Friday, October 20, 2017

Herbal and dietary supps often mislabeled

Eat the sandwich, hold the pills. 
Heads up at the health food store! In a paper presented at the American Assn for the Study of Liver Diseases Meeting,  Victor Navarro, MS, chair of heptology at the Einstein Medical Center in Philly, reminds us that herbal and dietary preparations are not required by the FDA to be tested for safety or for effectiveness.

Potentially mislabeled products can contain ingredients that are highly toxic and damaging to the liver--remember the liver is designed to remove toxins, but these may overpower it.

Between 2003 and 2016, 341 supplement products were tested (1,263 patients).

 Only 90 of 230 products had labels accurately depicting their contents.

--80% of bodybuilding and performance products had faulty labels

--72% of weight loss substances also were mislabeled.

Soooo....bear this in mind. The liver is a wonderful, necessary organ--it can regenerate itself--but there are  limits.

These products are not tested for effectiveness, remember. You may be downing a damaging product that does nothing but harm.

Thursday, October 19, 2017

Mindfulness..,mindfulness...is it full of it?

In the 1970s I was active in a yoga ashram in Wash DC. Did yoga every night, met swamis traveling through--we learned various breath control techniques. I still use some when I can't sleep or am nervous.

But now, according to Ephrat Livni in Government Executive, some techniques have now been packaged as mindfulness and even offered as psychotherapy at such Mom and Pop's as Google.

Meditation...yup, another name for it.

Problem is, according to a paper in the Oct 10 issues of Perspectives in Psychological Science, mindfulness is not very scientifically based.

This can lead to people being charmed, cheated, disppointed, and disaffected.

Mindfulness originated as Buddhist term, associated with meditation based on the breath. Taming the mind is a term often heard. One proponent said the mind was like an elephant, mindfulness was a rope, and the breath was the post to tie up the elephant.

Voila--the elephant becomes well-trained, attentive, able to concentrate.

In industry, mindfulness is cheap--no equipment needed. Supposedly it leads to high productivity, more cooperation, teamwork, lower medical costs, less absenteeism, and better morale.

Whew.

The few studies that have been done get tangled in particulars--who is a novice, who is an adept?

It is difficult to measure.

This does not mean mindfulness doesn't work, but proving it scientifically does not.

That is--most attempts to "prove" it. There have been some MRI evidence of meditation activity.

So...if you meditate, don't stop.

As we used to say in the Sixties--if it feels good do it. But don't expect miracles. For now it's a buzzword.

We used to recite, "Energy in, negativity out," but you can use any mantra. For the record, I am still pretty negative.

Wednesday, October 18, 2017

Half of US medical care delivered by ERs

I admit it--even though I have a Medicare HMO, I have gone to the ER when in pain--they can do tests right on site--if you go to the doctor, it can take days for the appt and then they farm you to imaging centers and labs--more days.

Yes, the ER is the most expensive care you can get. But it's available, and they have to treat at least your presenting complaint (and usually not beyond that).

Researchers at the University of Maryland have now done a study that shows half of medical care is done in ERs.

The researchers say the study shows how important ERs are. (And little known--hospital budgets depend on payment in ERs by people with insurance.)

Examining several large national databases, the researchers found that there were 130 million ER visits in 2010--compared with 101 million outpatient visits and 39 million inpatient encounters.

Over the next 10 yrs, emergency care visits increased 44%. Outpatient (doc's office) visits accounted for 38% and inpatient 15% in that time,

Most likely to use the ER:

--African Americans (54% of the time)
--Patients with "other" insurance (often meaning no insurance)
--More people in the south than northeast
--Medicare and Medicaid holders

In other words, vulnerable populations.

Use of the ER is often criticized--since many times, the reasons are not emergencies. But some experts say this trend is covering for weaknesses in inpatient and outpatient handling and lack of prevention.

Emergency room use is not likely to be reduced any time soon, the researchers said. But--they add--we need to connect ERs to care in other sectors. Not sure what that means.


Tuesday, October 17, 2017

Food-borne illness on my mind

Three nights ago, we ordered Mexican takeout. I did not exactly get the throwups, but I was a gas balloon, the burps, pain, etc...Miserable all night.  My daughter also felt crummy.

Today, I am baking chicken breasts and am reminded that I recently read you do not have to rinse them off (salmonella) before roasting, because the heat will kill the bad stuff. Rinsed anyhow.

So today--you get another post on food-borne illness.

--First, babies and the elderly (me, I guess) are most at risk.

--Some foods can be left out if they are cooked properly.

--But other foods--starch-based--can get more contaminated if cooked and then reheated.

From Bernard Camins, MD, assoc professor of infectious diseases at the University of Alabama Birmingham, says the main bacteria in foods are salmonella, E.coli, shigella, listeria, and campylobachter. Most are found in foods, but listeria comes from the soil.

These can cause diarrhea, sometimes bloody. And of course, vomiting.

Bacteria that makes you sick reproduces and creates toxins that in turn make you miserable.

Mayo and icing can harbor staph.

Cookie dough contains eggs, which can cause salmonella.

Reheated starch foods are a risk.  Say pasta that was cooked then reheated to a warm-only state.

Cooked meat is usually OK--although processed meat like hot dogs and salami have been linked to listeria.

If you get sick from eating a food, this usually lasts 24-72 hours. But people sick with other illnesses can get to a serious state.

--Keep food at proper temperatures

--Separate clean and contaminated dishes in the sink

--Keep meat separate--use a different cutting board for veggies, a different knife.

--Wear disposable gloves while cooking

--Wash hands a lot! (My daughter washes the gloves.)

I would say this is making me hungry for lunch, but strangely, I am not that hungry.

Monday, October 16, 2017

Vegan vending

Yes, peanut butter crackers are vegan, but are they delish and healthy?

According to a story by Erin Brodwin in Business Insider, Lamiaa Bounahmidi has started a company called LeCupboard to dispense healthy food out of vending machines.

The dishes range in price from $6 to $13 and come in reusable glass dishes, that can be returned for a $3 refund. So far, the "cupboards" are located in seven places around San Francisco.

The author tried three items...

--First she tapped in any dietary preferences or restrictions on the touchscreen (avoid gluten avoid nuts, etc).

--In 30 seconds the dish comes out along with an ingredient list and nutritional profile.

--An appetizer featuring lemon, seaweed and veggies was delicious, she said. The beets were glazed on a lemon marinade and paired with a veggie that tastes like seaweed. A light serving of black rice in a spicy sauce topped it.

--The main dish she picked was a falafel bowl, inspired by visits to Cairo. She said the falafel might have been heated for more intense flavor, but it was tasty and filling.

--Dessert was called Le Versailles, a plant-based choc mousse sprinkled with sea salt, raspberries and pistachios. Fluffy and rich. She said she could eat this once a week.

Still, the author said she often gets street food--easy and cheap.

I can see this concept being further defined--returning the containers sounds like a pain.

Friday, October 13, 2017

Men have fun with new baby, women do more of the work

A study done at Ohio State showed that three months after the birth of their first child, on days when both parents were at home, the men were most often relaxing while the women did the housework and child care.

Women spend 49 minutes relaxing, but men spent 101 minutes in leisure activities. (Journal of Sex Roles)

The investigators went out of their way--they say--to give men as much credit as possible for work around the house.

Fifty-two couples were surveyed.

On workdays and non-workdays, women did about the same amount. But men doubled their leisure activities on non-workdays.

This disparity, the researchers said, can lead to relationship issues. No kidding.

They also said in some cases, women need to step back and let the father do more housework and childcare--to their own standards, not the women's.

LET them?

Oh, well, best not to be bitter.

I remember once my ex- suited up in overalls, grabbed about six cleaning products, and went to clean the bathroom...When he got done, he looked at me, expectant. I think he wanted me to see how it's done so I could do it...I said, "Cool--when are you doing it again?"

Thursday, October 12, 2017

How to prevent lower back pain

Exercise I did. No, that's not
me, you silly puppy. I wish.
If you are approaching a "certain age," you may be among the 80% of adults who experience lower back pain.

Some yrs ago, I had it...Called the doctor and they said, "Oh, everyone over 50 gets it." They didn't even say to come over. I did some yoga poses for a while and it went away. Now I only get it if I lean over for a long time--changing the cat litter or something.

But there is a spine surgeon at the Atlantic Spine Center--Kaixuan Liu, MD--who says once you have had it once, there is a good chance it will recur. Causes can range from sprains, to age, to sitting, or stress.

Some tips on preventing that:

The impulse is to rest your back, but Liu says that is the worst thing you can do....Exercise is key.

--Walking or running can prevent compacted discs.

--Other aerobic exercise is also good. Lifting, cycling, or swimming. Stay away from high-impact exercise sich as lifting, twisting or bending.

--Aerobic activity means less pain--without drugs.

--Less pain means more active--see where I am going?

--Exercise should be regular and sustainable.

Guess the kitty litter gambit fell into the "lifting" category...Maybe getting up from the desk would help.

Wednesday, October 11, 2017

Dressing in your stomach--not on the side

Dip or pour--good for you.
According to Wendy White, associate professor of food science and nutrition at Iowa State, eating salad with some fat (soybean oil) makes the veggies more nutritious--namely, eight micronutrients. No dressing--less likelihood of absorption.

Published in the peer-reviewed American J of Clinical Nutrition, White's said added oil aided in absorption of:



--Four carotenoids--0alpha and beta carotene
--Lutein and lycopene
--Two forms of Vit E and Vit K.
--Vit A

Getting these nutrients in usable form helps eyes and may help prevent cancer, among other goodies.

The more oil--the more absorption.

This is not open season on dressing--the recommended amount of 2 tablespoons a day should be guilt free.

Soybean oil is common in commercial dressings--but you could check the label. Also, the study did not check other oils, although they may provide similar benefits.

Tuesday, October 10, 2017

Screening youngsters for scoliosis

I know I have written on this before--I think I have written on EVERYTHING before--been at this for over 11 years.

Anyhow, one in 25 children will develop curvature of the spine--scoliosis. Most cases are evident in the preteen years.

The causes are not known, but it may run in families. Girls are more likely than boys to get it. So the recommendation is that girls be screened twice in their developing years, boys once.

What does screening amount to: A school nurse or pediatrician checks for asymmetry in the back--maybe one should is higher than the other...or the hip, pelvis or chest will be more pronounced on one side.

Usually the child is not in pain. This must be spottted,

If the curve is less than 25 degrees, as determined by followup x-ray, the child is observed over the years.

Curves from 25 to 45 degress--a brace is worn 18 hours a day for a year or two to prevent the curvature from worsening.

At 50 degrees--surgery may be considered. Operating at 50 degrees is easier and safer than operating at 80 degrees.

The surgery usually involves fusing where the ribs are and does not affect bending or motion.

Surgery in young kids involves a full-torso case for months or a year or even 18 mos (changed every few months).

For pre-adolescents, who are growing fast, growing rods may be placed along the spine.

Would yoga, physical therapy, or chiropractic help instead? No--not supported by the science, the experts say.

Putting your child in a big cast for a year sounds awful--but it may be necessary. There are support groups--check Google.

Monday, October 09, 2017

10 medical things you probably don't need

Transesophageal echo--no way for me
According to Interesting Engineering, the University of Maryland went through some databases searching for words like "overtreatment" and "unnecessary" and found 10 treatments or tests you can probably refuse. Your call.

Antibiotics--use and overuse.  A 2016 study said for every 1,000 people seen by a doc, half get a prescription--but only 353 of those were needed. The CDC is trying to reduce antibiotic use by half over the next few years. Drug-resistant bacteria cause 2 million diseases and 23,000 deaths in the US each year.

Cardiac imaging.  Does nothing for low-risk patients and results in expensive hospital stays.

CT scans for respiratory issues. A lot of radiation exposure and not good for those with non-life threatening symptoms.

Carotid artery ultrasounds and stenting. Sonograms of the artery in the neck can show blockage, but 9 out ot 10 resulted in unnecessary. (This goes for those testing places in malls, too.)

Aggressive prostate cancer management. One percent of the men who get surgery die of the disease--about the same number as those who get alternative treatment.

Surgery for torn meniscal cartilage in the knee.  Painful, but rehab and proper management can yield same results as surgery.

Transesophageal echocardiography. An echocardiogram under sedation with a wand down the throat...I had one and woke up fighting for breath--five days in the hospital. Not worth the sedation, the researchers said.

Inpatient nutritional support. When a person is critically ill a feeding tube or special formulas can actually cause trouble.

If a doctor suggests a procedure, I say google it. AND ask:

--Do I really need this?
--Risks and side efx?
--Simpler, safer options?
--What happens if I do nothing?
--Cost and will  insurance pay?

Personally, I have had the transesophageal and multiple CT scans. I promise to be less compliant.

Friday, October 06, 2017

Danger in a can?

My, you look healthy--keep it that way.
I had a plumber come over for an emergency (don't ask) a month ago. He remarked that he had drunk six Monsters that morning.

I asked my daughter what a Monster was. An energy drink--"a strong one, Mom." When the plumber came inside, I said, no more Monsters. He agreed-sheepishly. I love playing the Mom card. However, the man was in his fifties.

Yet, many countries allow the sale of these drinks to young people. A new study in the J of Nutrition Education and Behavior suggests some strategies for keeping feckless young people from energizing themselves into the  hospital.

Energy drinks are non-alcoholic, but contain caffeine and other ingredients billed as improving energy, concentration, metabolism, and performance. They bring in $30 billion a year from 160 countries.

While they may or may not do the above, these drinks do cause headaches, nausea, sleep problems, seizures, irregular heartbeat--and sudden death.

Overdoses of these are on the upswing in the US and Australia.

First step--raise awareness of this. Educational campaigns.

They did a study in Australia--411 people, 12-25 years of age. They were familiar with energy drinks, some even had drunk them in large quantities. Some could name caffeine and sugar as ingredients--but not the other elements.

Many reported negative effects. They said peer pressure had led them to drinking this stuff.

The participants themselves had some ideas: (1) Restriction on sales and availability, (2) changing the packaging, (3) increasing the price, (4) reducing visibility on the shelf, and (5) conducting more research.

Different interventions should be directed at different age groups. More reporting of adverse reactions was recommended, as were warning labels.

Young people HAVE energy--wise up! And older people probably would prefer their hearts not stop.

Thursday, October 05, 2017

Special connection between the elderly and dogs

A dog and his purpose.
I am a mush-ball when it comes to dogs. I am listening to the audio of A Dog's Purpose by W. Bruce Cameron--life from a dog's viewpoint. Corny as heck, but I cried.

But I do not own a dog now--my last one threatened to trip me about 10 times a day...A nice young couple gave him a new forever home. I am wobbly with my arthritis--and also worried about the financial liability for vet bills.

Lisa Esposito writes in US News & World Report about the connection between older adults and canines. She also talked about the health angle.

According to the October issue of The Gerontologist, owning a dog leads to lower BMI, fewer doctor visits, and less sitting.

We all know walking a dog is good exercise and thus good for you. But this study also showed that even the leisurely sniff-and-explore way dogs prefer to walk leads to better bonding with the pet than a forced march.

Bonded pet owners also stop and talk to others about their pets.

But even attached owners could be better attuned to the needs of their pets. If you have a chronic condition, you may walk the dog less. Take your energy level and the dog's into consideration when selecting a pet. Some dogs don't even like walks!

Or, a strong, active dog could drag a weaker older person. Also not good.

And, as you age, your dog does, too--but not necessarily 7-1. A 7-year-old dog corresponds to a human 44-56. At age 10--that dog could be equal in health to a 56-78 yr-old human. (For cats--15 cat years equals 78 human yrs.)

Older dogs tend to get arthritis. Their hearing and vision can fade. If the owner is frail, lifting a labrador with a bad hip can be impossible. Aging pets also get cancer, heart disease, kidney problems, liver disease--all heartbreaking or expensive.

So am I right to not have a dog--just a 20-yr-old cat? She, by the way, is lithe, leaps around, screams for snacks and food. She sure wouldn't like a dog to come to stay. (We used to have a dog and four cats and now she is queen.)

Still....

When my grandmother was in a nursing home, she kept telling my father she missed her dachshund. Finally he said, "Now, Mom, what would this place be like with dogs running all over the place?" She thought a moment and said, "Heaven."

Wednesday, October 04, 2017

Focus on Iris, you are not going to die

Ashley Halsey III, Washington Post, writes about Iris, a soothing voice in some driverless cars.

Seems 87% of people are leery of these automaton autos. Half say they would never buy one.

Yet, these cars are expected to be smarter and better drivers than humans--so what's the beef?

Well, human-driven and driverless will be sharing the roads for as long as 30 yrs.

And it's easier to tell what a programmed car will do than what an unprogrammed, and perhaps idiotic, driver will do.

Enter Iris--voiced by a gal named Heather Caruso.

Naming her, hearing her, is designed to calm people (J of Experimental Psychology). Iris is thinking, riders reason...she is not mindless.

She made people four times as confident.

In the test, if there was a crash (gulp), people listening to Iris found the other car at fault four times as often.

Still, the experts think to introduce these cars, there will have to be cordoned off areas where only driverless cars will be allowed.

That should be easy. Not.

Still, the researchers say people will get used to this like they did the iPhone.

Oh--I forgot. One good feature of Iris is that people listening to her were so relaxed when there was a crash, they were not as badly hurt.

I feel better already.

By the way--don't we already have female voices ordering us where to turn...And sometimes they drive you into a lake.

Tuesday, October 03, 2017

Teaching docs about climate change

Whether you "believe" climate change is all man-made, partly, or a natural cycle, changing conditions are creating health issues--diseases are arising and are not killed by cold weather, pollutiion is affecting fetuses and infants, not to mention everyone else. Violent storms are injuring, displacing and killing people.

Launched in 2017, the Global Consortium on Climate and Health Education is an international forum for helping health professions schools to incorporate climate change into their lessons. They call it a living knowledge bank.

This knowledge bank already contains the latest in warning about or dealing with heatwaves, as well as other medical interventions. Efforts can also reduce air pollution or traffic injuries.

Researchers see this as an opportunity.

Schools training health professionals can sign up by going to:

https://docs.google.com/forms/d/e/1FAIpQLSefKZuBNaeB09QZY6yBvJg3Wn4R1XNHoCrwbaII7Ccp_PnpdQ/viewform

Probably the kids seeing effects of changing conditions today will be working on this when they come of age--but we have to start somewhere. Why not with health workers?

By the way, students can also get onboard. Check it out.

Monday, October 02, 2017

It's that time again

Figuring out which strains of flu might hit the Northern Hemisphere is an art, not a science.  The local officials try to figure out how hard they will be hit. And people wonder if they will be hit.

Uncertainty.

Yet, thousands of people do die of influenza in the US each year.

The flu can start up as early as October. The season in Pennyslvania is between Jan and March.

Since it has been warm, many people think it's best to wait to get the shot. But any time now is good.

At best, the shot is only 50%-60% effective in preventing the flu or making symptoms less severe.

Way more effective than not getting it!

Although the vaccine is made up of killed virus and can't gvie you the flu, the body detects enough signs that it responds with immune behavior.

So even if the strains they pick are not a good match--the vaccine is effective enough to help some.

This year, the flu mist will not be given. It did not prove effective.

Shots are recommended for almost everyone over six months of age. If you have doubts--check https://cdc.gov.

Oh--and be a good citizen...even if you never get the flu, get the shot to prevent spreading it to others who as not as lucky.

I used to not get the shot--was arrogant...Now, I get the super-duper strong old people's vaccine. I have enough annoying ailments...am aiming to stay out of the hospital.

Friday, September 29, 2017

Your humble correspondent goes to the doctor

Gizmo to check eye pressure
--mine was OK--no glaucoma.
I am a bad, bad health blogger--I avoid the doctor if I can...none of these "wellness" runs, overtesting, forced visits more than once a year for me--if I can avoid them.

But 10 yrs ago, I had a most unfortunate medical event--a detached retina. I was eating lunch in a restaurant and it seemed like a maroon-colored tree branch crossed my vision. Whoa. I covered one eye, then the other--it was the right eye. Still there when lunch ended.

I went to the ER. That was a Saturday. The nurse asked me how many fingers she was holding up. Basically after some hours, I was told to leave and go to my eye doctor on Monday.

I didn't have an eye doctor.  In months, I had many eye doctors--cornea docs, retina docs, surgeons.

I had three surgeries...the first failed, the second two failed...My retina was lasered so many times, the right eye was blind...with only a slight dim light coming in...And in the course of the operations, they accidentally cut the nerve to the surface of the eye--and I got bad infections I could not feel. The sewed my eye shut the first time--10 weeks of ugly, itchy rubber sewed to my face. The second time, I said no way--they used tape, which worked fine.

A library rat, I turned to audiobooks. I could hardly pick through a magazine in a week--with magnifier readers and a separate magnifying glass.

They told me I had a cataract on my GOOD eye--yipes! Wait as long as you can to operate, they added...uh, yeah, will do.

Jump ahead three years. I decided on a new eye doc and finally went to see about that (gulp) cataract. If anything went wrong, I would be blind.

Waited 90 minutes. Finally the doctor appeared...Oh, there was no cataract on the good eye...The good eye was fine!

A prescription for glasses costs extra (weird--these are eye docs). Anyhow, he slipped me one gratis. I don't want to wear glasses all the time...but I do need bigger magnification for the TV.

So...that is a lot of worry wasted, I guess...but as a worrier, that is just what I do. No big.

Thursday, September 28, 2017

Third of older people use sleep aids

I have never been a good sleeper...even as a youngster, I awoke 2-3 times a night. Now, it can be that and more.

A University of Michigan study now shows that nearly half of older Americans have sleep issues and more than one in three has resorted to some kind of medication--most adding that they just did it and did not consult a doctor first.

Problem is, over-the-counter and "natural" sleep aids can carry risks, either alone or in combo with other meds--and especially for older people.

Eight percent of older people take meds for sleep every night.

For those with trouble sleeping three or more nights a week, 23% have a prescription for it.

They take these drugs--designed for short-term use only--for years.

Sleep problems, doctors point out, cannot be "cured," as such.

Your first step is to talk to a doctor.

For instance, 23% of people with trouble said it was from being in pain.  Forty percent said their health was fair or poor. Worry, stress, need to pee--all reasons.

Insomnia can lead to memory issues, depression, falls, accidents.

I keep my audiobook player right next to my head on a little table...If I awake, I go to the john, then listen to a few minutes of a "story" and usually will fall back to sleep. The popular hormone melatonin makes me need to pee more.

Wednesday, September 27, 2017

The business of comedy is not all laffs

You got this far. Now be funny!
I love to watch comedians and comedy concerts. But I know behind the scenes, standup can be a seedy, dark profession.

Michael Jeffries has written a book called Behind the Laughs: Community and Inequality in Comedy.

In the world of professional comedy, he says, strong artistic communities are built within an exploitive industry.  But the benefits of these communities (improv groups, group houses) are unevenly distributed--different workers from different backgrounds have different prospects.

Comedians are only one element--also involved are club owners, bookers, and managers, not to mention audiences.

Comedians must read and adjust to their audiences every night--but at the same time, establish relationships that even allow them to get on the stage.

One comedian told Jeffries that being funny is not even the key--there are so many funny people, he said, it doesn't mean anything.

Women and people of color are often discriminated against openly..creating meaning and identities for these people is thankless.

Women, especially, are subject to expectations--the whole "women aren't funny" deal.  They often feel like they have to do anything to join the boys' team.

White males are the gatekeepers.

Technology is helping somewhat--Netflix, YouTune, and other digital media allow all sorts of people to gain exposure.

But overall, breaking in and staying  in is no joke. Remember that when you pay a cover or buy a ticket.

I enjoyed a documentary called "Knock Knock, It's Tig Notaro"...check it out. Netflix. Tig and fellow comedian John Dore go to people's houses to entertain. Now THAT is retail comedy.

Tuesday, September 26, 2017

Experiment in customized health care--wanta play?

Why does one kid get sick and the sibling does not? Why can one person tolerate a drug and another gets horrible side effects? Why do people of all weights get the same doses of many drugs?

Cookie-cutter medicine. One size fits all.

We depend on the average, sums up Francis Collins, director of the National Institutes of Health.

Now--the NIH is planning a project called "All of Us," to ferret out traits that make us unique in whether we will be healthy or respond to a treatment.

It's partly genetics, but also other things--how long you sleep, if you breathed smog or fresh air as a kid, if you exercise or sit, what meds you take, if your BP is fine at the doc but soars on the job--factors like that. and of course, age, gender, race or ethnicity and economic and social status.

More than one million people will be piled into the database so the scientists can spot patterns, or combinations of factors leading to certain health states.

A pilot of 2,500 people have already given blood samples.

If this goes well, the study will be opened next spring...If you want to be involved, all you will have to do is sign up online. But it is a commitment--10 yrs of involvement.  In return, you get free genetic info.

You will start simply..weight, BP, heart rate. Questionnaires and your health records. A blood sample.

Eventually you may be asked to wear sensors.

For more info, go to: https://allofus.nih.gov/

Sound interesting?

Monday, September 25, 2017

Bleeding injury--forget the ambulance, drive!

For stabbing, gunshot or bleeding injuries,
get to the hospital ASAP any way you can.
A new analysis done  at Johns Hopkins (JAMA Surgery, Sept 20) shows that penetrating injuries, such as stab wounds or gunshot wounds, need to get to a trauma center quickly and waiting for an ambulance, despite the gore, could be bad.

While they want to do more research on this, the investigators thought transport in a car, police car, or even a cab might be the better option for such injuries.

The catch is that there is more an ambulance crew can do for heart attacks (CPR, defibrillation), but for penetrating injuries, options are more limited outside the hospital. Pressure can be applied, but blood cannot be replaced, or blood vessels tied off.

The researchers studied data from the American College of Surgeons National Trauma Data Bank-103,000+ patients over age 16 with a gunshot or stab wound and went by ambulance.

About 16.4% of all patients went by private vehicle. The private vehicle patients has a 2.2% mortality rate--while 11.6% died when they went by ambulance.

So--while research is continuing--consider taking even a bloody mess by car--just get there.

Friday, September 22, 2017

No time for the gym--no excuse!

These scientists want us to MOVE! Good grief, they tell us everyday...

Now, a big study (130,000 people in 17 countries), published in The Lancet, shows that just about any activity can meet the goal of 30 minutes of activity a day--or 150 minutes a week--at a heartrate-raising level.

An active job, active commuting (bike or walking) and even housework counts.

Meeting the activity guidelines can reduce risk of premature death by 28%. Heart disease goes down 20%.

Seven hundred fifty minutes a week--jackpot...risk of death goes down 36%.

Gym to time-consuming and spendy? Walk! Run! Chase the kids around. Vacuum. Dance! Stay on the go.


Thursday, September 21, 2017

All senses distract us from work

You may think watching your officemates go over to talk to one another or wander around or the sights out the window are enticing, according to a story by Eve Edelstein in NEXTGOV, all of our senses are connected in a "connectome" and can conspire to distract you.

You are just as likely to be pulled away from work by someone making a smelly snack in the microwave...or hearing a loud phone convo.

Edelstin studies how the brain processes the senses when they encounter "design." Design incorporates the visual, smell, touch, balance, pressure, pain, body position.

One thing that is huge in offices is noise--acoustic design. In experiments, workers were more creative if bathed in "white noise."  However, such sounds can interfere with speech understandability and attention.

Loud noise is a great irritant. Phones left ringing, people talking.  Ninety-nine percent of those surveyed said this was a negative.

There is no one-size-fits-all solution. White noise can mask ALL conversations, so can only be used in certain ways. Unassigned seating can help..allowing individuals less involved in a meeting to site on the periphery.

Now, back to the woman who always makes smelly popcorn in the microwave...

When I had a "real" job, I had walls and a door. Also helpful.

Right now, it is TOO quiet in here...I can't concentrate.

Wednesday, September 20, 2017

More teens don't want sex or driving lessons

Tara Bahrampour, Washington Post, says teens are increasingly delaying the traditional "rites of passage."

Published in the journal titled child Development, the study showed that the percent of teens who have a driver's license, tried alcohol, who date, and who work has dropped since 1976.

The declines cut across all racial, geographic and socioeconomic lines--rural, urban, suburban.

Half of teens do still engage in these activities, of course, but between 1976 and 1979, 86% of HS seniors had been on a date--from 2010 to 2015, make that 63%.

Those that worked dropped from 76% to 55% in the same time periods.

High school kids that have had sex went from 54% in 1991 to 41% in 2015.

Are they just lazier or less highly sexed? No, they just have other outlets. They expect to live longer, don't need to rush the sex thing. They see that families need to be planned.

One researcher thought kids were saying why don't I stay with my friends--and away from things with heavy consequences, such as pregnancy or disease (or a big car payment?).

In other words, they are assuming the same anxiety about the future that their parents have for them.

One said she wasn't interested in staying out all night--too worried about her student loans.

One parent even said she wondered if her daughter was missing out on some life experiences.

I had plenty of those--and the result was, to be kind to who I was then, mixed.

So no sex, driving, money jobs...what's that leave? Hanging with friends, sports, biking, social media (no texting body parts), charity work, oh--and school work!

Tuesday, September 19, 2017

Does your doc know how to prescribe medical pot?

I have a friend who jumped through a ton of hoops to get a medical cannabis scrip in Illinois--she used to be a medical researcher and researched how to make the tincture she takes for pain and diabetes. Her doctor was no help.

Although 20 states and DC allow marijuana use for medical purposes, researchers at Washington University in St Louis found that this is not being taught in med schools.

Medical education needs to catch up, the lead researcher said. Physicians in training need to know the benefits, she adds.

They looked at 172 med schools, including 31 osteopath schools--101 replied. Two-thirds said their grads were not prepared to prescribe the active ingredients in marijuana.

According to the Assn of American Medical Colleges, only 9% of med schools prepare their students.

Some other researchers point out that medical marijuana has some detractors--so what should schools teach?

This training should be aimed at states where the drugs are legal.

Doctors in training get way more info about opioids, they point out. If asked about marijuana--even as a substitute for opioids, most doctors would not know what to say.

Monday, September 18, 2017

Trouble getting pregnant--it could be PCOS

Don't give up.
PCOS--polycystic ovary disease--is the leading cause of ovulatory infertility. Up to half of women who have it don't know they have it.

Dr Fiona McCulloch, author of 8 Steps to Reverse Your PCOS, has some observations:

--PCOS affects 10-15% of women (more than 7 million) in the US.

--It sounds like ovarian cysts are always involved, but that isn't true.

--PCOS is life-long, causing weight gain, irregular periods, infertility, facial hair growth, and hair loss. As a sufferer ages, it can also increase diabetes and cardiovascular risks.

Some facts:

--Women with PCOS have a lot of follicles in their ovaries. Follicle produce "eggs." With PCOS, these may secrete more testosterone than normal, keeping them from maturing into viable eggs.  These stalled follicles can look cyst-like on ultrasound.

--Women with PCOS ovulate late...up to 7 days later than normal. Cycles can be 35 days or longer. Some don't ovulate at all.

--Ovulation test kits often don't work for women with this. These kits measure luteinizing hormone, which is already high in PCOS patients.

--Good news--women with PCOS hit top fertility later--and also have delayed menopause. The difference can be 2 years.

--Most women with PCOS will eventually conceive. It just may be later. And there are  nutritional and lifestyle interventions that can help.

So take heart...and talk to your doctor.

/

Friday, September 15, 2017

Walkable communities in US: BIG FAIL

I once had a doctor who told me to walk an hour a day--no destination, no speed, just the timing--one hour. I could not think of a good reason not to, so I did. I found a way to sneak into the National Zoo before hours--so peaceful...the animals and me...It was blissful. I even got to pet the wild dogs out on a leash--probably a bad idea, in retrospect.

Anyhow, Washington University in St Louis a study that showed the US earned a big "F" for children walking behavior, public transportation, and pedestrian infrastructure.  For walking-friendly neighborhoods--D And for adult walking behavior--C.

The researchers insist "report cards" generate change. The US is car-centric right now.

Yet, the 2008 guidelines for Americans recommend at least 150 minutes a week of moderate activity for adults--brisk walking qualifies.

For physical activity, walking is easiest. Yes, doing it is one's choice--but the way communities are laid out can also encourage this.

How is yours?

I live in the suburbs of Phoenix now--no burbling brooks, paths, grumpy pandas having breakfast, or wild dogs, either. If you walk on the roadways, cars whiz past a foot from you. Also--I am now messed up with arthritis. My advice--walk while you can--and enjoy it.

Thursday, September 14, 2017

Introducing: Ruby Chocolate

Admit it--you can't get enough chocolate news. The global market for the yummy brown stuff is $98 billion and change.

In addition to to dark, milk and white chocolate...we now have ta-da! Ruby Chocolate.

Ruby is the first new flavor to be introduced in 80 years.

This delectable is made from the ruby cocoa bean, with a unique form of processing that unlocks the pink color and fruity flavor without any flavors being added. Hats off to Zurick-based Barry Callebaut Group in Europe.

Ruby is silky and fruity, not sweet, bitter or milky.

Will this open more innovation? More ruby products?

Why not! I'm game--samples?


Wednesday, September 13, 2017

Is your health plan big on social media?

Erin Dietsche, writing on MedCity News, says Talkwalker, a social media analyzing platform, looked at Twitter data from the five big national health insurers.

These are Aetna, Anthem, Cigna, Humana, and United Healthcare.

From Aug 24-30, there were 26,700,000 mentions of these  insurers on Twitter.

Aetna scored the largest number of mentions--63.1%. More than 48% were negative, and 41.9 neutral. Only 9.9% were positive. This is probably because Aetna had accidentally revealed the HIV status of 12,00 members--which incited a lot of tweets and negative ones at that.

During that week, the others did not come close in number of mentions. United took up 16.7% of comments. Humana--11.2%., Anthem and Cigna--meh.

Most comments were neutral...but more than a third of Anthem's were negative. Cigna scored 21.4% positive.

So what does this show? Humana, Talkwalker says, is the smallest insurer, but its members are most engaged--it got 1,671 rewteets--the others were in the hundreds.

United is the largest provider--but lags in social media.

Have you tweeted or retweeted on your plan? I am not even on Twitter. But I would think that, looking at this, you might get attention for a grievance by tweeting...since the numbers are not that high.

Tuesday, September 12, 2017

Is your mind on your driving?

Concentrating or spacing?
Each year, more than 2 million people are injured in vehicle accidents in the US, and 32,000 are killed.

Some researchers at George Mason University looked into this (Frontiers of Human Neuroscience) and learned that distracted driving is a major factor in these wrecks and deaths.

Unlike texting, eating, applying makeup, disciplining kids, arguing etc., which are also distractions, mind wandering cannot always be avoided. So how big a hazard is a wandering mind?

The researchers asked nine adults to participate in a driving simulation for 5 consecutive days.

Each day, the subjects "drove" 20 minutes down a straight, monotonous highway at consistent speed. This was supposed to simulate "commuting."

Between the two "commutes" each day, the participants completed a task requiring sustained attention. The second "commute" of the day was expected to be affected by thinking about the task.

During all driving sessions, the brain activity of the subjects was studied using an electroencephalogram.

Buzzers also sounded randomly during the driving and the subjects were asked was their mind wandering.

The upshot was that their minds wandered 70% of the time on the second drive. Yet, they were aware of it wandering only 65% of the time.

But is mind wandering dangerous to driving? Isn't that the point? The researchers are not sure--more research is needed.

Sorry--my mind wandered there...what a letdown. Still, does your mind wander...do we need some mindfulness? (I am so sick of that concept!)

Monday, September 11, 2017

Let sleeping dogs lie--in their own beds

Ah--perfect.
Forty million American households have dogs. Sixty-three percent of these consider these dogs to be "family."

Still, many do not allow dogs into the bedroom, much less the bed, at night.

Now, Mayo Clinic has done a study that says having pets in the bedroom may not disrupt sleep and many people find comfort from sleeping with their pets.

They looked at 40 healthy adults with no sleep disorders and their dogs--over a five-month period.

Who knew--dogs may help people sleep better, from miniature poodle to Great Dane (I know a woman who lets 5 on her bed).

The catch is that the dogs should not be in the bed under the covers.

So maybe a nice dog bed right next door to you in the big bed?

Friday, September 08, 2017

Older people and dentists

I will say the outset that I am the worst about the dentist...EVERY time I have gone in my life, I always felt conned a little--they would not clean my teeth because I would not agree to that $250 a mouth-quarter "deep cleaning," sight unseen. Or they insist on that panoramic x-raying (radiation hog), or they propose a fun payment plan that never gets paid off, and in once case, told me I have seven cavities...turns out that was seven POTENTIAL cavities, but why not fill them just in case. Or if you need a crown or have missing teeth, how about crazy-expensive implants?

In a study done by the University of Michigan, 56% of older respondents said they only seek care for serious problems, not normal preventive. Thirteen percent thought Medicare would cover this--nope.

Yet, three-quarters thought regular care was important.

Respondents who were female and white, had higher incomes and insurance, were more likely to get checkups. That left men, blacks, Hispanics, and poor people, or those without insurance to wait for a crisis.

Why didn't respondents get needed care? Cost--69% delayed or did not get care because of cost.

And one in five cited fear of the dentist as a major factor.

I have fear of "treatment" plans.

Of course, I am being a jerk for saying this--I should be recommending regular checkups and treatments. Guilty--I am a jerk. But so are some dentists...

Thursday, September 07, 2017

Entering a flooded home safely

Harvey is--at this writing--the worst natural disaster in our history. And another, then another, is on the way...Irma and Jose. As it is, 150 people a yr die in this country from various floods.

We have all seen the heart-shattering pictures of homes of loving history and keepsakes under muddy and polluted water.

And the pictures of people returning to their homes and hauling furniture and even walls out. Mold, sewage...well, it's bad.

Some tips if you or someone you know is facing such a cleanup:

--Turn off electric and gas first thing.

--All mud and water should be considered contaminated and toxic. Wear gloves, marks, googles.

--Saturated porous items--carpets and furniture--need to be thrown out to prevent mold.

--Solid materials, can be cleaned with water and detergent. Read labels on all cleaners to make sure they can be used together.

--If you think your (older) home contains lead or asbestos, call (800) 424-LEAD for lead or (202) 554-1404 for for asbestos instruction.

--Pregnant women, young children, the elderly, and immunosuppressed should not be involved in cleanups.

--Mold can be especially bad for the allergic.

--If you get health problems or symptoms, see a physician ASAP.

I would add--take 1000 mg of Vit C a day, get proper sleep, eat on a regular schedule.

This is a horrible task...try to pace yourself, accept help.

One homeowner found an alligator under the dining room table...proceed in all ways with caution.

Wednesday, September 06, 2017

Health tips for college students

Apama Sridhar, MD, assistant professor of obstetrics and gynecology at the David Geffen School of Medicine at UCLA, has some advice for those heading off to college (and leaving the medical nest of home):

Visit your doctor before you leave. Know your health details--allergies, surgeries, problems. Make sure your shots are up to date. An important one is for HPV, which can cause cervical cancer.

Know where you will go on campus to get health care--and what your insurance covers. If you take the student insurance, knowing what it covers is especially important.

Keep track of your "cycle" if you are female. You do this with an app.

If you have sex, use protection.  If you have a regular partner, you can get tested but still, condoms are recommended. Ask which birth control is right for you. Check out www.bedsider.org--it's accurate.

Follow good hygiene--change tampons or cups frequently. Avoid scented soaps or sprays in private areas.

Don't put off urinating--you could get an infection.

Own your sexuality, no matter what it is.

Don't tolerate sexual abuse or violence.  Raise your voice, report infringements. The school's website may have more specific info.

Think about your reproductive life plan...children early, late, ever?

Keep a sound mind. The body affects the mind and vice-versa. Get enough sleep. Think about yoga or meditation and stay in close touch with your family.

I would add--don't succumb to a lot of drinking. It can lead lots of places you don't want to be.

I had a fake ID to show I was 21--and when I swallowed a chicken bone and could not get it out, I needed surgery and I had to admit I was not 21 and my dad was called...very embarrassing and avoidable.

Tuesday, September 05, 2017

The "blow," not the cake, could get ya

Here I come--big killjoy. According to a study done at Clemson in Journal of Food Research, blowing out the candles on a birthday cake results in 1,400% more germs on the frosting than if the candles were not blown out.

And that's just regular candles--not those reigniting ones that make you blow and blow.

So are we being too persnickety?

Well, there are 500 to 650 bacterial specis in your mouth--make that a spitty toddler.
--Strep
--Rhinovirus
--Chronic fatigue or mono
--Flu
--Hep B and C
--Gum disease
--Clostridium

They actually covered Syrofoam with icing, had people blow, and checked.

What could you substitute for candles?
--Sparklers (for outside parties only)
--Cake toppers
--Candy canes
--Flowers
--Super hero figurine

Do you know anyone who suffered, much less died, from contagious cake? What if five candles were still lit--did that person have five kids? Nah.

The author, Suzy Cohen, says she is inventing antibacterial frosting. Get on it, Suze.

Friday, September 01, 2017

Women's progress helps men "marry up"

Back in the day, I wrote an article on "dating down"--when the two people in a couple were not the same approximate age, educational level, or made the same money. The pattern then was that men married down--younger, poorer, less educated women.

But now a study at Texas A&M (in Demography) shows men's chances of "marrying up" have have increased a lot for men--and decreased for women.

Women used to get more bang for the buck in education because it made them more marriageable in the "up" direction.

Now this advantage of education is declining. Women are more likely to be married to a less educated man. Men's contribution to the family income has also decreased.

But men are not complaining--their actual quality of life is up thanks to women.

Another effect: For less educated women, unable to find more educated men, the standard of living has declined.

Bottom line: Improvement in the family budget--now coming from women.

I had a guy who had no complaints whatsoever about my earning most of the money. I get this.

And I might add--some of my sources in my long-ago article were perfectly happy to be married to men who might be seen as "down." These were down-to-earth guys who could fix things and make things--not to be underestimated, ladies.

Thursday, August 31, 2017

RANT!

Did you ask any questions? 
I don't even know whom I am mad at. Myself? The doctor? The drug co? The insurance co? All of them!??

When I went for my introductory meeting with my new primary physician, he asked me did I want to get the new shot, Prevnar, that "can help" (Pfizer literature) prevent streptococcal pneumonia.

I have had two doses of the earlier vaccine--and had gotten pneumonia twice...

I asked would it make me dizzy or sick--he said no. So I agreed. I did not ask what it cost...you know, someone...since I have Blue Cross/Blue Shield Medciare Advantage (HMO).

Then I learned the doctor had billed Blue Cross $450 for that one shot--and $51 for the woman who gave it to me. He only got $170 or so (one shot, remember) and $12 for the woman.

I googled retail on the shot--for the 13-valent, about $170.

Should I have asked the cost? Would he have known it? I think I should have...

This is why health care costs are so outrageous...The govt cannot negotiate drug prices...

Almost five hundred bucks and I may still get pneumonia again! Sheesh. Maybe I sound like an idiot--but what personal responsibility do we bear?

Wednesday, August 30, 2017

Watching a lot of TV can make walking harder

A new study done at George Washington University (my alma mater) says TV watching can be a big risk factor for disability in old age.

Older people who watched more than five hours of TV a day and did fewer than three hours a week of physical activity had three times the risk of not being able to walk or having difficulty walking as those who did not.

The study analyzed existing data tracking men and women from 50 to 71 in six states and two metro areas.

At the end of eight yrs of TV watching 30% of the previously healthy seniors had mobility disabilities.

--Five hrs of TV a day--65% increased risk.

--The risk was worse when the subjects did not exercise at other times. Seven hours of activity a week equaled no increased risk, even with sitting of six hours a day.

Younger people get away with sitting more, the researchers said.

If you are older, they recommend:

--Watching TV or at the computer? Get up every hour! Or get a standing desk.

--Park several blocks from your destinations.

--March in place during commercials, if you do watch a lot of tube.

I am bad on all this--do as I say, not as I do.

Tuesday, August 29, 2017

Yes, kids 3-18 can get high BP

The American Academy of Pediatrics has published new guidelines for identifying and treating high blood pressure in children and adolescents. Go to http://aap.org.

The earlier guidelines, issued in 2004, have been updated.

For one thing, providers are urged to take pressures only during annual "wellness" visits and not in the ER or dentist's office--which had been resulting in false positives, according to Case Western Reserve researchers.

Obese or overweight kids, more likely to have high blood pressure, were removed from the standards..meaning the kids more in the middle, average weight, with elevated BP would show up better.

Blood pressure now is also to be taken by a cuff that records it in real-life settings. The old method was three high readings--you have it. And treatment, sometimes unneeded, would follow.

If medication is needed in a younger person, this should only come after an echocardiogram--an ultrasound of the heart. Before, echos were ordered for all high BP cases, not just those who were on or were to be put on medication.

What is high? Now, for a 13-yr-old and up, it's the same as for an adult..above 120/80, this might be pre-hypertensive, not automatically high.

I guess ask your doctor...as they say.

Monday, August 28, 2017

Eighteen or 80--sense of danger the same

Threat or threatened? 
You read all the patronizing stories on how easily duped older people are and sometimes I even half-believe it, thinking this or that home improvement vendor is out to "get" me.

But apparently, out on the streets, the protective instincts of older people are just as good as those of young adults in knowing when someone is aggressive.

Being streetwise is a skill honed in childhood and becomes more, not less, reliable as people age.

This according to research done at the University of Portsmouth, which is based on three studies.

They set out to gauge the ability to recognize threats, against the backdrop of fear of crime in older people.

Just being older is not directly related to fear of crime, which can be influenced by a number of factors including the type of crime, the person's gender, and the person's belief in the ability to defend him or herself.

Previous research showed that how a person walked could communicate likelihood of aggression.

While many people may be fearful of walking at night, some see risk where there is none.

But--would older people willing to take part in such research be more confident and less fearful?

By and large, streetwise-ness solifies in the late teens but does not trail off as people age.

According to this...

I wonder.

I feel more vulnerable and slow... I may recognize a threat--but then what?

Friday, August 25, 2017

Packing the kids' lunch boxes

When my daughter switched from public to parochial school, hot lunches were a thing of the past. I had to pack her lunch.

I used to make little salads in small plastic tubs I collected. One day I asked her if she liked those salads and she said, "Uh, I trade them."

But according to a story by Sarah D. Young in Consumer Affairs (Aug 24), kids eat 40% of their calories at school.

She recommends a mix of the food groups in that lunch box or bag.

--Keep it balanced. Include grains, lean proteins, colorful fruits/veggies, and low-fat dairy. Drinkable yogurt can be a good addition. Include hummus or dip for the veggies. Maybe peanut butter for the fruit. (If your school is not peanut-free, of course.)

--Include a protein--tuna, turkey, chicken or maybe edamame, beans or tofu. Be sure they get protein at breakfast, too.

--Be unexpected, creative. Cut fruit into shapes, use avocado as a spread, make pasta salads with little broccoli florets in it.

--As a beverage, stick with water or milk. Soda or energy drinks are not worth the calories.

As my child reached sixth grade, I had her shop for and pack her own lunch--to cut down on the "trading."

Tofu, huh? Don't remember our eating a lot of that--isn't it a host food for something with flavor?

Thursday, August 24, 2017

Darn it, people, you don't take your meds

Adhere Tech bottle. See
lighted strip,
Want to save a $100 billion to $300 billion? Take your meds as prescribed.

A whole industry is devoted to making "smart" pill bottles linked to the internet to alert you when it's time or if you haven't taken some pill as directed.

The final step in science, on researcher says, is the medication.  Researchers spend years or decades developing drugs, then get them approved and into the hands of doctors, who then prescribe them--but if the patient does not take it--all is for naught.

Up to HALF the time, people do not take pills as directed. This can account for as many as 100,000 deaths.

In one test, Harvard scientists did a randomized trial of (1) a pill bottle with toggles to make whether a pill had been taken, (2) a compartment pill box, and (3) a digital cap that acts as a stopwatch on top of a pill bottle.

They expected better pill taking from the digital cap--but there was no difference at all.

Meanwhile other bottles light up, trigger a call to your phone or a text, contact caregivers, and so on.

New on the scene is the so-called iPhone of pill bottles--by Adhere Tech. See picture.

They realize their average customer is 70 and may not be a wifi-ed to the gills.

It works out of the box--but is not yet available.

But even with a glowing pill bottle, people still don't take their pills...bottom line.

Patients, said one doctor, don't like taking pills every day--it reminds them of illness.

I will admit I take my BP meds but cheat on the two vitamins I am supposedly lacking.

And now--did you read this? They are not sure you really need to take all 10 days of your antibiotic.

Wednesday, August 23, 2017

Trees provide million$ in "services"

Megacities, home to 10% of the world's 7.5 billion people, are beholden to trees for more than $500 million each in benefits that make ccities cleaner, more affordable, and pleasant.

In a recent study in Ecological Modeling,  a team of researchers came up with the half a billion number for the benefits of trees.

The researchers also noted that these benefits can be increased by up to 85%. The key would be to establish trees throughout the cover area--to filter air and water pollutants, reduce building energy use, and improve human well-being (shade, beauty).

Trees directly and indirectly cool buildings and reduce human suffering through heat waves, the scientists pointed out. Trees also transpire water which turns hot air into cooler air.

Trees also remove particles harmful to respiration.

In other words, nature can cooperate with us. The researchers said this knowledge might encourage conservation and protection of trees.

And maybe the planting of more trees?

Tuesday, August 22, 2017

Few people "shop" for health care

Can encouraging people to price-compare on health procedures lower the cost of health care? We hear this all the time, yet two studies done at Harvard show that few people actually do this.

Published in Health Affairs (Aug), the two studies addressed the notion that by giving people "skin in the game" with high deductibles and copays will cause patients to choose lower-priced health providers--and thus drive prices down.

Ooops--turns out reality is more complicated.

One study looked at use of a cost comparison tool--offering the tool did not move the needle downward.

The second study, a national survey, showed that while a majority liked the idea of cost comparing, only 3% actually did it.

In fact, only 13% had even asked about costs before receiving care. Still, they did not believe the highest cost providers were necessarily the best.

So why not compare? Seventy-seven percent did not want to switch doctors to get a lower cost.

I would guess not only do people not want to switch docs based on price, health plans with networks might preclude it.

So much for this "competition" idea we hear so often. Do you really want to think you are finding the cheapest doctor available?


Monday, August 21, 2017

Better care for those with dementia

My mother had senile dementia--not Alzheimer's--just the old-fashioned kind. Basically she outlived her brain by 20 yrs--she looked cute, we made sure she had nice clothes, hair, nails, etc. But she was vague on the past, to say the least.

I moved from DC to AZ to help take care of her--she lived in various facilities (she had means), but my sister and I oversaw her care, selected places, and of course, managed her funds.

In one large facility, run by a well regarded company, she was drugged, we think. Also, in the same place, assaulted. This was on the second day--all this. There was no third day--we found a new place in a single family home accredited by the state of Arizona.

However, in many cases, even in extremely pricey nursing and assisted care places (think $10K a month), residents with dementia are "snowed" with antipsychotic drugs.

Rutgers Today spoke with Olga Jarrin of the Rutgers School of Nursing, and Stephen Crystal, of the Institute for Health, Health Care Policy and Aging research, about this.

Why is reducing use of anti-psychotic drugs important for patient safety?

Crystal:  ...(They are) associated with significantly increased mortality. The FDA has a "black box" warning on these meds.

What is being done in the US to address this--has it been effective?

Crystal: In 2012, the Centers for Medicare and Medicaid Services moved to reduce antipsychotic prescribingm stregnthened regulatory oversight, educated nursesm abd formed state bodies to oversee this.

 By 2016, use of thes meds had decreased by one-third. Some states cut it by 40%.

Where can consumers get info on where to get the best care?

Jarrin: Go to:https://www.medicare.gov/nursinghomecompare/search.html?  Homes get 1-5 stars. Detailed info is available, including how many patients are restrained or given antipsychotics.

How can pressure ulcers be reduced? 

Jarrin: Risk factors for these include poor mobility, poor nutrition, poor circulation, and  incontinence. Nurses can encourage residents to move, change position. One technique is to play music in the facility to remind residents and nurses people need to move.

How about unintentional weight loss? 

Jarrin: Patients may require asistance to eat. Hand feeding is recommended. If the patient refuses food, there are techniques to counter that.

I think too often "big drugs" are used to keep patients quiet and compliant. As people age, and I have found this myself, they metabolize drugs differently from younger people. This needs to be taken into consideration--not the ease of running a facility.

Friday, August 18, 2017

FDA reveals adverse cosmetic reports

The WEN hair products have apparently attracted thousands of complaints...I know when my hair fell out in handfuls a year ago and I considered WEN, people I knew said no, no, not that stuff.

But these complaints did have one effect--the FDA has released its Adverse Reporting System database.

The most commonly implicated products are hair care, skin care, and tattoos. Through 2014, complaints numbered under 400--but the WEN outpouring kicked that up 78%.

Many other people probably have reactions to cosmetics--but go back to the doctor and don't consult a govt agency.

If you have a beef, you can report directly to: www.fda.gov/cosmetics/complianceenforcement/adversereporting.

One dermatologist, who says he lives and breathes cosmetics day and night, said he has not thrown out  out all the soaps and creams in his house.

He also said he was not in favor of overregulation, which could result in higher prices.

So--I guess we're back o buyer beware--and now, maybe buyer report.

A month ago, my daughter was distraught--some new eye cream had made her eyes swell shut. Turns out it was a new nail polish--she had been touching near her eyes.

Thursday, August 17, 2017

Weight discrimination can affect health


...And health care.

Recently, a team from Connecticut College surveyed studies and found that disrespectful treatment and fat shaming to get people to change their behavior can cause patients to avoid treatment or even consulting a doctor altogether.

I am, ahem, no skinny and at age 40, gave up on the constant dieting. I also refused to get weighed at the doctor's office, because I had had doctors blame every complaint and symptom on my weight (one time even a strep throat) . I got a number of reactions to this refusal...One physician said get weighed or leave. I left. Another made me turn my back to the scale. Recently, because I was facing surgery and drugs based on weight, I had to return to the scale--the nurse said it's in kilograms, don't worry about it. Another said she never wanted to know the number, either.

Is the latter a change of attitude? I don't know.

More serious is the attitude you can detect in a doctor--of disgust, disdain, impatience. The study revealed that fat patients are often told to just lose weight, while the so-called normals are given batteries of tests.

In a study of over 300 autopsy reports, obese patients were 1.65 times more like to have undiagnosed conditions, indicating missed diagnosis.

Some doctors also prescribe the same doses for an overweight person as a normal weight person--resulting in underdosing.

And then there are the microaggressions. Doctors are people out in the world--they may share the same distaste for overweight people as many in the rest of the population. They may refuse to even touch a fat person to examine them. They may see the weight in the chart and wince or roll their eyes.

Medicalizing weight means weight is seen as a disease and loss as a cure. This assumes that weight is well within a person's control--more weight thus means poor health habits. Many, if not most, overweight people do not eat cheeseburgers r whole cakes all day. Many exercise. Other predictors of illness--notice, I say predictors not cause--are genetics, diet, stress, and poverty. And maybe bearing the weight of stigma?

Fat shaming is also prevalent in the social media--resulting in bullying.

All this leads to stigma, to feeling "less than" all day.

I once had a doctor tell me to walk an hour a day. I could not think of a good reason not to, so I did--for years. When I went back to her after a year, I said, I am walking. She said, well, I hadn't lost weight so she didn't buy it.

Never went back to her.

Wednesday, August 16, 2017

Binge-watching can be bad for ya

Research at the University of Michigan and the Leuven School for Mass Communication Research in Belgium found that high amounts of binge-watching leads to poorer sleep quality, more fatigue, and more insomnia than regular TV watching.

Binge-watching defined as watching "excessive" amounts of one show in one sitting.

The team surveyed 423 adults between 18 and 25 in 2016. They were asked about sleep, fatigue and insomnia and their frequency of binge-watching.

Most--81%--said they did binge-watch. Of that group, 40% had done it in the last month. Twenty-eight percent said they had done it a couple of times. Seven percent had done it every day during the preceding month!

The subjects slept on average seven hours and 37 minutes. Those who binge-watch reported more fatigue and poor sleep quality.

Too, bingeable shows tend to have plots that keep the viewer tied to the screen. The viewer becomes intensely involved.

This means a longer period is needed to "cool down." Or they may watch "just one more episode." (J of Clinical Sleep Medicine)

I binged on the first season of Breaking Bad--I would say it was disturbing but I don't remember sleep problems.

I guess there is such a thing as an overdose of horrible images.

Tuesday, August 15, 2017

We might get rid of the SQUEEZY BP machines

Remember this one?
March of progress!
It's ever so trendy now for the doctor's assistant who "rooms" you to slap on an automatic blood pressure cuff that then, in my experience, squeezes your arm until you scream for mercy and goes down just as slowly. Often, the reading is inconclusive.

Can you tell? I hate these! I often insist on my BP being taken with the manual soft cuff and by a non-sadist.

Now, researchers at the Jerusalem College of Technology and the Shaare Zedek Medical Center have developed a better way to take systolic blood pressure.

Systolic is the top number, diastolic the bottom one. The customary manual or automatic methods can be affected by "white coat syndrome"--the tendency of being the doctor's office creating a higher reading.

Sometimes patients are asked to take their pressure at home to avoid the white coat effect.

Still, the automatic is less accurate than the manual.

An incorrect high reading can lead to the prescribing of meds the patient does not need and which might be harmful.

This team therefore developed a new device using a pressure cuff on the arm and an electro-optic device on the finger. Similar to that finger clamp that measures oxygenation, the finger device sends light through the finger and picks up the pulses of the heart rate.

At the same time, the cuff is inflated. When the cuff pressure increases above systolic blood pressure, the pulses disappear. When the cuff pressure goes below the person's systolic, the pulses reappear.

Anyhow--it works. How soon can we see it in use? Who knows? And will the cuff part be so alarmingly tight?

Maybe it could use some more work...but stay tuned.

Of course, there are many variations on sale now...lower arm cuffs, finger alone, on your phone, etc.