Thursday, August 28, 2008

Health Care and GERD

Heartburn is an expression of a condition known as gastroesophageal reflux disease (GERD), a phenomenon in which acid and pepsin rise from the stomach into the esophagus, much like water bubbling into a sink from a plugged drain according to the Harvard Health Publications Special Health Report as reported by Everyday Health. The burning sensation is usually felt in the chest just behind the breastbone and often extends from the root of the neck to the lower end of the rib cage. It can last for hours and may be accompanied by the very unpleasant, stinging sensation of highly acidic fluid rushing into the back of the throat. There may also be a sour taste in the mouth.

But, according to the Harvard Health report, the heart of heartburn is the burning behind the sternum. A variety of foods; certain emotions such as anxiety, anger, or fear; and even particular positions, like reclining or bending forward, can aggravate it. While heartburn is obviously a nuisance for many, others seem to live with it quite well. However, people spend countless hours and untold sums of money looking for a way to spell relief. Heartburn can mimic a heart attack but luckily is not life-threatening. About one-third of Americans have heartburn at least once a month, with 10% experiencing it nearly every day. One survey revealed that 65% of people with heartburn may have symptoms both during the day and at night, with 75% of the nighttime heartburn patients saying that the problem keeps them from sleeping, and 40% reporting that nighttime heartburn affects their job performance the following day. This epidemic leads people to spend nearly $2 billion a year on over-the-counter antacids alone. Clearly, it's a major problem. states that a doctor may be helpful when the symptoms are worrisome to the patient or if they interfere with sleep or daily life. Many people can manage heartburn without seeking medical care, through dietary changes and over-the-counter medications. If you do seek your physician’s advice, providing a detailed account of your symptoms will help him or her make the diagnosis. The doctor will review your medical history and ask detailed questions about the nature of the pain and its pattern of onset. For example, he or she may ask whether symptoms are worse after you eat a heavy meal or known dietary troublemakers such as high-fat foods or dairy products. Your doctor will want to know if bending over to tie your shoelaces or lying down aggravates the symptoms and whether the pain seems linked to anxiety or stress. A physician may ask whether regurgitated stomach contents leave a bitter or acidic taste in your mouth. A sudden outpouring of salty fluid in the mouth, called water brash, can result from salivary secretions stimulated by reflux.

Though simple reflux is uncomfortable according to, it doesn't usually pose a danger to healthy individuals. From half to three-quarters of those with reflux disease have mild symptoms that generally clear up in response to simple measures. Over time, however, serious problems can develop when persistent GERD with frequent relapses goes untreated. These complications can include severe narrowing (stricture) of the esophagus, erosion of its lining, precancerous changes in its cells, and esophageal ulcers. One complication, known as reflux esophagitis, is inflammation that occurs when acid and pepsin, released from the stomach, erode areas of the mucosa, the surface layer of cells that line the esophagus. Besides the burning sensation of heartburn, patients with esophagitis may also complain of pain behind the breastbone spreading into the back or up to the neck, jaw, or even the ears. The pain can be so intense that you may have trouble swallowing and may even think you are having a heart attack. With esophagitis, food may feel as if it sticks in your throat before going down the gullet. Hot drinks are unpleasant to swallow, and you may have some nausea. You may also regurgitate some acid fluid into your throat, resulting in a cough. The inflammation of the esophagus can even lead to bleeding. Endoscopy is necessary to confirm the diagnosis of esophagitis and locate any associated ulcers or strictures.

AstraZeneca gives helpful tips for treatment of GERD. Medical treatment is not the only option for managing GERD symptoms. Changes in diet, nutrition, and routines can be used alone, or combined with a medical treatment, to gain relief from the pain associated with GERD. The following lifestyle changes have been shown to have a positive effect on symptoms associated with GERD in some patients:
--Losing weight
--Quitting smoking
--Wearing loose-fitting clothing
--Eating smaller meals
--Raising the head of the bed when sleeping
--Waiting at least 3 hours before lying down after eating
--Avoiding certain foods and drinks, including:
Alcoholic drinks
Caffeinated beverages
Citrus drinks
Tomato-based foods
High fat and/or fried foods

Make sure that if you experience this health situation that you visit your family doctor or an internist for a complete evaluation. They will be able to diagnose the problem and give helpful treatment advice including medications and other tests to verify the significance of the medical need. Don't postpone getting this health care issue resolved for your own comfort and peace of mind, and for immediate and long term improved health.

Until next time. Let me know what you think.

Wednesday, August 27, 2008

Health Care and Escalator/Elevator Safety

Safety is an extremely important health care issue, especially with children. Hidden dangers or hazards often taken a backseat to more highly publicized safety hazards, such as car accidents and drownings according to pediatrician Dr. Vincent Ianelli. Although the chance of your child getting hurt in an elevator, on an escalator, or playing on a soccer goal isn't very high, that doesn't make you or your child feel better if it happens to him. Learn about these hazards to help you protect your child and keep him safe. The Consumer Product Safety Commission (CPSC) reports that there were about 11,000 injuries on escalators in 2007, mostly from falls. In addition, there have been at least 77 reports of entrapment -- when hands, feet, or shoes (mostly clogs and slide sandals) get trapped in the escalator -- since 2006 according to as reported by Dr. Ianelli.

Your kids can still ride the escalator, but be sure they do it safely. They should: tie their shoelaces before getting on the escalator--stand in the center of the escalator, face forward, hold the handrail, and step off at the end. Also, refrain from sitting or playing on the escalator -- it should not be treated as an amusement park ride. Perhaps most importantly, learn where the emergency shutoff button is so that you can turn off the escalator if someone gets entrapped while riding. Dr. Ianelli has many suggestions for safety.

Elevator Dangers:
Elevators can be dangerous too. Although most injuries and deaths involve the people who work on and maintain elevators, passengers can get hurt too. According to the Consumer Product Safety Commission (CPSC) National Electronic Injury Surveillance System, on average, about six people a year die in and around elevators. This includes about one child under the age of ten years old each year. Many others are injured. One study found that about 2,000 children each year were injured in and around elevators, with the most common injuries occurring when the elevator doors closed on a body part, such as a finger, hand, or arm. Of course, the most serious injuries, including those that were life threatening, involved falls into empty elevator shafts, including when the elevator doors opened and there was no elevator car to get in to. Deaths and serious injuries involving elevators also occurred when people get struck by the elevator between floors, fall when trying to get out of a stuck elevator, or when an elevator collapses.

To keep your kids safe when riding an elevator, be sure to:
--Watch young children, especially toddlers and preschoolers, as they get on and off an elevator
teach your kids that they shouldn't try to stop an elevator door from closing with their hands or arms.
--Teach older kids and teens to stay in the elevator car if it gets stuck and wait for assistance (push the alarm button or call for help using the elevator phone), instead of trying to get out on their own, even if the elevator door is open and they can see the next floor.
--Consider having your child carry a cell phone if he regularly rides in an elevator without supervision so that he can call for help if the elevator gets stuck and the alarm button or elevator phone is not working.

The Consumer Product Safety Commission has tips on staying safe on escalators. Here are some steps you can take to help prevent escalator injuries, especially injuries to young children:
--Be aware that loose shoe laces, drawstrings, scarves, and mittens can get trapped in moving escalators. In the past year, CPSC reached an agreement with a number of children's clothing manufacturers to remove drawstrings from the necks and hoods of children's garments. If your child's clothing still has drawstrings, remove them.
--Always hold children's hands on escalators and do not permit children to sit or play on the steps.
--Do not bring children onto escalators in strollers, walkers, or carts.
--Always face forward and hold the handrail.
--Avoid the edges of steps where entrapment can occur.
--Learn where the emergency shutoff buttons are in case you need to stop the escalator.

Also, the American Society of Mechanical Engineers/American National Standards Institute Escalator Committee set a voluntary standard for escalators. The standard requires:
--That the emergency shutoff buttons be at the top and bottom of each escalator. The button should be on the right side of the escalator when facing the stairs.
--That sidewalls be made of low-friction material so soft-soled shoes cannot get caught easily.
--That "skirt obstruction devices" (which sense the presence of a foreign object and automatically shut off the escalator) be at the top and bottom of the escalator.
--That side clearance at the edges of steps be no more than 3/16 inch
--That warning signs be placed on escalators reminding parents to hold children's hands and face forward.
--That each step have painted foot prints or brightly colored borders.

SafeKidsUSA says children are at risk from hidden hazards due to their curiosity, tendency to put things in their mouths, and their size. Lack of supervision increases the risk for some of these hazards. Some result from activity that comes naturally to children. Others result from products that just don’t mix with kids. When you are with children at any time, supervision becomes ever more critical when you're around escalators, elevators, or any other situation with multiple moving parts. Don't let children get injured, especially when you have the power to prevent them from getting hurt. Pay attention in areas where accidents are more prone to happen. Simple observation and prevention will go a long way to protect children from injuries due to accidents. Make sure that you are alert to possible accidents looking for a time and place to happen. Educate your kids about safety, and it will be a lesson well learned.

Until next time. Let me know what you think.

Friday, August 22, 2008

Health Care and Medical ID Fraud

Identity theft is big business. According to the Gartner Report and other sources, it has been estimated that about 10 million victims file cases for identity theft each year--an average of 20 people every 60 seconds. The overall cost of this has been almost $60 billion dollars in the last year. And it’s not just your bank account number, credit card number, or social security number that people wish to have for their intentions to commit crime. Even your address, names of your relatives, date of birth, phone numbers, and other such personal information can be useful to those who would steal your good name. Criminals can put together a picture of you and use this information in order to perpetrate identity theft and identity crime. This fake persona can then be used against you to steal your money, your tax returns, and even your livelihood--including medical ID theft or fraud. The report on Medicare Compliance just announced that over 9 million adults in the U.S. this year alone believe they or a family member have had personal medical information lost or stolen.

According to the World Privacy Forum, medical identity theft occurs when someone uses an individual’s name or other parts of the individual’s identity – such as insurance information or Social Security Number – without the victim’s knowledge or consent to obtain medical services or goods. Medical identity theft can also occur when someone uses the person’s identity to obtain money by falsifying claims for medical services and falsifying medical records to support those claims. The essence of the crime is the use of a medical identity by a criminal and the lack of knowledge by the victim. Some identity theft cases arise in medical settings, but they are not medical identity theft. For example, if a hospital worker steals patient credit card number or other financially-related identity information and goes on a shopping spree at a mall, that is not medical identity theft. It is more traditional financial identity theft. In this situation, the crime did not affect the medical identity of the individual, even though it involved the use of personal financial information.

US News & World Report indicates that the thief isn't always an individual desperately needing medical care. In some instances, the perpetrator can be a doctor hoping to pad his or her income by filing fraudulent claims. Even worse, law enforcement authorities say that more and more frauds are being perpetrated by organized crime rings who steal dozens, and sometimes thousands, of medical records, as well as the billing codes for doctors. The rings then set up fake medical clinics—offering free health screenings as a ruse to draw in patients—that submit bogus bills to insurers, collect payments for a few months, and then disappear before the insurers realize they've been had. But some privacy advocates fear that the rush toward digital health records could ironically create new nightmares for victims of medical ID theft. Rather than residing in a single doctor's paper files, fraudulent information could circulate in other medical databases across the country. Given that some medical ID thefts are "inside jobs," wherein rogue clerks sell patient data to fraudsters on the outside, privacy advocates believe that allowing data to flow more freely around a national network could make such thefts even easier.

Even worse, it can be difficult for patients to purge any fraud from their records according to US News & World Report. While the Fair Credit Reporting Act gives victims of financial identity theft the right to see and try to correct any mistakes in their credit records, critics say that victims of medical ID theft don't have the same recourse. Health privacy laws are limited and don't reflect the possibility of medical ID theft, and incorrect information could bounce around for many years. Victims of financial identity theft have a much clearer path to recovery than those whose medical identities are stolen. If someone swipes your wallet and goes on a spending spree, you can ask any of the three major credit bureaus for a free credit report, place a fraud alert on your account, and get inaccurate charges expunged. With medical identity theft, it's not that simple. In the first place, your records are most likely scattered among many different providers, and there's no medical records clearinghouse that keeps them. Under HIPAA, the federal law that addresses medical privacy, you're entitled to a copy of these documents, though you may have to pay for it. If there's an error, you can add a correction to the record, but you can't have information deleted. And if an impostor gets healthcare services in your name, you may really be stuck. Healthcare providers may actually refuse to let you see your own record because once it's intermingled with someone else's, that person's privacy must be protected.

Unfortunately, law enforcement authorities complain that many health-care facilities do too little to protect their patient data. However, in their defense, health-care executives say they've taken steps in recent years to deter identity thieves. Some hospitals, for instance, have begun reprogramming their computer systems to restrict staffers from accessing any patient data beyond what they need to do their jobs. And some have instituted procedures to ensure patients are who they claim to be as reported by US News and World Report.

For a medical identity theft victim, according to the World Privacy Forum, medical and health insurance records are essential to figuring out the facts in your case. The thief may have used your name when seeing a doctor, obtaining prescription drugs with your health ID number, filing claims with your insurance company, or doing other things that left a trail in your medical records. The actions of the thief may be intermingled with the records of your own treatment and payment activities. For example, your health insurer may have records showing bills submitted by your dentist, drug store, and obstetrician together with other bills that resulted from the thief’s activities. In some instances, the crook is not someone who sought medical care but a health care provider who submitted a wholly fraudulent bill in your name, your spouse’s name, or your child’s name.

The World Privacy Forum also reports that if you have reason to believe that you are a victim of identity theft, you need to find the facts. Obtaining a copy of your medical records from your health care providers, hospitals, pharmacies, laboratories, and health insurers is the main way to learn what happened. You may be tipped off to medical identity theft by receiving an explanation of benefits from your insurer for services that you never sought or received. You may receive a bill for services that you did not use. You may receive a dunning notice (a notice that a bill has not yet gone to a collection agency, but will if not paid soon) or phone call from a debt collector for a health care bill in your name that was never paid. If any of these things happen to you, you need to find the facts by obtaining basic records from providers and insurers; and ask questions, preserve your rights, and follow the trail of information.

Medical ID fraud is serious business. Those who are affected by it face a huge task to clear up personal and financial issues that result from someone's unscrupulous behavior. Keep your records safe, and follow up immediately on any unusual circumstances related to your own health.

Until next time. Let me know what you think.

Thursday, August 21, 2008

Health Care and Consumerism

The Charlotte Business Journal has reported this month that participation in consumer-driven health plans is becoming an increasingly popular health insurance option. A survey released by employee-benefit advisory company United Benefit Advisors indicates that the total number of consumer-driven health plans has increased this year by 43% over 2007. They now account for nearly 13% of all plans offered by employers, and the plans cover about 4.4 million people. Consumer-driven health plans typically have lower premiums but higher deductibles and out-of-pocket costs for some medical procedures than other insurance plans. They typically include a health reimbursement account or health savings account to which employers contribute. The average employer contribution to a health savings account was $642 for a single employee and $1,053 for a family plan. AISHealth reports that according to a new study by George Mason University and the Urban Institute, total private health insurance expenditures are estimated in 2008 to be $829.9 billion.

For example, Aetna provides an overview of these plans for consumers. Consumerism in health care is based on the idea that individuals should have greater control over decisions affecting their health care. A number of innovative products and plans are advancing the consumerism trend. Health Savings Accounts (HSAs) and Health Reimbursement Arrangements (HRAs) are savings vehicles generally paired with High-Deductible Health Plans (HDHPs). Consumer-directed health care is a common-sense approach for addressing two of the most vexing challenges in our health care system: controlling costs and improving access to affordable, high-quality care.

According to Aetna, consumer-directed health plans typically consist of three major components: a health fund or health savings account, a high-deductible plan that includes preventive care not charged against the deductible, and access to information and tools that help consumers make better health care decisions. Monthly premiums are lower in these plans and, once the deductible is met, consumer-directed plans pay benefits like traditional health plans. Individuals typically use funds from an HSA or HRA to cover all or a portion of the plan's deductible. HSAs are personal savings vehicles - similar to IRAs or 401(k) plans - that allow individuals and, in some cases, their employers to invest tax-free dollars in an account to pay for routine health care or to save for future health care expenses. Funds put into an HSA belong to the consumer, regardless of changes in employment or insurance status, and they can be carried over year to year. HRAs are entirely employer-funded accounts that employees can draw upon to pay qualified medical expenses and they too can be rolled over year to year.

According to Aetna, these new consumer-directed products have four critical attributes:
1.) They give individuals better access to information and more control over their own health care, allowing them to make informed decisions about treatment and provider options.
2.) They increase consumer involvement and raise awareness about the real cost of health care, which research has shown to reduce total health care spending.
3.) Featuring lower monthly premiums, these products make it more affordable for employers to offer coverage and for individuals to purchase it.
4.) Finally, consumer-directed products encourage healthy behavior. shares insight on consumerism in health care for a second generation of consumer-driven health policies and products. The shortcomings of HMOs, capitation, IDSs, and the other components of managed competition have opened the way for alternative approaches to using market mechanisms for improving the health care system. Consumerism appeals to the widespread and legitimate desire for a more transparent, flexible, and personal system and provides a salutary counterbalance to the organizational hypertrophy and opaque administrative mechanisms of the managed care era. However, consumer-driven health care suffers from its own shortcomings. Blunt cost-sharing provisions, unadjusted for the patient’s income or health status, will penalize the poor and the sick while allowing their wealthier and healthier compatriots to retain higher balances in their HSAs. Nonselective network designs, the dismantling of utilization management, and a reversion to fee-for-service payment will encourage spending for high-cost services that fall above the insurance deductible. The emphasis on measurement, payment, and choice at the level of the individual practitioner rather than the provider organization will disvalue the information technology, managerial, and cultural infrastructure necessary to integrate care across comorbid conditions and codependent services.
After having tried every alternative, it is to be hoped that a market-oriented health care system will do the right thing and combine the best elements of the demand-side approach embodied in consumerism with the best elements of the supply-side approach embodied in managed competition. The combined approach could be termed managed consumerism.

A market-oriented approach must always put the consumer first before the provider as the locus of rights and responsibilities as indicated with critical research by Health Affairs. But the full potential of a consumer-driven system will be realized only when insurers create meaningfully distinct networks and providers create meaningfully distinct organizations among which informed and cost-conscious consumers can choose. Different consumer-centric benefit designs and provider-centric network designs will be appropriate for different health services, depending on whether utilization is strongly consumer preference–sensitive, provider supply–sensitive, both, or neither. Health plans are experimenting with various forms and levels of cost sharing and provider payment across services according to the sensitivity of demand and supply to financial considerations. Also, different forms of organization may offer the best combination of cost, quality, and convenience for different services depending on their clinical and technological characteristics. The health care landscape is blooming with minute clinics for low-acuity primary care, medical homes for chronic care management, centers of excellence for high-acuity surgical procedures, and focused factories for ambulatory surgery and oncology. Consumer choice needs to be combined with organizational management so that the pursuit of individual self-interest through market competition vicariously supports the social interest in an efficient, fair, and effective health care system.

Consumer Directed Health Care has been slow to take hold in the market place. Only in the past couple of years have employers and individuals seen how consumerism really helps to control costs and unnecessary treatment. As transparency and better methodologies become more available, the efficiency of consumerism in health care will demand that this model be more widely accepted every year. Taking control of your health is much more effective than government run health care. The market has changed in the past 5 years to make consumerism a very competitive option for health care. Explore options that save you money and keep you healthy, and learn to manage your health instead of reacting to it.

Until next time. Let me know what you think.

Tuesday, August 19, 2008

Health Care and Depression

Millions of Americans suffer from depression. According to a recent report by, more than one in 20 Americans aged 12 and older are depressed, according to the latest statistics from the CDC. Of them, 80% report some level of functional impairment because of their illness, with 27% reporting that it is extremely difficult to work, get things done at home, or get along with others because of the symptoms of their depression. Rates of depression were higher in women and baby boomers aged 40-59 and non-Hispanic black people than other demographic groups, the study shows. And rates of depression were higher among poor people when compared to people with higher incomes. A treatment gap also exists. Only 29% of depressed individuals said that they contacted a mental health professional in the past year, and just 39% of people with severe depression contacted a mental health professional in the past year. The stigma that is still attached to depression may be partially to blame. has plenty to say about this disease. Some people say that depression feels like a black curtain of despair coming down over their lives. Many people feel like they have no energy and can't concentrate. Others feel irritable all the time for no apparent reason. The symptoms vary from person to person, but if you feel "down" for more than two weeks, and these feelings are interfering with your daily life, you may be clinically depressed. Most people who have gone through one episode of depression will, sooner or later, have another one. You may begin to feel some of the symptoms of depression several weeks before you develop a full-blown episode of depression. Learning to recognize these early triggers or symptoms and working with your doctor will help to keep the depression from worsening. Most people with depression never seek help, even though the majority will respond to treatment. Treating depression is especially important because it affects you, your family, and your work. Some people with depression try to harm themselves in the mistaken belief that how they are feeling will never change. The consensus is that Depression is a treatable illness.

Major depressive disorder, commonly referred to as "depression," can severely disrupt your life, affecting your appetite, sleep, work, and relationships according to The symptoms that help a doctor identify depression include:
--constant feelings of sadness, irritability, or tension.
--decreased interest or pleasure in usual activities or hobbies.
--loss of energy, feeling tired despite lack of activity.
--a change in appetite, with significant weight loss or weight gain.
--a change in sleeping patterns, such as difficulty sleeping, early morning awakening, or sleeping too much.
--restlessness or feeling slowed down.
--decreased ability to make decisions or concentrate.
--feelings of worthlessness, hopelessness, or guilt.
--thoughts of suicide or death.

If you are experiencing any or several of these symptoms, you should talk to your doctor about whether you are suffering from depression. Additionally, there are other types of depression that require specific treatment for the disorder:
1.) Dysthymia is another mood disorder. People who have it may feel mildly depressed on most days over a period of at least two years. They have many symptoms resembling major depression, but with less severity.

Information also provided by indicates that symptoms of depression may surface with other mood disorders. They include seasonal major depression (also known as seasonal affective disorder), postpartum depression, and bipolar disorder:
2.) Seasonal Affective Disorder has symptoms that are seen with any major depressive episode. It is the recurrence of the symptoms during certain seasons that is the hallmark of this type of depression.
3.) Postpartum Depression is a type of depression that can occur in women who have recently given birth. It typically occurs in the first few months after delivery, but can happen within the first year after giving birth. The symptoms are those seen with any major depressive episode. Often, postpartum depression interferes with the mother's ability to bond with her newborn. It is very important to seek help if you are experiencing postpartum depression. Postpartum depression is different from the "Baby Blues", which tend to occur the first few days after delivery and resolve spontaneously.
4.) Bipolar disorder, another mood disorder, is different than major depressive disorder and has different treatments.

There are many causes for depression. Depression has no single cause; often, it results from a combination of things as reported by, and you may have no idea why depression has struck you. Whatever its cause, depression is not just a state of mind. It is related to physical changes in the brain, and connected to an imbalance of a type of chemical that carries signals in your brain and nerves. These chemicals are called neurotransmitters. Some of the more common factors involved in depression are:
--Family history. Genetics play an important part in depression. It can run in families for generations.
--Trauma and stress. Things like financial problems, the breakup of a relationship, or the death of a loved one can bring on depression. You can become depressed after changes in your life, like starting a new job, graduating from school, or getting married.
--Pessimistic personality. People who have low self-esteem and a negative outlook are at higher risk of becoming depressed. These traits may actually be caused by low-level depression (called dysthymia).
--Physical conditions. Serious medical conditions like heart disease, cancer, and HIV can contribute to depression, partly because of the physical weakness and stress they bring on. Depression can make medical conditions worse, since it weakens the immune system and can make pain harder to bear. In some cases, depression can be caused by medications used to treat medical conditions.

The National Institute for Mental Health (NIMH) reports that Depression, even the most severe cases, is a highly treatable disorder. As with many illnesses, the earlier that treatment can begin, the more effective it is and the greater the likelihood that recurrence can be prevented. The first step to getting appropriate treatment is to visit a doctor. Certain medications, and some medical conditions such as viruses or a thyroid disorder, can cause the same symptoms as depression. A doctor can rule out these possibilities by conducting a physical examination, interview and lab tests. If the doctor can eliminate a medical condition as a cause, he or she should conduct a psychological evaluation or refer the patient to a mental health professional. The doctor or mental health professional will conduct a complete diagnostic evaluation. He or she should discuss any family history of depression, and get a complete history of symptoms, e.g., when they started, how long they have lasted, their severity, and whether they have occurred before and if so, how they were treated. He or she should also ask if the patient is using alcohol or drugs, and whether the patient is thinking about death or suicide. Once diagnosed, a person with depression can be treated with a number of methods. The most common treatments are medication and psychotherapy.

The NIMH offers suggestions to help a friend or relative:
--Offer emotional support, understanding, patience and encouragement.
--Engage your friend or relative in conversation, and listen carefully.
--Never disparage feelings your friend or relative expresses, but point out realities and offer hope.
--Never ignore comments about suicide, and report them to your friend's or relative's therapist or doctor.
--Invite your friend or relative out for walks, outings and other activities. Keep trying if he or she declines, but don't push him or her to take on too much too soon. Although diversions and company are needed, too many demands may increase feelings of failure.
--Remind your friend or relative that with time and treatment, the depression will lift.

There are many resources to help with depression. Consult your doctor about how to get treatment. Also, there are many sources including both public and private where you can get assistance or refer someone who is suffering from depression. Remember, the sooner treatment is available, the more readily you or a loved one can begin to recover.

Until next time. Let me know what you think.

Friday, August 15, 2008

Health Care and Happiness

Almost everyone likes to be happy. Yahoo News reported that new research shows being happy can add several years to life. A Dutch researcher has indicated from studies done over 60 years that effects of happiness on longevity were "comparable to that of smoking or not". That special flair for feeling good could lengthen life by between 7.5 and 10 years. The finding brings a vital new piece to a puzzle currently being assembled by researchers worldwide on just what makes us happy -- and on the related question of why people blessed with material wealth in developed nations no longer seem satisfied with their lives.

Once the province of poets or philosophers, according to the Yahoo News release, the notions of happiness and satisfaction have been taken on and dissected, quantified and analyzed in the last few years by a growing number of highly serious and respected economists -- some of whom dub the new field "hedonics", or the study of what makes life pleasant, or otherwise. Growth in material wealth adds little to happiness. But happiness can be bolstered by friendship and human community, as well as larger social factors such as freedom, democracy, effective government institutions and rule of law. Economists are working to put "happiness" indicators (a new kind of quality-of-life index) into the measurement of growth. Happiness itself, according to the specialists, is generally accepted as "the overall appreciation of one's life as a whole", in other words a state of mind best defined by the person questioned. in general "happiness does not appear to prolong the deathbed." Among healthy populations, on the contrary, happiness appeared to protect against falling ill, thus prolonging life.

According to the research provided by the article released on Yahoo News, happy people were more inclined to watch their weight, were more perceptive of symptoms of illness, tended to be more moderate with smoking and drinking and generally lived healthier lives. They were also more active, more open to the world, more self-confident, made better choices and built more social networks. Chronic unhappiness activates the fight-flight response, which is known to involve harmful effects in the long run such as higher blood pressure and a lower immune response. Studies on job-satisfaction failed to address the question of life-satisfaction at work. educate people in the art of "living well", helping to develop the ability to enjoy life, to make the best choices, to keep developing and to see a meaning in life.

Medical New Today reported a study by Carnegie Mellon in 2005 that indicated the strongest links between positive emotions and health were found in studies that examined "trait" emotions, which reflect a person's typical emotional experience, rather than "state" emotions, which reflect momentary responses to events. People who typically report more positive emotions experience lower rates of chronic illness, symptoms and pain. Moreover, among the elderly who live on their own or with family rather than in retirement homes, positive emotional dispositions are linked to living longer. In contrast, positive emotions are not associated with increased longevity in studies of other populations, and though possibly beneficial for recovery from less serious diseases, extremely positive emotions are in some cases associated with poorer outcomes among those with serious illness.

The Carnegie Mellon study further indicated that one problem in interpreting the literature is that in many cases, it is difficult to distinguish between the effects of positive and negative emotions. For example, do elderly living on their own or with family live longer because they are happy or because they are not sad? Interestingly, people's experiences of positive and negative emotions are partly independent in some circumstances. For instance, in looking back over the last month or year, one can reasonably report having been both happy and sad. A definitive answer to whether positive or negative emotions are contributing to a health outcome can only come from studies that measure both types of emotions and examine their independent effects. Consequently, it is difficult to conclude from the existing literature whether happiness leads to a healthier and longer life or unhappiness results in a less healthy, shorter one. The authors also were concerned with the possibility that some measures of positive emotions may themselves be direct indicators of physical health. For example, adjectives such as "energetic," "full-of-pep," and "vigorous" may reflect a positive mood, but may also reflect how healthy one feels. Self-rated health has been found to predict illness and longevity above and beyond objective health measures such as physician ratings. Consequently, it is important for future research to include standard measures of self-rated health to help exclude the possibility that researchers are merely predicting good objective health from good perceived health masquerading as positive emotions. And, emotions can have a direct impact on health; for example, they may influence lifestyle choices, or the function of the immune and autonomic nervous systems. Alternatively, they suggest that positive emotions may also influence health by mitigating the harmful effects of stress.

A follow up study done by the same Carnegie researcher in 2006, reported in Psychosomatic Magazine, showed the people who report positive emotions are less likely to catch colds and also less likely to report symptoms when they do get sick. This held true regardless of their levels of optimism, extraversion, purpose and self-esteem, and of their age, race, gender, education, body mass or prestudy immunity to the virus. Also, when they do come down with a cold, happy people report fewer symptoms than would be expected from objective measures of their illness. In contrast, reporting more negative emotions such as depression, anxiety and anger was not associated with catching colds. That earlier study, however, left open the possibility that the greater resistance to infectious illness among happier people may not have been due to happiness, but rather to other characteristics that are often associated with reporting positive emotions such as optimism, extraversion, feelings of purpose in life and self-esteem. The new study finds that happiness and other positive emotions play an even more important role in health than previously reported. Researchers found that when happy people contract a virus, or “catch a cold”, they report fewer symptoms and in fact, are less likely to contract the virus at all.

CNN has reported about the happiness quotient. The Declaration of Independence affirms that we have an inalienable right to pursue happiness, and it is something people do with a vengeance. Americans will spend $750 million on self-help books and more than $1 billion on motivational speakers. More than 100 colleges now offer classes in positive psychology -- the science of happiness. With all those resources focused on achieving happiness, the nation should be brimming with joy. Our culture implores us to buy bigger, newer, better things, but research shows "stuff" does not buy happiness. By and large, money buys happiness only for those who lack the basic needs. Our genes hardwire us to reproduce, but children can have a small negative effect on happiness, research shows. When you follow people throughout their days, as they're going about their normal activities, people are about as happy interacting with their children, on average, as when they're doing housework. They're much less happy than when they're exercising, sleeping, grocery shopping, or hanging out with friends. In fact, neither unhappiness nor joy last as long as we expect. As you've probably guessed, winning the lottery will not guarantee a life of bliss. By the same token, becoming disabled does not relegate one to a life of unhappiness. The disabled spend their days about as happy as the general population. In general for most people, the older you get the happier you get -- until you reach very old age.

According to a Pew Research Center survey, the happiest age group is men 65 and older; the least happy: men 18 to 29. The survey also found:
--Married people are happier than singles.
--College grads are happier than those without a college degree.
--People who were religious are happier than those who aren't.
--Sunbelt residents are happier than other U.S. residents.
--Republicans are happier than Democrats -- but both are happier than independents.

Research shows, according to the Harvard study, most people have an innate level of happiness, and we can also try to boost our happiness a little bit above this natural "set point." You should pass on buying lottery tickets and find small things you can do every day that bring you joy, whether it's going for a walk or cooking a meal or reading a book. There is good evidence that people express at least some fundamental emotions like disgust, anger and happiness in a very similar way all around the world. Happiness from the most traditional cultures to the most modern depend heavily on close family and other human relationships. Additionally, in a report released to Reuters by researchers in January, 2008, those who indicated upbeat moods had lower levels of cortisol — a “stress” hormone that, when chronically elevated, may contribute to high blood pressure, abdominal obesity and dampened immune function, among other problems. In the study, published in the American Journal of Epidemiology, women who reported more positive emotions had lower blood levels of two proteins that indicate widespread inflammation in the body. Chronic inflammation is believed to contribute to a range of ills over time, including heart disease and cancer. Researchers have long noted that happier people tend to be in better health than those who are persistently stressed, hostile or pessimistic.

Health and happiness are very closely tied together in the human body and spirit. Your happiness, or lack of it, can have a direct effect on your health. Depression and mental instability as a result of being unhappy leads to physical maladies that must be treated with counseling, medication, and ongoing therapy until the patient recovers. There are physical, mental, and spiritual levels when dealing with happiness and your health. No one person ever has a life free of unhappiness. However, everyone has the option to choose happiness even in tough times. Remember, your character is not formed by what happens to you but rather by how you deal with it.

Until next time. Let me know what you think.

Wednesday, August 13, 2008

Health Care and Doctor Visits

People are not going to the doctor as much these days. About 22% of Americans have reduced the number of times they see their doctor because they want to save money in these tough economic times, according to a survey released this month by the country's state insurance regulators (National Association of Insurance Commissioners) according to the San Francisco Chronicle. Eleven percent of those surveyed also said they had cut back the number of prescription drugs they take or the dosage of those medications to make the prescription last longer. Some physicians noted an increase in such behaviors by their patients and were concerned about potential health consequences.

Men are the usual culprit most of the time according to a survey released on WebMD in 2007, which was conducted by Harris Interactive for the American Academy of Family Physicians. The report indicated that many U.S. men only go to their doctor when they're extremely sick, skipping preventive care. While most men -- 85% -- said they seek medical treatment when they're sick, almost all -- 92% -- said they waited at least a few days to see if they felt better before seeking care. In the survey, most men indicated that they have health insurance, have a doctor, and feel comfortable talking to their doctor. Nearly 80% said they felt they were in excellent, very good, or good health. However, feeling fine doesn't always mean you're in tip-top shape. For instance, someone who dodges doctor visits might not know whether their cholesterol or blood pressure is too high. Those problems don't have obvious symptoms. Men may be more likely to see their doctor if their wife or partner encourages them to do so, according to the survey--nearly 80% said their spouse/significant other influences their decision to go to the doctor. When men do go to the doctor, most say they always or usually follow their doctor's advice.

According to, Today, doctor visits have become more complex. Doctors are making more diagnoses per visit and managing multiple medications. And the patient may spend only 15 minutes actually seeing the doctor. That's why many patients are challenging the traditional model of "follow doctor's orders." With Web and other drug advertising, people are likely to ask more questions or voice strong opinions about their care. And research shows that patients who are active and involved with their own health care decisions tend to get better results. To get the most out of your visit, approach it as if you were planning for a business meeting. Organize your thoughts, establish an agenda, and by all means, write things down. Do you have symptoms? Jot down notes about when they started, what happens when they occur and what makes them better or worse. Are you on a medication? Write down questions about how long you're supposed to take it, the likely side effects, the costs, and if there is any food, drink or activities you should avoid while taking the medication. also gives very helpful tips about visiting your health care provider. Physicians offer these other recommendations to make your visit to the doctor's office an effective and beneficial one:
1.) Choose a doctor you like. After all, this relationship is an intimate one, and hopefully long-standing. You should feel comfortable asking questions and discussing your health care with your doctor. If he or she speaks in jargon, don't be shy about asking for a simpler explanation. And remember, there's no such thing as a dumb question.
2.) Make an appointment early in the day if you can. A doctor can be knocked off schedule by emergencies or longer-than-expected hospital rounds, or just trying to see too many patients in one day. The earlier your appointment, the less likely you'll be affected by schedule changes. If the doctor is running late, you should be given an update or estimate of his or her arrival. If you're not told, ask.
3.) Involve the office staff. Many people express frustration at having to wait to talk to their doctors about simple health care questions. If this happens, try asking a nurse or another member of the physician's patient-care team to answer any routine questions.
4.) Mention all medications you are taking. This includes all the medications prescribed by other doctors, over-the-counter pills and supplements you take - and even those medications you are supposed to take, but don't. Make a list, or better yet, eliminate any doubt by bringing all your pill bottles.
5.) Tell the doctor about what you used to do, but can no longer do. Sometimes patients come to accept a certain level of disability, particularly if it's the result of a condition that has come on slowly. For example, if you used to run but your knee bothers you, or if you used to garden or knit, but your hands and fingers ache, these are things you should tell your doctor. If you don't share these problems with your doctor, you may miss out on treatments.
6.) Tell the doctor about your concerns - or fears. Make a list, in order of importance, of medical concerns or worries you may have. If you smoke, if you're depressed or under stress, or if you're having incontinence problems, these may be difficult subjects to talk about, but your doctor can help.
7.) Mention if a family member has recently been diagnosed with a serious disease or condition. Family history is crucial information for a doctor. Many patients provide this information when they make an initial visit, but it's also important to keep this information current.
8.) If you travel outside of the country, be sure to let your doctor know, particularly if you're going to formerly remote places in Africa and Asia. This information can become key if you come down with vague "flu-like" symptoms.
9.) Bring along a family member or friend. If you think you may have a hard time remembering or understanding the doctor's recommendations, it's OK to have someone accompany you to the office. Because of patient confidentiality, however, it may not be appropriate for your companion to ask for confidential information on a follow-up phone call, unless you have given the doctor permission to provide such information.
10.) Before you leave, make sure you know what you're supposed to do next. When are you due back? Are you supposed to call, or will someone from the office call with your lab results? What routine screenings are coming up next? How should you prepare for them? Don't leave the doctor's office unclear about what happens next. Otherwise, you'll be making follow-up calls to the office.

Remember, your relationship with your doctor is a partnership. Effective communication will help you and your doctor make the best decisions for your health. It's common to feel confused, and overwhelmed. These feelings and your health condition can make it especially difficult to keep track of and prepare for appointments, medications, and tests. When you go to your doctor you want to accomplish two main goals:
( 1 ) Assist your doctor in determining your medical needs and most appropriate treatment plan;
( 2 ) Ensure that your receive timely access to medical care and the related services you need.

Americans made over 1.1 billion visits to physician offices and hospital outpatient and emergency departments in the last year, which works out to an average of four visits per person per year, according to statistics released by the U.S. Centers for Disease Control and Prevention. With all this activity in the health care marketplace, patients and physicians need to communicate effectively at the time of service and with all follow up visits and correspondence. Time is too precious to waste on ineffective medical solutions, expense, and confusion. The vast majority of medical practitioners are extremely interested in the health and well being of their patients, and effective results benefit both the medical community and the public. Be prepared to work with your doctor when you have your next visit. Don't be afraid to ask questions and seek other options. Trust your doctor and listen to the prognosis. But don't forget, he works for you. The medical industry wants to heal the sick; but overall, it's your health. Make sure you find a physician that fits you for mutual benefit.

Until next time. Let me know what you think.

Monday, August 11, 2008

Health Care and Consumer Reform

The Washington Post online has reported this month that about 82% of Americans are not happy with the current system of health care in the U.S., and they want it overhauled. The Commonwealth Fund survey indicated that the majority of people in the study interview are very frustrated with health care issues such as inefficient and time-consuming record keeping and timely access to medical care. Americans want and deserve improved quality of care with more affordable options. They also want and deserve improved performance by medical providers, access to health care locations, and better treatment by physicians and staff at the time of service.

MSNBC reported the findings and indicated that about a third of those surveyed wanted a complete rebuilding of the U.S. health care system, and about half wanted fundamental change. The majority of respondees felt that health insurance should be simplified, and about 90% of those in the survey supported a wider use of health information that could be shared more efficiently between medical providers. Overall, about 16% of those surveyed felt the system works well and only needed minor reform. The views held were similar regardless of income and insurance status.

The Commonwealth Fund also reported that efficiency and accountability among health care providers needed improvement. Medical providers should be rewarded for high quality care and patients shoudl be incentivized for seeking health providers that offer the best and most efficient care. The number of uninsured should be reduced, and all Americans should have access to affordable care. Americans want a regular family physician who is available to see them on a timely basis and get referrals to specialists and other medical providers. They want improved quality and timeliness of care.

According to the report as released on the Washington Post website, the majority of Americans are very frustrated with the way their health care is managed. There is a lack of coordination including the delay in getting test results and the amount of follow up that is required by the patient. Almost half of those surveyed said they had to make multiple calls to find information. Important health data is not shared between doctors and nursing staff on a timely basis or at all, and the majority of patients wanted access to their medical records. People want a single point of service and coordination of medical information about their care. Patients also reported major issues with contacting physicians for appointments, phone advice, and after hours follow up.

Recommendations by the Commonwealth Fund were offered for improved care--moving away from fee-for-service plans and paying doctors and hospitals based on quality of care. Barriers should be removed that prevent doctors from sharing vital information; doctors and hospitals should be accredited based on quality measures; patient information should be more readily available to physicians at the point of care; and accountability for patient care should be more clearly enforced. Doctors and other medical providers should be trained to work as teams. And the federal government should mandate and support electronic health care records as an alternative to control costs and ease access to information by providers.

In February, 2008, Consumer Reports conducted a similar survey asking questions on how the health care system should be changed. About 80% of the respondees said that a reformed system should guarantee the following: coverage for all uninsured children; protection against financial ruin due to a major illness or accident; the ability to obtain coverage regardless of a pre-existing condition; coverage that continues even when people are laid off, changing jobs, or starting their own business; premiums, deductibles, and out-of-pocket expenses that are affordable relative to family income; and, the ability of people to keep their current health insurance if they choose. Additionally, the Consumer Reports survey also found that Americans are worried about escalating health costs, regardless of their financial status. Overall, 81% of those polled by CR said they're concerned about being able to afford health care in retirement, 68% worry about being bankrupted by medical bills following a serious illness or accident, and 65% fear losing their job-related health coverage.

Consumers were asked their support on the following issues:
-- The most popular proposal -- a mixed public/private system that would require all uninsured Americans to buy health insurance -- drew support from half of the respondents.
-- Thirty-six percent of respondents support public insurance, similar to the Canadian health-care system.
-- One-third of respondents favored a mix of employer-sponsored plans, private health-insurance plans, Medicare, Medicaid, and other public programs, which is the arrangement we have today.
-- Only 26% supported the idea of giving tax incentives for individuals to purchase insurance and relying on market pressures and competition among insurance companies to hold prices down.

The report also offered the following suggestions for improved health care:
1.) Complete coverage: Private insurance and public programs must be expanded to guarantee that everyone is covered from cradle to grave, regardless of health status and ability to pay.
2.) Fair cost spreading: No family should face financial ruin to pay for healthcare. Costs should be spread fairly among government, employers, and consumers.
3.) Safer care: Millions of Americans are harmed each year by the care they receive. Improved safety systems would save billions of health-systemdollars.
4.) Better care: Comprehensive, easy-to-understand public information about the safety, cost, and quality of care by doctors, hospitals, and nursing homes would help consumers and employers choose the best care.
5.) Prevention: Smoking and obesity related illnesses such as certain cancers, heart disease, and type 2 diabetes threaten to overwhelm health expenditures. The primary-care physicians whose job it is to prevent and control those conditions are the most poorly paid of all doctors. Our system should find ways to fix those problems.

It is true that Americans should have the best health care system in the world, but asking the government to pay for it (ultimately the American taxpayers) is not the best course of action. Mandating certain controls, such as sharing health records may reduce costs, but the issues raised by common database sharing need to be fully fleshed out in order to eliminate any potential problems associated with access to patients' private medical information. Transparency of medical information and costs is an area of health care that should be greatly improved. Better access to physicians is also something that should also be improved. Whatever the methods, Americans deserve a health care system that functions more like a finely tuned jet engine than a propeller driven bi-plane.

Until next time. Let me know what you think.

Friday, August 8, 2008

Health Care and Newborns

Going home with a new baby is exciting, but it can be scary, too, according to the National Institutes of Health. Newborns have many needs, like frequent feedings and diaper changes. Babies can have health issues that are different from older children and adults, like diaper rash and cradle cap. Your baby will go through many changes during the first year of life. You may feel uneasy at first. Ask your health care provider for help if you need it. And, according to the Nemours Foundation, consider recruiting help from friends and family to get through this time, which can be very hectic and overwhelming.

While in the hospital, use the expertise around you. Many hospitals have feeding specialists or lactation consultants who can help you get started nursing or bottle-feeding. In addition, nurses are a great resource to show you how to hold, burp, change, and care for your baby. For in-home help, you might want to hire a baby nurse or a responsible neighborhood teenager to help you for a short time after the birth. In addition, relatives and friends can be a great resource. They may be more than eager to help, and although you may disagree on certain things, don't dismiss their experience. But if you don't feel up to having guests or you have other concerns, don't feel guilty about placing restrictions on visitors. The University of Virginia Health System says that assessing the health of a newborn is very important for detecting any problems in their earliest, most treatable, stages.

Since newborns require constant attention, the UVAHS also provides valuable information about looking for any warning signs to monitor the health of babies. Your newborn baby is going through many changes in getting used to life in the outside world. Almost always this adjustment goes well, however there are certain warning signs you should watch for. Some general warning signs with newborns include, but are not limited to:
--no urine in the first 24 hours at home. This can be difficult to assess, especially with disposable diapers.
--no bowel movement in the first 48 hours.
--a rectal temperature over 100.4° F (38° C) or less than 97.5° F (36.5° C).
--a rapid breathing rate over 60 per minute, or a blue coloring that does not go away. Newborns normally have irregular respirations, so you need to count for a full minute. There should be no pauses longer than about 5 seconds between breaths.
--retractions, or pulling in of the ribs with respirations.
--wheezing, grunting, or whistling sounds while breathing.
--odor, drainage, or bleeding from the umbilical cord.
--yellow coloring of the eyes, chest, or extremities.
--crying, irritability, or twitching which does not improve with cuddling and comfort.
--a sleepy baby who cannot be awakened enough to nurse or nipple.
--any signs of sickness (i.e., cough, diarrhea, pale color).
--the baby's appetite or suck becomes poor or weak.

Every child is different, so trust your knowledge of your child and call your child's physician if you see signs that are worrisome to you. If any of these signs should occur, you should contact the doctor right away or take the newborn to the nearest medical facility. Waiting too long or ignoring these medical issues may seriously jeopardize the health of the newborn. Even if the infant is not in imminent danger, any significant change of health, especially in the first 30 days or less, should be addressed as a matter of precaution. Newborns are, indeed, fragile. And they are totally dependent on adults to make sure that their health needs are attended to as a matter of safety and ongoing care during the first days and weeks of life out of the womb.

A very good online resource for newborn information is One of the areas they detail is material concerning pre-mature babies. These newborns require extreme care from health care facilities, physicians, medical staff, and parents. A normal pregnancy lasts nine months, or about 38 to 42 weeks. Newborns are considered to be premature if they are born before they are 37 weeks old. Although there are many risk factors that can help to predict which pregnancies are at risk for premature delivery, in most cases, no cause is found. Among the risk factors that may increase your chances of having a premature baby include:
--Having delivered a previous premature baby, which puts you at a 20-40% of having another premature baby.
--Multiple gestation pregnancies, such as twins, triplets, etc. The risk increases with each additional fetus.
--Placental abruptions and placenta previa are two causes of bleeding that can lead to a premature delivery.
--Having too much (polyhydramnios) or too little (oligohydramnios) amniotic fluid.
--Infections during pregnancy, especially if they spread to the uterus or placenta.
--High blood pressure.
--Preeclampsia, which causes maternal high blood pressure, proteinuria (spilling protein in your urine), and swelling.
--Maternal smoking or use of illicit drugs.
--Maternal malnutrition, especially if it leads to poor weight gain during pregnancy.
--Fibroids, an abnormally shaped uterus and cervical incompetence.
--Becoming pregnant while being treated for infertility, having a previous abortion in the 2nd trimester, and not having prenatal care.
--Problems with the fetus can also lead to a premature delivery, including infections, poor growth and certain birth defects.

The site also recommends that if you think you have risk factors for having a premature baby, be sure to discuss them with your obstetrician. You may have to be seen by a perinatologist, who is a doctor that specializes in high risk pregnancies. If you believe that you are having preterm labor, then you should call your doctor. Among the symptoms of preterm labor include frequent uterine contractions, pain, and increased vaginal discharge, especially if bloody (it may be your mucus plug) or a lot of clear fluid (which can be your water breaking). The more mature your baby is at birth, the more likely that it is that he will not have any problems, so that babies born at 26-29 weeks have a much better chance of surviving and growing up either normal or with mild or moderate problems. Babies born at 30-33 weeks usually do even better, and have a very high rate of survival. After 34 weeks, babies are usually only mildly immature and usually do very well. has much more detail that can assist you in learning more about pre-mature birth and other newborn needs.

The Pregnancy & Parenting section on has information about newborns and the first hours of life related to tests done by the hospital staff. After your child's birth, your baby will experience many important medical procedures, many of them mandated by law. But as long as your child is healthy (and 90% of full-term newborns are), we recommend requesting that all tests (except the Apgar evaluation, which must be performed immediately after the birth) be delayed for at least the first hour of your child's life. This will preserve a very special time for you and your partner to bond with your child immediately after the birth. The following tests and procedures may be performed: Apgar evaluation, eye prophylaxis, vitamin K injection, newborn metabolic screening, blood sugar testing, and hepatitis B vaccine. The Apgar test is a score (named for its creator, Virginia Apgar) that helps evaluate your baby's general condition at birth. The test is performed at one and five minutes after birth by evaluating the infant's heart rate, breathing efforts, muscle tone, reflexes and color and assigning a score of 0, 1 or 2 to each category. A total score of 10 is the highest, and most babies will rate between seven and nine by five minutes.

According to the March of Dimes, newborns send signals to their parents about how they feel and what they need. But as a new parent, you may not know how to read those signals. As the parent of a newborn, you will want to be aware of the following:
--How babies signal that they're hungry, tired, don't feel well or want to play.
--How sleep patterns change over time.
--How a newborn responds and moves.
--How to manage a crying baby.
And, among other issues, you will also want to be knowledgeable about these newborn traits:
--States of awareness
--The newborn's senses
--Reflexes and movements
--Playing and break time

Providing nurture and care for a newborn is a full time job not to be taken lightly by any parent or health care provider. Knowing what to do is also as important as when to do it. If you have experienced a recent birth or are about to for the first time, take time to get educated on the best ways to manage their care. There are plenty of resources available that leave no doubt about the care and treatment for newborns. Newborns, regardless of whom or where, are precious gifts from God. Treat them accordingly.

Until next time. Let me know what you think.

Thursday, August 7, 2008

Health Care and E-Health

Americans are very interested in getting information about health care information on the internet. The Pew Internet Project just released indicates that 10% of internet users say they searched for health information "yesterday," which in a tracking survey like this one yields a picture of the "typical day" online. Health has moved up in the "typical day" list (from 7% in 2006 to the current 10 percent of internet users), but for most people the average day includes lots of emails (60% of internet users), general searches (49%), and news reading (39%) if they are online at all (30% of internet users are offline on a typical day). The internet is an important source of health information and a force for change in health care.

The Journal of Medical Internet Research (JMIR) defines e-health as an emerging field in the intersection of medical informatics, public health and business, referring to health services and information delivered or enhanced through the Internet and related technologies. In a broader sense, the term characterizes not only a technical development, but also a state-of-mind, a way of thinking, an attitude, and a commitment for networked, global thinking, to improve health care locally, regionally, and worldwide by using information and communication technology. Also, eHealth describes the application of information and communications technologies across the whole range of functions that affect the health sector, from the doctor to the hospital manager, via nurses, data processing specialists, social security administrators and - of course - the patients.

According to Wikipedia, eHealth (also written e-health) is a relatively recent term for healthcare practice which is supported by electronic processes and communication. The term is inconsistently used; and some would argue it is interchangeable with health care informatics and sub sets, while others use it in the narrower sense of healthcare practice using the Internet. The term can encompass a range of services that are at the edge of medicine/healthcare and information technology:
1.) Electronic Medical Records: enable easy communication of patient data between different healthcare professionals (GPs, specialists, care team, pharmacy)
2.) Telemedicine: includes all types of physical and psychological measurements that do not require a patient to travel to a specialist. When this service works, patients need to travel less to a specialist or conversely the specialist has a larger catchment area.
3.) Evidence Based Medicine: entails a system that provides information on appropriate treatment under certain patient conditions. A healthcare professional can look up whether his/her diagnosis is in line with scientific research. The advantage is that the data can be kept up-to-date.
4.) Consumer Health Informatics (or citizen-oriented information provision): both healthy individuals and patients want to be informed on medical topics.
5.) Health knowledge management (or specialist-oriented information provision): e.g. in an overview of latest medical journals, best practice guidelines or epidemiological tracking.
6.) Virtual healthcare teams: consist of healthcare professionals who collaborate and share information on patients through digital equipment (for transmural care).
7.) mHealth or m-Health: includes the use of mobile devices in collecting aggregate and patient level health data, providing healthcare information to practitioners, researchers, and patients, real-time monitoring of patient vitals, and direct provision of care (via mobile telemedicine).
8.) Medical research uses eHealth Grids that provide powerful computing and data management capabilities to handle large amounts of heterogenous data.

The publishers of Telemedicine and e-Health magazine indicate that eHealth covers all aspects of clinical telemedicine practice, technical advances, enabling technologies, education, health policy and regulation and biomedical and health services research dealing with clinical effectiveness, efficacy and safety of telemedicine and its effects on quality, cost and accessibility of care, medical records and transmission of same. Telemedicine applications play an increasingly important role in health care and provide tools that are indispensable for disease management, home telemetry, and remote care that encompasses not only rural health and battlefield care, but nursing home, assisted living facilities, and maritime and aviation applications. Advances in technology including wireless connectivity and mobile devices will give practitioners, medical centers, and hospitals important new tools for managing patient care, electronic records, and medical billing to ultimately enable patients to have more control of their own well being. As the nation once more addresses health care reform, the contributions of telemedicine need to be fully understood and appreciated and reimbursement policies must be in place for these applications.

Additionally, according to the eHealth Institute, eHealth resources can help:
--Improve health status by supporting healthy lifestyles, improving health decisions, and enhancing health care quality;
--Reduce health care costs by improving efficiencies in the healthcare system and prevention;
--Empower people to take greater control of their health by supporting better-informed health decisions and self-care;
--Enhance clinical care and public health services by facilitating health professional practice and communication; and
--Reduce health disparities by applying new approaches to improve the health of underserved populations.

Here are the 10 E's of eHealth, according to the JMIR:

1.) Efficiency - one of the promises of e-health is to increase efficiency in health care, thereby decreasing costs. One possible way of decreasing costs would be by avoiding duplicative or unnecessary diagnostic or therapeutic interventions, through enhanced communication possibilities between health care establishments, and through patient involvement.
2.) Enhancing quality of care - increasing efficiency involves not only reducing costs, but at the same time improving quality. E-health may enhance the quality of health care for example by allowing comparisons between different providers, involving consumers as additional power for quality assurance, and directing patient streams to the best quality providers.
3.) Evidence based - e-health interventions should be evidence-based in a sense that their effectiveness and efficiency should not be assumed but proven by rigorous scientific evaluation, and much work still has to be done in this area.
4.) Empowerment of consumers and patients - by making the knowledge bases of medicine and personal electronic records accessible to consumers over the Internet, e-health opens new avenues for patient-centered medicine, and enables evidence-based patient choice.
5.) Encouragement of a new relationship between the patient and health professional, towards a true partnership, where decisions are made in a shared manner.
6.) Education of physicians through online sources (continuing medical education) and consumers (health education, tailored preventive information for consumers)
7.) Enabling information exchange and communication in a standardized way between health care establishments.
8.) Extending the scope of health care beyond its conventional boundaries. This is meant in both a geographical sense as well as in a conceptual sense. e-health enables consumers to easily obtain health services online from global providers. These services can range from simple advice to more complex interventions or products such a pharmaceuticals.
9.) Ethics - e-health involves new forms of patient-physician interaction and poses new challenges and threats to ethical issues such as online professional practice, informed consent, privacy and equity issues.
10.) Equity - to make health care more equitable is one of the promises of e-health, but at the same time there is a considerable threat that e-health may deepen the gap between the "haves" and "have-nots". People, who do not have the money, skills, and access to computers and networks, cannot use computers effectively. As a result, these patient populations (which would actually benefit the most from health information) are those who are the least likely to benefit from advances in information technology, unless political measures ensure equitable access for all. The digital divide currently runs between rural vs. urban populations, rich vs. poor, young vs. old, male vs. female people, and between neglected/rare vs. common diseases.

In addition to these 10 essential e's, the JMIR says e-health should also be:
--entertaining (no-one will use something that is boring!), and

Electronic medicine and eHealth are the future, and we need to use it now. Being able to access health care data quickly and efficiently will definitely help to reduce costs and decrease inefficiencies in the medical marketplace. eHealth is beneficial to insurance companies, medical providers, government, and patients. Americans deserve the best.

Until next time. Let me know what you think.

Wednesday, August 6, 2008

Health Care and Menopause

Menopause, or the permanent end of menstruation and fertility, is a natural biological process, not a medical illness. Even so, the physical and emotional symptoms of menopause can disrupt your sleep, sap your energy and — at least indirectly — trigger feelings of sadness and loss, according to the Mayo Clinic. Hormonal changes cause the physical symptoms of menopause, but mistaken beliefs about the menopausal transition are partly to blame for the emotional ones. First, menopause doesn't mean the end is near — you've still got as much as half your life to go. Second, menopause will not snuff out your femininity and sexuality. In fact, you may be one of the many women who find it liberating to stop worrying about pregnancy and periods.

Most important, even though menopause is not an illness, you shouldn't hesitate to get treatment if you're having severe symptoms as described by the Mayo Clinic. Technically, you don't actually "hit" menopause until it's been one year since your final menstrual period. In the United States, that happens about age 51, on average. The signs and symptoms of menopause, however, often appear long before the one-year anniversary of your final period. They include:
--Irregular periods
--Decreased fertility
--Vaginal dryness
--Hot flashes
--Sleep disturbances
--Mood swings
--Increased abdominal fat
--Lost of breast fullness
--Thinning hair

Menopause affects every woman according to WebMD. Premature menopause symptoms (or early menopause symptoms) may include irregular periods or hot flashes. Other signs of menopause include night sweats, sleep difficulties, and irritability. Menopause treatments may include hormone replacement therapy, although this is not for every woman. Herbal remedies for menopause may include soy foods and natural supplements. If you have bleeding after menopause, call your doctor as it may indicate a more serious problem.

Menopause, according to the Mayo Clinic, begins naturally when your ovaries start making less estrogen and progesterone, the hormones that regulate menstruation. The process gets under way in your late 30s. By that time, fewer potential eggs are ripening in your ovaries each month, and ovulation is less predictable. Also, the post-ovulation surge in progesterone — the hormone that prepares your body for pregnancy — becomes less dramatic. Your fertility declines, perhaps partially due to these hormonal effects. These changes are more pronounced in your 40s, as are changes in your menstrual pattern. Your periods may become longer or shorter, heavier or lighter, and more or less frequent.

Eventually, your ovaries shut down and you have no more periods according to Mayo Clinic. It's possible, but very unusual, to menstruate every month right up to your last period. You're much more likely, though, to have a gradual tapering off. Unfortunately, there's no way to know exactly which period will be your last. You have to wait until well after the fact — 12 months after, by official definition. In your final months before reaching menopause, it's still possible to get pregnant, but it's quite unlikely. The signs and symptoms of menopause are enough to tell most women they have begun going through the transition. If you have concerns about irregular periods or hot flashes, talk with your doctor. In some cases further evaluation may be recommended.

Because this process takes place over years, menopause is commonly divided into the following two stages as reported by the Mayo Clinic:
1.) Perimenopause: This is the time you begin experiencing menopausal signs and symptoms, even though you still menstruate. Your hormone levels rise and fall unevenly, and you may have hot flashes and other symptoms. Perimenopause may last four to five years or longer.
2.) Postmenopause: Once 12 months have passed since your last period, you've reached menopause. Your ovaries produce much less estrogen and no progesterone, and they don't release eggs. The years that follow are called postmenopause.

Researchers at Rush University Medical Center in Chicago have recently discovered some new and interesting relationships between menopause and sleep. In a recent study, they found that difficulty falling asleep and staying asleep increase as women go through menopause. The study also said that waking up earlier than planned also increases through late perimenopause -- before menopause -- but decreases when women become postmenopausal.
Also according to the Mayo Clinic, several chronic medical conditions tend to appear after menopause. By becoming aware of the following conditions, you can take steps to help reduce your risk:
1.) Cardiovascular disease: When your estrogen levels decline, your risk of cardiovascular disease increases. Heart disease is the leading cause of death in women as well as in men. Yet you can do a great deal to reduce your risk of heart disease. These risk-reduction steps include stopping smoking, reducing high blood pressure, getting regular aerobic exercise, and eating a diet low in saturated fats and plentiful in whole grains, fruits and vegetables.
2.) Osteoporosis: During the first few years after menopause, you may lose bone density at a rapid rate, increasing your risk of osteoporosis. Osteoporosis causes bones to become brittle and weak, leading to an increased risk of fractures. Postmenopausal women are especially susceptible to fractures of the hip, wrist and spine. That's why it's important during this time to get adequate calcium and vitamin D — about 1,200 to 1,500 milligrams of calcium and 800 international units of vitamin D daily. It's also important to exercise regularly. Strength training and weight-bearing activities such as walking and jogging are especially beneficial in keeping your bones strong.
3.) Urinary incontinence: As the tissues of your vagina and urethra lose their elasticity, you may experience a frequent, sudden, strong urge to urinate, followed by an involuntary loss of urine (urge incontinence), or the loss of urine with coughing, laughing or lifting (stress incontinence).
Weight gain. Many women gain weight during the menopausal transition. You may need to eat less — perhaps as many as 200 to 400 fewer calories a day — and exercise more, just to maintain your current weight.
According to the U.S. Health & Human Services, eating a healthy diet and exercising at menopause and beyond are important to feeling your best. Most women do not need any special treatment for menopause. But some women may have menopause symptoms that need treatment. Several treatments are available. It's a good idea to talk about the treatments with your doctor so you can choose what’s best for you. There is no one treatment that is good for all women. Sometimes menopause symptoms go away over time without treatment, but there’s no way to know when.
The National Institute on Health has suggestions on health care after menopause. Staying healthy after menopause may mean making some changes in the way you live.
--Don’t smoke. If you do use any type of tobacco, stop—it’s never too late to benefit from quitting smoking.
--Eat a healthy diet, low in fat, high in fiber, with plenty of fruits, vegetables, and whole-grain foods, as well as all the important vitamins and minerals.
--Make sure you get enough calcium and vitamin D—in your diet or with vitamin/mineral supplements.
--Learn what your healthy weight is, and try to stay there.
--Do weight-bearing exercise, such as walking, jogging, or dancing, at least 3 days each week for healthy bones. But try to be physically active in other ways for your general health.

The NIA also offers other things to remember:
--Take medicine if your doctor prescribes it for you, especially if it is for health problems you cannot see or feel—for example, high blood pressure, high cholesterol, or osteoporosis.
--Use a water-based vaginal lubricant (not petroleum jelly) or a vaginal estrogen cream or tablet to help with vaginal discomfort.
--Get regular pelvic and breast exams, Pap tests, and mammograms. You should also be checked for colon and rectal cancer and for skin cancer. Contact your doctor right away if you notice a lump in your breast or a mole that has changed.
Menopause is a change of life for all women who live to the age when it happens. It can be very frustrating and confusing for many women who have trouble dealing with the symptoms. Other family members also must deal with the physical and emotional issues that are brought on during this time. Consultation with primary care providers and other health care counselors will help you deal with the complications that are part of menopause. Remember that there are many resources available to you if you are experiencing this particular season of life. Use them.
Until next time. Let me know what you think.

Friday, August 1, 2008

Health Care and Heart Disease

Heart Disease is one of the top killers in the U.S. today. According to, coronary heart disease kills almost half a million Americans a year. According to the American Heart Association, about 62 million Americans have some form of cardiovascular disease, which can include high blood pressure, coronary heart disease (heart attack and chest pain), stroke, birth defects of the heart and blood vessels, and congestive heart failure. Heart disease is by far the #1 killer in the U. S., although a third of those deaths could be prevented if people exercised more and followed better diets. There have been a few improvements, though, which comes from a reduction in risk factors like cholesterol, blood pressure, and smoking. Additionally, improvements in surgery and procedures are decreasing death rates to some degree.

According to the U.S. Department of Health and Human Services, heart disease is a group of diseases of the heart and the blood vessel system in the heart. Coronary heart disease, the most common type, affects the blood vessels of the heart. It can cause angina or a heart attack. Angina is a pain in the chest that happens when the heart does not get enough blood. It may feel like a pressing or squeezing pain, often in the chest, but sometimes in the shoulders, arms, neck, jaw, or back. Having angina means you're more likely to have a heart attack. A heart attack happens when a blood vessel is blocked for more than 20 minutes.

The American Heart Association says that some heart attacks are sudden and intense — the "movie heart attack," where no one doubts what's happening. But most heart attacks start slowly, with mild pain or discomfort. Often people affected aren't sure what's wrong and wait too long before getting help. Here are signs that can mean a heart attack is happening:
--Chest discomfort. Most heart attacks involve discomfort in the center of the chest that lasts more than a few minutes, or that goes away and comes back. It can feel like uncomfortable pressure, squeezing, fullness or pain.
--Discomfort in other areas of the upper body. Symptoms can include pain or discomfort in one or both arms, the back, neck, jaw or stomach.
Shortness of breath. May occur with or without chest discomfort.
--Other signs: These may include breaking out in a cold sweat, nausea or lightheadedness.

The HHS also indicates certain signs of a heart attack:
--Pain or discomfort in the center of the chest for more than 20 minutes.
--Pain or discomfort lasting more than 20 minutes in other parts of the upper body, including the arms, back, neck, jaw, or stomach. Other symptoms may include:
1.) unusual tiredness
2.) trouble sleeping
3.) problems breathing
4.) indigestion (upset stomach)
5.) anxiety (feeling uneasy or worried)

With Congestive Heart Failure, according to eDocAmerica, when the word "failure" is attached to a particular organ, e.g. kidney failure, liver failure, heart failure, etc., it conjures up thoughts of a final or terminal phase in the function of the organ. In most instances of organ "failure", however, there is a variable period of time in which the function is diminished prior to the time that the organ ceases to function altogether. This is particularly true of congestive heart failure (CHF). Depending on the cause for the heart failure, the course may be acute and severe, but typically the "failing" heart keeps working, just not as efficiently as it should. At issue is the underlying cause for the heart failure and how effectively it is managed. The most common reasons for developing CHF include:
--Coronary artery disease which results in diminished blood flow to the heart muscle.
--Heart attack with the development of "scar tissue" which interferes with the normal pumping action of the heart.
--High blood pressure which causes the heart to have to pump against higher resistance.
--Disease or deformity of the heart valves.
--Congenital heart disease
--Infection of the heart muscle or valves.

As may be expected, according to eDocAmerica, when the CHF is related to an acute event such as a heart attack or an infection, the course may be more rapid than when it occurs in association with a long-standing problem such as hypertension. In most cases, CHF is a chronic, long-term condition. A number of treatments are available that can help ease the workload of the heart and relieve symptoms. Lifestyle changes, medications, and surgery each play a role in the management of CHF. Beneficial lifestyle measures include not smoking, limiting alcohol consumption, eating a diet low in saturated fat and salt, and participating in a doctor-approved exercise program. A number of medications may be used, depending on the type of heart failure and its severity. The most common of these are diuretics (to help rid the body of extra fluid), digitalis, which strengthens the heart's pumping ability, ACE inhibitors, which reduce heart enlargement and improve heart function, and beta blockers, which can reduce the workload on the heart. Since hypertension is a leading cause for the development of CHF, use of medications to control blood pressure is highly important also. When coronary artery disease is contributing to the CHF, surgical procedures to open these arteries (angioplasty, stenting and coronary bypass) may be necessary. Other surgical treatments, depending on the underlying cause for the failure, include heart valve repair or replacement, correction of congenital heart defects, and pacemaker insertion. The diagnosis of Congestive Heart Failure is not synonymous with a death sentence. In most cases, CHF can be managed with improvement in symptoms and in quality of life.

There are many types of heart disease. Issues concerning heart disease are extremely important and should be diagnosed early if you feel that you are suffering from any symptoms. To not take action is life threatening. Make sure that you keep a healthy regimen and see a primary care physician on a regular basis. At some point, you may wish to take a stress test to make sure that your heart is in good shape. A healthy heart means a healthy life.

Until next time. Let me know what you think.