Wednesday, May 24, 2017

Weight loss surgery still problematic

Every year, 200,000 Americans undergo some sort of weight loss, or bariatric, surgery. This has been going on for 20 years.

University of Michigan researchers, however, took a look at outcomes and have published several papers on the high level of variability of outcomes from facility to facility and the incidence of complications. (Annals of Surgery)

--Nearly one in five Medicare patients with adjustable gastric band surgery (done laproscopically through small incisions) end up needing at least one more operation, either to remove or replace the band or switch to another approach.

--Nearly half of the money Medicare spends on bariatric surgery--47%--is to repair or replace the bands.

--This form of surgery has declined in popularity and constitutes only 5% of operations, but hundreds of thousands of people still have the bands installed.

--In addition--there is tremendous variation between surgery centers in terms of the rates of re-operation.

--Even accredited "centers of excellence" can vary widely as to complications. The worst to the best, even in such centers, varies 17 fold. That's a huge swing.

--Hospitals with the lowest complications rate before the operations cheaper, too.

The conclusion? Efforts to improve the quality of this surgery would affect not only patients, but also costs.

Anecdotally, I also know people who have "eaten" though this surgery and have not achieved close to the expected weight loss or it has not been lasting if it has been achieved.

Do your research!

Tuesday, May 23, 2017

The first visit to the gynecologist

I remember--waaay back in the Wayback--my first visit. The doctor said, "You will do this a million times in your life, so here is how to do it." Zip, zip, kind of embarrassing and gross--but fast.

Julie Jacobstein, a board-certified adolescent gyno with LifeBrige Health, has some tips you can pass on to your daughter:

--Explain why this visit is important, even though your daughter is not sick and has no complaint. This is a safe place to ask questions (without your mother being present). Often, the first time is just to establish a relationship--the "exam" part may not even take place.

--Tell your daughter this involves her medical history--including questions about whether she is sexually active. Also--bring your vaccination history.

--Explain the two parts of the exam. The breast exam and the pelvic exam. Emphasize that all this is over with quickly, which it is, although it can be a little uncomfortable--be honest.

--If your daughter wants to, discuss concerns beforehand--what if your child wants birth control--will she tell you or involve you in the types?

--After, ask her how it went. Your daughter may share a lot or gloss over it. Is she seems disturbed by the practitioner in any way--find a different doctor.

--Tell her this will be a regular part of her health care--get her used to it.

Those stirrups--every woman encounters them at some point.

Monday, May 22, 2017

ESAs versus service dogs

ESAs are Emotional Support Animals. These can be various species and have little or no specific training. They provide companionship, relieve loneliness and can help with anxiety or depression.

In contrast, Service Animals help owners do specific tasks, such as guiding the blind,  and have years of training in helping the disabled.

Certifying ESAs proves to be a problem.

Researchers at the University of Missouri are looking into this.

ESAs can be pets, but legally are not really pets--they can go places pets cannot go.

The laws---Federal and state--concerning ESAs are ever-changing and confusing.

---A landlord can bar a pet, but not an ESA (and often must waive pet deposits for them, too).

---ESAs can go in the main cabin of a plane or even a restaurant.

So mental health professionals must certify these animals somehow.

The researchers agreed that ESAs are appropriate for some patients. Also:

--Requests for ESAs should be met with the same thoroughness of any disability evaluation.

--Professional guidelines are needed.

--Local, state, and national policymakers should meet with mental health professionals to evaluate future legislation involving ESAs.

They also recommended the evaluators not be the owner's doctor or practitioner--this can lead to biased assessments.

So where does that leave us? Pretty much dependent on future actions, I would say. For now, a beloved "pet" could still get special privileges. But, at the same time, those special privileges could benefit the owner greatly and even save his or her life.

Google "emotional support animal"--there are many websites claiming to certify these animals. You will also find out more about the law as it stands now.

Friday, May 19, 2017

Patients of older doctors may be at slightly more risk

When I consider a physician, I wonder: Will just out of medical school with fresh information be better? Or will long experience substitute for recent training if the doctor keeps up?

My father was a doctor--he got medical journals every month--but hardly ever looked at them that I could see. I am not saying my dad was a bad physician, just observing.

Doctors are required to undertake Continuing Medical Education--is this enough?

Harvard recently examined more than 700,000 Medicare patients of 19,000 doctors from 2011 to 2014 (Ars Technica).

They found that mortality rates rose with the age of the doctor.

--Doctors under 40--the mortality rates for elderly patients within the first 30 days (of what?) was 10.8%.

--Doctors 40-49, 11.1%

--50-59, 11.3%

--Above age 60, 12.1%

In real terms, this means one more death per 77 patients for a 60-year-old doctor, compared with a 40-yr-old one.

A little over one-fourth of US doctors are over 60 years of age. Nine percent are over 70.

The researchers said this did not mean as doctors get older, their quality of care slips--it probably means there is a difference in training from before and now.

Medical technologies are evolving all the time. It might be harder for older doctors to keep up, the investigators said.

Also a cautionary note--the study involved only older patients. Would this apply to a cross section?

Still--let's keep up the Continuing Medical Ed. And not just that provided by drug companies, either.

Thursday, May 18, 2017

Treating the whole suffering person, not just the pain

I have chronic knee pain, ooo, ouch, I count every step, I talk myself through outings involving long limps, I mean, walks. But I don't want knee replacements. I have just had too bad luck with surgeries, it's as simple as that.

So I take Tylenol--carefully rationed. No more than four a day and only on bad pain days. Did you know pain can vary from day to day? It can.

I have a close relative who got into the pain med cycle--opiate dependence, if you will. It has not been good.

The American Pain Society has said for decades that you must treat the whole person, not just the pain.

Holistic medicine expert David Katz, MD, at Yale (a guy I have interviewed) urges multi-pronged approaches to pain.

Katz recommends medical, social, psychological and lifestyle factors be considered for each patient.

For instance, the doctor can look at your sleep habits. Pain can cause sleep problems. People who sleep less also have less energy, move around less, and gain weight--which can lead to more pain.

Just the exercise from sleeping more and better can improve pain.

What you are looking for is more vitality, a greater sense of well being. Sleep can be a start.

I have slept badly all my life. A few hours at a time. Now, with age making me need more pit stops in the night, this is emphasized. Even that is usually OK--but if I worry and can't sleep, mind racing, I will have terrible knee pain the next day.

So there is a link.

However, I think all this improvement of lifestyle is limited when it comes to pain. The nerves are wired to warn you when you do something the body does not "like"--each and every time you do it.

Those nerves will fire no matter how chirpy you feel.

Wednesday, May 17, 2017

The search for a new primary

I came to Arizona 21 yrs ago to help take care of my mother. In that time, my mother, who died a couple of years ago, and I had too many physicians to count--and many I have repressed. We don't have a car, so are limited to doctors relatively close by.

At this point, I think I have had a doctor in almost every physician group within 10 miles and for one reason (probably more than one), no longer see that doctor.

I have had eight cardiologists--and recently got a ninth.

Am I a nutcase who can't get along with anyone? Not really, but I do seek a doctor who will respect me, keep up with the literature, discuss new findings with me, and not go ballistic when I won't go on my thousandth diet or take big drugs I know will make me nauseated or dizzy. I also like a well-run office, response to calls, prescriptions renewed in a timely way, and consideration for the physical demands of my arthritis when it comes to trotting over to the office for this and that when it's not strictly necessary.

This week, I learned that my primary of about five years has moved too far away to get to.


I spent four hours looking up doctors on my "plan" and googling and reading reviews. (I also check each with the Medical Board for lawsuits and to see where they went to school.)

We have some real characters in the medical profession out here. The most common complaints patients seem to have are: (1) Won't touch me, (2) Doesn't renew prescriptions promptly, (3) Makes me come every three months and there is nothing wrong with me, (4) Has a rude or indifferent office staff,  (5) Turfs me to the nurse or physician assistant, (6) Won't answer all my questions, (7) Won't look at me--just the computer, (8) Is mean.

I saw so many comments along the lines of: Beware. Or Do yourself a favor--don't come here. Or--The worst doctor I ever talked to.

All these commenters cannot be nutcases. They took the time to go to a site and comment. Sure, complainers comment more than praisers, but this is pretty overwhelming.

I finally picked a guy...Who knows...I might be writing this same post in a few months.

By the way, I saw a couple of prospective doctors give a little talk on YouTube--that was interesting...Something I had not encountered before.

Tuesday, May 16, 2017

The landfill can't digest all these nutrients

In a world where people scrounge for grains of rice on the ground, the Johns Hopkins Center for a Livable Future just calculated all the protein, fiber, and other nutrients than end up thrown out in the US in a single year.

Nutrient-dense foods like fruits, veggies, seafood, and dairy are discarded a disproportionately high rates.

Previous research indicated that 40% f food is wasted nationally.  But this study shows how nutritional much of that is (J of Academy of Nutrition).

They looked at the nutritional value of the retail and consumer-level food waste in 213 categories, using US Dept of Ag data.

In all, they looked at 27 nutrients:

--1217 Calories per person PER DAY
--33 grams of protein
--5.9 grams of dietary fiber
--1.7 mcgs of Vitamin D
--286 milligrams of calcium
--880 milligrams potatssium

Why so much food waste?

--Food looks "bad"
--Large portion sizes
--Bad management of perishables

We are dumping a lot of high quality, nutritious food people could be enjoying, one researcher said.

Enjoying and benefiting from.

Monday, May 15, 2017

Really? You would let kids swim without supervision?

Little kids swim like rocks without training.

Yet, a national poll done by the University of Michigan shows that a more than one out of three parents surveyed--37%--would let their children swim in a home, hotel, or community pool unsupervised.

In a lake? 16%/ In the ocean, 13%.

Familiar places--like your own backyard pool--provide a false sense of security.

Even if the child is a good swimmer, kids should not be in the water without a watchful adult present.


Nearly ONE THOUSAND kids a year drown. Five times that many end up in the ER with non-fatal water-related injuries.

All parents polled thought kids should have basic swimming skills--but one in seven parents of kids who could not swim independently thought it was OK to leave the child in the water unsupervised.


--Half of white parents said their kid had taken swimming lessons

--39% of Hispanic kids

--37% of black kids

Black children drown at 5.5 times the rate of white children.

Communities must work to find ways to make swimming lessons more affordable, the researchers said.

That's all well and good--but use your noggins parents. All it takes is taking that one long phone call or looking away from your child in a packed, splashy pool , or depending on some 16-yr-old lifeguard to watch your kid along with 50 others.

Friday, May 12, 2017

Another medical adventure

I hate this bed! I hate this sight!
Are we having fun yet? As regular readers know, I had emergency surgery to correct a hernia a month ago. Trauma surgeon--the whole nine yards. You can scroll down for details.

After three weeks, the surgical glue began to loosen on the 7-inch incision and part of it--about 1.5 inches worth--gapped. I was afraid my entrails would tumble out or something else unappealing.

It was a Friday. The surgeon's office said to text a picture of my wound, which looked infected--white and green goop.

By the time, I got the picture to them, it was Saturday...and the receptionist (or whoever's phone number it was) said go to the ER.

When I hauled my sore, arthritic self over there, they kept saying why are you here? No tests, no IV--just why. I said because my doctor said to come.

The nurse assigned to me told me my guts were not going to spill out. Pretty much all I wanted to know.

We kept asking was a doctor from our group there to talk to me? No one seemed to know.

After three hours on their rock hard cot, my right knee was dislocated and screaming in pain.

Finally a young man showed up, introduced himself by first name only, and under questioning, indicated he was from our doctor's group--but was a Physician Asst, not a doctor.

He glanced at my gaping incision and said make an appt in the office for Monday.

What? We already had an appt for the following Friday.

All this cost me a $75 copay for the ER, plus money for Ubers there and back...$100. For nothing.

I will take it up with the surgeon today at the scheduled appt.

This young man also made it clear that he had much better things to do than look at some old gal coming apart at the seams...He could not wait to get away from me.

Medicine today?

Thursday, May 11, 2017

New weight loss drugs

As we slog into the 21st century, fat shamed, doctor shamed, spouse shamed, self shamed, what about a magic pill?

I was clapped onto amphetamines when I was 12--lost enormous amounts of weight three times, but it always found me again.

Now, according to an article in ELLE by Joseph Hooper, the FDA has approved four new drugs to combat obesity: Qsymia and Belviq (2012), Contrave and Saxenda (2014).

In 2010--Meridia was yanked off the market--it increased heart attack and stroke.

In the 1990s, patients downed fen-phen, which did cause weight loss, but also, if you took it long enough, injured your heart valves.

Now--do the researchers have it right? One said--maybe "righter."

They think they know more about the physiology of weight loss--weight-specific pathways in the body, as mysterious as that sounds.

Qsymia and Contrave are drugs prescribed for other ailments besides obesity--they have a history of being used. Still, Qsymia should not be taken by anyone with heart disease--it contains the "phen" part of fen-phen--phentermine. this substance can make you feel "speedy."

Each of the four drugs had to cause test subjects to lose 5% of their body weight, which may not sound like much, but as most dieters know, is not all that easy.

These drugs dial hunger down or satiety up, basically.

But even if you are not "hungry," you may eat for a taste reward or other reason.

Contrave, for example, contains an anti-depressant (Wellbutrin) and the anti-opiate drug naltrexone, which blunt cravings.

Belviq is an all-new drug, which affects the brain's response to the happy chemical serotonin (but not the receptors in the heart valves like fen-phen did).

All the drugs list side efx, of course. For Saxenda nausea applies to all that take it until the body "adapts." Charming.

Also, these drugs are expensive. Try a thousand bucks a month for Saxenda. And usually not covered by insurance.

So this is no miracle "cure." It's not for those last ten pounds. It's medicine. You need to thrash this out with your doctor.

The FDA, it should be noted, would not even test these on people with a BMI under 30, or 27 if the subject had an accompanying problem related to weight.

Half of American adults could meet that standard.

Wednesday, May 10, 2017

Giving older people psychiatric meds tied to falls, sorta

Researchers at the University of Michigan's School of Nursing have found that a moderate increase in depressive symptoms among people over 65 was associated with a 30% increase in the likelihood of falling over the next two years from first date of measurement.

Why? They say it's may reflect a greater use of psychiatric medications.

Still, they backed continued use of such medication while improving the monitoring of fall risk.

The depressive symptoms and presumably the medication came before the falls, though.

I found their ultimate conclusions pretty wishy-washy.

--Older adults should stay active and reduce risks of falls.

--If you are depressed, talk to a family member or your doctor about it.

--Doctors should dispense big drugs carefully at proper doses. Duh. I would add--they should also discuss side efx with the patient and family or caregivers.

A third of Americans over 65 fall at least once a year.

Big, woozy-making drugs cannot be helping.

Tuesday, May 09, 2017

Do you know the BEFAST stroke symptoms?

A friend of a friend recently went to the ER with vague strokey-maybe symptoms, which made me think of the acronym BEFAST.

B--Balance loss
E--Eyesight changes
F--Face drooping
A--Arm weakness
S--Speech garble or difficulty
T--Time to call 911

The cues used to spell FAST..the latter four--but now the B and E have been added to pick up back of brain strokes. Now 10% more strokes are being identified.

A stroke there may make you off balance or have trouble walking. There also can be vision loss in one of both eyes.

If you can't talk or be understood--the stroke may be in the process of happening.

This applies to younger people, too--strokes in those 65 and older ate down 65%. Strokes in people 25 to 44 are up 44%.

Time saved is brain saved. Don't screw around--get help.

To get the big anti-stroke drug TPA, you need to react within 3 hours. Eighty-six percent of stroke victims don't make the cutoff.

Monday, May 08, 2017

Rich and poor--we all eat fast food sometimes

The popular conception is that only down-and-out, ignorant people grab a fast food burger a few times a week--or month.

A new nationwide study, however, shows that middle-income Americans are most likely to eat fast food.

Even the richest people were only slightly less likely to report that they, too, went to our popular fast fooderies.

The study, done at Ohio State's Center for Human Resource Research, used data from the National Longitudinal Survey of Youth, which has questioned the same group of Americans since 1979.

The data came from 8,000 people who were asked about their fast food habits in 2008, 2010, and 2012.

The participants--in their 40s and 50s when surveyed--were asked how many times in the last week they had eaten food from McDonalds, KFC, Pizza Hut, Taco Bell or the like.

Overall, 79% had eaten fast food at least once and 23% more than three meals in the week.

About 80% of the lowest 10% in income ate fast food at least once a week--but for those near the middle in income, this was 85%.

If their incomes changed over the study period, their fast food consumption did not.

The researchers also found people who ate all their meals at fast food joints--a la Morgan Spurlock, who made the film Supersize Me.

Of course, the participants were not asked what they got at the fast food places. Maybe salads or just a cup of coffee.

Sure. I am positive that's what they got.

Friday, May 05, 2017


We once had an influx of dog ticks--outside in the yard, inside on the (then) dog, riding on the backs of the cats like jockeys...ticks crawling the walls...dreadful.

I loathe ticks.

But prepare for a bad tick season, says a Cornell University tick expert. A relatively mild winter means more deer and mice--and more ticks.

Even in the city--like NY--there are large mammals, meaning ticks can thrive.

The best-known "bad" tick is the blacklegged tick or "deer tick"--which carries Lyme Disease, babesiosis, and anaplasmosis.

If you now anyone who finally got a Lyme diagnosis, you know this is a long-lasting or chronic disabling ailment and is often not diagnosed for years.

The lone star tick is spreading out in the Northeast and Midwest, thriving in hotter, dryer places and transmitting ehrlichlosis and tularemia.

You need to learn to identify ticks and how to protect yourself.

--Use permethrin-based tick repellent on clothing when in wooded outside areas, even Central Park.

--Inspect yourself and kids for ticks after outings or even everyday.

--Remove a tick carefully, pulling on the head, not the body, with a tweezers.

--Try to keep the head intact in case you get sick and it has to be identified. Put it in an empty pill bottle.

Yick to ticks. Still, we have to be aware.

Thursday, May 04, 2017

The problem--no recess, kids don't play outside?

Not that this is only about money, but if we could increase the number of grade school children who participate in 25 mins of physical activity three times a week from 32% to 50%, we could avoid $21.9 billion in medical costs and lost wages over the lifetimes of these kids.

In a study done by researchers at the Bloomberg Global Obesity Prevention Center, published in Health Affairs, just a small increase in the frequency of exercise among children 8-11 could save 340,000 kids from being fat,

Running around makes kids feel better and develop healthy habits.

The scientists looked at various levels of activity. If we stay at the current level of 32% of kids exercising 25 mins 3 days a week, 8.1 million youths will be fat.

I guess we could start boosting these numbers one kid at a time...Send the tots out to play!

Put down that joystick and learn the joy of running around like a wild animal.

Do kids run around like feral beasts--we did as kids--sadly, I doubt it.

We were horrible brats and loved it.

Wednesday, May 03, 2017

Good eating--it's childsplay

If good health were as simple as eating more fruit and veggies and exercising 30 minutes a day, says Audra Rankin, a pediatric nurse practitioner at Johns Hopkins, everyone would be fit.

Not sure about that claim, but I do think kids could be enlisted into their own "health" changes.

Rankin has co-authored a book called Gordon Galloway's Mealtime Makeover--a tale of a young cow who loves junk food and doesn't get enough physical activity.

Gordon breaks down his changes into bite-size pieces (sorry)--such as eliminating one soda a week or taking a walk after dinner each day.

Beyond the book, Rankin has created a four-week program called "Lit and Fit." It's being rolled out in Kentucky. Kids and parents not only get the Gordon book but training in making healthy meals.

The latter could be effective---kids will eat what they prepare and will buy into something in which they have an active role. Adults, too.

About that title "Lit and Fit." I assume it means "lit" for literature--meaning the book--and not lit as in stoned. As we know, the latter will not lead to the healthiest food or lifestyle choices.

Monday, May 01, 2017

Thinking about face filler?

Rare--but do your research
Looking at Trump's baggy face every living second and also getting my own self videotaped last weekend, facial filler surfaced in my mind...not that I could ever afford it or even need it really.

Also--I have seen some examples of unfortunate uses of these techniques.

Now, in an article in Plastic and Reconstructive Surgery, the official mag of the American Society of Plastic Surgeons, some researchers from the Dallas Plastic surgery Institute wrote about some facial "danger zones" docs should take into consideration in shooting in fillers.

Soft tissue dermal fillers can reduce lines and wrinkles and present a younger, fuller appearance. Recovery time is short. Fillers are now second only to botox in popularity. In 2016, 2.8 million filler procedures were performed.

But--whoever does this (and it's not just plastic surgeons anymore), that doctor needs to avoid injecting into or damaging blood vessels. Partly for this reason, the doctors who wrote the article often prefer hyaluronic acid where possible--these can be reversed with a rescue injection.

The researcher say there are six danger zones on the face, from forehead to chin.

In the article is a link to a video showing how to handle each danger zone.

Might be worth discussing with your doctor before you pump up the facial features.

Friday, April 28, 2017

Have you gone from phone obsession to addiction?

Larry Rosen, PhD, professor emeritus at Cal State Dominguez Hills,, is a technology addiction expert. For 30 yrs, he has studied the impact of technology on 50,000 children, teens, and adults worldwide.

He says--get this--the average person checks his or her phone 60 times a day--for a total of four hours!

Addiction becomes a serious problem when you need more, more, ever more--games, apps, social sites, vibrations, texts..

When you are not on the phone, are you thinking about being on?

Video gaming is already poised to become a formal addiction under the Diagnostic and Statistical Manual of Mental Disorders.

What is the difference between obsession and addiction? Obsession is an anxiety-based issue--your brain and other organs are releasing chemicals such as adrenaline and cortisol that make you feel anxious--the brain says do the activity, checking the phone, that gets rid of those chemicals.

Addiction is the need to do an activity to release pleasure chemicals, such as dopamine and serotonin.

Some people feel pocket vibrations even when the phone is not in their pocket.

Such motivations can lead to loss of relationships, jobs, and grades.

Parents, he notes, are terrible role models on this subject--and often hand their children a phone in a restaurant or before bed.

There must be a better app for those occasions...LOL.

Thursday, April 27, 2017

Up your nose

Loyola University pharmacists published a paper (Annals of Emergency Medicine) that said more ERs and ambulance crews are administering drugs by shooting a mist up patients' noses.

I have not personally experienced this.

Fast, easy, noninvasive--they say.

In short, an atomizer is attached to the syringe of medication and the medication mist covers the inside of the nose on the fast track to the brain.

No needles, no IV, no infections.

In the article they looked at five meds administered this way: tranquilizers, pain killers, drug overdose neutralizer, anesthesia, and child sedation.

But--of course-- there is also a downside. This is more expensive and the dose may not be large enough for adults. It also cannot be used if cocaine use has restricted blood vessels or the patient has other nose issues.

At least they had a sense of humor: The paper was titled, "When to Pick the Nose."

Wednesday, April 26, 2017

People pick produce based on smell and appearance

Is this news? I do remember Mel Brooks observing that he would eat a rotten nectarine over the best peach in the world because of the name "nectarine," but I don't think that is relevant to this.

University of Florida Institute of Food and Agricultural Sciences researchers says growers and grocers need to know people pick their fruits and veggies based on aroma and appearance--not, say, cost and trendiness or even vitamin content.

But--appearance does not always correlate to flavor or aroma.

Consumers like fruit to be sweet and juicy, but in a survey of 1,220 people, they thought the flavor was a matter of luck.

Au contraire!

Scientists work to find the genes that give fruits and veggies their finest taste and smell traits. Genes can also be manipulated to make the plants for insect resistant and to stay fresh longer.

--Of the six commodities in the survey, consumers bought strawberries the most, followed by tomatoes.

--30.9% thought appearance was most important--price was the Number One factor for 28%.

--Some consumers said they would pay up to 25 cents a pound more for better-tasting fruit. (Grocers say they won't.)

--Consumers do not like fruit with bruises.

Remember those garden tomatoes your grandmother used to serve? Can't find those babies in the store much anymore. We used to stand in the garden with a salt shaker and eat them like an apple. Even those hideous tomato worms with the horns on them did not deter us.

Tuesday, April 25, 2017

Forget the kids, seniors are phoning in the car

You hear a lot about young people with their quick reflexes tweeting and texting and otherwise being idiots in the car.

But a team of researchers at the Training, Research, and Education for Driving Safety program at University of California San Diego looked at the driving habits of California seniors.

Involved in the study were 397 anonymous adults 65 and older.

The older folks drive distracted less than the youngsters, but are still involved in dangerous behavior.

In the sample, the older people with cellphones 60% spoke on them while driving.

Usually involved was a "skewed sense of their multitasking ability," the researchers said.

Here are some fun facts--please read these while parked.

--Older drivers already suffer from medical conditions that impair safe driving--bad vision, frailty, bad thinking, slow reactions.

--Using the phone increases the risk of crashing by four times.

--Using the phone is like driving with a legal blood limit for intoxication.

--75% of seniors think they can use a hands-free device.

--27% drove kids under 11 last month and of those, 42% talked while on the road.

--3% of  the seniors had gotten a ticket for cellphone use, thought they did say the ticket changed their behavior.

How about changing it so you don't get a ticket--or something worse happens?

Monday, April 24, 2017

The signs of autism

Lisa Nalven, MD, director of developmental pediatrics at the Kireker Center for Child Development at Valley Hospital, says 1 in 68 kids are identified with a disorder somewhere on the autism spectrm.

Parents, she says, need to recognize the warning signs.

But--remember, interventions are available and recognizing the signs is constructive.

The most fundamental red flags are:

--No big smiles or warm, joyful expressions by 6 mos or thereafter

--No back-and-forth sharing of sounds, smiles, and facial expressions by 9 mos

--No back-and-forth gestures, such as pointing, showing, reaching or waving by a year

--No words by 16 months

--No two-word phrases (without repeating from the parent) by 2 yrs

--Any loss of speech or babbling at any age

Your pediatrician will watch for signs--but if you are concerned, face it, and ask.

Friday, April 21, 2017

Ah--unicorn food

Mermaid Toast
I never heard of this before...but now I have. According to Liam Stack (NYT, Apr 19, 2017), unicorn food is playful, colorful food popularized by Instagram and other social sites.

Starbucks now sells unicorn Frappacinos on Wednesday (for 5 weeks). Like all unicorn food, this java is amped up by cuteness.

Some foods feature fruit in animal shapes, pastel marshmallows, or even a real horn and ears made of sugar.

Toast can be uicorned with vari-colored icings, sprinkles, etc.

Who kicked this off? A wellmess blogger in Miam named Adeline Waugh.

She started it by using beetroot natural dye to pop her food pix.

Of course, her creations were healthy, but the trend has now gone down other paths. Now, sugary sprinkles and weird frostings are involved.

Doesn't sound like a healthfest to me, but hey, sometimes we need some fun, too.


Thursday, April 20, 2017

More kids can read by first grade

A new study shows that kids entering first grade in 2013 had far better reading skills than similar students a dozen years ago.

Even low-schieving students saw gains in basic reading skills.  But that did not translate into better overall reading for the less-skilled students. The gap between them and the higher-skilled students actually widened--meaning, I guess, that the higher-skilled kids sprinted ahead.

Overall, though, good news, the researchers are Ohio State said. (Educational Researcher)

One take from the researchers was that lower-skilled kids needed more time just reading text and less time being drilled on basic skills.

The study involved 2,358 schools in 44 states, a total of 364,738 kids.

What is the takeaway if you have kids? In my view, it's that preschool is a good thing and that reading should be encouraged at home, too.

To me, though, the really important thing is a love of reading--to somehow instill that.  Reading for pleasure has made my trip through this vale of tears bearable.

Wednesday, April 19, 2017

Even little kids feel fat

A study done at Leeds Beckett University showed that children as young as age 6 worry about body image, Children as young as three are stigmatized because of their weight, too.

I remember being furious with my ex- because he looked at our toddler daughter and said, "Is she getting fat?"

As if I had not gone that whole route my whole life-starting with amphetamines, threats, insults, etc., when I was not yet in junior high.

The study investigator points out that weight stigma and discrimination greatly influence the change of suffering from mental health issues--such as stress and anxiety.

He says non-stigmatizing supportive health care is paramount, because stigma reduces the potential of all interventions of any kind.

Eating behavior has been associated with depression and mood--and your mood in turn impacts food choice and consumption.

Doctors, he noted, need to "prescribe" exercise to treat both mental and physical concerns.

I don't even know if that's the whole answer.

Everyone needs to be more conscious of this....all this.

Just today, a friend told me about an obese 25-yr-old who had a gallbladder attack. The friend said she was "not being mean, the girl is fat." Yes, obesity can increase the risk of this, but I also know "skinny" people with gallbladder stones. Why is "fat" always the first go-to?

Tuesday, April 18, 2017

Hospital food--a new approach

I was hospitalized for 2.5 days last week. I noticed one big change. The food. Long the butt of jokes, hospital food used to be a tray of "dishes," ranging from mystery meatloaf , to a white roll with butter (nutritionless), to Jell-O cubes (ditto).

People loved to diss it.

This time, I noticed a large, laminated menu on the bedside table. It had pictures of luscious-looking food and categories such as Liquid Diet, Soft Diet, Regular Diet.

Apparently food at this hospital is not delivered a set times. You order--like room service. They arrive with snappy little bellboy hats on--but despite the incredibly heavy lids and plates, it's is cold anyway.

I know from blogging about this that this is an attempt to improve "customer service." But may I point out several things:

--The menu was on a table too far for me to reach--so I had to call a nurse to get me a menu. Then I needed to fish out the phone.

--I did not have my glasses the first day and could not read it. I ordered by the pictures. The nurse dialed the number.

--It was up to an hour to arrive.

--Your guests could eat--but they had to pay a pretty hefty fee.

I ordered once one day, twice the next...too much trouble. I did not have much of an appetite anyway, but wanted to eat something to heal, to gain strength.

And I wondered what if you were on say, a liquid diet and ordered a hamburger anyway--would they forbid it? Would you get in a big fight?

I missed the Jell-O cubes, I guess. the food--when it arrived--was regular old hospital food anyhow, The pictures lied.

Monday, April 17, 2017

Report from your hospital insider

I missed posting for two days because I was in the hospital. One service I provide is getting all the diseases and problems so my readers don't have to.

I posted Wednesday, but was in agony from 6 am that day. I have made a reference (scroll down) to having a hernia. In the crazy mess our health care system is these days, and the difficulty I have with mobility with arthritis and no car, I had finally gone to the ER with the huge lump, knowing I could get tests and a diagnosis in one place. No trip for imaging, no trip for labs, no appts only on my kid's day off, etc.

They allayed my fears that is was cancer and said to consult a surgeon. Getting that appt took three weeks. We finally cabbed to him. He said since I have atrial fibrillation (irregular heartbeat), I would need a cardiologist to clear me. I had fired eight of them, but made an appt three weeks hence with a ninth. In turn, THAT guy wanted me to get two tests, which then had to be approved by my Medicare HMO and then scheduled. We had gotten one done.

Last Wednesday, the pain was horrible. I toughed it out all day and night and then the next AM, Thursday, we cabbed back to the ER. They said come back if it got worse--so I figured that was my doctor. I didn't even know. After another CT scan, they said the hernia was strangulated--meaning to a life and death point that could kill intestinal tissue.

The surgeon I had seen was not available and another doctor from his group took over and operated within an hour of seeing me. The intestinal tissue had not died (relief) and I woke up with five incisions, glued together with lavender skin glue (cool?).

The next day and a half in the hospital was a nightmare--so many tubes, could not turn over with no stomach muscles or knees to flip me, could not get up...ugh. I finally got out Sat afternoon after waiting 2 hours and 45 mins for the in-hospital doc to spring me (where the heck was he?).

I feel tired now, but the incision pain is greatly better this AM.

They said the hernia has probably been growing since I had a hysterectomy 33 yrs ago.

I will talk about hospital food--maybe tomorrow. I love all of you and am glad to be blatting away again.

Wednesday, April 12, 2017

Kids don't need sports drinks

Many youngsters in after school sports drink sports drinks. After all, they see pro athletes drinking these.

But the average recreational athlete does not play at the intensity of a pro and thus may not need the extra sugar and salt in a sports drink.

You need a solid 45 minutes of exercise to need that, says Matthew Silvis, MD, director of primary care sports medicine at Penn State.

Energy drinks are also at issue.  Pro athletes sometimes drink these for the added boost from caffeine.

Katie Gloyer, MD, a primary care sports medicine doc at Penn State, does not recommend energy drinks--even for pro athletes.

It's better to hone your skills and practice more rather than rely on these drinks, she says.

For children and teens, energy drinks can even be dangerous--the contents are not well regulated and can contain several doses of harmful products, which an elevate blood pressure and cause heart arrhythmias.

The focus needs to be on WATER.  After playing 30- or 45-minute halves, young people should have a water break--with maybe fresh orange slices or maybe a granola bar.

What is best for post-work out recovery? Chocolate milk! This has the perfect combo of fat, proteins, and carbs to help your system recover.

But overall--think water. Otherwise, you may take in more calories than you burn exercising.

Tuesday, April 11, 2017

Poly want a pharmacy?

You know what "polypharmacy" is? When someone is taking too darn many prescription medicines.

An increasing number of Americans--centering on the elderly--are taking too many drugs and supplements they do not need. Those medicines, in turn, interact with other medicines in the person's system and cause even more problems than the original conditions.

Many prescription drugs, these days, actually interact with the body in powerful ways and taking a lot at once can be dangerous.

Austin Frakt wrote about this in the New York Times, Apr 10, 2017.

About one-third of "adverse event" hospitalizations include drug-related harm, leading to longer hospital stays, greater expense, and worse health for the patient.

 That amounts to 400,000 preventable events each year ((Institute of Medicine).

Not every adverse drug event means a patient has been given an unnecessary or harmful drug. However, 2/3s of Medicare patients have two or more chronic conditions and almost half take five or more prescribed medications.

At least one in five older patients are on an inappropriate medications--one they can do without or one that can be changed to a safer drug.

A study of over 200,000 older veterans with diabetes found that over half were candidates for dropping a blood pressure or sugar medication.

Researchers have also found a correlation between number of meds a person takes and the risk of an adverse event, such as a fall.

Too, there are many studies on the effects of prescription drugs, but few on the effects of not taking them,

Still, many doctors believe the benefits outweigh the risks and go on loading up patients with drugs. Or patients get prescriptions from various specialists and no one surveys the whole picture.

Researcher say patients need to ask their doctors: "Are there any medications I am on that I don't need anymore--or that I could try doing without?"

But do ask the doctor--don't do it on my say-so.

I only take three--all for high blood pressure--and those make me so nauseated, I have developed a routine of taking them half a pill at a time.

Monday, April 10, 2017

Does you doctor let you set the agenda?

Don't just sit--type!
They did a pilot study at the adult medicine clinic at Harborview Medical Center in Seattle asking patients to use a waiting room computer to type into their own chart what they hoped their visit would accomplish (Annals of Family Medicine).

Both doctors and patients liked this and wanted it to continue, according to the third-year med student at UW Medicine, who honchoed the study.

A UW professor named Joann Elmore, MD, is research director of Open Notes, a national movement to share the notes professionals write with their patients.

Eighty percent of the doctors and patients in this study said setting the agenda helped set priorities.

Other doctors' offices use computers onsite so patients can data-enter their own clipboard.

I see some issues with this. For one, under today's insurance strictures, each encounter is about 15 mins, and often less. I set my own priorities about what to mention and what to ignore. I even had a doctor lean over and try to see my written list and how long it was.

Two, under many federal guidelines, docs are now supposed to bring up certain things such as do you have a gun in the house. Do you feel safe--is anyone abusing you? I even had a doctor--two weeks ago--ask me to spell the word "lunch" backwards--I guess to see if I was senile yet.

And they also push the ever-popular dieting, so-called preventive tests (really early warning tests in almost every instance), and in a flash, your time is up.

I even had a doctor tell me, "Sorry, we can only answer one question..can you make another appt to get the others answered?"


I did notice the last appointment I had, there were computers in the waiting room. A fellow patient said she loved those because she could check her email.

Friday, April 07, 2017

"Natural" eating attributed to the hippies of yore

The New York Times ran a story saying the hippies had won--that their vegan and whole foods ways had entered or even taken over the mainstream.

Granola is now a category in the supermarket. Kombucha is sold on street corners and in Walmart.

Yoga and meditation--everyday activities.

Miso, tahini, dates, seeds, turmeric, ginger--stables of other cultures are commonplace on the American table.

This is also blending with technology in the popular culture--iPhones and pal santo (S Am wood used to smudge areas with healing smoke), one source said.

The super masculine meat culture is giving way to acai and other delicacies.

Some of this is coming from our learning more about the microbiome--the inhabitants of your intestinal tract. This area benefits from biodiversity, but fading soils and big ag farming have limited the range. Now people are trying to repopulate their guts--especially with fermented items.

People tend to like umami--the fifth sort of yeasty taste that is now right up there with sweet, sour, bitter, and salty.

People also like more textures in their food than before.

Remember "nights"? Maybe you are too young. But many families ate the same dishes on each given night of the week--Monday was meatloaf, Tuesday was supermarket pizza, etc. Every meal had a protein, a "starch" (carb), a veggie, and a sweet dessert.

Those days are fading or gone.

A lot of the commenting letters on this story said why attribute this to hippies? It's just wholesome eating. But I do remember being introduced to most of this at a yoga ashram I went to nightly for a decade and to the Whole Earth Catalog, which I loved.

You youngsters missed a lot. But there is still some good eating ahead.

Thursday, April 06, 2017

Crying babies by geographical area

According to research done at the University of Warwick (UK), babies cry more in Britain, Canada, Italy, and Netherlands than in other countries.

Babies in Denmark, Germany, and Japan cry the least.

Professor Dieter Wolke, from the dept of psychology, looked a studies involving 8,700 infants.

In addition to singling out countries with the most or least crying, this study allowed the researchers to determine a "normal" amount of crying for each age of the child.

--Babies cry, on average, two hours a day for the first two weeks.

--This peaks at 2 hours and 15 mins at six weeks.

--And reduces to 1 hour 10 mins by 12 weeks.

Some babies, though, cry as alittle as 30 mins a day--and others over 5 hours.

Colic, or painful gas, elicits crying of more than 3 hours a day for at least three days a week.

--In the UK, 28% had colic at 1-2 weeks.

--In Canada, 34.1% at 3-4 weeks.

--And Italy, 20.9% at 8-9 weeks.

Figuring out "normal" amounts of crying helps parents decide if they need extra support or should consult a doctor.

Bottom line? Even "good" babies cry--but sometimes and in apparently some locales, this can be excessive.

Wednesday, April 05, 2017

Little "pitchers" can get grownup problems

Americans love baseball...sometimes too much.

Michael T. Freehill, MD, associate professor of sports medicine and orthopaedic surgery at the University of Michigan, says he is seeing patients as young as 8 with injuries from overusing their arms in baseball.

Freehill himself plays professionally for eight years.

In a recent interview, Freehill defined "pitch count," as the number of pitches a player throws in one game. But this, of course, is not the extent of the throwing--players also warm up by throwing beforehand or throw between innings.

As the thrower gets tired, the muscle or soft tissue become less effective at protecting the arm. The ulnar collateral (Tommy John) ligament will see more stress from the fatigue.

Overuse injuries appear in many sports and at all ages. Often these come from player specializing in say, pitching, but there does not seem to be evidence that specializing makes a player more likely to be drafted when he or she gets older.

Evidence on high-level pitch counts is scanty. Still, some experts are issuing guidelines.

One guideline is that kids should play multiple sports. Allow them to develop as athletes.

Specialization should not occur before high school.

Check out

Remember where I mentioned the Tommy John ligament? Well, even little kids these days sometimes require the Tommy John surgery, as they call it. Surgery!

Tuesday, April 04, 2017

No rest for the over-50s--start a business!

There are more people over 50 who are self-employed than young adults.

This according to a report by Babson College, Universidad del Desarollo, Universti Tun Abdul Razak, and the Korea Enterprise Institute.

These groups studied 1,540,397 adults from 18 to 80 acorss five regions of the world. Check it  out at

The conclusion was that older people are a significant entrepreneurial force.

--18% of adults between 50 and 64, and 13% between 65 and 80, are self-employed.

--Just 11% of those between 18 and 29 are.

Yet, most programs for entrepreneurs are aimed at the younger crowd.

Senior entrepreneurship is highest in Sub-Saharan Africa. Here businesses require lower skills and less money to get going.

Senior business owners bring a host of economic, social, and environmental benefits, including less need for state financial support and job creation.

Moreover, older investors give more money than younger ones.

Elderly entrepreneurs also express more satisfaction  with their lives and their work. They are more willing to take risks (but may also have the lowest self-confidence).

Also--entrepreneurial intentions are lowest among senior women. Six senior women for every 10 senior men start businesses.

There are 1.6 billion people over 55--now is not the time to collapse in a heap. There is work to do.

Monday, April 03, 2017

You may be taking too much Vitamin D

A few years ago, researchers and doctors changed the level of Vitamin D--the sunshine vitamin--you should have in your blood. Suddenly, everyone I know had a yearly blood test that came back "low" or also commonly, "dangerously low," in Vitamin D.

I resisted downing yet another pill--but it was true, due to my disabilities, I did not get out in the sun much. Finally, I decided to take a supplement because the vitamin was supposed to help bone health. a paper presented to the meeting of the Endocrine Society yesterday, the Recommended Daily Amount intake is 400 International Units (IUs) rather than the Institute of Medicine's recommended 800 IU. Whether this applies to those diagnosed as low or dangerously low is unclear.

But it's half as much.

I won't wade into the weeds about how they determined this--you could google it. It involves a newer liquid chromatography tandem-mass spectrometry technique--weeds! Weeds!

Apparently this 400 IU amount is enough to supplement the sun even in winter. I do remember the doctor being undecided--maybe I could take 5000 IUs for a couple of weeks, then less, or just take that much...I think I am taking 5000. I may cut that due to this...down to 400, though--not sure.

So if you are taking Vitamin D for bone health--this recommendation does not necessarily apply to other reasons, Ask your doctor. Or cut back your dose. Or both.

Your call.

Friday, March 31, 2017

Weekend warriors: Don't overdo

Spring is sprung--many places.  Whether you are starting a new workout routine or digging a veggie garden or playing with the kids or in your office sports league, injuries are a possibility.

Martin Mufich, MSN, RN, sports massage therapist and clinical asst profssor at Texas A&M College of Nursing, has some tips for you.

Ligament injuries

Suddenly your foot lands on a bump or uneven spot followed by a jolt of pain. Your ankle likely has been sprained or twisted.

A sprain involves the overstretching or tearing of ligaments, the fibrous tissues that connect bones to each other. They can happen in any joint--but ankles are a common target.

The symptoms of a sprain are pain, inflammation, tenderness, bruising or hampered movement.

A mild sprain takes 7 to 10 days to heal. A torn ligament, called a severe sprain, makes it difficult to walk and can take several weeks to heal--for those a health care provider needs to be involved.


A strain is the overstretching or tearing of a muscle or tendon.  These connect muscle to bone. Strains can be a one-event thing or accumulate from repetitive motions.

Symptoms are muscle spasms, weakness, cramping and immobility--plus pain, bruising and swelling.


Tears are the ripping of fibrous tissue--in the ligaments, muscles, or tendons. This is more serious and can take months to mend. Some tears may require surgery.

Treatment and prevention

When any injury like this occurs, the body first reaction is to send in a lot of fluid and white blood cells to the damaged area. This means swelling, which can compress nearby nerves and cause pain.

You need to follow the RICES:

R -- Rest. Avoind putting weight on the injury, perhaps by using crutches.

I --Ice.  Apply cold not heat for 10-20 minutes every hour or two throughout the first 24-72 hours. Or until swelling goes down.

C -- Compression. Wear an elastic wrap for the first 24-36 hours. Snug but not crazy tight.

E -- Elevation. Rest the injury above heart level for 2-3 hours a day--in other words, put your foot up.

S -- Stabilization. Stabilize the area until care becomes available--this applies mostly to being in the wild.

You may feel discomfort thought this process--but should not feel a sharp pain.

To prevent these unpleasant occurrences--or minimize the risk--know your limits, warm up, wear protective equipment if appropriate, and wear proper fitting shoes.

Also--ask about rehab or proper physical therapy.

Thursday, March 30, 2017

We do have new colors--or at least new names

I like to have one tank top in each color for summer. I cruise around eBay and feel limited--we need new colors, I think.

Well, researchers in Japan and Ohio State looked into this. Apparently Japan has more colors with no English equivalent. Example: Pale blue. They don't call it "pale blue"--a shade of another color--they call it "mizu," which translates to "water."

This is similar to say, our color magenta--we don't say purplish-red, we say magenta.

This study was published in the Journal of Vision.

The researchers asked 57 native Japanese speakers to name colors on cards put before them. They came up with 93 unique color terms (they were not allowed to say "light" or "dark").

Almost everyone nailed "mizu." "Kon"--dark blue--was also commonly cited.

For the US part, we say lavender, peach and magenta--no Japanese counterpart.

Mizu is as different from "blue" and Green is from "blue."

We may say "sky" but we don't say it often. We also may say "powder blue," but that includes the word "blue."

Actually I see quite a few weird color descriptions in paint colors and makeup and other venues. Here, in the US. But many are not known and not used outside of ordering from a catalog. Colors like soot, blush, even taupe...which I insist is not a color at all. Neither is beige.

What does this have to do with your everyday life,much less health? It's just interesting. I bet you think about it again today.

Wednesday, March 29, 2017

Paralyzed man moves with mind power (and scientists)

Bill Kochevar, who had not moved his right arm or hand for eight years, grabbed a mug of water and drank some through a straw.


He had a brain-computer setup--with recording electrodes under his skull and a functional electrical stimulation (FES) system activating his muscles--with direction from his brain.

This guy is the focal point of research led by Case Western Reserve. The work was published in Lancet this week.

This is a major step toward independence for the spinal cord injury community, according to a top researchers at Case.

Basically, they take the brain signals Kochevar, who was injured in a bike accident, emits when he attempts to, say, scratch his nose, and use them to control his arm or hand.

This research is part of a larger effort called BrainGate 2--a clinical trial being held by academic and VA institutions.

The 96-channel electrode array implanted in Kochevar's skull is about the size of a baby aspiring. He practiced emitting these signals on a virtual reality arm on a computer.

 He could do it within minutes.

Then the 36 electrical stimulation electrodes were placed in his arm.

After a while, he could just think "out" and the arm would reach out.

Kocehvar may get more surgery to make this even more precise.

Cool, huh?

Tuesday, March 28, 2017

Best and worst states for docs--from their POV

When I say best state for a doctor, I mean the states where they can make the most money. How does that translate to best or worst
for the patient--you have to decide.

BEST STATES (from WalletHub)
S Dakota

Rhode Island
New Jersey
District of Columbia
New York

Fun facts:

Nebraska has the highest annual wage for surgeons (adjusted for cost of living)--$307,590.

This is 2.5 times the District of Columbia average for surgeons.

Idaho has the lowest number of doctors per 1,000 residents--DC has ten times as many.

Florida has the highest expected share of people 65 and older by 2030. That would be 27.1% of the population. Utah is lowest--13.2%.

Wyoming has the most disciplinary actions taken against physicians--with south Carolina coming in with the least.

North Dakota has the lowest amount of malpractice awards per capita..35 times lower than NY!

Wisconsin has the lowestt malpractice insurance rate--New York's is six times higher.

I always check my doctors with the medical board to see if they have paid out for malpractice. Do you?

Monday, March 27, 2017

How about some wind sprints for the youngsters?

An international study conducted by Wake Forest Baptist Medical Center indicates that 10 minutes a day of high-intensity physical activity would reduce the risk of some children's developing heart problems and diabetes,

Children who would benefit most had a large waist measurement and elevated insulin levels.

The study, in the journal of Medicine & Science in Sports and Exercise, analyzed data from 11, 588 kids from 4 to 18 who were included in 11 studies in the US, Brazil, and European countries.

Each child studied had at least one marker for cardio-metabolic risk.

They matched the markers against vigorous activity (while controlling for other factors) and found 32 associations out of 360--all related to waist size or insulin levels.

In these cases, the researchers concluded that avoiding being sedentary and even engaging in low-intensity moving about did not produce the results that vigorous exercise did.

But--of course--more study is needed, meaning looping in diet and genetic information.

In the meantime, hup, hup, kids--get up and race around. Can't hurt.

Friday, March 24, 2017

The Big Sneeze is coming

With a whiff of spring in the air, people are thinking outdoor activities, but what about allergies?

It's that time again.

Still, allergist Stephen Tilles, MD, president of the Am College of Allergy,  Asthma and Immunology (, says there are some simple ways to make allergies more bearable.

Spring cleaning. Sweep away the cobwebs, do some deep scrubbing (mold, pet hair). Vacuum pet beds and wash their bedding often.

Pollen. Two-thirds of those with asthma have an allergy...conversely, your "allergy" may be asthma. If  you can't get rid of a cough or are short of breath, get checked for asthma.

Clear the air. Do NOT get an ionic air filter. The ionization makes particles stick to the wall or any surface, where you will pick them up anyway. Also--the produce ozone, which can create problems. Instead, get a HEPA room air cleaner rated with Clean Air Delivery Rate (CADR). Central air? Change your filters every three months and used filters with a MERV rating of 11 or 12.

Fresh air. Forget it--don't open windows and let the spring come in. Turn on the AC with the new filer you just put in.

Also forget Dr Google. Sneezing a lot--ask an allergist. There are medications, even shots, that can help ease your suffering.

The Old Wives did not know everything.

Thursday, March 23, 2017

Even with insurance, medical bills hurt

Ipsos, a market research company, released a study showing that many Americans are unable to handle unexpected medical bills.

Three-quarters of Americans have seen their health costs rise and not go down--so for many, this means avoiding medical care.

---One in five Americans avoid going to the doctor because of the cost--this includes 56% of people without insurance and 27% of Millennials.

--Forty-nine percent say they don't have enough info on what things will cost to determine what they will have to pay. A broken arm? Almost half of those asked said it would cost them under $500--the real cost, almost $1200. (And that is probably with insurance.)

--In 2015, 41% of Millennials asked for a cost estimate--but only 21% of Boomers and 18% of seniors. HOWEVER--34% of the time, the final bill was higher than the estimate.

Shocker, huh.

Strapped Americans also are not saving for health care. Only 32% contribute to a Health Savings Account.

Bottom line: People who could not afford an unexpected bill over $100 without borrowing--37%. If the bill were more than $2,000 77% said they would have to borrow.

And now--we have a health proposal to make this worse. It's sickening.

Wednesday, March 22, 2017

Is dread of robots really delusional?

Baylor University researchers examined data from Wave 2 of the Chapman Survey of American Fears (1,541 people).

First, they found the fear of losing a job to a robot is real. This is a "substantial portion" of the American population--37%--identified as technophobes.

Technophobes, according to this study, are very afraid or just afraid of robots in the workforce, decision-making robots, and technology they don't understand, such as artificial intelligence.

--Women, non-whites, and women report being most phobic.

--Technophobes are three times as like to fear losing their jobs, and three times as likely to fear not having enough money in the future.

--Technophobes also are 95% less likely to be able to stop or control worrying.

All this is published in the Social Science Computer Review.

But isn't automation going to cause unemployment? Mark Cuban said it was. Bill Gates, also no dummy, said robots should be taxed and the money used to retrain people (presumably for jobs robots don't want--notice how intelligent I made them there?).

Fear of automation is not new, of course. People said cars would not catch on.

But it's coming on a scale we have not seen.

Visionaries may see blue skies ahead with more leisure time and fabulously fulfilling, non-routine jobs for people.

But--the fear remains--and maybe it is realism and not mental illness. Think?

Tuesday, March 21, 2017

Which people with atrial fib should be on blood thinners?

Just another day for someone with afib.
First--this is not medical advice. Second--I don't want to get too far into the weeds here.

But over a decade ago, a doctor discovered I had irregular heartbeat--known as atrial fibrillation. One in five Americans have it--my brother does, also a maternal aunt. For once, this is not related to being fat!

Basically, this is when a clump of regulating cells near the heart go off  track somehow and cause the heart to beat funny. One doctor kept referring to mine as my "hippety-hoppety heart."

This funny beat, in turn, can cause blood in the upper chamber of the heart to get sort of churned up into a clot that can travel to other parts--and cause a stroke. People with afib, as they call it, have a greater chance of a stroke as those with "normal sinus rhythm."

Some people get a fluttery feeling and are "in" afib for a time, then revert to normal. Others--like me--are always in afib. My pulse is sort of  like BEAT BEAT...Slidy slurry BEAT...PAUSE...BEAT....

At first, they put me on a med called amiodarone to regulate the beat. This drug made me so sick I ended up ion the hospital and later they said they didn't know if I was coming out alive. I did!

Then they put me on blood thinners--a blood thinner--warfarin. Every month, I had to go to a lab and get a blood test...they would call and say eat a spinach salad--vitamin K in spinach affects your blood thinness. It was wacky...then my intestine bled, leading to a terrible hospitalization for a colonoscopy. Can't have that with thinners on board, so they tried to counteract the thinner with blood plasma. The colonoscopy could not be completed.

I stayed on thinners. They said to.  Eventually, I experienced another bleed--in my right eye, leading to terrible clots, a fully detached retina, four surgeries, and now a blind eye.

I quit warfarin. Now I am on an aspirin only and have been for 10 yrs.

There are two other approaches to afib--ablation (try to kill the rogue cells with radio waves or heat) or the "paddles"--shock you into proper rhythm. I refused both

Long story longer, research from the Intermountain Medical Center Heart Institute in Salt Lake City now says there is an effective way to tell if someone needs thinners. First, you do a questionnaire called the CHA2DS2-VASc (see what I mean by "weeds"?) and then a second scoring--the Intermountain Mortality Risk Score.

The first is not predictive of outcomes, but has been used for years anyway. It is oversinmplified, the researchers say--a woman over 65 would automatically get a thinner, even though this is not a comprehensive way to tell is she needs one.

The new Intermountain score adds more variables.

Well, fine and dandy...I am seeing my ninth cardiologist next week--to see if I can withstand hernia surgery.  Wonder if he will recommend this.

As I peer into the screen with my one remaining eye--I have no idea.

Monday, March 20, 2017

42% of parents say they would take their kid to Urgent Care

The C.S. Mott Children's Hospital National poll on children's health said 42% would also try to communicate with the doctor without a visit.

More parents were confident of getting same-day phone advice (60%) than a same-day appointment (53%).

In other words, the researchers said, many parents are frustrated about getting timely advice when they have a sick child.

While retail clinics (in stores) or urgent care clinics may seem convenient, they may not have the child's history and can be expensive. And don't even ASK about the ER--see below.

Most doctors' office have a limited number of "sick" visits a day. I remember my daughter's pediatrician gave out a booklet of when to call or make an appt. I about had it memorized.

Discuss this with the doctor before deciding on a provider--the researchers recommended.

Most often, for a number of reasons, the primary care doctor's office is your best bet.

I will admit I often consider other venues. I even got so desperate with stomach pains two weeks ago, I went to the ER, knowing I could get imaging, testing, and an opinion in one place...and not be shuffled one day to a lab, the next to an x-ray place.

But the bottom line for that six hours...$11,600!!! My part was way less, of course, but someone thought that was what the services were worth,

I think the entire health care system is hardly worthy of the name system these days.

Friday, March 17, 2017

Attitude toward health care depends on age

A Vitals Index study surveyed Millennials,  Gen X, and Boomers and found different attitudes on health care.


The youngest group surveyed, the Millennials are the healthiest.  In fact, they utilize health care less often than previous generations did at their age. Only 35% of these even have a primary care provider. One in four say they use an alternative facility--say an urgent care center--when sick.

The Millennials, however, tend to have a high degree of trust. Also, they tend to be over-sharers (social media) and favor a more open doctor-patient relationship. They are not afraid to engage authority--their parents have taught them their voice matters. Millennials also use digital media--such as doctor reviews. They also tend to trust institutions with their health data.

Generation X

These are in their late 30s and 40s. They don't trust doctors or the system. They tend to believe doctors are more about money than helping. They hate to open up with their doctors.  They are less likely to follow up on advice--and only 56% have a primary care doctor. In fact, one in four say they have lost trust in a doctor or institution in the last two yrs--more than any other generation.

Baby Boomers

This generation, being oldest, is the unhealthiest. They have a high rate of chronic disease, more disability, and lower self-rated health than any previous generation at the same age.

Therefore--83% of Boomers have a doctor. They prefer a team approach, though.  They value a doctor who will discuss treatment options in detail.  They also expect doctors to work at least a 50-hour week like they do and keep up on medical information. To find a doctor, Boomers rely more on recommendations from friends and family than the internet.

This seems to track with what I have observed. What do you think?

Thursday, March 16, 2017

Good sleep--better than winning the lottery

University of Warwick (UK) researchers analyzed the link between sleep and mental and physical well-being and said working on achieving better sleep could be an effective, cheap health strategy.

The quality of sleep, the researchers pointed out, was more important than the length or number of hours.

They even quantified the benefits--equal to winning 200,000 pounds in the lottery.

Moreover, positive changes in quality of sleep, over time, using less sleep medication, improved scores on the General Health Questionnaire, used to determine mental well-being.

A person's physical health is also improved. And lack of sleep, and bad sleep quality lead to worsened states.

Bottom line: The benefits of sleep are accessible to everyone.

Some general principles:

--Cool room
--Dark room
--No devices or blue light
--Limit liquids at night to cut bathroom runs, don't eat after 8 PM
--Alcohol before bed can make you fall asleep but then rebound awake
--Comfortable mattress, bedding, and night clothes
--Maybe separate room from spouse who snores
--Pets in or out of bed depending on your preference

See? You didn't even need to buy a lottery ticket.

Wednesday, March 15, 2017

Patients like "telehealth" but does it cut costs?

Conferences with docs by phone or videoconference are becoming more popular--more than a million such consultations were reported in 2015.

The idea is that this is not only more convenient for minor ailments, but costs the system less, too.

A study of 300,000 people in a Blue Shield of CA HMO (Health Affairs) showed that patients probably would not have gone to the trouble of going to the doctor and so the tele-visit is an added cost.

A telehealth visit costs about $79, compared with $146 for an office visit.

The researchers found that only 12% of the telemedicine encounters replaced an in-person visit to a doctor or ER, while 88% represented new demand.

Mostly the virtual visits focused on respiratory ailments, sinusitis, bronchitis, pneumonia and tonsillitis.

Too, telehealth visits themselves may cost less than in-person, but they often result in followups, lab tests, and prescriptions, just like in-person ones do.

The costs of respiratory ailments in the group increased by $45 per user.

Of course, the honchos at telehealth companies disagree. The head of Teledoc said the numbers are outdated.

Still, to achieve real cost savings, the tele-visit must replace the in-person.

What do you think? Have you tried this? I have not, though I hate going to the doctor because my arthritis makes it so painful to gimp around.

Tuesday, March 14, 2017

Can you stand another post on my upcoming surgery?

After this, I will give it a rest for a while--for me, as much as for you.

The American Society of Anesthesiologists encourages you (me?) to take some steps before the "big day."

In my case, this means seeing a cardiologist (my ninth in AZ) because I have atrial fibrillation, a rhythm disorder suffered by 20% of people.

So they want to be on the safe side there, I guess, even though I don't want to tangle with another cardiologist--the two ways of treating my thing backfired on me big time and the other two ways don't last, from what I have heard. So I am not treating this, except for a mild blood thinner--aspirin,

They hate that.

Anyhow, that is one piece of advice--possible pre-op specialist visits.

Other recommendations:

--Find out who will be administering the anesthesia. They are physicians at the Society so they recommend you insist on a physician-anesthesiologist not a nurse-anesthetist. We could get into that, but not here. Physician-anesthesiologists have 12-14 years of medical ed and 12,000 to 16,00 hours of  clinical training. They work with your surgeon and other members of your care team to manage you while unconscious and your pain afterward.

--Talk with this person. You need to provide detailed info on your meds (including over-the-counter, vitamins, supps), chronic issues, diseases and ailments, allergies, recreational drugs, and so on. I have found--and it just happened with my daughter's gallbladder operation, that this conversation is sketchy and takes place right before the surgery and often after you get some "soothing" medication.

--Detail your previous experience with anesthesia. Will this person want to know that the guy who numbed my eye for one of my four detached retina surgeries did it wrong and I felt the first cut--yow--followed by bam! I was out for 10 mins of more numbing then back awake? Will I sound fearful, disrespectful? Probably won't get into this--since my operation this time is not under a local.

--Tell this person your fears. Yeah, OK. I have fears.

--Ask questions. Hmmm...I would ask my odds on waking up...but I had odds on my eye that were not too meaningful, so maybe not.

--Ask about afterward. This means pain control. I will be in the hospital, I am told--this is not in-and-out surgery for me.

So--typing this has freaked me out--but that is my role. I get this stuff so you don't have to.