While I don’t have any answers as to universal health care coverage, whether there should be one payer or many. However it’s nice to see something that shows a positive effect for having insurance.
This site is a reminder to take a lot of “advice”, or at least some headlines, with a grain of salt. In earlier posts I’ve gone over a bit as to where to get health information and things to think about when evaluating claims (Here are the posts: Where do you get your health information? and Evaluating Health Care Claims ). This link talks about some of the more common myths that still make rounds a lot on the internet.
For me this is an exiting and interesting story. As I have said in earlier posts, exercise is important. This just reinforces the notion that exercise, even if started later in life, does help health. I won’t wax poetic about how exercise is a “veritable fountain of youth” as I try to avoid being overly dramatic with health care claims.
Recently there was something in the news about roughly half of the information in the shows “The Doctors” and the Dr. Oz show was correct (actually it was 63% of the time in “the doctors: and correct about 49% on the Dr. Oz show). See an article reporting on this here. Often times people will have looked things up on the internet when they come into the office.
Now I’m not bringing this up to knock Dr. Oz or the doctors who appear on “The Doctors”, nor looking things up the internet. However it’s important to ask several questions when evaluating health claims.
1) Does the claim have any scientific basis?
2) Has the study (if a study is being quoted) been replicated with the same or similar results?
2a) Who funded the study? Was it reported in a reputable journal?
2b) If it is a product being touted, did the company making the product fund the studies of the product?
3) Does the person ‘reporting’ the results, or pushing the product have a connection with the company? If there is, what is the connection? Just because someone is employed or funded by a company doesn’t necessarily mean they’re biased, but it is something to take into account.Well you get the picture.
Looking up things on the internet may be just as hard, given that websites may not be what they seem. If a patient asked where to look for information I’d give the following advice:
Lean toward sites that end in .edu, .org (though it doesn’t totally eliminate the possibility of bias..) or .gov
Examples of places like this to start include:
WebMD does appear to be a commercial site with decent information
When on a site, look for a statement that indicates if they get funding from a source, and where that source is. Ask where is someone getting his/her data from (or if they’re willing to say).
Perhaps the best place to start is with your own physician.
One of my first posts in this blog was titled “Aging Well”. In that post I wrote mostly about staying healthy and how to (hopefully) age well and arrive at being an older adult being relatively healthy. In this post I’m going to talk about things to think about or do once you get there – and perhaps people to think about family members that are older. For the purposes of this post, the definition of older is 65 and above, despite the line that “65 is the new 40”.
Initially I would like to summarize a bit of what I said in the first post:
1) Be active! Both socially and physically (more on this later).
2) Control as best you can the health problems you do have.
3) Keep mentally active as well. Whether it’s taking adult education classes, daily crossword puzzles or playing cards with people often, do it!
4) Use a healthy eating pattern. For a fuller summary, go here to see the original post: aging well
For he remainder of this post I’ll talk about other things worth doing.
Firstly, if you haven’t already, sign a health care proxy form, and give copies to your primary care physician as well as a friend/relative. You may never need to use it but it is important to have if you develop a health issue that prevents you from making decisions about health care. I have seen too many people admitted to the hospital with dementia that is so advanced that they were unable to make competent decisions for themselves in any capacity and did not have any family or friends who could speak on their behalf (legally I think family is given precedence over friends unless noted in the health care proxy or other similar legal document). There is a form called “five wishes” that not only, once filled out and properly signed, acts as a health care proxy but also gives your health care proxy and physicians more knowledge about your wishes regarding your wishes/goals/etc should you not be able to speak for yourself. Find the link here : aging with dignity – five wishes
Secondly, take a good look at your finances. Long term care is expensive and if you have a lot of assets, such as owning your own home, medicare/medicaid might not pay for living in a nursing home should that be what you need. Long term care at home might also be out of your reach. Hence it is important to talk to a financial planner or lawyer with experience in elder affairs or elder law respectively. If you have a disorder like dementia , it’s even more important to do this because you’re more than likely to need someone to make decisions for you at some point.
Elder abuse is also a concern, especially if there are cognitive or severe mental health issues. This also makes it important to have someone to talk to or know where to go (for more information, go here: National Center on Elder Abuse ).
Thirdly, as I mention above and in my earlier post, be socially active. This is potentially helpful in a number of ways. one is that people are social animals. There are likely multiple benefits to mental and cognitive health by having a lot of social interaction. Also, being part of a community means there are people who could be called upon to help with food shopping, transportation to and from doctors offices (among other things), and so forth if you happen to be unable to do these things yourself – even temporarily such as due to an illness.
Of note, I think when you click on the link above, you will have to download the PDF.
I remember reading this article abut the time it came out. Though I don’t think it necessarily has all of “The Answers”, it does bring up some interesting points. I’ve often why some health insurance plans won’t pay for some preventive care when it would benefit the patient. When I’ve asked colleagues this the answer I often get is “because the patient will be on different insurance [ie, medicare or a managed care product from a private insurance].”
However many private insurances also have a managed care product for seniors. people may not ‘graduate’ into a plan from insurance they have while working. However there are people that might go from Having Harvard Pilgrim Health Care to AARP’s program (through united health care). however, some might go from United healthcare to HPHC’s product (or an equivalent insurance in a different part of the country). This might even things out a bit.
Anyhow, I sugges you read the article and make your own conclusions.
In this post I’ll be talking about Strokes (also known as Cerebral Vascular accidents). It is the fifth leading cause of death in the United States. It also is a major cause of disability and in terms of treatment, missed work, etc costs an estimated $34 billion dollars a year in the U.S. alone. Although the risk for stroke rises as we age, according to the CDC website 34% of strokes were in people younger than 65.
There are two kinds of stroke. One is hemorrhagic, meaning that is caused by bleeding. The other is ischemic, meaning that it is caused by a a blockage in a blood vessel. The symptoms, however are determined by the location and size of the stroke. Symptoms include: Facial Droop, double vision, confusion, garbled speech, limb weakness (especially if it occurs on one side of the body), numbness, and headaches.
It is important that if one suspects he or she is having a stroke that medical care be obtained quickly. There is a 3 hour window of opportunity from the start of symptoms that ischemic strokes can optimally be treated with clot dissolving medications. More than three hours after the start of symptom and the likely hood of poor outcomes increases – and the riskier it is to use medications to try and unblock arteries.
An acronym used to keep in mind regarding stroke is the word FAST (Face – is the face symmetrical: is one side drooping? Arms – weakness in one arm. Speech – is it normal? Time – call 911 immediately if it seems someone’s having a stroke).
Ischemic strokes are the most common. Based on symptoms one can’t tell if a stroke is ischemic or hemorrhagic, so it’s better to get to a hospital quickly. At this point in time there may be fewer acute treatments to stop hemorrhagic strokes, but even then supportive treatment is available.
Sometimes symptoms resolve quickly (within a few minutes). This is called a Transient Ischemic Attack, or TIA. This should not be ignored because people who have had a TIA are at increased for having a major/bigger stroke.
Although there isn’t anything that can be done about some risk factors such as age, there are many things one can do to reduce the risk of having a stroke:
1) Control your blood pressure if you have high blood pressure.
2) Lower your cholesterol if you have high cholesterol.
3) Control your diabetes if you are diabetic.
4) If you smoke, stop. If you don’t smoke, don’t ever start.
5) if you have an irregular heart rate, talk to your doctor about whether you need to be on blood thinners as certain irregular heart rhythms increase your risk of ischemic strokes.
6) Exercise (this will help with numbers 1-3 above)
If there was a medication that you could take that would help reduce weight, reduce the chances of developing disorders such as diabetes, dementia, and osteoporosis, I think most people would take it. If the side effects of this medication (even in the absence of dementia, depression, fatigue, etc) were a better mood, a better ability to concentrate, less fatigue, even more people would probably clamor to take it.
There is such a medication: exercise. Some medical societies, such as the American College of Sports Medicine state that “exercise is medicine”. The current recommendations for the minimum amount of exercise is 150 minutes a week of moderate exercise. This comes out to 20 minutes 7 days a week or 30 minutes 5 days a week. Walking is an example of moderate exercise often used to give people an idea of what the effort level of moderate exercise is. One should be walking slowly enough that one could talk and not be out of breath, but fast enough that one couldn’t sing. When my patients state they can’t find the time to do 20 minutes a day, I encourage them to find 10 minute periods through the day to walk. Obviously for some forms of exercise (swimming, playing a game of basketball, etc), this would be impractical to do.
Some research indicates that exercise has an anti-inflammatory effect in the body. Other research seems to indicate increased sensitivity to insulin, increases in various other hormones (or decreases in others), it is likely the mechanism for the beneficial effect of exercise is due to more than one pathway. That is to say that rather than, say deceased inflammation is the cause for improved mood or a decreased risk of dementia, it is likely that improved insulin sensitivity, anti inflammatory effects, etc all act in concert to improve health in people who exercise regularly. When talking with my own patients I tend to avoid talking about why it works and prefer to talk about the kinds of exercising they could/should be doing.
Though I encourage people to do weight bearing exercises such as walking, jogging, basketball, etc, I also realize that there needs to be some accommodation. For someone who’s morbidly obese or has severe arthritis that limits, at least initially, how much they can walk I might suggest stationary bicycles, water aerobics or something like tai chi (which is a weight bearing exercise, but because one isn’t jumping around as much as with things like basketball) the stress on joints is lower. I also realize that if someone doesn’t like a particular form of exercise, that person’s less likely to do that than a form of exercise they enjoy doing. Prescribing exercise isn’t a “one size fits all” solution to promoting health.
For people who’ve read many of my earlier posts, have probably noticed that I’ve focused less on medication and more on lifestyle issues such as diet. This post is no different. Many of the most common diseases I see in the office are most commonly caused by, for lack of a better word, poor lifestyle choices.By this I mean having a poor (read “western”) diet and not exercising enough. Once one has hypertension, type two diabetes, obesity, etc, lifestyle changes might not be enough to totally reverse or cure a particular problem in a specific patient. However even if one needs an antihypertensive, diet and exercise don’t become less important.
With this blog post, I realize I run the risk of sounding like one of those people that touts a new food every day or month (drink pomegranate juice for it’s high anti-oxidant content. You’ll live to 100!! it’s the next superfood!!!!). As I’ve pointed out, when evaluating health claims for foods/pills/etc it’s probably better to evaluate the claims as how they relate to endpoints such as decreased risk for disease, death, etc. rather than take something just because it’s a good antioxidant or has other reputed health benefits.
Anyhow, if someone were to ask me what kinds of foods should I eat/have handy, here are a few things I’d probably suggest. It is not an exhaustive list by any means. Of course if one has allergies to any of these foods, then they shouldn’t be on that person’s list of foods to have:
#1) Olive Oil. This makes my list because of the health benefits associated with intake. There is an inverse relationship with olive oil intake and the risk of dementia (that is, the more you take, the lower your risk of developing dementia). I has a lot of anti-oxidants in it as well as healthy fats. It’s good for heart health as well. It is important to mention that it’s important to use it IN PLACE of other fats, not just add it to a bad diet. That is, use olive oil in place of animal fats, coconut oil and other saturated fats.
#2) Canola oil. It’s high in Omega-3 fatty acids which are associated with lower risk of death due to heart disease, dementia, etc. It has a higher flash point than olive oil so can be used to cook at higher temperatures (and has a less strong taste which can be important with some foods).
#3) Flax seed/flax seed oil/ground flax. Flaxseed is also a good source of omega-3 fatty acids. However these are medium chain omega-3 fatty acids (as opposed to the long chain omega-3 fatty acids which are found in fish. It is the longer omega-3 fatty acids which have been shown to have health benefits). Not all of the fatty acids are converted to long chain omega-3 fatty acids in the body, but any little bit helps, and any that takes the place of fully saturated fatty acids or trans fatty acids is a good thing. Fish such as tuna, salmon, and sardines, to name a few, are better sources for long chain omega-3 fatty acids.
#4) Legumes, any combination of them you might want (legumes include peanuts, lentils, any type of bean). In combination with a cereal (e.g. rice or wheat) will provide all the essential amino acids (make up a “complete protein”). The health benefits get even better if it’s a whole grain you pair the legumes with.
#5) Tree nuts such as almonds, walnuts, cashews, etc. Though relatively high in calories – they tend to be high in fats – they are healthy. They contain some fiber. The fats they have tend to be the healthier types of fats and tend to be high in fat soluble antioxidants. Using a handful of nuts such as almonds to stave off hunger pains can help keep someone from consuming even more calories at dinner due to hunger. And they’re better for you than sugary/starchy foods such as crackers.
#6) Eat many different fruits and vegetables. The greater the variety the better. One study showed that blueberry intake reduced the chance of developing diabetes by 40 % (however this is only one study. Whether this is close to the “real number” blueberry intake reduces risk would be determined by looking at/doing more studies). Other fruit intake also reduced risk of certain diseases, for example, apple intake is associated with a lower risk of developing emphysema. Rather than relying on one “super food” or whatever fruit is the fad of the day, having a variety of fruits is probably better. Each fruit and vegetable has a different mixture of antioxidants and phytochemicals. The different phytochemicals probably have different affinities for different tissues (this is my supposition here. I have no proof to back it up other than a feeling it might be the case) and by having a variety of foods, it’s likely that more parts of the body will be protected.
#7) A variety of spices. I would put turmeric high on the list of spices to have as it appears that the curcumin (a substance found in turmeric) is a rather potent anti oxidant and anti inflammatory agent. However, I would make the same argument about spices that I make about fruits and vegetables above. The greater the variety the better.
Notice I have not put on the list meat, poultry, milk or other sources of animal protein.I wouldn’t say avoid them, unless you have a particular cultural or moral stand on eating animal products. I only mention fish because of the healthy fatty acids some fish contain. Limiting the amount of meat one has is important for maintaining health. However the amounts of each, frequency of using these in diet is a topic for another time.
For this post I thought I would write about staying healthy, but in a slightly different manner than I’ve done in previous blogs. In older blogs I’ve written about screening, vaccinations, etc. In this one I thought I’d talk about using a medication to stay healthy, and in this case talk about aspirin.
Aspirin has been around for more than 100 years, and perhaps is a bit under appreciated since it is an over the counter medication (meaning one can buy it without a prescription). It is also something that is derived from a natural product. Willow bark had been used to treat fevers and it was eventually found that salicylic acid was the active ingredient. Salicylic acid was then derived from this. I won’t go into the chemistry of this (I figure if you’re a bit of science nerd like I am you probably already know, and if not I don’t want to bore you).
Most people probably think of it as a pain killer or a headache medication. It is much more than that. Aspirin plays an important role in treatment of patients who’ve had heart attacks – it helps treatment and also helps decrease the death rate from heart attacks. It is used in primary prevention heart disease as well. In the past high dose aspirin was used in the treatment of Rheumatoid Arthritis. It’s use in this latter population (at least for treatment of Rheumatoid Arthritis) has been eclipsed by other medications. However it still should be used to treat/prevent heart disease in this group of patients.
Use of aspirin in ischemic stroke patients is advised as well.
Though less studied at this point, aspirin use to prevent recurrent deep venous thrombosis, is a consideration (this is after someone has been treated with coumadin for an acceptable length of time). A link to a review on this subject can be found here: http://www.ncbi.nlm.nih.gov/pubmed/24745726
There is some evidence linking aspirin intake to a decreased chance of developing colon cancer. At the moment there is not enough evidence to routinely suggest people take aspirin solely to prevent colon cancer. There is also some evidence that it only helps prevent colon cancer in certain groups of people – those that have a particular form of a particular gene. The only recommendation is for aspirin to help reduce the risk of heart disease.
Aspirin, like any other medication, has its downside as well. It can cause stomach ulcers. If the ulcers are large enough they can cause a lot of bleeding. It should not be used in children, except in rare circumstances and even then only then under the guidance of a pediatrician or other health care provider who provides a lot of treatment to children (EG pediatric rheumatologists, family practice physicians, etc).