist, who is a physician specializing in diseases and disorders of the ear, nose, throat, head, neck; and sometimes specializes in balance disorders.

Treatment is determined by the underlying cause.  As there are many causes, so too are there many treatments, which is why anyone with a balance disorder should be medically examined.  Often, there is no one, single cause. Rather, there may be an interplay of factors such as ear infections, drug reactions, low blood pressure, central nervous system disorders such as a stroke.

As a person ages, all these factors tend to coalesce, and create increased risk for balance disorders  There is no magic age in which these disorders are caused by age, but “older” adults experience them more than younger ones do.  One doctor reports that otherwise healthy patients in their 40’s have complained of symptoms consistent with balance disorders:

“I am not as steady on my feet as I used to be.”

“I feel more clumsy as I age.”

“I have to hang on to stair and step railings now.”

“I can’t bolt up and down the stairs like I used to without feeling a little off balance.”

“I am lightheaded and more dizzy as I age.”

No matter what age, however, a person should always report any balance disorder symptoms to their doctor.  They may be signs of a disease or disorder that can be treated, controlled or cured.

**

The vestibular system is a complex structure of fluid-filled tubes and chambers that constitutes part of the inner ear.  Specialized nerve endings inside these structures detect the position and movement of the head, as well as the rest of the body in space known as proprioception.  As a child grows and develops, this system matures as the child physically matures.  This system almost begs for stimulation as a child, which explains why children delight in spinning their bodies, riding merry-go-rounds as well as amusement part/carnival rides that spin them at high rates of speed, playing games that require spinning like Ring Around the Rosie, and being spun by someone else.

If you are an adult reading this, simply reading the above spinning scenarios may make you a little dizzy.  That is because as we age, our vestibular systems mature, and stop craving such stimulation.   At some point in adulthood, they typically reach a zenith of function, where everything is balanced, and normal, everyday activities provide just the right amount of stimulation.  No balance problems are experienced, and no more extra spinning is necessary.  Then, at some point later in adulthood, many adults seem to have decline in this happy medium, and their bodies don’t feel so stable anymore.  Even the thought or mention of spinning can bring a whiff of dizziness.

Anatomical studies have shown that the number of nerve cells in the vestibular system decreases from about age 55, but have been reported earlier. Blood flow to the inner ear also decreases with age.  One of the leading health concerns for people over 60 is falling, which is often caused by balance problems.  For adults over age 65, it is estimated that 30% of those who live at home fall in their homes.  One of the greatest risks for these people is the high probability they will fracture a hip, and of those who do, the risk of death as a result of a downward spiral of health after that fracture is a great concern.  Too often, recovery from this fracture is too complicated for the already-compromised health of the individual.  Falls are the leading cause of accidental death and injury in people 65 and older.

**33% of older adults fall every year, but only half of them talk to their doctor about it. **

If you have an older parent or a loved one who may be at risk to fall, have a frank, open discussion with them about this risk.  Perhaps they are one of those who don’t report a fall.  They may be scared to bring it up because they may fear loss of control if they admit it, and this may threaten their independence if they live alone.  They need to be made aware of the risk, these statistics, and what can happen if a hip is fractured.  Other broken bones or a head injury are also considerable risks.

There are many factors that play into good balance in this population, including reliable input from the vestibular system and the proprioceptive system (both were discussed earlier).  The sensors that determine the messages of our proprioceptive systems weaken, as the nerve endings are not as reliable as they once were.  The feet are full of such sensors that tell the brain how and when to move in order to maintain balance.  One suggestion experts make is to go barefoot in your home and whenever possible to keep these sensors stimulated and working as they should so that they can send accurate messages regarding position and balance back to the brain.

The older adult is also more likely to suffer from other disorders that will affect this system, including vision disorders.  Cataracts, glaucoma, diabetic retinopathy and macular degeneration all affect vision with age, and will likely in turn affect the older adult’s ability to see clearly to make safe judgements about movement.  Diabetic peripheral neuropathy affects position sense in the feet and legs, and, finally, overall degeneration of the vestibular system creates a decreased sense of balance.

**

Aging brings a host of challenges to one’s health.   It seems we must work harder to maintain what once was effortless.  With a little focus, dedication, and work, good balance can be the norm throughout the aging process.  Remaining in good physical shape through regular exercise is important not just for balance, but for every aspect of good health.  Good nutrition cannot be ignored either.

To reiterate these and other important considerations, please keep these suggestions in mind:

  • Regular exercise—walking is one of the best forms.
  • Maintain good eating habits.
  • Be aware of stressors and keep them in check.
  • Strive to get enough good-quality sleep.
  • Get regular checkups from you primary care doctor.  He or she can be alerted to any symptoms that   may cause imbalance and increase fall risk.
  • While most adults are aware of the signs and risks of high blood pressure, many  don’t know that    low blood pressure carries its own unique set of risks, and light-headedness is one symptom. Keep tabs on your blood pressure, and report any concerns to your doctor.
  • At any age, don’t take unnecessary risks when icy conditions prevail outdoors.   The number of falls and broken hips increase exponentially on ice.
  • Seek out physical therapy if your doctor feels it would help.
  • Consider yoga or Tai Chi.  Both are structured forms of exercise that focus on stability and balance. There are classes that cater specifically to the older adult.

**

While balance disorder and falls may be common as a person ages, they are NOT normal.  Common and normal are not to be confused.  There are many things a person can do to maintain good balance and vestibular health.  It may take extra effort, but it is worth it.

We are upright creatures.  Please stay that way.

IT’S SO GOOD TO HEAR YOUR VOICE

“So the one frog says to the other frog, ‘I think I have a person in my throat.”

**

Just as there are no two human faces that look exactly alike, there are no two human voices that sound alike.  Each of us has a uniquely personal voice, and it is a part of who we are.  Voice qualities are determined by gender, age, resonance, pitch, breath support, energy levels, inflection and volume.  One’s overall speech patterns are determined not only by voice, but by regional dialects, rate, fluency, articulation, and presence/absence of other physical qualities that can affect communication.

Too often, however, vocal quality is adversely affected by poor health and the habits that cause it.

Most of us don’t think twice about the ability to produce our voices.  We speak without effort, and our voices simply come out.   At least once in our lives, however, most of us have had at least a mild case of laryngitis, and we have temporarily lost our voice.  It is only then we realize how important the human voice is.

If you have ever experienced a loss of your voice for any reason, you are in the majority.  You likely felt helpless when you were not able to speak, and you likely hadn’t thought about what a gift it is to be able to produce your voice without any forethought or effort.  You likely got your voice back without any effort as well.  Lucky you.

It is estimated that at any given time in the United States, 6% of the general population is experiencing voice disorders.  Up to 21% of Americans will experience chronic, repeated laryngitis, which is the most common voice disorder.  Most of us, at one time or another—or multiple times—will experience a bout of laryngitis as a result of a cold, sinus infection, overuse, virus, injury, or other, less common causes.  In most cases, it is isolated, and we regain our voice.  Again, though, for that 21%, it is recurrent and chronic, likely requiring medical attention.

Most of us have heard of famous singers who have had to cancel concerts due to voice problems.  They are on “vocal rest,” which is the only way to heal the problems they experience from overuse.  Singers rely on their voices as their livelihood, and most of them take this advice seriously.  Concerts are cancelled, rescheduled, vocal cords are healed, and the show goes on.

**

You have likely had a callous on your hand or your foot at some point in your life.  It is caused from overuse, from another surface rubbing too hard and too frequently against the tissues of your skin.   When singers experience such vocal problems as a result of overuse, it is much like when a callous forms.  The surfaces of the vocal cords rub against each other with too much force, too often, and repeated again with the next song and performance.  Vocal nodules are created, which are much like callouses.  As you know, the only way to get rid of a callous is to give that area on you’re a skin a rest from the contact with the offending object—perhaps it is a shovel or a rake that you are not used to using.  If you give it enough rest, your skin will return to normal.  So too will the vocal cords with enough rest.

If you perform an online search for “video stroboscopy” you will see there are many online videos that show the function of vocal cords in action.  Any source from a university clinic is likely reliable.  These videos will likely show the subject holding out one sound such as “aaaaahhhhh.”  You will see the vocal cords vibrating, which is caused by the air rushing up from the lungs between them, thus creating your voice.

**

Daniel Bernoulli was a brilliant man.  So brilliant, in fact, that he had an effect named after him.  The Bernoulli Effect is illustrated by this airflow, which creates the human voice.  Another illustration of the Bernoulli Effect that most of us are familiar with is the airflow over and under an airplane’s wings.  When these two forces meet at the back of the wing, lift is created, and the airplane takes off and stays aloft.

Physics principles are alive and well in your body every time you speak.

**

Like so many other incredible functions of your incredible human body, you likely take your voice for granted.  It takes essentially no concentrated effort, it performs for you day in and day out and asks for nothing (much), and gives you the ability to experience a most wondrous human phenomenon:  connecting with another human.   Except when it doesn’t.  When you experience laryngitis—which usually resolves on its own, you realize how much you rely on your vocal cords.  If that is the most extreme vocal problem you ever experience, consider yourself lucky.  That 21% of the population mentioned in the first paragraph has, or will, experience more complex vocal cord problems at some point in their lives.

Most voice problems—besides laryngitis—are reported simply as a “scratchy voice.”   Hoarseness is also another complaint.  Other difficulties people can experience with their voice are pitch breaks, whereby the normal rise and fall of one’s voice cracks in inappropriate places,  or simply comes out sounding too high or too low.  This is an expected part of development for teenage boys, and it typically passes when their bodies become matured.

Every breath you take goes over your vocal cords.  This accounts for the scratchy, leathery voice one produces after many years of smoking.  The low, raspy voice is almost unmistakable.  After time, the abuse of cigarette/cigar and other types of smoke against one’s vocal cords cannot be hidden, and it is apparent in the vocal quality the speaker produces. When it comes to the voice, cigarettes don’t lie.  It’s never too late to stop smoking, and the entire body—not just the vocal cords—will thank you.

Unfortunately, nearly every case of laryngeal cancer could have been prevented by not smoking.  Most of us have interacted with or at least heard someone speaking with an artificial larynx, a vibrating device held to the neck to substitute for the voice when the vocal cords were removed due to cancer.   There are only several other alternative modes of communication for someone who has lost their vocal cords, and none of them can restore the voice to its original beauty, clarity and function.

Smoking is clearly an abuse of the vocal cords, but many of us—smokers and non-smokers alike—abuse our voices just as we do many other muscles in our bodies.  Overuse/inappropriate use of one’s voice such as yelling for prolonged periods or producing unusual sounds such as grinding one’s voice for effect can take a toll.  Chronic throat clearing is another abusive habit that many people have.  Ironically, most of the people who interact with this person notice it, but the guilty party does not.  It can be a nervous habit, or the result of excessive throat clearing after an illness that produced phlegm and secretions that needed to be cleared.  This is an uncomfortable situation, because to help that person overcome it, it needs to be brought to their attention, and that can be awkward and can cause hurt feelings if not handled carefully.

Often, children are guilty of abusing their voices.  Many young children exercise their vocal cords too well, and yell during play or during competition in sports.  This habit needs to be brought to their attention in order to be resolved, and it is typically easier to confront a child with this problem than an adult who has a chronic throat clear.  Children in school may be able to receive direct speech therapy from the school’s speech therapist to help correct this problem, and speaking with the child’s teacher is a good first step.

Chronic voice problems should always be examined medically.  A visit to your primary care practitioner is a good place to start, and you may be referred to an ear-nose-throat (ENT) specialist.  Many people fear the worst, but, mercifully, many a hoarse, scratchy voice is caused by vocal nodules, which are tiny growths on the vocal cords, and are benign in nearly every case.  Vocal rest is always recommended, and they can also be treated medically.

Acid reflux can also be the culprit.  When stomach acids come back up into the esophagus, they can proceed up to make contact with the vocal cords.  This acid can cause a burning effect on the vocal cords, and can affect the voice.  Again, this is treated medically.

Sometimes, there is no cause that can be found.  Voice problems can also be accompanied by a chronic cough, and when all other causes are ruled out for the cough as well, it can be as simple as this:  Drink more water.  Many voice problems and chronic coughing can be “cured” by simply drinking enough water.  Again, when there is no medical explanation after an examination, be sure that you are consuming enough water, but always be sure to get it checked out by your doctor.

What is “enough?”  The standard 8 glasses a day is good, but there is a more precise amount that is recommended by voice therapists.  Because a large person—say, a 250-pound man—has more tissue to hydrate than a small, 125-pound woman who is half his size, each person’s needs are different based on body mass and size.

In order to determine the ideal amount, simply divide your body weight in half, and strive to drink that many ounces.  This likely sounds daunting to most people, but anything closer to that goal versus what you are drinking now is a step in the right direction. This is good advice for general wellness too, as our bodies are made primarily of water, and require continued hydration to replenish themselves and remain healthy, or return to health.

Many people feel that any fluid will suffice, and some sources say it will, but voice experts will affirm that, indeed, the human body is made of water, not juice, tea, coffee or soda.  Therefore, water is the ideal liquid to ensure vocal health.  Those beverages are enjoyable for many people and should not be avoided altogether, but should not be substituted for water.

**

The human voice is part of the incredible process of communication.  At the moment a baby is born, the parents, doctors and nurses want to hear the voice in the form of a cry.  Speech comes much later, but from birth, we are using our voice to let everyone know we have indeed arrived.  When we are with a loved one at the moment they leave this earth, we hope to hear their voice one last time, leaving us with words we will treasure.

Take care of your voice, it’s the only one you will ever have.

HAPPY, HEALTHY HOLIDAYS TO YOU!

‘Tis the season to be merry and light, to be giving and forgiving, to be joyous, feel the peace flowing all around and to look ahead to a new and brighter year.  For most people, this comes effortlessly, and any minor stresses are outweighed by the joy.  It is indeed a magical time of year, when the spirit of giving and the memories of the holiday thrills of childhood are savored.

The gifts are bought, the parties are scheduled, the menus are planned, and the spirit of joy flows.  The kids are giddy—and some of the adults are too.  We begin to celebrate weeks ahead of time by shopping, decorating, writing cards, planning meals and sharing our joy.

We humans, as a group, share food too.

This is the time of year when plates of candy and cookies show up at our door or in the break room of the office.  This is the time of year the television and internet commercials bombard us with images of delicious, seemingly irresistible goodies.  This is the time of year when we consume large, delicious holiday meals with our family and friends.

And we should enjoy them.  That is one of the most basic and pleasurable things humans can experience.  These tasty treats please our taste buds, and, if we are lucky, bring back happy memories from a long list of happy holidays past. Eating good food is truly one of life’s greatest pleasures.

Unless, of course, we enjoy them too much, which, unfortunately, many of us do.

Finding a happy medium is the key.  Enjoying these delicious pleasures should be something to look forward to, savor as we consume them, and relish the memory of how good they tasted. This is possible and doable.  In certain amounts, that is.  With the exception of those with severe diabetes, or allergies to certain ingredients, these goodies should not be avoided.  Consuming just enough to enjoy, but not too much so as to overdo it is the balancing act that many of us struggle with.  Even if weight is not an issue for you, then the health factor should be considered:  so many of the holiday treats are not healthy foods, and eating too much of them simply is not good for your health.

Easier said than done. 

How does one achieve the “everything in moderation” goal when it comes to eating holiday treats?  It’s not always easy, but there are tips and strategies you can put to work in your favor if you are mindful of your eating behavior, the degree of nutrition the foods have, and the amount of what you are consuming.  The following list is filled with helpful and, perhaps, novel ways to achieve this

  • Don’t skip meals.  Maintaining your regular meal schedule is essential so that hunger doesn’t overcome you when you are presented with challenges.  Seeing the table of goodies in the office isn’t such a temptation if your stomach is already full of good food from your last meal.
  • Be realistic.  A few pounds gained during this time of year isn’t going to make or break you, and will likely be worth the pleasure you received from eating those tasty treats.  Just know that it is a special time of year, and you will return to your good habits in good time.  Don’t beat yourself up.
  • Maintain or begin an exercise plan.  Don’t skip your regular workout; it is essential more than ever to keep any weight gain at bay or to a minimum.
  • If you overindulge at one meal/party, go light on the next one.  Try to strike a balance between the two meals/parties, or, on a larger scale, if you blow a whole day and overdo it, just take it easy the next.  Try not to adopt a “what the heck” attitude, as if it doesn’t matter anymore what you eat since you’ve already overindulged.  It does.
  • Survey the entire menu/table of treats before you dish up your plate.  Try to take only your most favorite dishes, and in small portions.  You can always go back—or not, and this won’t be your last chance to partake.  There will be tomorrow, and probably the next day, and next week…
  • Keep your time-honored and beloved holiday baking/cooking/eating traditions, but try not to make them the only focus.  Plan a gathering to wrap gifts, make wreaths, write cards, go caroling, or shop for a less-fortunate family.
  • It truly is better to give than to receive.   Bake all those goodies, but give them away to someone who is less fortunate.  Take cookies or candy to a nursing home.  Senior citizens are partial to sweets, as their other taste buds diminish over time, but sweet taste buds remain strongest as we age.
  • Curb your own sweet cravings with something bitter.  If you feel like you can’t resist another cookie or piece of candy, try eating a pickle.  The bitter taste bud will usually trump the sweet taste bud if you satisfy it—keep that jar of pickles handy.
  • Brush your teeth.  That minty-fresh taste will help you resist putting more food in your mouth.
  • Chew gum.   It may be easier to pop a piece of gum or a mint in your mouth instead of brushing if you find yourself tempted at the table.
  • Wear your tightest pants—within reason, of course.  If you keep your midsection swaddled with snug fitting bottoms, you are more easily reminded what happens after you partake.
  • Eat until you are satisfied, not stuffed.  This can be a gray area, as most of us don’t feel full until long after our stomachs are at their maximum capacity.  It takes about 20 minutes for the feeling of healthy fullness to register, so give yourself a time-out after the first round, and see if you really do need to eat more to honestly be satisfied, instead of stuffing yourself.
  • Put your fork, spoon or finger food down in between bites.  This forces you to focus on the bite in your mouth, not the next bite waiting eagerly on your fork or in your hand.  Savor the flavor, move it slowly around in your mouth, chew it thoroughly, then swallow before you pick up the next bite.  This works all year round too, not just during the holidays!
  • Stand away from the treats table in conversation.  You will be less tempted if you are not looking over your conversation partner’s shoulder at the smorgasbord behind them.
  • Bring a fruit bowl of plate of veggies to the gathering.  You probably won’t win the prize for the favorite dish, but you will be able to choose from your own plate so that you won’t eat only the less-healthy options.  Be sure to eat these first, to fill up as much as you can.  Choose the other healthy options first too, such as nuts or cheese before the sweets.
  • Pay first, enjoy later.  Take a walk around the block before you take your break and head to the dessert table in the break room at work.
  • Be aware of high-calorie drinks.  Fruit-based drinks are often sugar bombs.  They do not take the place of eating fresh fruit.  Other specialty holiday drinks tend to be laden with calories and/or fat.  Of course, alcohol packs a punch in calories too, so be aware of any increased consumption of spirits during the holiday season.
  • Use smaller plates and utensils.  Pick up a plate from the stack of small plates instead of the larger plates.  Filling the smaller plate is obviously better that filling and eating a larger one.  Be aware of bite sizes, as smaller bites are more easily chewed, swallowed and digested.   Again, this works like a charm all year round!
  • Take half of your plate home.  You can enjoy it later, after your stomach has had time to recoup, and perhaps your craving has subsided.  Better yet, save it for tomorrow.
  • Don’t go hungry to the grocery store or the mall.  You will make healthier choices in both places when it comes to making decisions about what to eat at that moment, or when planning menus for the upcoming meals.
  • Find an accountability buddy.  If there is someone in your office or family who consistently demonstrates stellar self-discipline, but yet does enjoy the goodies, watch how they do it.  They don’t even need to know you are watching if you don’t tell them.  If you know someone who struggles as much as you do, set up a plan to touch base daily by phone or text to confess your sins, or to brag about your willpower.  Two willpowers are better than one.  Using them as an exercise partner, if possible, is an excellent way to keep your eating in check, or to work it off if you didn’t.
  • Look online for healthy recipes, or buy a cookbook dedicated to healthy holiday foods.  An online search for “healthy holiday recipes” will yield a wealth of websites that offer recipes that are designed to reduce calories and carbs, and can offer tricks that may painlessly take away some of the calories, carbs and/or fat.  Using skim milk, reducing the amount of eggs in a recipe, clever substitutions that won’t even be noticed and healthy cooking tips are available on many websites.

**

If you are blessed to have healthy gums and teeth to chew with, strong muscles to swallow with, and a stomach ready to receive food, consider this a blessing, and enjoy everything you consume.  It truly is a gift, one of the greatest pleasures known to humans, and we are meant to enjoy it all, in moderation, of course.

Happy, healthy holidays to you.

MATTERS OF THE HEART

She has a big heart.

I am broken—hearted.

I know it in my heart of hearts.

Have a heart.

You’re in my heart.

My heart breaks for you.

The heart is the organ most commonly used in expressions of emotion in our language.   Without being consciously aware, we speak of the human heart in so many ways, most of them referring to how we feel emotionally.  Physically, however, it is one of the most vital organs in our body.  We literally are nothing without its constant beat, its unfailing mission to keep blood pumping throughout our bodies.  Except when it does fail…

 **

Heart disease is one of the leading killers of men and ranks as the leading cause for women.  There are many diagnoses that define poor heart health, and many causes for these diagnoses.   Heart Failure is a general term used to describe several diagnoses, and does not mean the heart has stopped working completely.  Rather, it refers to a heart condition that causes the heart function to be compromised, and not work as well as it was designed to do.

As one of the miracles of modern medicine, thankfully, there are many procedures, treatments and surgeries that can improve heart health, which in turn can drastically improve the general health of the human body it keeps alive.  This article will explore all aspects:   symptoms, diagnoses and treatments.

Just as matters of the heart in emotional terms vary differently between men and women, so too do they differ physically.  Those differences will be highlighted as well.

**

A healthy heart works like this:  the pumping action of the heart moves oxygen-rich blood as it travels from the lungs to the left atrium, then the left ventricle, which, in turn, pumps it through the rest of the body.  This left ventricle supplies most of the heart’s pumping power, which accounts for its larger size relative to the heart’s other chambers.  In left-sided heart failure, the heart must work harder to pump the same essential amount of blood to the body.   This failure may occur in either of the two phases:  systolic, whereby the ventricle loses its ability to contract normally.  In diastolic failure, the ventricle cannot relax normally due to stiffened muscles, therefore preventing the heart from filling properly with blood during the short rest period between beats.

In a healthy heart on the right side, the pumping action moved “used” blood that is returned to the heart through the veins via the right atrium, then on to the right ventricle, which, in turn, pumps the blood back out of the heart into the lungs to be replenished with oxygen.  When the right side of the heart fails, it is typically a by-product of left-sided failure, because the right side must compensate for left weakness.  The right side then loses its pumping power, backing blood up in the body’s veins.  This swelling or edema is most common in the ankles and legs, but can affect other body parts too.

A general term, congestive heart failure (CHF) refers to increased backup or congestion of blood in the bodily tissues, typically, again in the ankles and legs, but it can occur in other body parts too.  It may collect in the lungs and cause difficulty breathing and shortness of breath, and general respiratory distress.  CHF requires timely medical attention.

Heart failure may also affect the kidney’s ability to rid themselves of sodium and water, thus retaining water in the body’s tissues.

Most every adult has heard the advice:  eat healthy foods, get plenty of exercise, keep weight within normal limits, reduce stress, keep cholesterol levels in check, don’t smoke or quit if you do smoke, get regular checkups, be aware of family history and get plenty of sleep.  These are all great words of advice, and should be followed as closely as possible for everyone.  Even in those who follow these rules faithfully, there still exists a risk for heart failure or heart attack.  Family history, as mentioned above, is a risk factor that must be considered.

 **

The following symptoms, possibly alone or in any combinations, depending upon the severity, may indicate heart failure and should prompt medical attention:

  • shortness of breath
  • persistent coughing or wheezing
  • buildup of excess fluid in body tissues (edema)
  • unusual fatigue
  • lack of appetite or nausea
  • impaired thinking
  • increased heart rate

**

If any of these following symptoms are experienced, you should seek immediate medical attention, calling 911 if necessary, as seconds may count:

*discomfort in the center of the chest that lasts longer than a few minutes, or goes away and comes back, including:  uncomfortable pressure, squeezing, fullness or stabbing pain, HOWEVER:

NOT ALL HEART ATTACKS ARE PRECEDED BY CHEST PAIN

Other symptoms include:

  • chest discomfort
  • discomfort in other upper body areas including one or both arms, the back, the neck, the jaw or stomach
  • shortness of breath with or without chest discomfort
  • pounding heart or changes in heart rhythm
  • heartburn, nausea, abdominal pain, vomiting
  • breaking out in a cold sweat
  • dizziness or lightheadedness

For women, the symptoms are likely to include:

chest pain, but women are more likely to experience shortness of breath, nausea/vomiting and back or jaw pain than men

uncomfortable pressure, squeezing, fullness or pain in center of chest, lasting more than a few minutes, possibly going away and coming back

Again, these symptoms should receive IMMEDIATE medical attention, as seconds do count—your life or the future of your heart may depend on it.  Heart attacks do not always present as they do in the movies, as a dramatic, one-moment occurrence.  Rather; they may come on slowly and last a bit longer that that one dramatic second on television or the movies.

Research has shown that women are more likely to attribute any or all of these symptoms to acid reflux, the flu, normal aging and “normal” fatigue.

Most women think the signs are unmistakable, but in reality, they may be far less extreme than for men.  Many women are shocked to learn they have had a heart attack when they have been diagnosed.   As most women are a caregiver in some form—children, parents—they typically deny their needs and put others needs first, failing to acknowledge the severity of their symptoms.

Depending upon the diagnosis, there are multiple surgeries and procedures that may be performed to improve heart health, including:

Angioplasty:  tubing with an attached deflated balloon is threaded up to the coronary arteries.  The balloon is then inflated to widen blocked areas.  This surgery is minimally invasive, and generally requires an overnight hospital stay.  The surgery lasts about 30 minutes, and greatly reduces the risk for future heart attacks, allows higher levels of physical activity, and decreases chest pain (angina).

Artificial heart valve surgery:  replaces a diseased heart valve with a healthy one to improve valve function.

Bypass surgery:    Also known as Coronary Artery Bypass Graft, or CABG or “cabbage”, this surgery involves grafting veins from other parts of the body to bypass the diseased or clogged arteries to allow better blood flow through the heart, and to avoid the blocked areas.   This is considered major surgery, and typically requires at least 3 days in the hospital.   This surgery improves blood flow throughout the body, reduces risk for further heart attacks, decreases chest pain, and increases capacity for physical activity.  Minimally invasive heart surgery is similar to this surgery, but small incisions are cut into the chest with ports placed to insert small veins from the leg or chest arteries to be attached to the heart to bypass the affected area.  It is much less invasive than bypass surgery.

Cardiomyoplasty:  This experimental surgery takes muscles from the patient’s back or abdomen and “wraps” it around the heart to improve the pumping function of the heart.  It is aided by a device similar to a pacemaker to stimulate contractions.  Its primary purpose is to increase the pumping motion of the heart.

Heart transplant:  removes a diseased or malfunctioning heart from the patient, replacing it with a donor heart.  It is generally recognized as a successful procedure to restore heart health in appropriate patients.

Stent procedure:  A stent is a wire mesh tube used to prop open the artery during angioplasty.  The stent stays in the artery permanently, holding the artery open, improving blood flow to the heart, and improving chest pain.

Radiofrequency ablation/catheter ablation:  A catheter with an electrode at its tip is guided through the veins to the heart muscle, taking a real-time x-ray that is displayed on a large screen.  The catheter is placed at the exact site inside the heart where the cells that are creating the irregular beat give off their electrical signals.  A mild, painless radio frequency (similar to a microwave) is delivered to a small area, carefully destroying the problematic cells.  This is the preferred treatment for many types of rapid heartbeats, as it replaces the erroneous signals with more even, better timed signal.

Pacemaker:  a battery powered device that generates a regular electrical signal to stimulate the pumping activity of the heart is implanted just under the skin, with wires attached to it and to the heart.  It is used  with certain conditions that affect the rhythm of the heartbeat. 

**

Heart failure occurs in adults most commonly due to poor lifestyle choices such as smoking, inactivity and poor diet, as well as conditions such as high blood pressure, diabetes, coronary artery disease and bad heart valves.  Sadly, heart failure can also occur in children and babies, although for other reasons.  Structural defects that are often diagnosed within days of birth—approximately 1% of babies are diagnosed and treated, viral infections as well as birth trauma can cause heart defects in newborns.

With adolescents, viral infections can damage the heart, as can certain strong drugs that are typically prescribed to treat cancers.  The heart’s electrical system can be damaged since birth, and may have gone undetected.  Children with muscular dystrophy may experience heart failure, as the heart may become an inefficient pump as the disease progresses.

Earlier today, November 18th, 2015, Doug Flutie, a famous NFL player from the 1980’s, made a public announcement regarding his family.   This morning, his father, who had been struggling with heart disease, died of heart failure.  One hour later, his mother, who had been married to his father for 56 years, also died of a heart attack, unexpectedly. 

“They say you can die of a broken heart,” he said. “I believe it.”

Despite all the medical advancements, the complex and sophisticated treatments and surgeries and extensive research, the human heart will, as the above story illustrates, always remain somewhat of a mystery.

For Doug Flutie, his family, and anyone else who has ever lost a loved one to heart failure, my heart breaks for you.

Awareness is the Beginning…

During the month of October, the nation becomes awash in a sea of pink. The American Cancer Society sponsors the Breast Cancer Awareness Month every October.

Beginning in 1985, the American Cancer Society partnered with Imperial Chemical Industries—which is now part of Astra Zeneca—to begin this annual month of activities designed to increase awareness of breast cancer signs and symptoms. Ultimately, this awareness has increased the national rates of testing in the form of self-examinations, physician consultations and mammograms. This is exactly what it was intended to do, with a long-term goal of decreasing mortality rates.

Beginning around the year 2000, the mortality rates from breast cancer began a slow but steady decline, and have continued ever since. This decrease does coincide with a national decrease in the use of hormone replacement therapies (HRT), which has been shown to increase breast cancer risk, and likely is responsible for some of the decrease in breast cancer rates as well.

Awareness, however, is the focus this October, as it is every October. And awareness, as we all know, is the first step in solving any problem.

This campaign has been successful in instilling such awareness in women. While not near as common, breast cancer is also a risk for men. Throughout a man’s lifetime, he carries a 1/1000 risk of developing breast cancer, while women carry a 1/8 risk, which translates into 12% of women developing breast cancer during their lifetime.

The American Cancer Society (ACS) supports any and all activities that increase awareness of any kind of cancer risk. Many other forms of cancer are highlighted throughout the year with awareness activities designated during specific months each year. While ACS does not officially coordinate all efforts and activities, many more cancers are publicized in hopes of increasing awareness, just as breast cancer is highlighted during the month of October.

Each year brings various monthly activities to increase awareness of various cancers and illnesses. An asterisk (*) follows the activities that are sponsored by the American Cancer Society:

JANUARY:
Coaches vs. Cancer Suits and Sneakers Awareness Weekend*
Coaches vs. Cancer Suits and Sneakers Challenge*
Healthy Weight Week
National Cervical Health Awareness Month

FEBRUARY:
National Cancer Prevention Month
World Cancer Day—Thursday, February 4th

MARCH:
Colorectal Cancer Awareness Month
International Women’s Day—Monday, March 7th
Kick Butts Day—March 18th (non-smoking campaign)
National Nutrition Month

APRIL:
National Cancer Control Month
National Minority Cancer Awareness Week
National Minority Health Month
National Oral, Head and Neck Cancer Awareness Week
National Volunteer Week
Testicular Cancer Awareness Month
World Health Day—April 7th

MAY
Brain Tumor Awareness Month
Cancer Research Month
Don’t Fry Day—May 27nd*
Melanoma Monday—May 2nd
National Women’s Check-up Day—May 9th
National Women’s Health Week
Skin Cancer Detection and Prevention Month
World No Tobacco Day—May 31st

JUNE
Coaches vs. Cancer Golf Invitational*
Men’s Health/Cancer Awareness Month
National Cancer Survivor’s Day—June 7th
National Men’s Health Week

JULY
UV Safety Month

AUGUST
Summer Sun Safety Month

SEPTEMBER
Childhood Cancer Awareness Month
Gynecologic Cancer Awareness Month
Leukemia and Lymphoma Awareness Month
National Ovarian Cancer Awareness Month
National Prostate Awareness Month
Take a Loved One to the Doctor Day—typically the last week in September
Thyroid Cancer Awareness Month

OCTOBER
National Breast Cancer Awareness Month*
National Mammography Day—October 16th*
American Cancer Society Making Strides Against Breast Cancer events*

NOVEMBER
Coaches vs. Cancer Classic*
Great American Smokeout—November 19th*
Lung Cancer Awareness Month
National Family Caregiver Month
Neuroendocrine Tumor Day
Pancreatic Cancer Awareness Month

DECEMBER
No events scheduled

Again, awareness is key. No problem can be effectively solved unless the people involved are aware of the situation. The same can be said for any health concern or illness. The American Cancer Society is the official sponsor for those events that are marked with an asterisk (*), but they do support any positive strides toward increased awareness of any cancers, illnesses or health-related needs in our society.

There are many more illnesses that are not recognized in this list. It is important to see the human body as a whole, and to stay in tune with all health aspects that are not listed, such as heart health. Cardiac disease is one such illness that continues to claim far too many lives in the United States. While great strides have been made, mental illness remains a subject that too few people are willing to openly address, so the stigma continues. Such illnesses affect the function of many adults and children, contributing to decreased overall societal wellness.

In addition, prevention is an important component of a healthy lifestyle. Many elements of modern American lifestyle pose risks for most of us, such as sedentary habits, poor dietary intake, lack of sleep, excess stress, too much sun, overindulgence in alcohol and using illegal drugs.

The primary objective of these awareness campaigns is to increase early detection of cancers, thus decreasing the negative health consequences and increasing the survival rate, as well as improving the quality of life for the survivors. The power of the human group is evident throughout such campaigns as well. When people band together for a cause, each person is empowered by the others, and gains strength. These awareness activities foster such feelings of like-mindedness.

No matter what the problem, whether it be a health issue or any problem faced by any person, complete awareness of the facts by all parties involved will certainly facilitate solutions.

October is a good month to increase your awareness of early detection of any disease, breast cancer or otherwise. Taking steps to make sure your health is as good as it can be is always a good idea, but especially right now, you are in good company.

JUST BREATHE…AND SLEEP…AND EXERCISE…AND…

Sounds simple. Yet, most of us overlook the value of these habits as health benefits, as well as a means of stress reduction. Along with many other practices that we all need to make into habits, these can be very effective, natural and free ways to improve our health and reduce stress.

We have the power to control our health more than most of us give ourselves credit for. It does take work, but most people have the means to improve their health by taking a few small—and maybe a few big—steps.

Seeking the help of a health care practitioner when illness strikes is usually the best thing to do. That is what they are there for, provided it is not a mild cold or a simple case of the flu. Sometimes, a general sense of malaise can make us feel that something is wrong, and, if it persists over a long period of time, it is advisable to seek medical attention.

In order to maximize this medical assistance, we need to make sure we have taken care of ourselves first. There are many things each of us can do to ensure the best health possible. We have the power to improve our health in ways that most of us do not realize.

The human body was designed to be healthy. The body craves wellness, and will do whatever it can to achieve this state. It will overcome illness, injury, lack of sleep, poor nutrition, poor water intake, inadequate activity and general abuse—for awhile. It is incredibly resilient, and can bounce back from major setbacks in surprising fashion—most of the time. It has been known to prove even the most experienced and brilliant health care providers wrong, and can beat slim odds for survival and good health that sometimes are offered based on the “average” person’s chance of returning to good health.

“I tell my patients that if you are ‘average’, this is what you can expect. Who is average? It is typically a person who could take better care of themselves, because most people don’t. ‘Are you average?’ I ask them. If they take care of themselves by eating right, getting enough exercise and rest, and keep stress at bay, then they are not really ‘average.’ They stand a better chance of getting better that the ‘Average Joe’ or ‘Average Jane,’ simply because they have stacked the odds in their favor. Add all these to a positive mental outlook, on top of expert medical care, and your chances at recovery are as good as can be expected by anyone.” 

—A health care practitioner

It is human nature to take the path of least resistance. We are wired to find the easiest way to complete tasks in the least amount of time, with the least amount of effort, with the least amount of pain. This is not a bad thing. It is foolish to invite extra work upon oneself when there is no need, so finding this path of least resistance is typically the best way to get a job done. It is how highly efficient people make it happen.

However, it isn’t typically the way to good health. It is the easy way, the easy path to not exercise, to eat what our taste buds demand, to scrimp on sleep and to let stress rule our lives. It takes work to fight these things, it is NOT the path of least resistance to exercise regularly, eat nutritious, wholesome foods, ensure adequate sleep, and keep stress at bay. All these things take work. To further complicate this issue, many of us don’t realize the extent to which we have let ourselves go down the easy path. We have had these habits for so long, we have made them a pattern that we don’t even realize we follow. As well as craving wellness, the human body, unfortunately, falls into patterns of behavior that can lead to poor health, if we allow it to go down this path of least resistance. Like a small child or a pet, the body must be trained, and it’s not always easy.

Ask anyone who regularly exercises, gets enough sleep, eats wholesome, healthy foods, drinks enough water, practices deep breathing and other means of stress relief, and they will all resoundingly agree: It keeps them healthy and feeling good, and it is worth the effort. The struggle is within the change that is necessary for most people to create these new patterns. The human body is stubborn; it wants to do what it always does because that is the easy way, the way it knows.

Some psychological studies have reported that it takes about 21 days to change a habit or to create a new one. There is likely some variance from person to person, but generally it does take at least a few weeks of daily, diligent and focused behavioral changes before the brain realizes it as new pattern, and acts accordingly. Any one of the changes you can make for improved health can be daunting, which is why most professionals would recommend making one change at a time. Focusing all one’s energies into one specific direction can yield more obvious results, which can, in turn, motivate you to continue to make changes in that direction, as well as in other directions as well.

**

Let’s break this down into simpler terms: The body is designed to take in fresh air in deep breaths, clean water in adequate amounts, movement of its muscles, get enough sleep, tolerate manageable stress levels, consume wholesome foods and maintain a positive attitude to bring it all together. Each one of these has its own benefits, just as Nature designed.

Deep breaths: The lungs have upper and lower lobes. Most of us breathe in quick, shallow breaths, allowing the shoulders to move as air is taken in. Ideally, the stomach should move as air is forced down into the lower lobes, and the shoulders and upper chest should stay still. If you watch a baby breathe deeply as it sleeps, you will see its stomach expand with each deep breath. This is how humans are designed to breathe, and somewhere along the way, most of us lose this habit in favor of shallow, rapid breaths that fill the upper lobes of the lungs. This does allow full respiration to occur, and allows old, stale air to collect in the bottom of the lungs.

**Place one hand on the stomach, and one on the chest. Breathe in through the nose and out through the mouth. This takes practice, but the hand on the stomach should be pushed out—as if there is a balloon in the stomach being inflated—and the hand on the chest should stay still. This should be performed while seated or lying down, because light-headedness and overall relaxation is likely to occur. If you are lying down, placing a book on the stomach is a good way to gauge its proper movement—you should be able to see the book rise and fall.
Just breathe—the way the human body was designed to.

**

Drink water: Most of us don’t want to talk about or even think about our weight, but let’s use that number for a moment: Divide your weight by two. This is the amount of water—in ounces a person should consume on a daily basis. The body is made of water, and it takes water to replenish it on a daily basis. It is a system that flushes the toxins out of the body, and bathes the inside. Most of us have known someone who suffered from dehydration, whether it was an older person who became ill, or an athlete who pushed themselves beyond their limits and didn’t remain adequately hydrated. The reality is that most humans don’t consume enough water, and exist in a pre- or minimally-dehydrated state.

“As a voice professional, the first question I ask a new patient when they come to see me to treat a hoarse voice is this: ‘How much water do you drink?’ Most of them say ‘a lot’ or ‘not enough.’ ‘Not enough’, of course, is never enough, but ‘a lot’ is rarely half of their body weight in ounces daily. They think they are drinking ‘a lot’ but in reality, it’s not enough. If they don’t drink enough, I don’t even begin to treat them until they can commit to at least a week of drinking ‘enough’ water daily. More often than not, this ‘cures’ them of their voice problem. Often a chronic cough is a sign of dehydration as well, as the dry vocal cords irritate each other and cause an annoying cough. This little ‘fix’ is so simple, yet so overlooked. I am not an expert on the rest of the body, but if it can do this much good for the voice, imagine what drinking enough water can do for the rest of the body.” 

—a professional voice therapist

A common misconception is that any liquid will keep a person adequately hydrated. Not so. The human body is made of approximately 70% water, not coffee, tea, soda, juice or any other liquid. In fact, drinking any caffeinated beverage puts you “in the red,” leaving a “debt” to repay with equal amounts of water that should be consumed in order to bring the intake level back up to zero.
The formula stated above—half the body weight in ounces—is the ideal target to strive for, but any amount above what is currently being consumed is a step in the right direction. Slow strides with small amounts added to total consumption on a weekly basis will, in time, bring you closer to the ideal amount, even if the goal is not reached.

MOVE IT OR LOSE IT

The human body is designed to move. Its complex system of muscles allows a person to move in incredible ways. The more our bodies move, the more they contribute to our good health. Athletes are gifted individuals who move their bodies in specific and repeated ways to achieve a goal, which most of us are not. We don’t have to be.

Simply moving your legs in a brisk walk for even 20 minutes will bring about immediate results. Our bodies feel the immediate effect of motion, and respond accordingly. Our physical energy increases, our mood increases, and the world suddenly looks brighter. Other simple exercises such as riding a bike, playing a sport or engaging in yoga can be beneficial to your muscles in very specific ways. Again, no one has to be an athlete to get in the game. Simply engaging to the best of your abilities will bring about short and long-term results. People with physical handicaps face special challenges with exercise, but with the help of a professional, there are typically ways that the body can be exercised for maximum benefits.

It has been speculated that, if the positive effects of exercise could be bottled and sold as a drug, it would fly off the shelves as the most incredible wonder drug ever formulated. So why don’t more people—everyone for that matter—simply engage in regular exercise to reap these benefits? Again, it is not the path of least resistance. It does take effort and energy to commit oneself to a regular exercise plan. Once that 21 day (or so) period of forming that new habit is under your belt, it becomes much easier to keep it going. In time, it will be self-sustaining, and missing a regular exercise activity will feel as if you have been cheated.

When your body is in prime physical shape as a result of exercise, you are less likely to become sick in the first place, and, if you do, recovery is quicker and less painful. If you suffer from an injury, or require surgery, your return to good health is considerably aided by the fact that your body was in its best state prior to the event.

Exercise has been touted as a good remedy for what ails you for good reason: It can be. So much research and reports of personal experience can’t be wrong.

ZZZZZZZ…And then there is sleep. If you are an “average” American, chances are you have been made to feel that sleep might be for wimps. If you work long hours and are trying to climb that ladder, sacrificing sleep is, unfortunately, probably a necessity. Don’t tell anyone you actually got eight hours of sleep last night, because you probably should have spent at least a few of those hours at work.
Sleep is a basic necessity for the human body, we all know that. We all know that it is painful to be so tired that you can barely move. We have all experienced the “brain fog” that comes with too little sleep, and research confirms just that: the hours we spend sleeping are downtime for the brain. The brain is bathed in cleansing fluid while we sleep, essentially it “takes out the trash” every night during a good deep sleep. It wipes away the slime and sludge, and gives us a fresh mental start every morning.

Without regular, deep and adequate sleep, research has also shown that the risks of heart disease and other killer conditions increase sharply. A few missed nights of sleep here and there are expected, but over a lifetime, too many of them can add up. In addition, too little sleep sharply increases the risk of accidents while driving or performing work-related tasks that take sharp focus, such as those required of pilots and surgeons, or anyone working with machinery or power tools. Simple mistakes on paper that are made when we are tired can cause big problems as well. Poor decision-making in any job as a result of too little sleep can show up in magnified ways later.

Tuning out of any electronic equipment including computers, smartphones, televisions and any device several hours before bed allow the brain to begin the process of shutting down that is should do nightly. The light rays that are emitted from any device delay this process, and contribute to delayed onset of sleep, and poor quality of sleep.

Eat your vegetables…If you are like the average human, you already know what to eat and what not to eat. The hard part is making those hard choices when your taste buds dictate otherwise. They rule most choices we make about what to eat, but, interestingly, are such a small part of the big picture of eating and digestion. The food passes over them swiftly, allowing them to savor the food they so desired, and then the food is sent down to be dealt with for hours, days, weeks and sometimes months or years when it finds a home in fat tissue somewhere in the body.
Just like we all know that smoking is not good for our bodies, we also know what foods are good for us, and which ones are not. Small changes in our dietary habits can lead to big changes in our health.

Don’t stress…Easier said than done. This one is included at the end because if any or all of the suggestions made previously are implemented, stress will automatically be reduced. Exercise, especially, is known to be a very effective stress buster.

Stress is not simply “out there” as an external force. Rather, we allow a situation or an event to become stressful to us by the perception of its negative effect upon us. Adopting a mindset that we have control over how these events or situations affect is necessary to reduce stress for the long term. Experiencing stress from any situation sets us up to regard that situation as stressful, so we are likely to regard is as such anytime we are faced with it. Test-taking, on-the-job performance reviews, encounters with certain people, holidays and bill-paying are common situations that are perceived as stressful. Acknowledging that they are likely to cause us negative feelings sets us up to feel that way.

This brings us to the final tip: Think positive. Believe you can make the changes necessary. Have faith that you are strong enough to do the work to make your life better. Know that it can get better, and that you are the one who can bring about these positive changes. It starts in the mind, and when you tell your brain and your body they can do it, they believe it too.

So get started! All you have to do is just breathe…

Medicare, Medicaid and Social Security: Then and Now

HAPPY 50TH BIRTHDAY MEDICARE AND MEDICAID:  THEN AND NOW
HAPPY 80TH BIRTHDAY SOCIAL SECURITY:  THEN AND NOW

We take care of our own.  As Americans, we, as a whole, have prided ourselves on serving our senior and disabled citizens with a national health insurance program, and a national retirement program, despite the struggles and crises it continues to experience.

Prior to July 30th, 1965, only about half of Americans aged 65 or older had health insurance.  Now, virtually all seniors have coverage.  Their rate of insured is at nearly 100%, a much higher rate than those younger than 65.

“No longer will older Americans be denied the healing miracle of modern medicine.  No longer will illness crush and destroy the savings that they have so carefully put away over a lifetime so that they might enjoy dignity in their later years.  No longer will young families see their own incomes, and their own hopes, eaten away simply because they are carrying out their deep moral obligations to their parents, and to their uncles, and to their aunts.”    —-President Lyndon B. Johnson, upon signing into law the Medicare and Medicaid bills.

Much like Obamacare today, Medicare and Medicaid were not universally accepted upon their introduction into our system.  Many people doubted their necessity or their long-term viability, as well as the structure and operation of the systems.   Now, 50 years later, it is hard to imagine our society without these blankets that cover so many deserving and needy members of our country.

Medicaid was slower to pick up momentum as a universal program, but it has caught up to Medicare in the importance of services it provides.  Medicare now pays for just under half of U.S. births, and a little over half of nursing home care in America.

Together, Medicare and Medicaid cover about one-third of all Americans.  We have all heard the grim predictions:  Neither one can go on like this forever.  Tax increases, benefit cuts and reductions in payments to medical providers will be necessary in order to keep the programs alive.

When these programs were conceived, the demographics were different.  The long-term plans and projections for both programs were based upon current life expectancies, as well as social norms and trends.

Here’s a snapshot look at the past and present of these programs:

  •  1965:  At age 65, men could be expected to live 13.5 more years.  Women could expect to live 18 more.
  • 2015:  Men can now be expected to live 19.3 years past age 65, and women average 21.6 more years past age 65.
  • 1965:  Especially in the South, racially segregated hospitals and nursing homes were common.
  • 2015:   Segregated facilities are unheard of.  In order to receive Medicare and Medicaid benefits, hospitals and nursing homes must assure the federal government that they don’t discriminate, or face losing payments.  School desegregation proved to be much more difficult that desegregating medical facilities.
  • 1965:  Medicare did not cover prescription drugs.
  • 2015:  Medicare D took effect in 2006, created especially to cover prescription drugs under President George W. Bush.
  • 1965:  Income wasn’t used to determine specific eligibility for Medicare.
  • 2015:  With income levels above $85,000 annually for singles, and $170,000 for couples, Part B premiums increase in cost for outpatient services such as physical, occupational and speech therapy.  Prescriptions under Part D also increase in cost at these income levels.Analysts predict that these increases in premiums will continue, if not become greater as Medicare’s long-term funding crisis continues to grow.
  • 1965:  Medicaid eligibility was dependent upon receiving government welfare checks.  Thus, many underprivileged children did not qualify with their family’s welfare status.
  • 2015:   Regardless of income, about one-third of all children in the United States today receive Medicaid benefits, thanks in large part to the welfare reform laws of the 1990s.   Among lower-income families, three out of four children now receive benefits.President Obama’s health care laws expanded Medicaid coverage.   Lower-class working adults with no children at home were once left in a coverage gap.  Now, with the passage of Obamacare, this major group largely receives coverage.
  • The evolution of Medicaid has created a blanket program for all low-income people in the United States.
  • 1965:  Medicare and Medicaid did not use private insurance agencies behind the scenes to deliver benefits, but did utilize their services to process claims.
  • 2015:  It is now the norm for private insurance plans to provide benefits to the consumer, especially through Medicaid.  In Kansas, the most common providers are United Health Care, Sunflower, and Amerigroup.  Together, these are administered through KanCare, which is the official state agency that administers Medicare benefits.  A key element of Medicare is a restriction of the beneficiary’s choice of doctors and hospitals.

 

In addition, the prescription drug benefit—Part D—is provided privately.

With one in three Americans being covered by one or both programs, they are a key element of our health care system.  Long-term solvency and continued success of both programs depends upon lawmakers careful planning and decision-making.   Considerations of all possible changes and improvements are foremost among our domestic issues on the political table.  Keeping them a priority will help to ensure their long-term survival, and help them to continue to celebrate many more milestone birthdays.

 

SOCIAL SECURITY TURNS 80

 President Franklin D. Roosevelt signed Social Security into law on August 14th, 1935. It allows older and disabled United States citizens to retire with at least some measure of income.   Coupled with Medicare, it provides a higher standard of living for U.S. citizens who qualify.

Like Medicare and Medicaid, it has seen some big changes:

  • 1935:  Services and payments were provided face-to-face.
  • 2015:  Increasingly, the services are provided online, while the toll-free telephone system is still in service, as well as minimal face-to-face.  Payments are made electronically into a bank account, or can be loaded onto a debit card.  Most retirees no longer receive paper checks.  Online statements are also used versus paper.
  •  1935:  The standard retirement age was 65, but reduced benefits could be drawn as early as 62.
  • 2015:   The full retirement age is 66 or 67, depending upon birth year.  Early reduced benefits can be drawn at 62, and is a popular choice.
  •  1935:  Cost of living increases were not instituted for 10 years after its inception.  Thereafter, increases occurred mostly in election years.
  • 2015:  In 1972, Congress passed a law mandating cost of living adjustments based on annual increases in consumer prices, which continue today.
  • 1935:  Benefits were given only to retirees, and no family members.
  • 2015:   Amendments in 1939 allowed minor children and spouses of retired person to receive benefits, as well as surviving children and spouses of deceased workers.  In effect, this provision acts as life insurance.   Disability payments were added in 1956 for older workers, and extending to all ages of disabled people in 1960.
  • 1935:  The very first Social Security check was issued to Ida May Fuller of Ludlow, Vermont in 1940 for $22.54.
  • 2015:  The average monthly payout in June 2015 was $1,335.00

As our nation continues to grow and evolve, Medicare, Medicaid and Social Security continue to be re-examined by lawmakers and policy makers in order to keep it current, effective, functional and up-to-date.   Sweeping economic and social changes are major factors that determine current and future policy-making efforts.  As with any governing body, there is not always a clear consensus and agreement between the politicians and administrative professionals involved is not always guaranteed.

As with any government agency, the bureaucratic element can hinder progress and function.

Given these seemingly unavoidable factors, our Medicare, Medicaid and Social Security systems provide a framework and safety net for people who would likely have no other means of care and support.  The system is not perfect, but it is working for millions of Americans.

THE CONTINUUM OF CAREGIVING:

THE VARIOUS LEVELS OF ASSISTANCE

For most adults, Independence Day is every day. We are able to take care of ourselves in our own homes without requiring help from anyone. We can get out of bed, shower, use the bathroom, get dressed, prepare and eat meals, and take care of family, professional, household, social and personal obligations.

Sometimes, however, we all need a little help. Perhaps it is a case of the flu, a broken limb, recovery from surgery or an accident, or getting through dark days due to loss of a loved one, a job loss, or other personal struggles. In most of these cases, we manage. We get a little help from our families, spouses, friends and/or neighbors, and we move on. We return to our lives as we knew them, and life does indeed go on.

Sometimes, though, it doesn’t. It is not possible to return to one’s life as it was. Life at home without assistance is no longer the norm. Sometimes, it becomes painfully clear that long-term help is necessary, and Independence Day every day is no longer a reality. Perhaps it is due to a stroke, a fall with a broken hip, dementia that has progressed to a point that it is no longer safe to live alone or other progressive diseases. At this point, decisions must be made.

In most situations, the person needing care is an elderly person, but there are times that young adults need care too. Accidents, injuries, illness and chronic disease are a few of the issues that can befall a person of any age, thus requiring care. As a person’s age increases, however, the chance that they will need help typically increases.

Knowing just how much help is necessary is the first major decision. For the vast majority of people, there’s no place like home. Remaining at home is the most comforting, comfortable, familiar and inexpensive option. Sometimes, this is possible—with help.

PLAN ONE: IN-HOME CARE

Family members are often the first line of defense with such a plan. If there is a spouse, perhaps he or she will be required to be at home more to meet the needs of the affected person, and to ensure their safety. Often, when there is physical or cognitive impairment—or both, falls increase due to poor judgment, weakness, unrealistic expectations of one’s abilities and/or poor balance. Ensuring safety in the kitchen is also an important consideration, as burns from cooking can result, or the risk of the stove or oven being left on increases with cognitive deficits. Similarly, some adults cannot determine if it is indeed safe and appropriate to give out personal and/or financial information over the phone, and this compromise can lead to them being taken advantage of.

Sometimes, other family members are enlisted to help. Adult children or siblings can provide care and support. In some cases, there are close family friends who volunteer to help as well.

If no family or friends are available, or if their time is limited, there is caregiving to be received through a paid caregiver, or to an agency who places caregivers. These caregivers can provide full-time, 24/7 care, or limited care depending upon the need involved. Some people only need help for grooming or meal preparation, others need more extensive care. Some agencies employ registered nurses or licensed practical nurses, as well as certified nurse aides for those who need less intensive care. Companion care is an option when there are no medical needs necessary; some people simply need to have someone else available in the event of an emergency, and to ensure safety with in the home, as well as providing companionship. Sometimes this is simply respite for the family member who is the primary caregiver when he/she has an appointment or needs to have an evening out.

Which brings up a very important issue: care for the caregiver. Often, the primary caregiver can become weary, depressed or simply in need of some personal time. Many caregivers, due to their loving nature, are not comfortable in asking for time for themselves, feeling guilty for asking for what seems to be something selfish when their loved one obviously needs so much care, and they do not appear to have needs. The needs of the caregiver should be kept in mind too, as their physical and mental health is necessary for effective and appropriate caregiving.

Often, other family members who are not providing care do not fully realize that the primary caregiver—their mother, father, sister, etc.—are shouldering a tremendous weight that may become too heavy at times. Since the others are not typically present to see the day-to-day struggles—as well as the joys—they fail to realize the toll it is taking on the caregiving family member. Also, the caregiver typically feels guilty if they ask for help, feeling that this may appear to be a complaint or a sign of weakness. In fact, it is often a sign of personal strength when a person—no matter what the situation is—can ask for help.

The job of caregiving may appear to be “easy” to the non-caregiving family member, as if it is simply keeping them company, instead of having to meet so many of their needs. This failure to realize the extent of the work involved can create frustration and even animosity at times, when the caregiver feels they are expected to provide all or most of the care, when other family members could indeed be providing some of the help—when they likely don’t realize the extent of the need, or the time, effort and dedication that is necessary to provide such care.

Open, honest communication can be difficult, but it is vital at times like this. An atmosphere of understanding and calmness helps for both parties to understand the perspectives of the other person.

PLAN TWO: ASSISTED LIVING

There are times when remaining in the home is not the best level of care. Sometimes, there are no family members available to care for the person in need. Perhaps they are a widow/widower, and the grown children live far away, or there were no children. Also, the task of caring for one’s home may become overwhelming when health declines. When most of the person’s and/or caregiver’s time and energy are focused on meeting the needs of the person, the home can suffer. Large houses with large yards need care, and these become too burdensome at times like this. Giving up one’s home can be an emotional ordeal, but some people feel it is very liberating to no longer have to worry about the upkeep.

Assisted living is a viable option when a person’s needs are not so great that they cannot meet some of them on their own, but they simply need someone there to help some of the time, or with specific needs such as medication administration. Most assisted living facilities offer cooked meals in a group dining room, with small kitchenettes in the apartments for the residents to prepare and/or cook light meals. Most facilities have 24/7 nursing care available, but some people may not need regular care. Instead, they may just need to have the availability, just in case. Some facilities schedule their rates according to how much care is necessary, depending upon number of meals to be served, and whether or not they need medication administration.

The social aspect of assisted living is invaluable. Many seniors become isolated in their homes when their spouse and friends have passed away, or if their children and/or grandchildren do not live close, and meeting people and/or attending social events becomes a difficult endeavor. The nature of assisted living facilities offers instant social opportunities, with many other residents present who have a lot in common with each other.

For the family, knowing their loved one is in a place where there is around-the-clock care available, and knowing that if they don’t show up for lunch, their friends and the nursing staff will come to check to see if all is well. This peace of mind is typically invaluable for the family. For those people who are hesitant to give up their homes for assisted care, most are pleasantly surprised to find that they enjoy the facility, the food and the friendship that is readily available.

Some facilities also offer independent living apartments, which do not offer the assistance, but they do offer the close proximity of neighbors who often become close to each other, and serve to look out for one another. Also, there are entire developments that house only adults over a certain age, thus creating a retirement community that offers the companionship and mutual likenesses among the residents. Many older adults who are ready to give up their large homes and yards and choose to move to such an apartment find it to be a positive experience, and feel less stress that home ownership and caring for the home can create. Also, after having made this move, it may become easier in the future to make another move to a higher level of care when it becomes necessary. Moving into such an independent living situation is typically easier than going into assisted living from their homes, as they transition into partial care is more gradual.

The vast majority of such facilities are set up on a private pay basis, with no Medicare or other insurance assistance available.

Within both the personal home and assisted living environments, there also exists the Home Health option for care. If a person is deemed by their doctor to be in need of nursing and/or physical, occupational or speech therapy care, AND cannot easily leave their home to receive such nursing or therapy care, they then can be covered by Medicare to receive home health services. Nurses and therapists visit the patient in their home, providing the necessary care and therapy in order to strengthen them to return them to their prior level of functioning, or as close as possible. This is typically covered by Medicare at 100% for the duration of care, which can range from weeks to months. These visits are typically for several hours a week, not full-time. If a person has chronic medical needs such as wound care or medication assistance, and can otherwise stay in their home or assisted facility, then home health is a viable option, allowing the patient to remain in a less restricted living environment.

PLAN THREE: NURSING HOME CARE

When the need for physical care and assistance exceeds what can be offered in assisted living, the long-term care facility may be the best option. This option is also the most appropriate when a person is recovering from a stroke or hip surgery, to name a few diagnoses, and needs intensive nursing care and likely physical, occupational and/or speech therapy. When a person has been living in their own home, and suffers an acute event such as a stroke or severe fracture and cannot immediately return to their home, then the long-term care facility is most appropriate. This care, when it is received immediately after release from an acute care hospital setting, is called skilled care, and is typically covered by Medicare A at 100% for the first 20 days, then at 80% by Medicare A for up to 100 days, but only if consistent and functional progress is shown by the patient with continued therapy and nursing care. After the patient no longer shows improvement at any point within that 100 day period, then Medicare A benefits can no longer be drawn upon, and the patient either is deemed strong enough to return home, or may continue to stay at the long-term care facility by privately paying, using their long-term care insurance benefits, or by applying for and receiving Medicaid benefits, if they are not already receiving them. The vast majority of long-term nursing home residents in the United States have their stay covered by Medicaid, which may require a lengthy application process, with a person’s assets taken into account in that process.

Understandably, many people don’t want to consider going to a nursing home after their hospital stay. It may feel as if they won’t be able to go home in the end, but many patients do stay only for brief periods. In the past decade, there have been many Medicare changes that made it nearly impossible for hospitals to keep these patients long-term when they are in need of intensive therapy in order to return home. The better option for Medicare reimbursement is for the patient to receive short-term therapy and nursing benefits within a skilled facility in order to complete their recovery to a point where they can return home. Some, however, do continue to need the continued nursing care that a facility offers, and do stay longer.

It is important to note that these levels of care are not always fixed; a person’s needs can change, and the care level necessary can change as well. Therefore, a person may spend several weeks or months in a skilled care facility with intensive therapy provided. They may then be strong enough to return home and resume their independent lifestyle. A person may need several months of home health nursing and physical therapy care within their own home after hospitalization for a stroke, but may also require family to spend more time helping and checking on them. When they become stronger after the nursing and therapy care, they are better able to take care of themselves, and may no longer require family care.

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Care for the caregiver is more than just a notion, more than a catchy phrase. Caregiving is hard work, and the caregiver needs to have their needs met as well. No caregiver should ever feel guilty or selfish for looking out for themselves, or for asking for more help.

Remember, it is a sign of strength to ask for help, both for the person who needs care, and for the caregiver too.

Alzheimer’s Disease: The Mystery Remains

“I have lost myself.” – Auguste Deter, 1901, at 51 years of age.

Dr. Alois Alzheimer, just over 100 years ago in 1906, identified what would become known as Alzheimer’s Disease after he performed an autopsy on the brain of this 56 year-old woman.  As a psychiatrist, he publicly reported the disease he identified that had caused her, in her words during the early stages of progression, to feel that she had lost herself.   The disease would progress in Auguste to a point where she no longer knew she was losing herself.  In this autopsy, he found that distinctive markings around the neurons, but most notably, her brain had shrunk in size.

Alzheimer was not the first to notice symptoms; they had been reported for many centuries.  Even the ancient Greeks and Roman philosophers and physicians associated old age with the symptoms of dementia.  Alois Alzheimer was the first to formally identify and report them to the medical community.

Alzheimer’s is an illness that nearly everyone has heard of.  Nearly everyone has known or knows of someone who has or has had Alzheimer’s, and if the current trends of incidence continue, there will be a substantial increase of the number of people diagnosed with Alzheimer’s.  Sadly, it will become even more familiar.

Alzheimer’s is one form of dementia, but accounts for 60-70% of identified cases.   There are many types of dementia identified, including dementia resulting from drug abuse, alcoholism,  head injuries— including the type identified in professional football players or boxers due to repeated blows—as well as other physical illnesses that can affect the brain, such as multiple strokes or Parkinson’s Disease.  Some research has suggested that a long history of depression or having lived with mental trauma can facilitate Alzheimer’s symptoms.   While the causes for dementia may vary and cannot reliably be identified, Alzheimer’s is typically the diagnosis given when all other potential causes can be ruled out.

In 2014, it was estimated that 5.3 million Americans were diagnosed with Alzheimer’s, at a cost for care of $214 billion, much of it being billed to Medicare, Medicaid and private insurances.  The Alzheimer’s association projects that figure to reach $1.1 trillion by 2050 if the current trends continue.   As our national population increases with Baby Boomer’s aging, all illnesses including Alzheimer’s will likely increase in incidence and prevalence.  There is no cure for Alzheimer’s Disease, and no known preventive measures that significantly reduce risk.  In only 1-5% of cases have genetic differences been identified, although research into this aspect is ongoing.    Its causes remain largely a mystery.

There is no certain prevention for Alzheimer’s Disease.  Global studies have been underway for years, with no consistent results to report.  Epidemiological studies have proposed relationships between certain factors such as diet, heart health, prescription drug intake, level of exercise and level of intellectual activity.  Only further clinical trials and studies will reveal whether these factors can help to prevent Alzheimer’s.

Professionals frequently advise, without disagreement or question, to keep the brain engaged and involved in challenging cognitive activities such as crossword puzzles, reading, playing board games, playing a musical instrument and maintaining strong social ties in order to minimize risk of developing Alzheimer’s Disease.

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Alzheimer’s Disease is divided into four stages.  While there is overlap between each stage, there is a progressive pattern of cognitive and functional decline noted.  There is no “typical” length of time for each stage; many factors play into each individual case, thus making it nearly impossible to predict with any certainty how long each stage will last.  The average life expectancy following diagnosis is six years, but some can live more than fourteen years.

Six percent of people over 65 are affected, and it most often begins after age 65.  However, 4-5% of cases develop before age 65.    In 2010, 486,000 deaths were recorded as being caused by dementia.  In itself, the disease does not typically cause death.  It does allow in other opportunistic conditions such pneumonia that typically cause death.    In the most severe cases at the end of stage four, the patient can no longer eat or drink, and thus, cannot survive.

 

Stage One:  Pre-dementia

This stage is easily confused with normal aging, and typically is only confirmed in retrospect when the symptoms increase in severity.  With normal aging, short-term memory loss and absent-mindedness is common, though it remains mild.  This stage is also termed “mild cognitive impairment.”  The symptoms include:

  • short-term memory loss
  • apathy and depression
  • irritability and reduced awareness of subtle memory deficits
  • abstract thinking impairments
  • decreased understanding of conceptual relationships

 

Stage Two:  Early Dementia

  • increased memory deficits are the most noticeable symptom
  • long-term memory suffers less than short-term, although it’s compromised
  • shrinking vocabulary
  • decreased awareness of deficits
  • may require assistance with cognitively demanding tasks, such as paying bills or following a simple recipe

 

Stage Three:  Moderate

  •  progressive deterioration hinders independence
  • basic tasks such as brushing teeth become hard
  • vocabulary difficulties including word substitution or “inventing” words
  • unable to carry on a coherent conversation with appropriate turn-taking and following sequence of discussion
  • risk of falling increases
  • may not recognize close relatives
  • wandering aimlessly
  • irritability and mood swings, including crying and aggression
  • ”Sundowning” may occur, which is a deterioration of mood in the late afternoon/ early evening hours
  • urinary incontinence may develop

 

Stage Four:  Advanced

  • complete dependence upon caregivers
  • simple phrases or single words used; eventually becomes non-verbal
  • may understand and reciprocate emotional communication
  • extreme apathy and exhaustion with occasional aggression
  • unable to feed themselves, eventually unable to swallow or may not appear to remember how to swallow.
  • frequent difficulty swallowing which can lead to aspiration pneumonia
  • pressure ulcers from being bed-bound

There are many medical and ethical decisions to be made regarding the caregiving aspect of Alzheimer’s Disease.  Most family members want to keep their loved on at home as long as possible in order to keep them comfortable in the most familiar environment.

This familiarity is important as the disease progresses.  Daily routines are crucial in order for the person with Alzheimer’s to remain as calm as possible.  These routines are their markers for predicting what will happen next, and what their next actions should be.  If the daily car ride through town after lunch is missed, the affected person may become frustrated and out of sorts, as they can no longer predict what their next step should be.  They may become angry and show aggression, or may demonstrate symptoms of anxiety.

Caregiving in the home is ideal for the patient of course, but can exact a heavy toll on the spouse or other family member who is the primary caregiver.   If the spouse is the primary caregiver, and other family members—including children—visit, they may not realize the extent of caregiving that is necessary, and this can cause isolation and frustration for the caregiver.  “Care for the caregiver” cannot be stressed enough.

Placing the person with Alzheimer’s into a care facility is a difficult and painful decision.  Their home routine is gone, and a new one must be learned.  Increasingly, more facilities are catering to the needs of the Alzheimer’s patient, with locked units that prevent wandering, a dedicated and highly trained staff who work only with the Alzheimer’s patients, and a strict daily routine to create familiarity and comfort for them.

No option is easy, as any caregiver or Alzheimer’s loved one can attest to.

Medically, there are no treatments that can reverse the symptoms, but some drugs can lessen the symptoms and delay the progression for periods of time.  However, some Alzheimer’s patients appear to develop a “tolerance” for these medications, and they don’t work as well as time goes on.

Physical, occupational and speech therapy may help to show the caregivers the best way to assist the patient with ambulation, activities of daily living such as getting dressed and grooming, and speech therapy may help to devise simple picture/word cards or books to aid with communication.  Diet recommendations and swallow strategies can be provided by speech therapy as well with a swallow evaluation.

Many people with Alzheimer’s lose their appetite, and nutrition and hydration become of paramount importance.  As the disease progresses and swallowing becomes difficult, diet changes may be necessary to minimize risk for choking and aspiration.  Softer foods and thicker liquids are the safest choices for most patients.  In the advanced stages when swallowing is no longer possible, the option to implement an artificial feeding method is one of the most difficult decisions to make.  Inserting a feeding tube directly into the stomach provides necessary hydration and nutrition, but it does prolong life as well as the progression of the disease.  Decisions about this option are best discussed and made in the earliest stages of the disease while understanding is still there.  Ideally, every person should discuss this in good health with their families and put it in writing in the form of a living will, not just for the possibility of Alzheimer’s, but for any illness or disability that may involve artificial means of sustaining life.

There is, at this point, no bright light at the end of the tunnel in Alzheimer’s research.  No sure thing, no high hopes for sustained relief of symptoms or a cure is within reach.  The research continues, and dedicated medical professionals and scientists continue to devote their livelihood to finding a cure, or to delaying onset and decreasing symptoms.   It is at the forefront of medical research efforts in many aspects.

As a society, we cannot give up hope.  Research will continue to offer insights as to causes in order to increase preventive measures, and new strides will surely be made to increase awareness of lifestyle factors that may diminish the risk somewhat.  Good health overall is a goal that can only help to decrease risk and delay the progression.

Caregivers have a unique and challenging role in the maintenance of life for persons with Alzheimer’s.   This typically poses a significant stress for the caregiver, and he or she should not be afraid to ask for help, ask for a break, or to consider other alternatives such as facility placement when their own physical and mental health is adversely affected.

There are caregiver support groups that can offer invaluable information, support, validation and companionship for the person who takes care of the Alzheimer’s patient.  Contact the Alzheimer’s Association at alz.org to find a local group or to join an online group, which can also be very helpful.

Until then, we can take comfort in knowing that all medical researchers involved are dedicated to finding a cure.  For those of us who are fortunate enough to choose, we can increase our overall health by proper diet, exercise and stress reduction, which can only help with decreasing our chances of succumbing to any illness.  Non-caregiving family members need to fully realize the hard work that is involved in caring for a person with Alzheimer’s.  Caregivers need to reach out to others in their situation to realize they are not alone, either through formal support groups, or finding others who are struggling as a caregiver.   As a population, a greater understanding of what the disease involves, as well as understanding the burden on the caregiver will foster a greater sense of hope.

Hospice Care: Living and Dying with Grace

It doesn’t take much looking to find books, articles and other information to show virtually any human how to live well.  Along with possessing knowledge, experiencing adventure, and, of course, obtaining nearly any material thing our hearts desire are high among the things the “average” human strives for.  We live for it.  We might even say we are dying for it.  Living well is a goal for most people.  Dying well is rarely considered.

Striving for, obtaining and enjoying these things can enrich life.  They can bring us a measure of happiness, and can give us a sense of accomplishment.  There is nothing wrong with this pursuit, and the enjoyment of one’s gains.

In life, however, there comes an unavoidable time when these things—these things—can no longer bring us peace and pleasure.  There is a time when life narrows down to what really matters.  That time is when one is dying.

This time in life is not easily reckoned with for many people.  Our culture doesn’t glorify death, it is focused on the here and now.  Speaking of death is taboo, and thinking of it is a place in most people’s minds that is not frequently visited.  Thus, they process of dying is too often denied, ignored or avoided, even when the diagnosis, the doctors and the dying have made it all obvious.

In centuries past, dying and death were embraced as a normal part of the circle of life.  Death was welcomed when it was obviously unavoidable, and without extensive medical care that is now available, the dying process was relatively short, and death happened quickly.  There were no cures, no medical treatments and no recourse.  The dying person and their family prepared for the inevitable, and it inevitably came.  Life for the living went on, and their loved one’s passing was more easily accepted.  The great circle was now complete for that person, and they carried on, knowing and accepting that one day, it would be their turn to go to the great unknown.

So what is it that really does matter at the end of one’s life?  The answer varies considerably, but there is one near-constant:  being with loved ones.    The possessions, honors and adventures the dying person once enjoyed can no longer bring joy.  Only the love of family and friends can bring joy during the dying process.  This joy can be marred by incredible pain that dying sometimes brings.  The loved ones may struggle to accept the dying process their mother, father, spouse, sister, brother or even their child is enduring.  This process may indeed be easier for the dying person that those who will remain.

This is where hospice comes in.  They can help ease the physical pain and suffering for the dying person, and they can provide support and structure for the loved ones who are struggling to cope with the inevitable loss.

The word hospice is defined as a type of care/philosophy of care that focuses on the palliation of the terminally ill, chronically ill or seriously ill patient’s pain and symptoms.  This includes attending to their spiritual and emotional needs.   (Palliation is care that strives to relieve pain and improve quality of life, while not treating/attempting to cure the illness due to its advanced state.)

Within the United States, the term “hospice” is generally recognized as a specific type of care which may be administered in a hospice facility or within the home of the patient.  In other countries, however, “hospice” is generally recognized as a place, a center or a facility that serves the terminally ill.   Inpatient hospice centers can be found in larger cities in the United States as well, but a majority of the care is provided in the patient’s home, or the home of a caregiver or loved one if the patient is staying there.  The inpatient stay in a hospice facility is typically not long-term; rather, it is designed to relieve the family and caregiver when they need time to restore themselves from the full-time caregiving process.  It is also designed to serve as a means to regulate and modify the patient’s pain medications for optimal relief and comfort.  Some patients, however, are not able to stay with a loved one, and the inpatient hospice becomes the place where they spend their final days, weeks and/or months.  Hospice care can also be provided within a nursing home setting.  While the patient’s physical and medical needs are being filled by the nursing home staff, the hospice staff can visit to provide specialized care and guidance through the dying process to the patient as well as the family.

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If you were to ask healthy, middle-aged adults where they would like to spend their final days, most would answer that they would choose to be in the comfort of their homes.  Few would choose to spend that time in a hospital.  It is a natural feeling to desire to live out one’s life in the place they call home, instead of a medical institution.  Hospice allows this to be.

According to hospice statistics, only approximately 10% of us will die a quick, sudden death—likely accidental, or from a heart attack or stroke, or some such emergency.   The rest of us will die from an illness that may be short-term, or may last for months or years.  Thus, the vast majority of us could likely benefit from hospice care at the end of our lives.   If we were given the choice to sign up for one or the other, most of us would choose a sudden death.  Few would choose to spend their last months and years as long-term patients fighting an illness.  However, illness and suffering is what will happen to many people.

There is hope, and this hope is hospice.  Hospice can help with the extended pain and suffering that dying and ultimately death can bring.  Its goal is to make the process of dying as pain free as possible, while allowing as much dignity and grace as possible.  There is the spiritual/emotional component as well, which encompasses the dying person as a whole, as well as the family’s grief.  This dimension strives to bridge the unknown chasm between here and what lies beyond here, and it is addressed in whatever form is most comfortable for the patient and their family, whether it be with pastoral care, religious rituals, or other individualized belief practices.

In order to qualify for hospice care, the patient must be medically certified to have less than six months to live.  While the most brilliant doctor can never predict exactly when death will come, these estimates allow a patient to qualify for services and for these services to be covered by Medicare or private insurance.   Medicare and most insurance plans cover most, if not all hospice costs for standard hospice care.  It is recognized that hospice care is necessary as the most appropriate way to manage the pain and care that the patient needs at the end of their life.   Ironically, there are sometimes patients who “graduate” from hospice; the predictions made by their medical team do not come to pass, and their lives continue past the six month mark with improved health.

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One of the most difficult aspects of hospice care to manage is the initiation of services.  This begins when the patient and/or the family decide that it is time to acknowledge that the patient’s life is nearing an end.  Our culture is largely a death-denying one, so choosing to acknowledge that death is imminent is not an easy process.  Many people choose to fight the unavoidable with denial, which may hurt the dying person’s chance to live their final weeks/months with dignity and acceptance.   In some cases, the patient may wish to begin hospice care, but feels that it would hurt their family if they admit they are ready to accept death, when, perhaps, their family is not ready to begin the process of letting them go.

Nearly every family who has received hospice care will report after their loves one’s death that it was the best decision they could have made.  Most report extreme satisfaction with the way hospice care handles the heartbreaking experience of dying, both for the patient and for the family.

Estimates of overall Medicare expenditures in the last year of the patient’s life are considerable.  One study estimated that 80% of all Medicare funds are spent in the last year of life.  Much of this is for treatment that is ineffective, causes more pain, decreases the quality of life and the level of dignity the patient can enjoy.

When the physician orders hospice care, the hospice team begins their work.  This team consists primarily of nurses, with other staff such as social workers providing structure and support for both the patient and the family.  Also, most hospices have volunteers who spend time with the patient to simply keep them company, provide respite for the primary family caregiver, or help them enjoy hobbies they once enjoyed.  Many patients enjoy conversation, being read to, working on puzzles or crafts, and some are even able to take walks.  Many hospice patients have a strong bond with their pets, and this is incorporated into their care whenever possible. In some areas, hospices provide “adventures” that the patient once enjoyed such as fishing, or even taking a final flight in an airplane as a co-pilot when they once were the pilot.

Many hospices have support networks for the family after their loved one has passed.  Follow-up phone calls and grief support groups are offered to help the grieving family to cope with their feelings of loss.

St. Catherine Hospice in Garden City provides hospice care for 17 southwest Kansas counties, including Stevens County.  They can be reached at www.st.catherinehospice.org, or by phone at 620-272-2519.

Good Carbs; Bad Carbs

 “You are what you eat.”

“A moment on the lips, a lifetime on the hips.”

“I never met a carb I didn’t like.”

“Everything in moderation.”

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Eating is one of the greatest pleasures of life.  The taste buds provide us with a sensory experience that is unparalleled.  Each of us has had certain food cravings, a desire so strong that it can only be sated by indulging in the object of the craving.  We have all been there.  We are all human.  Many of these cravings are carbohydrates (carbs), and of those, sweets are one of the most common indulgences.

Sweets.  White sugar.  Desserts.  Candy.  Soda.  Pastries.  Ice cream.

Do any of these stir up a craving as you read the word?  Are you hankering for a little something sugary to satisfy that sweet tooth?  Most of us have one, and it can be hard to control.

We base many of our food choices on one simple factor:  How it tastes.  Our taste buds rule many of our decisions when it comes time to choose what to eat.  Ironically, the food spends mere moments on the taste buds, passing over them swiftly on their way to their destination:  the stomach.  From there, many of them are stored as fat somewhere in the body, often on a long-term basis.  Often, it accumulates slowly over a long period of time, leading to obesity, diabetes, high blood pressure and a host of other maladies.

Some argue one simple reason for all these health problems:  bad carbs.

 

The great pendulum swing in the carbohydrate scene seems to have made a full arc.  Not long ago, the current weight-loss hype was that fat was bad, and carbs were good.  Now, we are hearing more from health-information sources that perhaps, fat might just be good for our bodies, and carbohydrates are bad.  Perhaps, if we wait it out awhile longer, the pendulum will swing back the other way, and we will once again proclaim that carbs are good; fat is bad.   There is no way to tell.  There are always proponents and opponents for each side.

So how do we know the truth?  The proof, my friend, is in the pudding.  Not literally, but in the results you get.  Clearly, for people like diabetics, carbohydrates are not to be taken lightly.  In extreme cases, they can be the difference between life and death.  Most of the population—90%– is not diabetic, so the difference is not as crucial.  However, they can make a difference in other ways.

Carbohydrates are considered essential for fuel for our bodies and brains, especially when participating in extreme physical activity.  Thus, the term “carb-loading” has come into the vocabulary of athletes.  Aside from athletes, everybody’s body needs carbs to regulate moods and keep our intestines moving the food on through.

Not all carbs are created equal, though.  A quick check of most labels will separate the number of carbs separated into different types, typically fiber and sugar.  Fiber is considered the good guy.  We are cautioned against eating white bread, white sugar and white rice because the fiber is stripped away.  When it comes to carbs, the advice “Don’t eat anything white” is hard to argue with.   This stands only for carbs.  Proteins such as cottage cheese, milk and other cheeses are high in protein and low in carbs, and very good for a low-carb diet.   The fiber that comes with whole grains is the shell of the grain, having been preserved in the processing of the grain.  Our bodies need that fiber to keep our intestines going strong.   This fiber also keeps our cholesterol lower, lowers heart attack risk and helps you feel full.

Not all carbs are bad.  There are foods that are high in “good” carbs, and offer many health benefits.  Among these good carbs are:

  • Beans:  garbanzo, black, butter, pinto to name a few.  Beans also provide much-needed protein.
  • Squash:  butternut, spaghetti squash, acorn
  • Oatmeal: high in fiber known to improve heart health
  • Popcorn:  a whole grain that is best air-popped
  • Quinoa (pronounced “keen-wah”) a whole-grain protein.  It can be prepared with a variety of ingredients added for flavor.
  • Sweet potatoes:  colorful foods such as the sweet potato contain carotenoids, known to prevent cancer.  Also a good source of vitamin C, protein and potassium.  Best with the skin on to increase fiber.
  • Bananas:  rivaling sports drinks, bananas are “nature’s sports bar” Packed with natural sugars, it provides athletes with natural sugars for energy, and everyone benefits from the fiber and vitamin B6 it is packed with.   Vitamin B6 is crucial for more than 100 different functions in the body.
  • Berries:  You can’t go wrong—raspberries, strawberries, blackberries and blueberries, which are all known to fight against cognitive decline.

 

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THEN AND NOW…

Supersize.  We have all heard that word.  In the not-too-distant past, this word hadn’t been invented yet.  It was unheard of.  There was no such thing as “supersize.”  A serving of soda was about 6-8 ounces.  A hamburger was one hamburger on one bun.  An order of french fries was likely the size one would receive in a kid’s fast food meal.

Now, our sodas are over 20 ounces.  Our hamburgers are several patties—which isn’t the biggest problem, it is the multiple buns, which are typically white bread.  Adding to that are the sauces, and even ketchup that add carbs.  “Biggie” fries are at least 3 times the size of what an order of fries used to be.  This is all considered to be necessary to fill us up.

The average consumer doesn’t stand much of a chance, at least not like they used to.  We are all bombarded with television commercials advertising food.  Billboards advertise restaurants.  Recently, for the first time in recorded history, consumer spending in restaurants and take-out food exceeded the spending in American grocery stores.   When a person eats out, the portions are pre-determined, and typically are larger than what would be consumed at home.  All this boils down to more food, more calories, and more bad carbs.  Eating only half of your restaurant entrée and taking the rest home cuts your bad carb intake in half, cuts the calorie intake in half, and promotes a healthy awareness of just how much—or how little—we really need to eat in order to be satisfied.

Lurking in many of our foods are hidden carbs.  Ketchup and barbecue sauces contain more sugar than most people realize, creating more bad carb intake.  Salad dressings are notorious for this as well.  While the creamier dressings are noted to be high in fat, there are many that are sweetened without the consumer’s awareness, creating more bad carbs.

While beans are recommended as a good carb, baked beans typically are bathed in a sauce rich in sugar and—you guessed it—extra carbs.

Sodas, colas, “pop”; no matter what name they go by, they are among the most highly sweetened products that many of us consume habitually.  Adding sweeteners to one’s morning coffee creates the same bad carb indulgence.

Candy?  No need to explain any further—refined sugar is the worst.

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Awareness is key.  Many people don’t realize that, even though wheat, rice and other grains are natural and healthy, it is the white version that is not healthy.  Processing these grains to turn them white strips them of all fiber that occurs naturally in the shells, which is what carries the food through the gut, creating a smooth passage through the body.  Without this fiber, the bad carbs in these forbidden white foods tend to stay in the body in unhealthy and unattractive forms.

“I grew up on a wheat farm.  I watched the grain being harvested every year.  I knew where grains came from, where they went from harvest, and what became of them.  I knew when I ate bread, that it started in a wheat field.  I felt good about eating this fruit of the earth.  I didn’t know that white bread wasn’t good for me.  I had to learn that white pasta and white rice were not healthy for me either.  All the good stuff that was a part of the grain when I watched it being harvested was stripped away, leaving the unhealthy part.  I didn’t know.”

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Digestion is one of the most difficult processes the human body must carry out.  It takes more energy than many forms of athletics, and, if not performed efficiently, can leave us exhausted and overweight.  Good carbs provide high levels of fiber to help this process along.

If, as the quote at the beginning of this article states, bad carbs can be consumed in moderation, then perhaps they can be a part of a healthy lifestyle.

What is moderation?  Try consuming a little less in bad carbs than what you are consuming now, and then a little less than that next week, and the week after.  See what happens.  See if you feel better, perhaps lose a few pounds.  Then, you can decide for yourself if the bad carbs are worth it.

May the pendulum swing in your favor of your good health.

Allergies: ‘Tis the Season

If you are one of the approximately 36 million Americans who suffer from seasonal allergies, there is some hope. As you probably already know, however, it is not always easy to ease the discomfort.

Allergic Rhinitis, as it is known medically, is the allergic inflammation of the nasal airways. When pollen, dust or animal dander is inhaled by someone who is sensitive to that particular allergen, it causes symptoms similar to colds and/or flu.

When it is caused by the pollen of any plant, it is technically known as pollinosis. When it is caused by grass or tree pollens, it is known as hay fever, which is the name commonly attributed to most allergies in the past. This name resulted from the (incorrect) theory that the symptoms were caused by new hay in the haying season. It has also been called hay asthma.

If you are one who suffers from allergies, clearly you are not alone. Allergies are very common, with estimates at up to one in three persons having symptoms at any given time. It is also estimated that at least one in four people will have at least one reaction at some point in their lives. In Western countries, between 10-25% of people are affected annually by allergies.

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In 1819, the physician John Bostock first identified hay fever, believing it was a disease. In 1859, Charles Blackley correctly identified pollen as the causal agent . In 1906, Clemens von Pirquet correctly theorized that hay fever was a hypersensitivity, and modern research and treatment is based on this premise.

The symptoms then are still the same symptoms that are identified today:

  • excess nasal secretion
  • itching
  • sneezing
  • nasal congestion and obstruction—“stuffy nose”
  • swelling of eyes
  • middle ear discharge

*The “nasal salute” is the action of the allergy sufferer rubbing his/her nose upward with the palm of their hand. This may result in a crease running across the nose, and can actually lead to permanent physical deformity if repeated enough.

*There is no true fever with hay fever; rather, it may cause an increased fluctuation of core body temperature due to inflammation.

*Some allergy sufferers also report a cross-reaction to certain foods such as potatoes or apples. Protein similarities between the allergens and these foods are responsible for this reaction.

*While hay fever is most prevalent during the spring, it can cause symptoms throughout the year.

*The most common plants responsible for hay fever include:

  • pine, birch, cedar, willow, poplar and olive trees
  • rye and timothy grass
  • ragweed, plaintain, nettle/parietaria and mugwart weeds.

DIAGNOSIS

While it may seem easy to self-diagnose allergies, the only way to define the exact allergens are to complete medical allergy testing, ideally under the care of an allergist. Skin testing is the most common method of testing, which involves exposing a patch of skin to particular allergens to determine the possible allergic reactions.

A less common method is to drop a small amount of the allergen onto the lower eyelid of the patient to determine sensitivity, but should never be performed by the patient, since it can cause harm if not conducted properly. If the doctor determines the patient is not able to undergo skin testing, there may be alternate blood tests that can diagnose the allergy.

TREATMENT

The goal of treatment is to reduce the symptoms caused by allergic inflammation in order to provide relief to the patient, but first, reducing your exposure to allergens is a recommended step:

  • Stay indoors on dry windy days. The best time to go outdoors is after a rain, which essentially rinses the air clean. However, long-term moisture with repeated rains may increase the pollen counts. This may also increase outdoor mold. If the area has experienced heavy rain or flooding, the allergy symptoms may be exacerbated.
  • Delegate any activities that may expose you to allergens such as lawn mowing, weeding and gardening.
  • Remove clothing after coming indoors, showering may also help.
  • Don’t hang laundry outside—pollen can attach to fabrics.
  • Wear a dust mask if you must go outside for chores.

When pollen counts are high, extra measures may be necessary:

  • Check pollen forecasts via internet, TV or radio. When they are predicted to be high, start taking any allergy medications you normally take before symptoms start.
  • Close doors and windows at night or any time when pollen counts are high.
  • Pollen counts are highest in the early morning; avoid outdoor activities during that time if possible.

While the air outdoors cannot be controlled, the air in your home can be somewhat controlled:

  • Use the air conditioner in your home—and car.
  • Use high-efficiency filters if you have forced air heating or air conditioning.
  • Use a dehumidifier to keep indoor air dry.
  • Use a portable HEPA (high efficiency particulate air) filter in your bedroom.
  • Clean floors with a vacuum with a HEPA filter.

While these measures can help prevent or minimize allergy symptoms, it is often necessary to take medications to alleviate discomfort. Oral antihistamines such as Allegra and Claritin are available over the counter, while Zyrtec and Clarinex are by prescription only. Prescription eye drops can help itchy eyes, and prescription steroidal nasal spray can alleviate symptoms as well. Nasal irrigation with a saline water solution has helped some allergy sufferers as well. Your physician should be consulted regarding any allergy remedy that is not prescribed by him/her prior to using it.

A long-term solution for some people is to take allergy shots, also known as immunotherapy. Tiny amounts of the allergen are introduced into the body over time, provoking a controlled response. This method is intended to actually change a person’s immune system, by desensitizing them to the allergen slowly over a long period of time. This long-term method generally is employed over a 3-5 year period.

A new therapy currently in its developmental stages is known as “sublingual” allergy therapy, whereby a small amount of the allergen is placed under the tongue, which employs the same theory of slow desensitization as do the allergy shots. This mode of delivery is thought to be more convenient than a series of shots.

Any allergy sufferer is well-advised to consider the “oral allergy syndrome”, whereby certain foods may provoke symptoms in those with ragweed allergies. The most common foods that cause such sensitivity include: bananas, cucumbers, melons, zucchini, sunflower seeds and chamomile tea.

Pollen in the air obviously causes great physical stress, as well as mental and emotional stress. Just as it is important to keep other stressors to a minimum, try to remember to not let this get the best of you—just breathe.

Bless You.

The Gift of Sleep

Sleep is a symptom of caffeine deprivation.”

“If people were meant to pop out of bed, we would sleep in toasters.”

I’ll sleep when I am dead.”

“The worst thing in the world is to try to sleep and not to.”

“Without enough sleep, we all become tall two-year olds.”

“The amount of sleep required by the average person is five minutes more.”

“A day without a nap is like a cupcake without frosting.”

 Sleep is a remarkable landscape nearly every person traverses each night, but without any recollection of doing so.  We move in and out of different phases of sleep, we dream, we may turn and occasionally toss, we wake up in the middle of the night or not, and if we do, we may not realize it.  We may sleep, but get up and feel like we didn’t sleep at all.  We may talk or walk in our sleep, or, in extreme cases, we may eat, leave the house or hurt others with no memory of having done so.

It is a strange place indeed.  When the nightly trip there isn’t of high quality, however, we pay the price the next day.  If we continue to experience many nights of poor or too little sleep, and this becomes our pattern, we place ourselves at risk for many illnesses.

While every one of us sleeps—even those few who insist they can never sleep—most of us could not give an accurate description of what sleep is.  We simply put ourselves to bed, and it typically just happens.  Sleep researchers characterize sleep as:

  • a period of reduced activity
  • decreased responsiveness to external stimuli
  • a state that is relatively easy to reverse, as opposed to a comatose state, or hibernation (in animals)
  • associated with a typical posture such as lying down with eyes closed
  • decrease in body temperature by 1-2 degrees
  • breathing rate decreases and becomes more regular
  • overall reduction in heart rate and blood pressure
  • physiological changes including increased release of growth hormone, digestion, cell repair and growth
  • dreaming occurs

Anyone who values a good night’s sleep will tell you they prioritize sleep over other activities that may impede a good night’s sleep, including socializing, watching TV and getting work done.  Anyone who doesn’t value sleep will tell you they have better things to do:  socializing, watching TV and getting work done, to name a few.  Many people fight the feeling of being tired or fight falling asleep, so they don’t go to bed.  Others feel they need the extra time to accomplish work tasks—tasks related to their job, as well as housekeeping.  College students—as well as many high school students—compromise the amount of time they sleep in exchange for more time to complete homework—or to have fun.  Then, there are those who involuntarily give up sleep, typically as a parent of a baby or young child who does not sleep well, as well as those who are caregivers for family or loved ones who are ill and require care.  There are also those who do not get enough sleep not by choice, but are kept from sleep by pain, anxiety and many other factors that cause insomnia.

No matter what the reason for too little sleep, it has the same unfortunate consequences.  Sleep experts recommend between 7-9 hours of sleep nightly, but no more than nine, as this can cause other health issues.

There are both short-term and long term consequences of too little sleep.  Short term effects include:

  • fatigue
  • poor judgment
  • negative mood
  • ability to learn and retain information
  • increased risk for accidents and injury

 Long-term effects include:

  • risk of diabetes
  • increased obesity
  • cardiovascular disease/increased blood pressure
  • reduced lifespan
  • poor judgment and risk of accidents/injury

Sleep should be considered a priority, not a luxury. Sleep researchers are partnering with other medical researchers to determine more exactly the relationship between sleep deprivation and disease.  There are three main types of studies that researchers use to study this link:

  1. Sleep deprivation studies:  subjects are deprived of sleep in order to study the short-term effects of lack of sleep.
  2. Cross-sectional epidemiological studies:  examination of questionnaires providing information about sleep habits and disease patterns.
  3. Longitudinal epidemiological studies:  the most convincing of the three types, this involves tracking the sleep habits of subjects and correlating them with their overall health and disease patterns. 

It is common knowledge that proper diet and regular exercise are crucial for maintaining a healthy weight.  It is now becoming increasingly obvious to researchers that insufficient sleep is a major factor in weight gain, perhaps a factor just as important as diet and exercise.  Studies show that people who habitually sleep less than six hours per night are more likely to have a higher body-mass index (BMI), and those who sleep eight hours have the lowest BMI measurements.

During sleep, the human body secretes hormones that control appetite, energy metabolism and glucose processing.

  • Cortisol, the “stress hormone” is secreted in higher amounts with poor sleep.
  • Insulin is the hormone that promotes fat storage and regulates insulin, and it is secreted in higher amounts with poor sleep.
  • Leptin is the hormone that alerts the brain that it has had enough food, and its secretion is decreased with poor sleep.
  • Ghrelin is a biochemical that stimulates appetite.  Poor sleep increases this stimulation, causing food cravings even when we are full, especially foods such as sweets that have little nutritional value.

Adding to all these factors that are related to diet, we are likely too tired and too full to exercise in order to burn off excess food intake.

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The cost of poor sleep affects the individual, but also can negatively affect the entire society.  Many automobile accidents kill innocent people, and they are caused by people who are sleep deprived.  On a much larger scale, costly disasters have been known to be caused by extreme sleep deprivation.  The following tragedies were studied in depth, and it was revealed that sleep deprivation was a major factor in all of them:

  • Three Mile Island Nuclear Disaster, 1979
  • Chernobyl Nuclear Disaster, 1986
  • Space Shuttle Challenger Explosion, 1986
  • Exxon Valdez Grounding, 1989

 In addition to these highly publicized disasters, it has been shown that sleep deprivation has caused a significant number of medical errors.  Doctors who work continuous shifts of 24-36 hours cannot make sound medical decisions, and nurses who are required to work long, strenuous shifts struggle to make the best decisions for their patients.

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When the body determines it is time to sleep, the pineal gland in the brain secretes melatonin, the hormone that alerts the body to begin to shut down.  This should happen at approximately the same time every night, as every person has a cycle that should correspond to daily rhythms, known as the circadian system.  This system regulates many bodily functions on a 24-hour basis.  Another internal system that is important to consider is the sleep/wake homeostat, which counterbalances the circadian system as it monitors the need for sleep based on how long we have been awake. These two systems do operate independently, and can sometimes contradict each other.  This misalignment is demonstrated when we experience jet lag, or when one tries to train their body to stay awake for shift work.

There is always hope.  If you are one who sleeps too little by choice, choose to make good sleep a priority.  After you have made this decision, the following tips may help you get started.

  • reduce caffeine intake after 4:00 p.m.
  • exercise regularly, but not within two hours of bedtime
  • limit screen time—TV, devices—for an hour before bed.  This type of  artificial light stimulates the brain to stay awake
  • make your bedroom as dark as possible, and cool rather than warm
  • go to bed and get up at the same times daily, even on weekends
  • practice stress reduction techniques if stress keeps you awake, including deep breathing exercises. 

Good Night!

Diabetes: How Sweet it Isn’t

Things are going to get a lot worse before they get worse.”  —Lily Tomlin

If the current trends continue, it is predicted that by 2050, one in three Americans will have diabetes.  Currently, 8.3% of the adult population in the world has diabetes.  This accounts for 387 million people in 2014.  According to the 2014 National Diabetes Statistics Report, 29 million Americans—9% of the population—were living with diabetes in 2012.   Of that 29 million, 1.7 million were new cases, and the growth rate is expected to continue to progress.

Diabetes was one of the first diseases described in early medical history.  In Egyptian manuscripts, it was called “too great emptying of the urine.”  Indian doctors noted that the urine would attract ants, thus calling it “honey urine.”  The word “diabetes” means “to pass through.”

There are essentially three types of diabetes:  Type One, Type Two, and Gestational Diabetes.  This post will discuss primarily Types One and Two.

Type One accounts for approximately 10% of the cases.  This type is partly inherited, with certain genes known to influence the risk.  When certain environmental (such as a viral infection) and diet factors line up, it is the perfect storm:  the onset of Type One Diabetes occurs.  Most affected people are otherwise healthy and of a normal weight when onset occurs, which is primarily in childhood.  The onset is relatively sudden in comparison to Type Two.

The classic symptoms of untreated diabetes include:

  • weight loss
  • frequent urination
  • increased thirst
  • increased hunger

Additional symptoms, though not specific to diabetes include:

  • blurry vision
  • headache
  • fatigue
  • slow healing of cuts
  • itchy skin

People with Type One diabetes may also demonstrate the following symptoms of diabetic ketoacidisos, constituting a medical emergency:

  • nausea and vomiting
  • abdominal pain
  • acetone smell on the breath
  • deep breathing known as “Kussmaul breathing”
  • decreased consciousness in severe cases

 Long-term risks of diabetes include:

  • cardiovascular disease
  • stroke
  • kidney failure
  • foot ulcers
  • damage to the eyes. 

 Type One diabetes cannot generally be prevented, but it can typically be well controlled.  It is caused by the body’s failure to produce enough insulin.  It has previously been referred to as “insulin-dependent diabetes mellitus” or “juvenile diabetes” because the onset is typically in childhood.  Insulin is the hormone that carries glucose to cells throughout the body to be converted to energy.  The glucose molecule is created after food is broken down in the digestive system.

Type One diabetes is managed by keeping blood sugar levels close to normal.  Typically, this is accomplished with diet, exercise and use of appropriate medications—typically insulin.

  TYPE TWO DIABETES

  •  Type Two diabetes accounts for 90% of cases worldwide and in America.
  • It has equal rates in men and women.
  • It is caused primarily by lifestyle factors and genetics.
  • Lack of physical activity, obesity, poor diet, stress and urbanization are risk factors.
  • Consumption of sugar-sweetened drinks in excess increases the risk.
  • Over-consumption of white rice increases risk, especially in countries that include white rice as a staple in their diets such as India, China and Japan.
  • Lack of exercise is estimated to cause 7% of cases.

 

In the early stages of Type Two diabetes, the predominant is reduced insulin sensitivity.  If detected early enough, this can be reversed by a variety of measures, including medication that increases insulin sensitivity or reduced glucose production by the liver, thus avoiding the full-blown onset of Type Two.

Prediabetes  is defined as the condition whereby a person’s blood sugar levels are higher than normal, but not high enough for a diagnosis of Type Two diabetes.  Many people stay in this state of prediabetes for many years, never fully developing Type Two diabetes.

While obesity is listed as a risk factor, it is notable that while 80% of people with Type Two diabetes are overweight, most overweight people do not develop diabetes.

Experts are not sure why it occurs in the remaining 20% who are not overweight.  This suggests that environmental factors and genetics are to be accounted for.  Researchers know that excess body fat produces compounds that lower sensitivity to insulin, which could explain the 80% figure.

One fact that all experts are certain of is this:  Diet and exercise are crucial.  Carbohydrates have long been the enemy, but whole grains are embraced as being high in fiber, and won’t send a rush of glucose into the bloodstream the way processed carbohydrates such as white bread, pasta and refined sugar do.  Whole grains improve insulin sensitivity and lower the glucose spike after a meal.

Exercise is always a good idea.  Doctors have long known that muscle contractions stimulate glucose uptake from the blood.  Brisk walking is a highly recommended exercise, as it is easiest for most people, and an all-around good exercise.

Gestational Diabetes is the third major type of diabetes.  It occurs in 2-10% of all pregnancies, and may improve or disappear after delivery.  However, after pregnancy, it is found that 5-10% of those women who did have gestational diabetes, do indeed have diabetes mellitus, typically Type Two.  Gestational diabetes is fully treatable and requires medical management as well as lifestyle changes.

While it can come and go, untreated gestational diabetes can damage the health of the fetus and/or the mother.  Fetal risks include:  congenital cardiac and central nervous system anomalies, as well as skeletal muscle malformations.   Respiratory distress syndrome may also occur.

There are many important aspects of treatment, specifically Metformin as the first medical pharmaceutical treatment for Type Two, while insulin is the primary medication for Type One.

Lifestyle plays a pivotal role in the management of diabetes.  Adequate exercise and good nutrition are the primary focus of keeping the blood sugar levels under control, generally for the lifetime of the person with diabetes.

In extreme cases of Type One, a pancreas transplant is considered who have severe complications, including end-stage renal disease that requires kidney transplantation.

The good news is this:  the vast majority of diabetes cases—90%–could likely be prevented.   Constituting that 90% is Type Two diabetes, which is typically caused by poor diet and lifestyle choices.   Some persons are predisposed to Type Two diabetes, but with careful food choices, exercise, and keeping one’s weight in check, the risk is significantly lowered.

Let It Go and Just Say ‘NO’ to Holiday Stress

May this season bring you all the joy you deserve, and no matter what this year brought us as individuals, we all deserve joy as the holidays are celebrated. Unfortunately, stress is too often a part of the holiday season.  Minimizing or eliminating it can enhance this joy that is our right.

My hope is that every part of the holiday season and its accompanying festivities brings you nothing but joy.  If this is the case, read no further and have another blessed holiday.  You are a gift in and of yourself.  If, however, you do feel any stress – a little or a lot, please read on, and may you find at least one way to reduce or eliminate that stress.  You deserve it.

Most of us say ‘yes’ to invitations, gifts, requests to host, and to donate time, money and energy to worthy causes.  These things bring us joy, for the most part, except when they don’t.  When they don’t, we don’t have to agree to them, unfortunately, most of us don’t even think that ‘no’ is an option.  Sometimes, it is.

 

Stress can be defined by any event, stimulus or action that produces an emotional, mental or physical feeling of discomfort in its mildest form, to extreme pain in its most severe form.  Physical stress is often inflicted upon us from external sources.  Always, emotional/mental stress is induced from within.  It is our perception of an event that causes stress, not the event itself.  Granted, there are some life events that inevitably cause emotional stress, such as loss of a loved one, illness, financial woes, and family discord.  It is nearly impossible as a feeling, caring human being to NOT feel stressed by these extreme events. We all must experience some of this kind of heartbreak in our lives, there seems to be no way to skate through life without it.

On the grand scale, however, there are many stressors that rank much lower on the scale of life-changing, negative occurrences.  Many of these perceived stressors manifest themselves around the holidays, mostly because we have chosen, once again, to let them in.   It is part of our package of traditions that we unwrap every year, unwittingly or with full realization.  We sign up for much of our own misery without conscious awareness, simply because it is what we have always done.

So why not take a step back and take another look at these things that stress us out?  Why not evaluate them as an outside observer, as a task-master assigned to simplify and dovetail obligations and responsibilities into one smooth, efficient process?  Re-evaluate the necessity and worth of every obligation – large and small – and determine if perhaps some of them can be reduced or eliminated.

The list of stressors could be inexhaustible, but around the holidays, the following are some of the most common for the average American:

Choosing and buying gifts – often gifts that are not necessary, reciprocated, appreciated, or affordable.

Not having enough money to buy these gifts that may not be necessary, reciprocated, appreciated or affordable.

Family obligations – feeling that you have no choice but to spend time with family members who may not bring you joy at this time of year—or any time of year, for that matter.

Conflicts of time/expenditures on one’s family vs. one’s in-laws.  Many married couples struggle to allocate time and money fairly between both families.

Feeling overwhelmed with host/hostessing obligations.  Perhaps you have always been the one to invite the entire family to your home, providing the perfect eleven-course Christmas dinner with little or no help buying, preparing or cleaning up the food and dishes, just plenty of help eating it.  If you have always done it from year to year, and never complained, then everyone likely thinks you will continue to do it, and that you even enjoy it.  Hopefully you do, but if you don’t, you have the right to re-think it, and do it differently next year.

Feeling the need to decorate your home lavishly, because you always have, and it is your tradition.  Consider paring down on the number of decorations, perhaps even parting with some that are not sentimental.  You don’t have to have the most and brightest lights on your house to show up the entire neighborhood.  Let someone else on your block pay the ridiculous electricity bill next month.

Continuing to force yourself to churn out incredible pans of cookies, fudge, candies and other baked goods to give to people who probably have more than they want or need to eat already.  Consider doing this at another time of year, letting them know that you have chosen to give when perhaps the giving will be more needed and appreciated.

Feeling bombarded with requests to donate money to charitable causes.  Many people maximize their giving at the end of the year to take advantage of tax breaks, and this is always a good idea if your tax situation and income level allows it.  Charitable giving to legitimate causes is always a good idea within your budget.  Be aware of scam requests, as this time of year unfortunately brings out the worst in many organizations that perhaps do not use the money as they say they will.  There are plenty of good causes out there, just be sure you do your homework.

Rushing to get the cards/annual holiday letter sent out to the long list of people you send it to every year.  Consider taking a family picture at another time of year, and sending it as a holiday card in July, Thanksgiving, or any day of your choosing.

This list is not complete; each one of us will likely experience unique feelings and situations that may be less common than these.  There are situations that, when they coincide with the holidays, the stress can be overwhelming, understandable, and hard for anyone to shake.  Among these are:

  • Death of a loved one, or dealing with persistent grief from a loss earlier in the year, or in past years that has never become manageable.
  • Loss of one’s job around the holidays, or remaining unemployed after a job loss earlier in the year.
  • Divorce or the end of a meaningful relationship.
  • Family discord that causes estrangement or conflict.
  • Being away from family as a member of the United States Military, or having a loved one/family member who is serving and is away.
  • Dealing with a serious physical or mental illness or a loved one’s illness.

These situations, if they cause persistent and paralyzing stress, should be addressed with professional counseling/treatment.  There is help available, and while it can be hard to admit that you need it and difficult to ask for it, it can help to resolve it for future happiness.

When the stressors are not major life events/crises, it is helpful to realize this:  Awareness is the first step to changing them.  Step back and evaluate the necessity of all the gift giving, the hosting, the decorating, the cards, decorations and the shopping.  For whatever reason you celebrate the holidays, the core of most celebrating revolves around general goodwill towards other people.  If you are wound up tight with all these things that bring you no happiness, and likely bring no one else happiness either, then you are likely too challenged to bring any joy to others.  You may even be letting your negativity and reactions to your self-made stress bring others down.

“NO” can be a very positive word, even with its longstanding negative rap.  When it frees you up to be happier, more productive and less stressed, you are better for yourself, and as a consequence, better for those close to you.

At this point in the holiday season, most of us are firmly entrenched in the path we always take, going through all the motions we normally go through, whether or not they bring us any joy.  As we complete this cycle once again, think about the parts of the holiday that bring about any negative feelings.  Is there anything you can do to reduce those feelings for next year?  Can any of your obligations be eliminated without extreme discord from your family/loved ones?  What is most important to you?  Focus on these priorities and make your decisions accordingly.

The news is good:  You have it within you to make any changes that will bring you the most holiday happiness.  Change is sometimes very difficult and takes work, but when it is for long-term happiness, it is good for everyone, and it is worth it.  Be aware that our families and loved ones may take a little time and effort to understand your motives.  Seeing the positive changes in you will likely bring about a ripple effect.  Pass it on.

Happy Holidays to you – you deserve it!

ORGAN DONATION AND TRANSPLANTATION

“I wouldn’t have thought of not doing it.  He was my grandson, he needed a liver, and I was a match.  He was born with a severe liver defect, and he needed a new liver.   Seth was three years old, I was 54.  I gave him 24% of my liver, and he is now 12 and healthy.  My liver regenerated inside me,  his new liver grew inside him, and we are both so lucky.”

– Claire, grandmother of Seth.

 

“My heart breaks for the family of the person who died suddenly—I understand it was a car accident—but my daughter Lila has a new heart, saved by the selfless gift of the donor.  I wish I could reach out to them, show them what a gift their loved one gave; perhaps in time I will.  For now I will cherish Lila and the fact that she was not taken by the severe virus that suddenly attacked her heart.  Within days of her illness beginning, we were looking at losing her.  She has a long road of recovery ahead of her, but she is alive and will be well again.”

– Maria, mother of Lila.

Some of us sign our organ donor card on our driver’s license without much thought, unless your life has been touched by the selfless gift of organ donation.  In America, we have an opt-in system for organ donation:  If you choose to be a donor, you indicate this wish on your driver’s license, or through the donor registry at the U.S. Department of Health and Environment, or through Donate Life America at donatelife.net.

Some industrialized countries have an opt-out system for organ donation.  In this system, every citizen is considered a potential donor, unless they complete the paperwork that indicates that they have chosen not to be a donor.   These countries can see rates for potential donors eight times as high as opt-in systems.

In America there are currently about 121,600 people awaiting organ donation.  Up to one third are inactive from time to time due to medical factors.  Typically, 75% of that group is awaiting a kidney.  Because this is the organ most in demand, the wait is typically the longest, averaging about 15 months.  Kidneys are in the highest demand for several reasons:  Advances in kidney dialysis have extended the lives of the patients, with the dialysis patients surviving longer than even before.  Secondly, as the life span in America increases, so too does the prevalence of high blood pressure and diabetes, thus increasing the need for transplanted kidneys.

Those waiting for a heart transplant typically wait three weeks when they are on the priority list, and three months for a pancreas or a liver.

A sensitive and debatable area concerning liver transplants is the issue of providing liver transplants to alcoholics.  Some view this as a disease that should be treated no differently than any other disease, while others feel is should be granted only after a long period of sobriety.

OTHER ETHICAL ISSUES

Organ donation and transplantation is a hotbed of debate on many levels.   For prison inmates, there are several issues.  Typically, the prison environment is a risky environment for communicable diseases, which is part of the reason why, currently, inmates can donate only to family members.  In addition, it is felt that prisoners are not fully liberated to make their own decisions, and thus may decide to donate due to coercion.   For prisoners who are receiving dialysis, the cost to the American prison system is approximately $120,000 per year to the taxpayer.  A kidney transplant would cost the taxpayer approximately $111,000.

In defining actual death, there is a distinction between brain death and cardiac death.  In the United States, the Uniform Declaration of Death Act defined death in the 1980’s as the irreversible cessation of the function of either the brain or the heart and lungs. When a patient is pronounced brain dead, his or her other organs may be functioning at a high level, and could provide optimal opportunities for organ donation.  With cardiac death, however, “irreversible” can be a gray area.  In some cases, a patient can potentially be revived up to 10 minutes after the cardiac arrest, and thus cannot be declared “dead.”

There are religious issues surrounding organ transplantation and donation as well.  All major Christian and Jewish religions see donation and transplantation as a necessary and right thing to do in order to save other’s lives.  Some do impose certain restrictions, while members of other small sects have been known to donate kidneys in large numbers to strangers, because they feel this is the best way to live out The Golden Rule:  Do Unto Others As You Would Have Them Do Unto You.    Other sects disapprove of organ donation and transplantation, and attempt to forbid their members form participating in either.

There is always the issue of organs for sale.  United States law prevents, it, but there was a U.S. citizen who advertised “one functional human kidney” on eBay in September 1999.  Under U.S. law, eBay was obligated to dismiss the auction, but the bidding had reached $5.7 million.  Other countries have legalized sale of organs, with conflicting results.  Unfortunately, there does exist a black market for organs, whereby they are purchased illegally, often harvested from unwilling donors.

Online advertising for organs, as well as billboards posted along busy interstate highways have become a reality.  These attempts typically come with an emotional plea in hopes of a stranger deciding to donate.  These methods are criticized because they undermine the traditional system of list-based allocation of donated organs.

While the damage is already done, the use of organs from a person who committed suicide is unnerving to some.  However, most family members of the suicide victim agree to donate any organs, and for an unknown reason, those who commit suicide have a higher donation rate in place prior to the suicide.  In many cases, the organs can be kept functional and viable with mechanical ventilation, thus providing optimal transplant opportunities.

*

Many organs and tissues can be transplanted, including:

ORGANS:

Heart—deceased to donor only

Lung—deceased and living related transplantation

Heart/Lung—deceased donor/domino transplant

Kidney—deceased and living donors

Liver—deceased and living donors

Pancreas—deceased only

Intestine—deceased and living donor

Stomach—deceased donor only

TISSUES, CELLS, FLUIDS:

Hand—deceased donor only

Cornea—deceased donor only

Skin, including face—autograft

Islets of Langerhans (pancreas cells)—deceased and living donor

Bone marrow/adult stem cell—living donor and autograft

Blood transfusion/blood parts transfusion—living donor and autograft

Blood vessels—autograft and deceased donor

Heart valve—deceased/living donor; xenograft—pig/cow

Bone—deceased and living donor

*

The history of organ donation and transplantation is relatively young, in terms of success:  (Dates indicate successful transplantation unless otherwise noted, though some recipients did not live long-term.)

1823:  1st skin graft/transplantation from one location on an individual’s body to another location on their body, Germany.

1905:  1st cornea transplant, Czech Republic.

1908:  1st skin graft from donor to recipient, Switzerland.

1933:  1st kidney transplant from cadaver donor, though incompatible. USSR

1950:  1st successful cadaver kidney transplant, USA

1954:  1st living related kidney transplant between identical twins, USA.

1955:  1st heart valve transplant from donor, Canada.

1962:  1st kidney transplant from a deceased donor, USA

1966:  1st  pancreas transplant, USA.

1967:  1st  liver transplant, USA.

1967:  1st heart transplant, South Africa.

1981:  1st heart/lung transplant, USA.

1983:  1st lung lobe transplant, Canada.

1986:  1st double lung transplant, Canada.

1998:  1st hand transplant, France.

1998:  USA’s 1st living donor-to-donor liver transplant

1999:  1st tissue-engineered bladder, USA

2005:  1st ovarian transplant, India

2005:  1st partial face transplant, France

2008:  1st baby born from transplanted ovary (country not specified)

2008:  1st transplant of human windpipe with patient’s stem cells, Spain

2010:  1st full facial transplant, Spain

2011:  1st double leg transplant, Spain

2012:  1st robotic parathyroid transplant, USA

2013:  1st urgent life-saving entire face transplant, Poland

2014:  1st uterine transplant resulting in live birth, Sweden.

 

There are several distinctions to be made in transplant terminology:

*Autograft:  transplant of tissue from same person

*Allograft and Allotransplantation:  organ or tissue transplantation between two genetic non-identical of same species.  Most human tissue and organ transplants are of this type.

**Isograft:  a subset of an allograft, whereby organs or tissues are transplanted between two genetically identical humans—typically identical twins.  This eliminates one of the greatest risks, that of rejection due to an immune response, because they are identical in terms of genetics.

Xenograft/xenotransplantation:  Transplantation of organs or tissues from one species to another, typically from porcine (pigs) sources to humans.    The most common is the heart valve transplant.

Split transplants:  in rare cases, an adult liver can be divided between an adult recipient and a child recipient.

*

Organ donation and transplantation are continually evolving fields, constantly improving and saving human lives.

Your help is important, please consider becoming an organ donor if you haven’t done so already.  Contact your driver’s license office, or visit donatelife.net, as well as the US Department of Health and Humans Services at hhs.gov.

Please consider this old adage:   You can’t take it with you.

 

EPIDEMIC OUTBREAKS: A SHORT WORLD HISTORY

When viruses begin to spread in parts of the world we are closely connected to as Americans, we are kept highly informed by the media. The recent outbreak of Ebola has been highly publicized in order to raise awareness and maximize preventive measures. Increasing public panic is not an intended function of this media attention, but, unfortunately, that can be a result. It is still extremely rare, and is not cause for alarm for the vast majority of Americans.

Ebola was officially identified in 1976. The name is derived from the Ebola River, a river in what was then called Zaire. This region is now the Democratic Republic of Congo, and the river is close to the area where the first outbreak occurred. After several official name changes, it is now officially Zaire ebolavirus, but is commonly called Ebola virus (EBOV). It causes a severe and often fatal hemorrhagic fever in humans and other mammals, and is transferred through bodily fluids.

The media attention surrounding the Ebola virus is warranted and plentiful. All suggested precautions and preventive measures should be taken seriously, and if you have been exposed, and you show signs and symptoms consistent with Ebola, follow the established medical protocol.

*

The world’s medical history is long and storied with multiple viruses and bacterial infections. Medical historians theorize that viruses began to proliferate about 12,000 years ago when humans began developing more densely populated agricultural communities. This allowed viruses to spread with ease.

There have been many different viruses and bacterial outbreaks that have claimed the lives of millions of humans across recorded history. There is a distinction to be made between an epidemic, which is defined as a widespread occurrence of an infectious disease in a particular community at a particular time. A pandemic is defined as an outbreak that spreads across a whole country, or the entire world.

SMALLPOX: Among the earliest viruses was the smallpox virus. In the 20th century it killed approximately 300 million people, likely more than any other virus. Its major symptoms are a high fever and an extensive bodily rash. This virus initially invades the mucus membranes of the mouth and throat, thus creating contagion from mucus and salivary secretions. In 1798, Edward Jenner introduced the smallpox vaccine. Due to extensive vaccination campaigns in the 19th and 20th centuries, smallpox was declared eradicated by the World Health Organization (WHO) in 1979.

In order of fatalities—highest to lowest, National Geographic has outlined the major epidemics of infectious diseases—not including smallpox—beginning 1500 years ago:

Plague of Justinian:
100,000,000 fatalities
Period: 541-542

This bubonic plague outbreak spread throughout the Byzantine Empire in the Mediterranean region. Estimates of the death toll vary widely, but CDC estimates that it eventually killed over 100 million people. The bubonic plague is an infection of the lymphatic system, transmitted by the bite of an infected flea.

Black Plague:
50,000,000 fatalities
Period: 1346-1350

The Black Plague is a form of the bubonic plague.

HIV/AIDS:
39,000,000 fatalities
Period: 1960-present

1918 Flu:
20,000 fatalities
Period: 1918-1920

This flu, unlike most influenza epidemics, targeted young, healthy adults. Studies determined it was caused by overreactive immune systems. Children and older adults had weaker immune systems, and were not as heavily affected.

Modern Plague:
10,000,000 fatalities
Period: 1894-1903

Asian Flu:
2,000,000 fatalities
Period: 1957-1958

Sixth Cholera pandemic:
1,500,00 fatalities
Period: 1899-1923

Cholera pandemics started in India in the 1800s. Cholera is a bacterial infection of the lower intestine, usually caused by infected water. It causes extreme diarrhea and vomiting, and can cause death for a healthy person in a matter of hours.

Russian Flu:
1,000,000 fatalities
Period: 1889-1890

Noted to be the first pandemic flu outbreak in the modern connected world.

Hong Kong Flu:
1,000,000 fatalities
Period: 1968-1969

Caused by a strain of the Influenza A virus

Fifth Cholera Pandemic:
981,899 fatalities
Period: 1881-1896

Fourth Cholera Pandemic:
704,596 fatalities
Period: 1863-1879

Seventh Cholera Pandemic:
570,000 fatalities
Period: 1961-present

Swine Flu:
284,000 fatalities
Period: 2009

Identified as a strain of the H1N1 flu, a combination of bird/swine/human flu strains

Second Cholera Pandemic:
200,00 fatalities
Period: 1829-1849

First Cholera Pandemic:
110,000 fatalities
Period: 1817-1823

Great Plague of London:
100,000 fatalities
Period: 1665-1666

Noted to be the last major epidemic outbreak of the bubonic plague in the Kingdom of England, which is now the United Kingdom.

Typhus Epidemic of 1847:
20,000 fatalities
Period: 1847

Typhus symptoms include headache, high fever, cough rash, falling blood
pressure, delirium and death. This outbreak was thought to be caused
by the massive exodus of Irish during the Potato Famine. Also known as
camp fever, ship fever, or famine fever because it proliferates after times
of wars and natural disasters. This epidemic occurred primarily in
Canada.

Haiti Cholera Epidemic:
6,631 fatalities
Period: 2011-present

2014 EBOLA VIRUS EPIDEMIC IN WEST AFRICA:
4,877 fatalities
Period: Present

Congo Measles Epidemic:
4,555 fatalities
Period: 2011-present

West African Meningitis Outbreak:
1,210 fatalities
Period: 2009-2010

Meningitis is an inflammation of the tissues surrounding the brain and
spinal cord. It causes a severe headache and high fever.

SARS:
774 fatalities
Period: 2002-2003

Severe Acute Respiratory Syndrome, causing flu-like symptoms.

 

For all the progress that has been made in the field of epidemiology, the great mystery of the human petri dish remains. Great strides have been made in the what, how, where and when, but the WHY remains.

CONCUSSION AND HEAD INJURY: WALKING WOUNDED

Football season is once again upon us, and increasingly, each year, the media provides us with more information about concussions related to sports injuries. Awareness is a good thing.

A concussion can be caused by many types of injuries, the vast majority of which can be prevented. Sports injuries, bicycle and car accidents, as well as falls, are the most frequent causes of a concussion. Sports injuries have been in the spotlight lately, and for good reason: the long-term effects can continue to compound and worsen over the athlete’s lifetime. The cumulative effect of multiple impacts on the head can contribute to mental decline characterized as dementia.

There have been many advancements made regarding the prevention, treatment and diagnosis of concussions related to sports injuries. New technology that allows sensors to be placed in football players helmets provides feedback regarding the impact and injury mechanisms. New rules in football are being considered for implementation , including those against “head-down tackling” or “spearing,” which is associated with a high injury rate. Rules that reduce such actions that have long been in place are getting more attention and enforcement.

Traditionally, the term “walking wounded” refers to those who are injured, but not so badly that they cannot walk. Often, this term is used for battlefield injuries. For those who have concussions and head injuries, their symptoms can be almost invisible, thus creating the illusion that they are “okay.” They may indeed be “walking wounded.”

They are not “okay.”

The term “concussion” may be used interchangeably with “brain injury,” and “mild traumatic brain injury.” In medical literature, concussion is frequently defined as “a head injury with a temporary loss of brain function, causing a variety of physical, cognitive and emotional symptoms, which may not be recognized if subtle.”

DIAGNOSIS: Concussion victims are typically assessed initially first to exclude a more severe head injury such as hemorrhaging or neck injuries. Symptoms that would indicate such increased severity include persistent vomiting, increasing headache, decreasing consciousness and increased disorientation, seizures and unequal pupil size. Brain imaging is typically implemented to detect lesions when these symptoms are present. When the symptoms are mild, concussion may be under-diagnosed. The memory loss may not be immediately noticed, and athletes often minimize their symptoms in order to remain in competition.

PREVENTION: Outside of sports injuries, concussions typically occur as a result of an accident or a fall. In motor vehicle accidents, there are several important safety rules to keep in mind in order to prevent a head injury, or any bodily injuries:

  • ALWAYS wear seat belts. Statistics show that only one in ten people without seatbelts fare better than those who wear seatbelts. Stated in question form, “Would you rather play Russian Roulette with one bullet, or nine bullets?”
  • Most newer-model cars have airbags. You have no choice but to use them if necessary, unless they are disabled.
  • This one bears repeating: Don’t text and drive. Better yet, don’t engage in any distracted driving habits. This includes texting, and using your cell phone only for emergencies. Focus on the road and not on other matters.
  • Always have a designated driver if you have been drinking or plan to drink alcohol.
  • Remind yourself—and especially teenagers—that no one is invincible. Accidents can and do happen, and they happen usually because one party could have prevented it.
  • Respect weather conditions. Adjust your driving speed, focus and habits when necessary.
  • Follow the posted speed limits—they are there for a reason. So too are the reduced speeds in school and construction zones. One moment of inattention can be tragic when children and construction workers are close to your moving vehicle.
  • ALWAYS wear a helmet when driving or riding on a motorcycle or scooter.

Many falls occur in the home. There are simple rules to keep in mind to reduce the risk of falling:

  • Keep floors free of clutter
  • Be aware of your pets or oxygen tubing/hoses underfoot.
  • Throw rugs increase the risk of falling. Be more aware of your step when walking on them, or get rid of them.
  • Wear low-heeled, smart and comfortable shoes.
  • Many falls occur in the bathtub because it is slippery. Install grab bars or rubber mats. (Towel bars do not constitute grab bars.)
  • Be aware of any diagnoses that can affect balance such as Parkinson’s Disease. Medications can also affect balance. Take the extra time and effort you need to remain safe when you move about your home.
  • Age brings its own challenges with balance and stability. Use stairway railings, and respect the natural slow-down of the human body. Slow down with it and enjoy.

TREATMENT: If a neck injury or more severe head injury has been ruled out, and concussion is suspected, observation should continue for several hours. Be aware of these warning signs that it is more severe than concussion:

  • dizziness
  • worsening headache
  • repeated vomiting
  • seizure activity
  • excessive drowsiness
  • double vision
  • slurred speech
  • unsteady gait
  • weakness/numbness

If these signs are observed during the period of several hours after a concussion, immediate medical attention in an emergency room is advised.

Traditionally, it has been advised to awaken the concussion victim several times throughout the night. Recently, however, there is discussion that perhaps it is more beneficial to let the victim sleep uninterrupted. Ask for medical advice from the physician regarding this.

Most symptoms resolve after seven-ten days, but recovery time may be greater in children and adolescents. Physical and cognitive rest is advised during this period. Activities that require attention and concentration such as school work, video games, text messaging and even leisure reading can over-tax the concussed brain. Time off from school may be necessary, either whole or half days. Increasingly, the education of school personnel regarding the treatment of these necessary measures for treatment will allow the victim a more efficient recovery.

Physical and cognitive rest should be continued, both daytime and nighttime rest are important. If prior activities are resumed, and symptoms do not recur or worsen, then it is likely that the victim can continue to increase their amount of activity slowly, and as tolerated.

The 2008 Zurich Consensus Statement on Concussion in Sport recommends that participants be symptom free before restarting in sporting practice after a concussion, and then progress through a series of graded steps. When one step in passed, 24 hours should pass before the next step is undertaken:

  • complete physical and cognitive rest
  • light aerobic activity (less than 70% of maximum heart rate)
  • sport-specific activities such as running and drills
  • non-contact training drills (exercise, coordination and cognitive load are the intended stimuli)
  • full contact practice
  • full contact games

Following these guidelines, and careful, watchful progression of activity is crucial to ensure complete recovery. The risk of re-injury poses a greater chance of even further brain injury if the initial concussion is not fully healed. Sustaining another injury when the brain is still recovering exponentially increases the chances of permanent injury, and in the most extreme cases, death.

*

“I remember the car accident, and I remember asking my brother —my passenger— three questions over and over: ‘What happened?’ ‘Are you okay?’ and ‘Where are we?’ He said I asked him about five times, and I do now remember repeating them. He was not injured, and was becoming quite frustrated with my repeated questions. I remember the feeling that I had just woken up, or became aware of my new surroundings, as if I had been dropped out of the sky into this new place. I remember then that I snapped out of it, and I began wailing, not from the pain, but from the awareness that I had just wrecked our other brother’s pickup. There was no physical pain at that point, even though my forehead and arm were full of glass. The physical pain would come later. The pain at that moment when I snapped out of my concussion was from the realization that we had been in a bad wreck, but luckily everyone recovered. I was wearing my seatbelt; I know I would have been killed without it. I remember vividly now coming to, and crawling out of the pickup. My brother tells me that, seeing the blood and my limp body at first, he thought I was dead. He was 14. I know that image has never left him.”
– Lynn, a female concussion victim, recalling the concussion years later.

James, a survivor of a life-threatening head injury, is able to answer simple yes/no questions about his accident. He was riding his scooter without a helmet, and was struck by a car going through an intersection as he was turning left. He had the right-of-way, but the car didn’t see him because he was behind a truck. The car struck him. He was two blocks from a major trauma center in a large city. This proximity has been credited with saving his life, because he was given a slim chance of survival. He underwent emergency surgery with his parent’s consent, and then began a two-month period of hospitalization; first, in surgical ICU, then acute, then to a specialized rehabilitation facility. James’s speech is now halted, and limited to simple one or two word utterances. This has improved from only a thumbs-up or thumbs-down gesture to indicate yes and no. He understands fully, and can comprehend these questions:

Interviewer A.J.: “ Do you remember the accident?”

James: (delay as he processes his answer) “No.” (Research shows most traumatic brain injury victims do not remember the moment the accident occurred.)

A.J.: “Do you remember not being able to speak a word?”

James: “Yes.” Hesitates, appears to be thinking. “Hard.”

A.J.: “What else do you want to tell us?”

James: (several second delay) “Lucky.”

Lynn and James are not walking wounded. They couldn’t walk after their accidents. They are both walking now. They are lucky.

Both accidents could have been prevented. Most can. BE CAREFUL.

STROKE: BRAIN ATTACK

In the 16th century, medical professionals began calling a stroke “a stroke” because it was attributed to a power out of their control: It was shortened from “a stroke of God’s hand.” It could be explained no other way. Modern medicine has found the causes in most cases, but sometimes its effects are as mysterious as they were 500 years ago.

In order to make it more clear, medical experts have recently begun calling a stroke a “brain attack.” Everyone knows what a heart attack is, so this similar term should be clear: it is the brain stopping its function, just as the heart does. It is to be taken no less seriously.

In order to get the lifesaving information out and clearly and efficiently, the following acronym has been implemented: FAST.
F: Facial weakness – your face feels numb or weak, especially on one side.
A: Arm weakness – especially on one side
S: Speech problems – you can’t speak or understand properly
T: Time – the faster you get treatment, the less damage to your brain.

Besides the sudden numbness in the arm or face, other symptoms include:

  • Sudden leg weakness
  • Sudden confusion
  • Sudden trouble seeing in one or both eyes
  • Sudden trouble walking, dizziness, loss of balance or coordination.
  • Sudden, severe headache with no know apparent cause. It has been described by stroke patients as “the worst headache I have ever had.”

According to www.strokeassociation.org:

  • About 795,000 Americans suffer a new or recurrent stroke. Thus, on average, a stroke occurs every 40 seconds.
  • Stoke kills more than 137,000 people each year. That is one of every 18 deaths, ranking it as the #4 cause of death in the U.S.
  • On average, someone dies of a stroke every 4 minutes.
  • Approximately 40% of stroke deaths occur in males, and 50% in females.

There is a drug known as tPA that can dissolve blood clots when administered within about three hours of initial symptoms, so time is of utmost importance in treatment. This drug treats the most common type of stroke, so getting treatment cannot be put off. Call 911 or have someone call for you, even if your symptoms disappear. If you return to normal functioning, you may have had a TIA, or transient ischemic attack, also known as a “mini-stroke.” TIAs precede major strokes in 15% of occurrences.

The medical term for stroke is cerebral vascular accident, or CVA. There are two general types: ischemic and hemorrhagic:

  • The ischemic stroke is a blood clot that blocks brain function, but does not burst. High blood pressure is the most important risk factor for ischemic stroke that you can change. Immediate treatment will keep the damage as minimal as possible.
  • A hemorrhagic stroke bursts and bleeds inside the brain. Thirteen percent of strokes are hemorrhagic. Blood collects in the brain tissue causing the cells to weaken and die. Hemorrhagic strokes are likely to be life-threatening.

There are many risk factors for stroke, and most can be changed or treated:

  • High blood pressure: this is the #1 cause of stroke, and the most important risk factor. Know your blood pressure and have it checked at least once each year. If it is consistently above 140/90, it is considered high. Talk to your doctor about how to manage it.
  • Tobacco use: tobacco use damages blood vessels. Don’t smoke and avoid second-hand smoke. Chewing tobacco increases risk for oral cancer, as well as stroke.
  • Diabetes Mellitus: having diabetes increases risk because it can cause disease of blood vessels in the brain. Work with your doctor to manage your diabetes medically.
  • High blood cholesterol: high blood cholesterol increases the risk of blocked arteries. If an artery leading to the brain is blocked, a stroke can result.
  • Physical inactivity and obesity: lack of physical activity and/or obesity increases your risk of all cardiovascular diseases. It is never too late to begin regular exercise, but be sure to consult your physician before beginning.
  • Artery disease: the carotid arteries in the neck provide most of the blood supply to the brain. A carotid artery damaged by a fatty buildup of plaque inside the artery wall may be blocked by a blood clot, causing a stroke.
  • Transient ischemic attacks—TIAs: recognizing and treating TIAs can reduce the risk of a major stroke. TIAs can precede a major stroke, but have no lasting effects. Know the warning signs of a TIA and seek emergency medical help immediately.
  • Atrial Fibrillation and other heart disease: In atrial fibrillation, the upper chambers of the heart quiver instead of beating evenly and effectively. This causes the blood to pool and clot, thus increasing the risk of a stroke. Other types of heart disease increase the risk of stroke as well.
  • Excessive alcohol intake: women should drink no more than one drink daily on the average, and men no more than two. Increased blood pressure can result. Binge drinking can also raise blood pressure.
  • Illegal drug use: IV drug use carries a high stroke risk, as does cocaine use. Illegal drugs normally cause hemorrhagic strokes.
  • Stress: A certain amount of stress is inevitable, but too much can increase blood pressure. Work related stress, family stress and situational stress can be managed with exercise, adequate sleep, good nutrition, lifestyle changes and changing the stress-causing situation. This is obviously easier said than done, but the rewards are worth the effort.

LIFE IS TOO SHORT, TAKE GOOD CARE OF YOURSELF AND ENJOY LIFE.

Considering that simple yet profound advice, there are several factors that cannot be controlled:

  • Increasing age: Stroke can affect any age, but as age increases, so too does stroke risk.
  • Heredity and race: Those with close relatives who have had a stroke have a higher risk of having one themselves. African Americans have a higher risk of death and disability from stroke than whites, because they have a higher incidence of high blood pressure. Hispanic Americans are also at a higher risk than whites.
  • Personal history of stroke: those who have had one stroke are more likely to have another one.
  • Gender: in most age groups, more men than women have strokes, but more women die from strokes.
    There are unique risk factors for women, including:

  • Atrial fibrillation: Women 75 years of age and older should be examined for this irregular heartbeat.
  • Migraine headaches with aura: These headaches combined with smoking boost your risk x 10.
  • Preeclampsia: During pregnancy, this blood pressure disorder doubles the risk of a stroke after childbirth. Women with high blood pressure before pregnancy may need aspirin or other drugs to reduce it. Women with a history of preeclampsia should be watched closely for strokes later in life.
  • Prolonged use of oral contraceptives: talk to your prescribing physician about the potential dangers of long-term use of birth control pills. When other risk factors are present, birth control pills can double the risk of stroke.

Given the profound and mysterious complexity of the human brain, each person who suffers a stroke likely has a set of symptoms that is unique to them. Few people have a stroke that is identical to someone else’s in its effects. Each person is different before the stroke, and each person who suffers a stroke is different from anyone else who has suffered a stroke.

Muscle weakness is common, likely on one side or the other. Some strokes affect both sides equally, but typically it is one-sided. This is due to the fact that the brain is divided into two halves, and a stroke typically happens in one side or the other, instead of at the base of the brain before it divides. The human body is controlled contralaterally, meaning that the right side of the brain controls muscle function on the left side of the body, and the left side of the brain controls the right side of the body. Therefore, if a person has a stroke on the left side of the brain, then the right side of their body—likely the arm and/or leg and perhaps the face—will be weak.

The brain also specializes in certain functions in specific areas on one side of the brain. For example, in a right-handed person, as well as the majority of left-handed people, the language center is housed on the left side of the brain, while the visual/spatial abilities are on the right side of the brain. Concrete brain functions such as mathematics are on the left side, and abstract abilities such as art and music appreciation and creativity are on the right side. A stroke on each side of the brain carries many different possible deficits.

LIFE AFTER STROKE

Some strokes leave little or no residual damage. Most, however, leave at least a small mark. Some people who have had a stroke report that their life is now close to what is was before the stroke, there is occasionally that small remnant of the stroke. Some report occasional speaking difficulty or loss of balance, but it does not affect their lives on a day-to-day basis. Unfortunately, most people live with a daily reminder of the stroke that left them somewhat impaired. Many find themselves living a life of a “new normal.”

There is help available. Therapy to improve physical abilities is offered through physical and occupational therapy, which address walking, transfers, balance and general gross motor strength and coordination. Occupational therapy addresses arm and hand strength, and activities of daily living—ADLs—such as dressing, grooming, cooking and other household chores. Visual-perceptual abilities are sometimes affected, which may be treated by both the occupational therapist and the speech therapist. Speech therapy also addresses speech production, cognitive function and swallowing deficits. These therapies are typically available in the hospital setting, and are initiated soon after the stroke patient has stabilized, in order to begin the rehabilitation process. There are other levels of therapy after dismissal from the acute unit of the hospital, as soon as the patient is physically stabilized:

  • Specialized rehabilitation units are appropriate for those patients who can withstand intensive therapy. These may be stand-alone facilities, or may be part of a larger hospital.
  • Skilled therapy is most appropriate for those who are not able to tolerate intense therapy. This therapy is typically provided within a long-term care setting, with the goal for most patients to return to their home.
  • Home health can be provided for those who are able to return to their homes but need assistance and therapy in order to return to their maximum function. Learning how to manage in what was once a familiar setting may pose new challenges such as negotiating steps and stairways, navigating around the house and transferring from bed to chair, or from car to wheelchair. Completing ADLs can be a new and unfamiliar challenge as well.
  • Outpatient therapy is another option for those who are strong enough to return home and can ambulate well enough to come to a clinic for treatment.

The physical rehabilitation process is one aspect of recovery. Many people find that the emotional and psychological part of recovery is an overwhelming challenge, and require help to find a way to cope with life as they now know it. As difficult as it is to lose physical abilities, the most difficult losses most people face are the loss of independence and sometimes their dignity. Many patients find it necessary to take prescription medications for depression, even if they never have before.

As with any loss, the people who can best understand are those who have experienced stroke themselves. Those who have “been there” are often the best therapists. In some areas, programs exist to match “peer-to-peer” people who have suffered a stroke. A person with a relatively new stroke may benefit from visiting with someone who has been living with the effects of stroke for a prolonged period of time. They can offer the new stroke patient ideas about how to live life with a stroke, and offer support and encouragement that those without a stroke may not have the insight to provide.

Stroke support groups exist in larger towns and cities. Most meet at least monthly, providing support and education for those who continue to live with the effects of stroke. There are many books written about life after stroke, as well as online support. Log on to www.strokeassociation.org for more information.

There is life after stroke. If you think you may be having a stroke, remember to think FAST.

EXERCISE: THE MAGIC PILL

If the health benefits of exercise could be bottled and sold as a drug, it has been said by many health professionals, it would fly off the shelves. There would be no negative side effects, no one would be allergic to it, it would not be expensive, anyone of any age could take it, and overdoses would be almost non-existent. Heart disease, stroke, high blood pressure and obesity would be the exception rather than the expected. Diabetes and other chronic conditions would be much less common. Depression, insomnia, chronic pain and fatigue would be greatly reduced.

So why doesn’t everyone sign up for these health benefits without a drug simply by exercising? Why aren’t more people taking the time and making the effort to make themselves healthier by exercising? Because it is the path of most resistance. Humans are wired to take the path of least resistance, and this is not it. It takes time, effort, and energy; three resources most people are short on. It is easier not to.

Ask anyone who has dramatically improved their health through exercise, and they will swear by it. Ask anyone who exercises regularly and they will tell you that without it, nothing else works quite like it should. It is a priority for them; they choose to spend their time, effort and energy on exercise because they know that without it, they don’t feel good. With it, they generally feel great.

*MOVE IT OR LOSE IT*
It is good for the body; those benefits are the most obvious. Research shows, however, that it is just as beneficial for the brain as it is for the body:

  • Cognitive test scores are higher in the subjects who exercise regularly vs. those who do not. Vocabulary skills are stronger among those who exercise.
  • Learning at all ages throughout the life cycle is enhanced by exercise, as brain cells are stimulated through exercise. This positive stress helps them develop their potential, just as muscles are stimulated by the exercise.
  • Among those who are genetically predisposed to Alzheimer’s disease (as established through testing), studies suggest that those who are active are far less likely to develop the disease, or show a much slower progression of the disease after onset as compared to sedentary peers.
  • Exercise lifts depression and enhances mood, self-esteem and body image. It may also create feelings of euphoria; the “runner’s high” is not a myth. This euphoria can be achieved through other forms of sustained exercise as well.

As a nation, our sleep patterns and habits have been observed, researched, studied, reported upon and tested. By and large, the results suggest that Americans don’t get enough quality sleep. This comes as no surprise to most of us, as most of us struggle to maintain efficient and adequate sleep patterns. Exercise has been noted to improve this as well, creating more quality and sound sleep. Paradoxically, many people state that lack of time is one of the primary reasons why they don’t exercise. Exercising in the early morning hours is highly recommended by experts and veteran exercisers, but this requires sacrificing sleep. The need for sleep can be decreased by regular exercise, as many people report that they need less sleep when they become active, and their sleep is more sound and of greater quality. Our brains and our bodies work better. In addition, early morning exercise fuels the body for the day, providing a higher level of energy to enhance all other activities throughout the day. When exercise is performed early, the “obligation” is met first thing, and it is less likely to feel as if it is just another task that must be performed before the long day is done, when other pressing duties may take precedence over exercise.

*MOVE IT AND LOSE IT*
The human body is designed to move. Every muscle, ligament and joint is part of a well-oiled machine, ready to engage in whatever action its owner wills it to—except when it doesn’t have the energy to do so because of excess weight.

Obesity is a national health crisis. Our bodies were created for motion, and for the most part, our lifestyles do not let it move like it should. Prior to the information age we all now live in, most people had to perform strenuous physical labor in order to earn their keep, or just to survive. The agricultural and industrial ages required that most people move their bodies all day as part of their work. Few people now perform these physical acts as part of their jobs. We are, primarily, a sedentary society at work.

Most obviously, physical activity typically decreases weight. It also will likely decrease the appetite, thus taking fuel away from the fire that overeating causes. In addition, metabolism typically increases, thus burning more weight long after the exercise period is over. It is a win-win-win situation.

ACTION BEGETS ACTION
Congratulations to you if you already maintain a regular exercise plan. You know the health benefits, and you make time to exercise. It is a priority. Keep up the good work. May you live long and continue to exercise.

If you are one who is not committed to regular exercise, there is hope. Your body is designed to move, and it will respond to any regular exercise, matter how much or how little. Before you start a regular exercise routine, it is a good idea to contact your physician to make sure there are no specific health risks for you.

For many people, getting started is the hardest part. It is likened to rolling a wheel up a hill. It is hard work for a long time, but if you stay with it, you will become stronger, the task becomes easier, it becomes a habit and you have created momentum with a regular exercise routine. You will reach the top of the hill where the wheel’s movement will be almost self-sustaining with much less effort than it required when you started. You may even have to run to catch up with it if its momentum carries it down the other side of the hill. By this time, you might even be enjoying it.

Thinking of an exercise program as a one-day-at-a-time proposition may help as well. If you tell yourself that this “drudgery” is something you must continue to do for the rest of your life, you will likely not succeed. Telling yourself “just for today” is a better mindset. Once you have a few days under your belt, you will likely realize that action begets action, and you will be motivated to continue. Psychology suggests that it takes about 21 days for a daily habit to be formed. Sticking with it for 2-3 weeks will change your mindset, and you will undoubtedly be feeling better both physically and mentally, which will motivate you to continue. Action begets action.

Exercise need not be an expensive venture. The most basic form of exercise—walking—requires only a good pair of shoes. If you own a dog, your pet is great incentive to get out and walk—they know the benefits of walking. Running requires a good pair of shoes as well. Both walking and running can be performed on a treadmill indoors if it is accessible, or when it is not possible to exercise outdoors. As with all outdoor exercises, it is imperative to remain visible with bright colored clothing, and reflective tape on your clothing if you exercise before sunrise or after dark. Dressing in layers will allow you to remain comfortable as your body heats up, allowing you to remove layers if necessary.

Aging slows the body down, making the movements less fluid. This can be used to argue against exercise as we age, or it can be seen as the reason why we should exercise as we age. Metabolism decreases, making it more difficult to maintain a trim physique. Flexibility decreases, balance is compromised and movements become more forced and less smooth. Several specific exercise types address this:

  • Yoga: This ancient practice incorporates deep breathing and relaxation with stretching. There are many types of yoga, and many levels of difficulty. There are yoga DVD videos available to guide you through routines. Some PBS television stations offer yoga shows from 6-6:30 a.m.
  • Pilates: This focuses on strength for the core/trunk. It also exercises the hips and thighs.
  • Tai Chi: Specific and measured poses/movements that target stress reduction and strengthening . This is a popular practice in many retirement homes, with classes offered for seniors.
  • Swimming: When available, a swimming pool is an excellent place to engage in no-impact exercises. This is important for those with joint pain and problems.

Accountability is a powerful force. Finding an exercise buddy whom you can commit to exercising with is another way to ensure that you will maintain your program. Standing someone up when you have committed to meeting them at a specified place and time is not a good feeling. This is a mutually beneficial relationship if you can find someone else who is trying to start an exercise program, as the encouragement goes both ways.

Team sports are an excellent way to remain accountable. The team depends on you to show up, practice and perform in matches against other teams that are typically similar in composition to each other. Leagues for volleyball, basketball and softball are offered in many locales. The social aspect reinforces the desire for many people to participate. The age-old grade-school sport of kickball is making a comeback in some areas, with leagues formed for adults.

Another social benefit of exercise can be found at the gym. You will meet others who are striving to improve their health, perhaps others who struggle as well. You will likely be motivated by others who are working hard to meet their fitness goals, and you will see that exercise really does produce results. You may even see someone who has to work harder than you do to achieve their goals. There are friendships to be formed as well if one is open to that.

Many workplaces have realized the importance of having healthy and fit employees. Incentive programs are offered for exercise programs being completed, pounds being lost, as well as other measures taken to increase health, such as screenings for various conditions. Employers know that healthy and fit employees are more productive and happier which increases the workplace morale, typically increasing the bottom line. All employees of the Stevens County Hospital are offered a membership to the local health club free of charge.

The fabled tortoise knew that slow and steady wins the race. Humans, as a group, tend to compete with one another and compare our progress to that of other people. This is not a bad thing, but keep in mind the overall goal of any fitness program is to compete with and improve yourself for the long-term. This broad focus will allow you to suffer through the “bad days” that every active person experiences, and get back in the groove of regular physical activity so that the lifelong goal of health and fitness can continue to be realized. There will likely come a point as age affects performance, that maintenance of one’s fitness level is the goal, and the urge to push beyond previous fitness levels will no longer be the focus. Instead, keeping fit for one’s later years can be the primary goal in order to prevent or minimize the effects of disease and aging. Most importantly, feeling good, remaining healthy and having a full reserve of energy to engage in daily activities to enjoy your life to the fullest should be the focus for anyone of any age. May you live long, exercise and prosper.

Healthcare for Baby Boomers

When World War II ended in 1945, the returning soldiers came home to America to a new economy, new opportunities, and a new world for them to start a new life. By the end of 1946, millions of them had done just that. They married, got good jobs, bought cars and houses, and had babies. Many babies. Thus began The Baby Boom.

Those babies born between 1946 and 1964 are now collectively called Baby Boomers—all 75 million of them. They are a driving force in our society, our economy, and especially our healthcare system. As they age, they present unprecedented numbers of patients to our medical system, most with multiple diagnoses. As they reach retirement age, they qualify for Medicare at age 65. About 3 million baby boomers will reach retirement age every year for the next 20 years. This will challenge the healthcare system overall through its policies, procedures, delivery methods and economics.

In 2011, there were about 41 million Americans aged 65 and older. By 2020, it is estimated that there will be 71 million Americans in that age group, a 73% increase. As these people retire in the next few years, they will no longer pay into the Medicare system. The age group that does pay into that group—adult Americans of working age— will shrink. In 2011, 13% of Americans were eligible for Medicare. By 2029, this number will be 20%. At the same time, the number of Americans paying into Medicare will drop from 63% in 2011 to 57% by 2029. Most of these Boomers will switch from commercial insurance plans to Medicare. This will determine the success or failure of the new reimbursement models being tested by Medicare, such as patient-centered medical homes and capitated, quality-linked reimbursement.

These numbers are alarming, but they have largely been overshadowed by the recent publicity of the Affordable Care Act as it relates to the population in general, not just Baby Boomers. As the numbers of retiring Boomers continues to increase, it will garner more attention from analysts as well as the media. This issue will only become more pressing as time passes due to sheer increases in numbers.

There are several major differences between the Medicare recipients of the past few generations and the Baby Boomers. First, the Baby Boomers typically present with multiple diagnoses, not just one or two. The top five diagnoses include hypertension (high blood pressure), arthritis, heart disease, cancer and diabetes. Sixty percent have at least one of these diagnoses, and only one in three engages in regular exercise to attempt to offset them. These multiple diagnoses require care from and coordination between specialists as well as the primary care physician, and the system is not currently set up in a way that promotes such collaboration and cooperation. This factor will require attention and a shift in the manner of interactions among specialists towards each other, as well as their relationship with the primary care physician.

The primary care physician is a role that will continue to increase in importance as the focal care provider. However, many medical students are choosing to specialize on one of many fields of specialized care, mostly due to a considerable difference in pay and the ability to maintain more feasible schedules and set their own hours, instead of being on call on a regular basis, as is the primary care physician. This generation recognizes the importance of having more time for themselves and their families, which is hard to maintain as a primary care provider. Thus, more young medical students are choosing to specialize.

Another factor that plays into the multiple diagnosis issue is the fact that with these people with chronic conditions are vulnerable and more likely to end up in the hospital as a result of a fall, a severe cold or an episode of the flu. This is already one of the biggest struggles for Medicare, as the care of the chronically ill patient with multiple diagnoses consumes a significant portion of Medicare funds.

*

Boomers have a collective wealth that far exceeds any previous generation, and they are not afraid to use it to improve their quality of life. From physical therapy to cosmetic surgery, they are utilizing services in far greater numbers and with far greater frequency than their parents or grandparents did as Medicare recipients. They go to the doctor more, and are willing to spend more on health care. In addition, this group continues to increase their spending on exercise programs such as tennis and yoga, gym memberships and other fitness classes. They also are driving the market up for “superfoods” that tout anti-aging properties and enhanced health.

This wealth, however, is concentrated among those Boomers who lost the least in the economic downturn that began in 2008. It is estimated that the Boomers who were born between 1946 and 1955 lost 28% of their net worth during the Great Recession. They lost their jobs in record numbers, spent down savings, and many have remained unemployed. Their retirement accounts shriveled, which will affect their ability to pay out-of-pocket expenses after they retire. Currently, the out-of-pocket average spent by Medicare recipients annually is $1,450 towards insurance, medical services, medications and supplies.

These findings indicate an increased likelihood for continued rising health care costs and a need for increased numbers of health-care professionals to care for them. The irony in that aspect is that a considerable number of these retiring Boomers are retiring from healthcare professions themselves, leaving gaps that are currently hard to fill, and will likely become harder. By 2020, approximately 5.6 million jobs in the healthcare field will be created to accommodate Boomer’s needs from home healthcare, nursing home care and community care, as well as manufacturing the pharmaceuticals. One of the greatest needs is expected to be in the direct-care field, as the need for nurse aides and home health care workers will increase at a pace consistent with or greater than the need for doctors, nurses, therapists, and other clinicians.

All this publicity may give Baby Boomers a bad name in the medical field, but some suggest they are not to blame. The emergence of costly new drugs, new medical technologies and diagnostics are driving costs up, and Boomers have no choice but to partake. In most sectors of the economy, technology decreases costs, but in healthcare, costs raise with new technology because the demand for the services increases. A prime example is stenting, whereby surgeons insert a mesh tube into a weakened artery for reinforcement. This was originally developed for a small and specific patient population, but now it is widely used. It is important to note also that no matter what the patient’s age, everyone is paying more for health care than a generation ago.

There are aggressive efforts aimed at improving the short-term and long-term health of Medicare in light of the Baby Boom generation aging and reaching Medicare age. Incentives towards prevention of disease and promotion of good health are the most proactive, but are slow to change the ability of humans to increase self-disciple in terms of taking care of one’s own health. The Affordable Care Act is a major force in promoting and testing models that focus on the value of the health care delivered versus the volume. Bundled payments for acute and post-acute care help to stress the value aspect of this plan, as do the creation of community-based organizations designed to assist the patient in the transition from acute to post-acute, whether it is to a nursing facility, assisted living facility, or as a recipient of home health care services.

Baby Boomers have matured along with technology, and most are not afraid to implement it. Thus, their willingness to engage in treatment that involves new technology that, unlike many new forms of technology is actually more economical—such as mobile health care and telemedicine—may ease some of the burden on the healthcare system and Medicare funding.

Longevity continues to increase, with the 85-plus age group growing the fastest. This factor raises an interesting perspective on the situation, as one of the most promising approaches is medical care based on the theory that aging itself causes chronic illness, and the focus should therefore be on the aging process and efforts to offset its effects. As one ages, typically more diagnoses are added to the list. “Health span” is a term that signifies a period of time that a person is relatively healthy. Efforts to increase these spans of time are showing promise.

Clearly, this pressing issue will continue to become more important as the numbers of retiring Baby Boomers continue to increase. Policymakers, analysts and medical researchers recognize the need to keep this issue at the forefront of their agendas. It is a unique and unprecedented problem in our society.

Medicaid 101: What Every American Needs To Know

Medicare is the social insurance program America offers to people over 65, as well as people younger than 65 with certain disabilities. Medicaid is also a social health insurance program, offering insurance for persons of all ages whose income and resources are too limited to afford health care. It is governed by CMS—Centers for Medicare and Medicaid Services—which is a branch of the United States Government.

Medicare is wholly funded by the United States Government, while individual state governments provide up to half of the funding for Medicaid, with the federal government providing the rest.

Unlike Medicare, Medicaid is a need-based program. Medicare enrollees pay a premium, but not every Medicaid enrollee pays a premium, dependent upon income and the specific Medicaid program they are enrolled in.

Together with CHIP—Children’s Health Insurance Program—Medicaid offers social health insurance to approximately 60 million Americans. This group includes children, women and men of all ages, pregnant women and people with disabilities. It is the largest funding source for Americans with low income, and is jointly funded by the United States Government and state governments. Each state has the option to participate—it is not mandated. However, every state in the United States currently participates in the program, and each state sets its own eligibility requirements. Each state manages its own program, and recipients must be US citizens or legal permanent residents. Eligibility is determined by each state, and if an enrolled person moves to another state, their eligibility may not transfer to that state. There are certain “mandatory benefits” that each state is required to cover, and there are “optional benefits” that each state can choose to cover, including prescription drugs.

Medicaid was created by the Social Security Amendments of 1965 which added Title XIX to the Social Security Act. The Medicaid Drug Rebate Program and the Health Insurance Premium Payment (HIPP) were created by the Omnibus Budget Reconciliation Act of 1990. This program was formed to control the costs that were being incurred by Medicaid for prescription drugs. The Affordable Care Act significantly expanded both eligibility for and federal funding of Medicaid.

Other changes since its inception include the implementation of an estate recovery program, which requires that states sue the estates of deceased Medicaid recipients for reimbursement of some or all medical and/or long-term care costs incurred by Medicaid, and a repayment of a percentage of medical costs incurred when an insured receives an insurance payment or lawsuit payment due to a physical injury that required this medical care.

CHIP—Children’s Health Insurance Program—provides coverage for nearly 8 million U.S. children whose family incomes are too high for Medicaid, but can’t afford private coverage. CHIP was signed into law in 1997. Like Medicaid, CHIP is jointly funded by the federal and state government. Typically, the federal contribution is 15 percentage points higher than for Medicaid.

Each state has a unique organization devoted to administration of Medicaid. In Kansas, KanCare is the branch of the state government that administers Medicaid.

  • KanCare began in 2013, and serves over 360,000 Kansas consumers. Medicaid and HealthWave ceased to function together on December 31st, 2012, when KanCare became the official state agency administering Medicaid services.
  • Kansas has contracted with three health plans or managed care organizations (MCOs) to coordinate health care for nearly all Medicaid beneficiaries.
  • These three plans are: Amerigroup, Sunflower and United.
  • New services offered by these three groups include: preventive dental care for adults, heart/lung transplants and bariatric surgery.

As health care costs continue to increase, KanCare is dedicated to controlling these costs, while providing optimal health care to its enrollees. KanCare coordinates all the different care a consumer can receive, including doctor visits, inpatient care, behavioral health services, dental and vision care, pharmacy, transportation to and from these appointments, and nursing facility care.

A significant percentage of nursing home care in Kansas is covered by Medicaid. Approximately 60% of nursing home residents receive Medicaid assistance. Income and asset guidelines must be followed in order for Medicaid to cover nursing home expenses. Medicare does not pay for long-term nursing home care, but it can cover most costs for up to 100 days of skilled nursing care as well as physical, occupational and speech therapy if the resident shows consistent progress. An enrolled person can receive both Medicaid and Medicare services, depending upon their eligibility. In some cases, Medicaid will pay the premium for Medicare.

Government-funded health-care spending in the United States has historically been an effective system, but does require continued and ongoing changes and improvements to maintain pace with political, social and medical changes in order to provide cost-effective and appropriate programs for those insured.

The goals of KanCare are to improve overall health outcomes while slowing the rate of cost growth over time. Their preventive services and screenings, as well as management of chronic conditions aim to reduce need for future health care services. They strive to accomplish this by providing the right care, in the right amount, in the right setting and at the right time.

Medicare 101: What Every American Needs To Know

No matter what your age, Medicare affects you or someone you know. It is our national insurance program for Americans aged 65 and older, and younger people with certain disabilities. A significant portion of our taxes paid to the United States government are used to fund Medicare. Check your pay stub—you will notice a deduction for Medicare tax. All working Americans pay into the program- which is funded with 15% of the federal budget—that’s a big slice of the pie, totaling $498 billion. It is predicted that by 2020, this will increase to 17%.

Medicare was created by Congress under the leadership of President Lyndon B. Johnson in 1965. It was designed to provide health insurance to people 65 and older, regardless of income or medical history. Before its creation, just under 70% of people 65 years of age and older had health insurance. Coverage was often unavailable or financially out of reach to the rest, because older adults were forced to pay more than three times as much for their insurance as compared to younger people. Upon its inception, Medicare payments were made to health care providers conditional upon racial desegregation, thus leveling the playing field for all citizens. Like many new government programs, there were mixed reactions from American citizens to this program. Many thought it was unreasonable and would never stand the test of time.

Since its inception almost 50 years ago, Medicare has undergone several changes. Provisions have been extended to include speech, occupational and physical therapy, and chiropractic care. With advances in health-care technology, the human life expectancy has extended, thus necessitating the need for health care through hospice care services. These services were covered initially on a temporary trial basis in 1982, and became a permanent benefit in 1984. Eight million people under the age of 65 are covered by Medicare due to certain disabilities. Adults of any age with end-stage renal disease, as well as people with amyotrophic lateral sclerosis (ALS, or Lou Gehrig’s Disease) are covered as well. As with any insurance program, Medicare spreads the risk of financial loss associated with illness across society to protect everyone. However, Medicare differs from for-profit insurers, who manage their risk by adjusting their pricing according to likely risk: everyone pays standardized amounts for Medicare.

In 2010, Medicare provided health insurance to 48 million Americans—40 million people aged 65 and over, and 8 million younger people with disabilities. 15.3 million inpatient hospital stays were paid primarily by Medicare in 2011, accounting for 47.2 percent of total inpatient costs in the United States. For those covered by Medicare, it pays approximately half of health care costs for enrollees. The costs that are typically not covered include long-term care, dental, vision and hearing coverage.

Currently, there are 3.7 workers for every one enrollee. In other words, there are 3.7 times as many people currently working and contributing as there are covered Americans. However, as longevity in America continues to increase, it is predicted that by 2030, this ratio will be reduced to 2.4 workers per every covered American. With this longevity comes more illness and disease, which will further weaken the system with the need for more health care.

By the year 2030, it is projected that enrollment will increase from 48 million to more than 80 million, and Medicare spending is expected to increase from $560 billion in 2010 to just over $1 trillion by 2022. As the Baby Boomers age it is estimated that 20% have 5 or more chronic conditions which will add to the future cost of Medicare. There are many recent proposals made by policymakers to reduce costs, and many screening and preventive measures are already covered by Medicare in an effort to limit future spending.

There are 4 components to Medicare

  • Part A is Hospital Insurance. It also covers up to 100 days of skilled care—nursing care, physical, occupational and speech therapy—home health for those who qualify, and hospice care. It DOES NOT cover long-term care after the period of skilled care.
  • Part B is Medical Insurance, covering outpatient visits and services.
  • Part C is a supplement plan comparable to other supplements. Essentially, it acts as a voucher.
  • Part D covers many prescription drugs, although some are covered by Part B. There is a list of covered medications called a formulary, with different tiers or levels of payment, dependent upon the drug.

PREMIUMS:

Part A: Most Medicare enrollees do not pay a premium for Part A, because they or a spouse have had 40 or more 3-month quarters in which they paid the necessary contribution taxes. For those who have not paid in enough, there is a premium.
Part B: Most Part B enrollees pay a premium of $104.90 per month, with higher amounts for those who have incomes above $85,000 per year, or $170,000 for married couples. The highest monthly premium charged for Part B is $319.70.
Parts C and D: Plans may or may not charge premiums, depending upon the plans’ design as approved by CMS (Centers for Medicare and Medicaid services).

CMS is located in Baltimore, Maryland. It is not in Washington, D.C. due to the restructuring of the system that took place in its early years, which placed it under the control of the Social Security Administration, which was headquartered in Baltimore.

MEDICARE REFORM:
As the number of taxpayers paying in to Medicare decreases relative to the number of people enrolled in Medicare, it is becoming obvious that the present trajectory of Medicare spending cannot functionally continue. The program is not perfect, but it provides medical insurance and coverage for Americans over 65 years of age, and those younger than 65 with certain disabilities. Without it, millions of people would struggle to receive adequate medical treatment.

There are many proposals for reform:

Premium support:
Currently, Medicare is a publicly run social insurance program with clearly defined benefits. The basic idea behind this proposal is to offer enrollees a set contribution toward a private plan offered by an insurer.

Raising the age of eligibility:
Due to the fact that the age at which an American can retire with full Social Security benefits is increasing to 67, it has been argued that the minimum age for Medicare eligibility should be raised to 67 as well. (Enrollees could still receive reduced benefits at age 62 as they currently can.)

Prescription drug price negotiation:
Medicare covers certain prescriptions through a Medicare Advantage Plan and Part D. Each plan negotiates the price it pays to drug manufacturers. However, each plan has a smaller pool than the entire Medicare program, thus reducing Medicare’s potential bargaining power with drug companies.

Dual-eligibility reform:
Approximately 9 million Americans are dually qualified for both Medicare and Medicaid. Most have particularly poor health and cost both systems significantly more money than single enrollees. Their care is split between both programs, and is generally poorly coordinated. They have higher rates of preventable hospitalizations, and because the two different programs cover different health care aspects , both have a financial incentive to shunt patients into the care of the other program.

Income-related premiums:
Currently, only 5 percent of enrollees pay an income-related premium due to their higher level of income. The primary concern regarding this proposal is that as a social medical insurance program, this method would decrease Medicare’s strength politically over the long-term.

Medigap—Medicare C—restrictions:
Some Medicare supplemental insurance plans cover all out-of-pocket expenses, guaranteeing financial security to individuals with significant health care needs. Many analysts believe this causes the insured to seek unnecessary and costly treatments, as they are guaranteed coverage. Many feel there should be incentives offered to seek the most cost-efficient alternatives.

There will not be a quiz, but if there were, this is what you should remember:

  • Medicare is a national health insurance program for persons 65 and older, and for those under 65 with certain disabilities.
  • All working adults pay into the program
  • Eligibility and premium amounts are determined by number of quarters—three month periods—each adult has worked and paid into the system.
  • In order to be eligible, a person must be a legal resident of the United States of America for at least 5 continuous years, AND, they or their spouse has paid Medicare taxes for at least 10 years.
  • Medicare was created in 1965 under the leadership of President Lyndon B. Johnson.
  • Medicare Part D (Drug plan) was signed into law by President George W. Bush in 2003.

Medicare can and does provide invaluable health-care coverage for a significant percentage of Americans, a number which will continue to increase as the Baby Boomers enter into eligibility in unprecedented numbers. This group of people will likely live longer as a group, as statistics show. They will continue to need increased health care as they age, and Medicare will take care of their needs, however perfect or imperfect the program may be.

Rehabilitation

Rehabilitation can best be defined as restoring someone to a state of good health or normal function through therapy and exercise. The need for rehabilitation can arise for many reasons. Some of the most common include:

  • Stroke
  • Injury
  • Chronic conditions such as arthritis
  • Progressive diseases such as Parkinson’s disease and Multiple Sclerosis
  • Cancer
  • Acute illness such as pneumonia or the flu
  • Decline in function due to normal aging
  • Vertigo

A comprehensive therapy program may include physical, occupational and speech therapy. When available, recreation therapy is often implemented to aid the patient’s return to the activities and hobbies of their previous lifestyle.
In conjunction with the opening of the new clinic at Stevens County Hospital, our physical therapy services are highlighted and explained. Physical therapy encompasses many aspects of movement. Basic strengthening and coordination are the foundation of what physical therapy can offer, but it extends much further to the following functions:

  • Balance
  • Gait training
  • Transfers: sit-to-stand, stand-to-sit, car and bathtub transfers
  • Muscle re-education
  • Sports injury rehab/specialized muscle training
  • Bladder retraining
  • Chronic pain: Headaches, stiff neck, back pain, joint pain
  • Amputee/prosthetic training
  • Therapy after joint replacement
  • Hip fracture rehabilitation
  • Reduce physical complications of diabetes
  • Strengthening to avoid surgery

A Physical Therapist—PT—is required to have a graduate degree—either a master’s degree or a clinical doctorate—from an accredited physical therapist training program before taking the national licensure examination that allows them to practice. They examine, diagnose and then prevent or treat conditions that limit the body’s ability to move and function in daily life.

Increasingly, physical therapists have a doctorate degree versus a master’s degree. More than 180 of the 210 accredited training programs in the United States that offer physical therapy training programs now offer the doctorate degree. A Doctor of Physical Therapy—DPT— is the “terminal” degree in the field, which means there is no higher degree to be held.

A Physical Therapy Assistant—PTA—works under the direction and supervision of a physical therapist. PTAs must hold an associate degree, pass a national licensure examination and be licensed or certified by the state in which they work. Hawaii is the only state that does not require a state certification or licensure.

The PTA provides components of the therapy program that is set forth by the physical therapist such as therapeutic exercise, functional training and physical modalities such as electrotherapy and ultrasound. The PTA may also provide instruction in exercise, proper body mechanics and other injury prevention and wellness topics.

In the Physical Therapy Clinic at Stevens County Hospital, our Physical Therapist is Megan Sullivan, PT. She has been with our hospital for 7 years, and she received her undergraduate education at Northeastern Oklahoma A&M and Oklahoma State University. She then received her PT training at The University of Oklahoma Health Sciences Center.

Our PTA is Jeff Beard. He received his education at Seward County and Fort Hays State University. He has been with our hospital12 years.
We are excited to announce that we will be adding a new physical therapist in May.

The long-term plan for our clinic is to add an occupational therapist and a speech therapist. These therapists would offer expanded rehabilitation services to further benefit our patients.

An occupational therapist (OT) works to strengthen and coordinate the arms and fine motor skills. Occupational therapists are required to have a four-year degree from an accredited program. Certified Occupational Therapy Assistants (COTAs) are assistants to the OT, and are required to have an associate’s degree from an accredited training program. Much like a PTA carries out the plan of care for the PT, the COTAs carry out the therapy program set up by the OT. There are many other functional areas that an OT can address, including:

  • Activities of Daily Living (ADLs) including: dressing, grooming, cooking
  • Visual-spatial skills
  • Hand rehabilitation after injury or surgery
  • Modifications to eating utensils, writing instruments and training for use
  • Measurement of reflexes and response times for driving tests

A speech therapist/speech-language pathologist (ST/SLP) works to improve communication, cognition and swallowing. SLPs are required to have a master’s degree from an accredited training program. There are Speech Therapy Assistants (STAs), but Medicare does not recognize them as medical professionals, and does not reimburse for their services. They are typically employed in school settings. Specific functional areas that are addressed by the SLP in the medical setting include:

  • Oral/motor strength to improve clarity of speech and chewing
  • Information processing to improve cognitive functions such as safe administration of medications and money management
  • Strategies to improve short and long-term memory recall
  • Alternative communication modes for loss of verbal skills
  • Swallow deficits resulting from stroke, disease or dementia
  • Dementia management with caregiver training/cues and strategies

The overall goal of the rehabilitation team is to restore function to the patient to allow them to return to their former lives as much as possible. When that is not possible, the focus is on compensating for the deficits the patient cannot overcome. Helping the patient learn to cope with loss of one’s abilities is a vital part of the rehabilitation process.

There is an old joke among therapists that goes something like this:
“So the OT says to the PT: ‘Well, you may be able to get your patient to walk to the door, but I can get them to open it.’ Then the ST adds: ‘But I’m the one who helps them say ‘Come in!’”

If you need help walking to the door, come see us. In the future, we plan to be able to help you open it, and say “Come in!”

Be sure to check out our update regarding the completion of our new Physical Therapy Clinic on our Facebook page. We welcome visitors!

What is the Health Insurance marketplace?

One of the critical components of the Affordable Care Act is the Health Insurance Marketplace, also known as the health insurance exchange. It is a new way to find quality health coverage, whether or not you currently have coverage. You can use it to “shop” for other options that may suit you better than your current plan. With one of the Marketplace applications, you can compare coverage options side-by-side, learn if you can get lower costs based on your income and enroll for coverage.

The goals of the Health Insurance Marketplace are to expand insurance coverage to more people, help insurers comply with consumer protection laws and compete in cost-effective ways. The exchange itself is not an insurer, so it does not bear risk but it does determine the companies that are allowed to participate. To date, over 120 insurance companies offer qualified health plans in the Marketplace. Ideally, the marketplace concept promotes insurance accountability and transparency and facilitates increased enrollment and delivery of subsidies. Additionally, it helps spread risk to ensure that the costs associated with expensive medical treatments are shared more broadly across large groups of people rather than spread across just a few beneficiaries. The sharing of risk is the most basic and essential concept of any form of insurance.

Insurance plans in the Marketplace are offered by private companies. They all cover the same essential health benefits and no plan can turn you away for a pre-existing condition or an illness. Treatments for these conditions or illnesses must be covered. Also, women cannot be charged more than men for the same plan. Many preventive services are covered at no cost.

When you use the Health Insurance Marketplace, you’ll provide information about your household size and income to find out if you can get lower costs on your monthly premiums for private insurance plans. You will also learn if you can qualify for lower out-of-pocket costs and see all the health plans available in your area. You can apply online, by mail with a paper application, by phone, or in person with the help of a Navigator or other qualified helper. Community Health Centers in all 50 states have received a total of $150 million in federal grants to help enroll uninsured Americans. Telephone help is available 24/7 at 1-800-318-2596 (TTY: 1-855-889-4325). Online chat is also available. Spanish-speaking consumers can go to CuidadoDeSalud.gov.

While all insurance plans are offered by private companies, the Marketplace is run by either the federal government or individual states, and every state is mandated to use the marketplace. Nearly $4.2 billion in federal grants has been awarded to 49 states, the District of Columbia, and four territories to establish their Marketplaces. Seventeen states (including the District of Columbia) will fully run their own Marketplace. The Department of Health and Human Services (HHS) will fully run a Marketplace in 19 states. In 15 states, HHS will work with the state to run a Marketplace. Kansas is run by the federal government, so our Marketplace is accessed through HealthCare.gov. You can apply and enroll on this website, and if you do not enroll in a plan, you will likely be penalized with a fee of $95 per adult, and $47.50 per child, or 1% of your income, whichever is greater. This fee increases every year. Some people are exempt from this fee, which is outlined on Healthcare.gov. If you enroll by March 31st 2014, you won’t have to pay the fee for any month before your coverage began.

Many people will not need to use the Health Insurance Marketplace. If you have job-based insurance, you are covered by this policy. However, you can consider switching to a Marketplace plan. You cannot qualify for lower costs based on your income unless the job-based insurance is unaffordable, or doesn’t meet minimum requirements. You may also lose the employer contributions your employer makes to your premiums.

If you have Medicare, you are considered covered and don’t have to make any changes. You cannot use the Marketplace to buy a supplemental or dental plan.

In addition to any job-based plan or Medicare, you are considered covered if you have Medicaid, CHIP (Children’s Health Insurance Program), a privately-purchased plan, COBRA, retiree coverage, Tricare, VA health coverage and some other kinds of health insurance.

Small employers will be able to choose from a range of coverage options for their employees through the Small Business Health Options Program or SHOP. Eligible employers may qualify for a tax credit worth up to 50% of the employee’s premium contribution to a SHOP plan. In 2014, SHOPs will have the flexibility to decide whether employers can let their employees choose from a number of plans, or offer their employees one plan chosen by the employer.

Non-profit health insurers, called Consumer Operated and Oriented Plans (CO-OPs), will offer coverage inside and outside the Marketplace. To date, 24 non-profits that plan to offer coverage in 24 states have been awarded nearly $2 billion to set up CO-Ops.

More information is available at healthcare.gov.

Critically Acclaimed

The Stevens County Hospital is a Critical Access Hospital (CAH). But what does that mean? In 1997, Congress created the Critical Access program to benefit hospitals like ours. Because we are a small hospital, we can focus only on providing the most essential medical services. Compared to larger, higher-volume hospitals that have more resources and greater flexibility to offer a wider range of services, we provide services that are considered essential to achieve and maintain our patient’s general good health. Larger hospitals have greater budgets and economic flexibility that allow them to provide less crucial, more optional health care services.

Because of geography and distance to larger hospitals, it is critical that patients have access to our services. We are a rural hospital, and we strive to provide health care that takes care of the resident’s immediate needs. We are critical to the health of this area.

Critical Access Hospitals (CAHs) survive largely due to a federal reimbursement structure from Medicare that provides funding of 1% above the cost of providing care. The Medicare Payment Advisory Commission (MedPAC) estimates that in past years, Medicare paid CAHs an average of $850,000 per year more than they otherwise would have without the CAH designation. Medicare recognizes that small hospitals like ours fill an urgent need to meet the essential healthcare needs of area residents, and without them, many people would find themselves in a crisis situation without local medical care.

The Critical Access program was created by Congress in 1997, after a wave of rural hospital closures. The program was aimed at keeping health care available to Americans in rural and isolated areas. In order to qualify to receive these benefits from Medicare, there are several criteria that must be met before a hospital can be defined as a Critical Access Hospital:

  • Located in a state that established a State rural health plan for the State Flex Program. Only Connecticut, Delaware, Maryland, New Jersey and Rhode Island did not have a State Flex Program.
  • Located more than a 35 mile drive from any other hospital—CAH or otherwise, OR, Located more than a 15 mile drive from any other hospital or CAH in an area with mountainous terrain or only secondary roads.
  • Located in a rural area or be treated as rural under a special provision that allows qualified hospital providers in urban areas to be treated as rural for the purposes of becoming a CAH.
  • Furnish 24-hour emergency care services 7 days a week, using either on-site or on-call staff. For on-call staff, there are specific response time frames that must be met.
  • Maintain no more than 25 inpatient beds that may also be used for swing bed services. It may also operate a distinct rehabilitation or psychiatric unit, each with up to 10 beds.
  • Have an average annual length of stay of 96 hours or less per patient for acute care (excluding swing bed services and beds that are within distinct units as mentioned above.

Notes: Payment rules require a physician to certify that an individual may be reasonably expected to be discharged or transferred within 96 hours after admission to the CAH. A swing bed is defined as a hospital bed that can be used for acute care for a stay expected to be under 96 hours, or it can be used for long-term care, similar to care received in a nursing home.

There are many other important facts regarding CAHs:

  • There are 1,330 Critical Access Hospitals in 45 states in the United States.
  • There are 83 Critical Access Hospitals in Kansas.
  • The typical CAH provides an average of 204 jobs to the local economy.
  • Seven million patients are treated annually in the emergency rooms of CAHs nationwide.
  • There are 38 million outpatient visits annually to CAHs.
  • 900,000 patients are admitted to CAHs each year.
  • 86,000 babies are born in CAHs across the Unites States every year.
  • 19.3% of the American population resides in rural areas that are served by CAHs.

The Office of Rural Health Policy (ORHP) is a subdivision of the United States Department of Health and Human Services (HHS). It was created in 1987 and is the lead federal agency responsible for monitoring and improving health care services for the 60 million Americans who live in rural areas. Historically, such services have been scarce and limited. In order to maintain, preserve and attempt to improve rural health care, the ORHP assists states in collecting and disseminating health-related information regarding rural health care, provides technical assistance to rural hospitals and providers, and works with communities to recruit and retain health care providers. Specific functions include:

  • provides funding and technical assistance in partnership with the National Rural Health Association
  • provides rural grant programs to benefit CAHs with acquisition of telemedicine and computer file-sharing equipment
  • supports rural health research centers to conduct short and long-term studies on rural health issues
  • offers technical assistance to more than 4,000 rural health clinics through quarterly conference calls
  • supports the Rural Recruitment and Retention network to locate and retain health professionals
  • oversees services provided by the University of North Dakota’s Rural Assistance Center, which serves as an information portal to help rural communities access the full range of available health care programs, funding and research.

Each of the 83 Critical Access Hospitals in Kansas belongs to a rural healthcare network, as required by the Kansas Department of Health and Environment (KDHE). In applying for certification as a CAH, each hospital must submit a plan to the secretary of the KDHE, specifying a Supporting Hospital that will be the primary recipient of patients who are transferred in need of more intensive medical care and the provision of emergency and non-emergency transportation among members. The Supporting Hospital also provides medical staff credentialing, risk management, quality assurance and peer review.

There are 19 networks in Kansas. The Stevens County Hospital belongs to the Southwest Kansas Regional Health Network, with St. Catherine Hospital in Garden City as the Supporting Hospital. Nine other southwest Kansas hospitals belong to this network, as well as one hospital in northwest Kansas. Six Kansas Critical Access Hospitals belong to networks with the Supporting Hospital in a bordering state due to their proximity to that hospital. The largest network in Kansas is the Northwest Kansas Health Alliance, with 24 CAHs in northwest Kansas that are supported by Hays Medical Center in Hays.

The history of rural healthcare has followed a pattern of economic struggle, with the future predicted to continue as such. However, Medicare provides incentives for hospitals and health care providers to provide essential services through CAHs, and offers reimbursement that is 1% above the cost of providing care. The dire need for rural health care through CAHs is recognized by Medicare, and their payments must continue in order for CAHs to continue to provide care.

47.3% of total reimbursement to CAHs nationally is through Medicare, with over 60% of the total revenue coming from Medicare and Medicaid (15.5%) combined. 35.9% of reimbursement comes from private insurance, with the remaining 1.3% coming from other sources. Because of the concentration of older, Medicare-funded patients in rural areas, the percentage of revenue from private insurance is considerably less than in urban areas.

It is frequently said that if a town loses its schools, then the town will not live on much longer. Some health care analysts feel that the same can be said for hospitals. Businesses typically don’t consider relocating or developing in a town that does not have a school, nor will they consider a town without a hospital. Thanks in part to our Critical Access Hospital Designation, our hospital is alive and well, as are our schools, and our community in general.

Western Kansas Physician Shortage

Nationally, 21% of the population is rural, but only 10% of general practitioners practice in rural areas. Kansas is predominantly rural, especially the western half of the state, where this discrepancy is felt acutely. The KU school of medicine reports that 101 of the 105 Kansas counties are partially or fully designated as shortage areas for primary care physicians.

At the Stevens County Hospital, we are blessed with three medical providers: Dr. Samer Al-Hashmi “Dr. Sam”, Dr. Edwin McGroarty and Jana Morris, APRN-BC. We know how lucky we are.

Many factors play into the shortage equation:

  • Physicians are trained primarily in urban areas, where they become accustomed to the amenities of city life. Many have never been exposed to the alternative joys that rural areas can offer.
  • When a spouse is involved, it becomes harder to convince two people to relocate to a rural area than just one.
  • There is a greater income potential for primary care physicians in urban areas due to the fact that more patients are covered by insurance in urban and suburban areas, versus a higher population of Medicare patients in rural areas.
  • Primary care typically does not offer the high salaries that specialty medicine does.
  • Many of the medical students hail from urban areas, and plan to maintain their residency there.
  • As exhausting as it is for the doctor, many are on call “permanently” in rural areas, because they are the only available physician, and they don’t turn their backs on emergencies.

There are other factors that set rural health care apart from urban health care, including:

  • While there are significant gains made in reimbursement, Medicare payments to rural hospitals and physicians are less than their urban counterparts for equivalent services. This correlates closely with the fact that in the past 25 years, more than 470 rural hospitals have closed in rural America.
  • One-third of all motor vehicle accidents occur in rural areas, but two-thirds of the deaths occur in rural areas due to a greater time and distance necessary to transport the injured to a hospital. In addition, the time it takes for EMS to respond to a call is greater due to the increased travel distance both to the injured and back to the hospital. The national average response time for EMS in motor vehicle accidents is urban areas is 10 minutes. In rural areas, it is 18 minutes.
  • People suffering from heart attacks, strokes and other immediate health crisis of an emergency nature also face a longer travel time to the hospital versus their urban counterparts, with survival rates reflecting that.
  • Due to the self-employed status of the many agricultural families that comprise a significant portion of the rural population, rural residents are less likely to have employer-provided health care coverage or prescription drug coverage.

Kansas is not alone, but due to our high rural population, we are one of the states with the most acute problem.

There are some creative alternatives being implemented to combat this shortage. In nearby Hamilton county, where they have not had a doctor at the Hamilton County Hospital for nearly eight years, people had to travel miles for health care. The addition of tele-medicine in the form of a robot has been great advantage to the hospital and to the area.

This complex piece of equipment has a 12-fold magnification so that the doctor can examine things like skin lesions better than with his or her own eyes. This robot gives the hospital the opportunity to see patients dealing with many different conditions. It is relatively simple to work, and many people working at the hospital can maneuver the robot to allow the attached camera to get an up-close view. The doctor is in a remote location, and can log on a computer or tablet in the clinic or the ER while he or she sits in the office or home.

In urgent care situations such as a heart attack or a stroke, time is of the essence. This service will save lives by virtue of decreased response time. Many diagnoses would have been made after the patient was airlifted or transported by ambulance to a larger hospital, which would take more time away from immediate treatment. These patients are now able to remain in the local hospital. If the patient has greater medical needs that require transporting them to a larger hospital, they can be stabilized here and given everything possible before they leave.

This robot is a bargain, according to the bottom line. If just one patient per month stays in the hospital there without getting shipped out, it will pay for itself.

Greater than breaking even is the fact that this service will likely keep the doors to that hospital open, when closure seemed imminent not long ago. They are now setting a new standard of healthcare not just for rural western Kansas, but for rural health care across America. Many providers have signed on to provide these tele-medicine services, opening many new doors.

It was mentioned that the vast majority of physician training programs are located in large cities. There is an exception to this rule in our state. Kansas University offers a full four-year medical education in Salina, with a maximum of eight students enrolled in the program. It is billed as the smallest in the nation, and one of its primary goals is to better prepare students for the realities of a rural practice. Research supports this notion.

Another means of addressing the shortage is to recruit students from rural areas, with the hopes of them return to practice rurally after graduation. Some schools give rural students preference for admission, and others who commit to practice in rural areas can qualify for loan forgiveness.

While this shortage is projected to continue for at least the next 50 years—research has borne this out—there are other creative ways that medical care will likely be offered in the near future.

Kansas University has another novel approach to fight the shortage. Students at KU are working on a prototype of what they call a “WellCar.” This medical office on wheels has devices integrated and is advanced enough to send medical data to hospitals and clinics where it can be evaluated. Some treatments could be given, and some prescriptions could be written by the nurse practitioners who staff it.

Any of us who have lived in western Kansas for a significant amount of time know that the amenities are not those of a large city, but there are other benefits to a rural life. Our medical providers seem to know this very well, and for this, we are grateful.

Physical Therapy Update No.2

We will soon be open in our new home in the former Pioneer Manor building! The ceiling is being installed, the walls are painted, the cabinetry is installed and our treatment tables and exercise equipment are expected to arrive in the next few weeks. It looks more functional and welcoming every day, and less like a construction site. We are looking forward to serving our patients in our expanded and updated facility. We plan to open in January, and hope to have another physical therapist on staff soon.

Keep watching for future updates!

Affordable Care Act

The Patient Protection and Affordable Care Act, commonly called The Affordable Care Act or “Obamacare,” is the most significant overhaul of the United States Healthcare System since the passage of Medicare and Medicaid in 1965.
From its introduction into the House 2009, The Affordable Care Act (ACA) timeline is as follows:

*Introduced into the House as on September 17, 2009, followed by Ways and Means committee consideration

*Passed the House on October 8, 2009

*Passed the Senate as “Patient Protection and Affordable Care Act” on December 24, 2009

*House agreed to Senate amendment on March 21, 2010

*Signed into law by President Barack Obama on March 23, 2013

HealthCare.gov outlines The Affordable Care Act, explaining how it may affect and protect you as a United States citizen:

  1. Enrollment online, by mail, by phone or in person allows you to shop in The Health Insurance Marketplace. You’ll be able to compare your options based on price, benefits, quality and other important features. More people than ever will be able to save money on private insurance coverage.
  2. Pre-existing conditions cannot cause you to be turned down for health insurance, nor can you be charged more for plans beginning in 2014. Women cannot be charged more than men either. The exceptions to this are for grandfathered plans.
  3. Insurance companies and group health plans must provide you with a Summary of Benefits and Coverage (SBC) written in a plain-language and succinct form. They must also provide a Uniform Glossary of terms used in health coverage and medical care. These features are designed to allow you to make an “apples-to-apples” comparison when shopping for insurance plans.
  4. The new law prevents insurance companies from cancelling your coverage if a mistake was made on your application. Previously, your insurance could be cancelled due to such a mistake, your policy could be declared invalid from the first day it took effect, or you could be asked to pay back any benefits you had already received.
  5. You have the right to choose your doctor in your insurance plan’s network, and no referrals are necessary for OB-GYN services. Out-of-network emergency room services cannot require higher co-payments, nor is prior approval necessary for out-of-network emergency room services.
  6. If you are under 26 years of age, you may qualify for coverage under a parent’s plan, even if you are married, not living with parents, attending school, financially independent or ineligible to enroll in your employer’s plan. (One exception is explained on healthcare.gov.)
  7. Many plans are required to cover certain preventive care services at no cost to you, including blood pressure and cholesterol tests, mammograms, colonoscopies and more. These rights do not apply to grandfathered plans created or bought before March 23rd, 2010.
  8. Insurance companies can no longer limit lifetime coverage for essential health benefits. Beginning in 2014, this applies to yearly limits as well. Limits can be imposed on services that are not considered essential.
  9. Rate Review is another essential feature, protecting you from unreasonable rate increases. Any rate increase of 10% or more must be publicly justified. This does not apply to grandfathered plans. Another key component is the 80/20 rule, which requires insurance companies to spend at least 80% of the money they take in on your health care premiums and quality improvement activities instead of administrative, overhead or marketing costs. This percentage is increased to 85% for companies selling to large groups—usually more than 50 employees. If these requirements are not met, you’ll get a rebate from your premiums.
  10. You have the right to appeal private health plan decisions. You must also be informed of the reason why your claim has been denied, and how you can dispute their decision. An internal appeal between you and your insurance company is the first course of action. If the appeal is not resolved, an external appeal is done by an independent organization.

The Affordable Care Act (ACA) is designed to increase the quality and affordability of health insurance, lower the uninsured rate and reduce the cost of healthcare for individuals and the government. The ACA also expands Medicaid eligibility and restructures Medicare reimbursement from fee-for-service to bundled payments.

The employer mandate states that a business who employees 50 or more people must either offer insurance to their full-time employees, or face a tax penalty if the government has subsidized a full-time employee’s healthcare through tax deductions or other means.

HealthCare.gov offers more information regarding The Affordable Care Act.

Physical Therapy Update

The former Pioneer Manor is getting a workout! Slated for early 2014, the Physical Therapy department will have a new home in the rejuvenated old Pioneer Manor building. Now resembling a construction site, the walls are being painted, the floors are being tiled, and the Physical Therapy staff anxiously awaits its new home.

Megan Sullivan, PT, has been the director of the program for the last seven years, with their only space as a single room. Jeff Beard, PTA, the Physical Therapy Assistant, has been on staff for 12 years, and has always worked in this same small space.

The renovated Pioneer Manor will have larger spaces to accommodate therapy equipment, allow for greater privacy and a gym area to complete therapy exercises. Most importantly, it will allow the therapists to offer patients the most appropriate and beneficial treatment.

In the past, there has been no space to expand the program, but with this new facility, there will be another physical therapist hired. There are also long-term plans to add Occupational and Speech Therapy services, and a swimming pool is being considered as well.

Watch for future updates!

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