Tag: Health

General interest
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Helping Mom die

by Fran Johns

Flight #12 had not even left the gate in San Francisco yesterday before the conversation was underway. The man in seat #16F was talking to his new friend in #16E about his trip: another of many undertaken by himself and his siblings to their mother’s home in the long process of packing up, sorting through, tossing out, agonizing over. The scene is a familiar one to millions of Americans: aging, often isolated mom; far-flung, often cash-strapped, over-stressed children; a bewildering assortment of issues to be dealt with, ranging from health to housing to family dynamics.

I, of course, am the mom. Well, not #16F’s mom, and currently in good health and of relatively sane mind. But 76, with children across the continent and a dizzying amount of Stuff to be dealt with if my husband should have the crass inconsideration to die first and leave me to deal with it. (Actually, he’s been very good about making arrangements for disposition of his Stuff, but still, there are those piles and boxes and shelves of miscellany and cupboards of chipped dishes. And closets full of clothes from the 1950s and still perfectly wearable… but I digress.)

My sisters and I were fortunate that our dad looked after our mom as she slowly died, swearing they had a fine conversation the night before although dementia had long stolen her ability to converse; my father created his own realities. Twenty years later, the town of Ashland, VA, with the assistance of Randolph-Macon College, looked after our dad, because indeed it takes a village. But fewer and fewer of us have the traditional village, and more and more of us have the complications: dementia, physical issues, personal problems, too little financial and emotional resources, too much Stuff.

There is help. There are community centers and assisted living arrangements, there is the new Villages concept (more about that one in the next week or so) and an array of other anti-isolationist possibilities; there are nonprofits of every sort, from the Family Caregiver Alliance to multiple physical/emotional-needs groups to my alltime favorite, in name at least, the National Study Group on Chronic Disorganization. God willing, we may even get health care, but thanks to those earlier, similar battles we at least now have Medicare and Medicaid.

But too many of us still put it all off, and it falls to the children. We cling to the past in the form of too many boxes of old photos and letters and opera programs; we drive too long and invite fender-benders or worse; we think that old chair is worth too much for a garage sale; we forget to take the pills.

The issue, of course, is not about dying; it’s about living. Living as well as possible for as long as possible, as closely as possible to what we would choose for ourselves. But here’s what happens eventually: mom dies. It’s tough, but it’s probably okay.

I gave my card with the True/Slant website on it to the nice people in #16E and #16F; maybe they’ll check in. When I get back home, though, I think I’ll clean out some files.

General interest/Health/Lifestyle/Politics & Causes/USA
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Safeway carrot-stick plan a boon to reform

by Fran Johns

There was a little local pride in a key segment of the Senate Finance Committee’s health care bill reported today by Andrew S. Ross of the San Francisco Chronicle:

It’s not every day a local grocery has a congressional amendment named after it. Such an honor has been bestowed on Pleasanton’s Safeway Inc., whose stick-and-carrot health insurance program is the model for a “wellness provision” in a health care reform bill that passed the Senate Finance Committee last week by an unusually bipartisan 18-4 vote.

“Yes, it’s quite fair to call it the ‘Safeway amendment,’ ” said a spokesman for Sen. John Ensign, R-Nev., who co-sponsored the amendment with Sen. Tom Carper, D-Del. “He’s a big advocate of the Safeway program.”The provision, designed to “incentivize Americans to lead healthy lifestyles in order to lower their overall health care costs,” would allow companies with self-insurance programs to reward employees with bonuses and/or premium reductions of up to 50 percent if they follow health guidelines, like undergoing regular screenings, quitting smoking, losing weight, taking cholesterol-reducing medications and so on.

While some question the accuracy of reported cost savings, the measure has strong support among key politicians up to and including President Obama.

As a beneficiary of Kaiser‘s “wellness” program — a constant push toward healthy lifestyles and preventive medicine — I hope this piece of the legislation stays. As long as he’s not going to resign, Senator Ensign might as well be doing something useful over there.

via Safeway plan part of Senate health care debate.

General interest/Health/Money/Politics & Causes/USA
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Healthcare coding for Ayurveda – Why not?

by Fran Johns

Having taken up brain fitness (see below) a few days ago, this space today offers a few notes on Emotional Vibrancy and Wellbeing in this modern day and age. They come straight from a lecture of the same title by Sudha Prathikanti, MD presented by the UCSF National Center of Excellence in Women’s Health and the UCSF Osher Center for Integrative Medicine. Dr. Prathikanti, UCSF Professor of Psychiatry, Consultant in Integrative Medicine and an exceptionally lovely young woman, clearly has achieved balance in her mind/body systems. Plus, she has a power-point lecture clear enough for lay listeners within her mostly-medical-professional audience to comprehend.

Emotional vibrancy and well-being, Dr. Prathikanti explains, “spring from a life lived in balance where one’s spirit is strong and resilient, with the capacity to embrace and grow from the pain and loss which are a natural part of human life.” Whereas western medicine tends to approach disease as a battle to be joined and conquered, she says, almost all other cultures from Native American to Asian have a more holistic approach. If you’re feeling a little out of balance, these glimpses into Ayurveda — the wisdom tradition of India — might help.

Ayurveda, Dr. Prathikanti explains, is a full medical system based on the concept that we humans are made up of the five basic elements (5 Great Bhutas) — earth, fire, water, air and space. We embody three life sources (3 Great Doshas): Vata, Pitta and Kapha. Each dosha has specific expression; we come with all three in unique individual constitutions, and they are initially in balance. It’s when they get out of whack that trouble comes.

OK, perhaps this is sounding obtuse, but stick with it; you may discover something useful.

Vata (air, space, water) is all that moves — the beating heart, the blinking eye, the wandering mind. Pitta (mostly fire, a little water) has to do with heating — those digestive enzymes busy cooking up dinner, the fiery intellect. Kapha (earth/water — think clay) involves all that binds, the joints, body mass, memory. Ayurveda will seek to determine at what point your mind/body function was at its best — say, that summer you worked as a lifeguard on the beach and were doing graduate school classes at night — and keep you in that good balance.

Dr. Prathikanti conjured up three sample people and gave them a case of severe grief to illustrate how the different doshas work when things get out of balance. Vata, slightly built and having a quirky, creative mind, under such stress might wind up jumpy and restless, change jobs too much, have trouble making decisions. Pitta, owns her own business, the fiery mind etc, could wind up smoking and drinking and eating too many hot tamales. Kapha, earthy homemaker, might eat and sleep too much, become listless and withdrawn. The process of recovery would address each of these issues in ways to regain balance.

None of this is likely to make it into the health reform bill. But since we have finally begun to acknowledge that AMA-guided traditional American medicine may not know everything there is to know — Kaiser, when I considered acupuncture recently for a chronic pain issue promptly sent me to their Chinese Medicine class — perhaps a little ancient Indian wisdom will be useful.

By the end of the lecture I had figured out I’m a predominant Vata married to a definite Pitta, and is that good? Dr. Prathikanti assured me that understanding one’s doshas and keeping them in balance is indeed advisable, but she rather gently suggested that having a consultation with an ayurvedic practitioner for starters is wise.

In other words, it’s a good idea to know what you’re talking about. Still, we offer the above as a toast to your health.

General interest/Health/Money/USA
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How's your brain fitness today?

by Fran Johns

Pick five random numbers, say them out loud. Now say them backward. No fair using props. You have now exercised your brain, and your brain appreciates it.

Alvaro Fernandez, co-founder and CEO of SharpBrains, author of The SharpBrains Guide to Brain Fitness, enthusiastic speaker on healthy brains and how to keep them, addressed a group at the New York Library — great spot for exercising brains — recently and another in San Francisco a few days later. If you’ve ever despaired over forgetfulness or worried about some day getting Alzheimer’s, Mr. Fernandez will brighten your day. Much as the gym trainers promise you your muscles can be strengthened, Alvaro Fernandez can convince you those neurons can multiply and prosper. With an energy and demeanor to match his several degrees, he may one day be the Jack Lalanne of brain fitness.

The San Francisco audience was made up of members of San Francisco Village, the second such aging-in-place organization in California. (Other village-concept communities are springing up across the country, preferred options for many seniors who want to stay in their homes.) Most of them highly active and engaged, they were receptive to Fernandez’ proposals about how to stay that way.

Fernandez began by offering facts to debunk a few popular myths about brain function: Lifelong neuroplasticity means we can always help our brains evolve through lifestyle and activities; brain function can be affected by a variety of things, from yoga to cognitive therapy; and nothing is carved in stone that says brains deteriorate with age. In short, you might not be able to avoid Alzheimer’s completely if it’s in your genes and your karma, but you might well be able to forestall it with vigorous exercise.

Four “pillars of maintenance” will keep the brain fit, Fernandez says: good nutrition, stress managment, physical exercise and brain exercise. Potato chips and TV are not on the pillars list. The best comment of the event, in fact, probably came from author/healthy aging expert and SF Village advisory board member Walter Bortz, MD, who quoted a Harvard study that revealed “watching TV is like staring at a brick wall.”

Your brain is, when you come right down to it, not interested in the TV.

General interest/Health/USA
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Modeling how to die

by Fran Johns

My remarkable friend Mary died yesterday, after showing us how to do it. Not when, mind you, because she was far too young and energetic — just how. How to question and oppose, to look at options, and eventually to accept the fact that life is fine and finite and go with grace into whatever lies ahead.

Diagnosed with pancreatic cancer barely a year ago, Mary began what would be a studied exploration of traditional and experimental interventions to see if she might wrangle some extra quality time on the planet that she had carefully nurtured throughout her life. Almost as importantly – most importantly to her host of concerned friends – she and her husband Tom signed up on CaringBridge. Immediately, her host of friends also signed on, forming a sort of cybercircle around the family.

As the journey progressed, they would post pictures and notes about their travels and travails, filled with exuberant photos, irrepressible humor and a clear-eyed view of our shared mortality. Friends and relations would sign in with their own comments. Sometimes the latter would include off-beat ideas for something else to fling in the face of the disease; more often they would be notes about how Mary and Tom were brought spiritually into other circles when they couldn’t be physically present. Sometimes they would be long and rambling; more often they would be simple affirmations of how the couple and their family were being held close in so many hearts.

It was an extraordinary gathering. With their three grown children and a few others on site, there was relatively little taking-of-casseroles over these months, though Mary was always the first to show up with a giant jug of homemade chicken soup whenever some affliction struck at my house (and many others.) The cybercircle kept us regularly informed, assured us that we were part of the journey, and served, I believe, as a constant reminder to Mary and Tom that dozens and dozens of their friends were at their virtual side along the way. It helped that both of the central characters – and they were central characters in all the best senses – were thoughtful and eloquent writers.

While preparing for a new round of treatment not long ago, Mary and Tom learned that her tumors had returned with a vengeance. So instead of setting out for one adventure they settled in for another. Hospice was called in, their children gathered even closer. Postings in cyberspace documented the passage of those days, from occasional sunset walks into the nearby hills to readings of comments from friends, as Mary grew weaker, that might win what Tom described as the ultimate honor, “the coveted arched eyebrow.”

As she died, Mary’s family fluffed the pillows and administered “magic drops and potions, all of which helped only sort of.” Afterward, Tom opened the window as a friend had prompted, ” to free her spirit, not that she needed any help from me” and hung their Revolutionary War era ‘Liberty’ flag out front.  And sent a final note into cyberspace for the ever-expanding circle of friends: “All hail, Mary, so very, very full of grace.”

General interest/Health/Money/Politics & Causes/USA
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Pills vs. Time: The Power of Patience

by Fran Johns

Another interesting article about slowing down our rush-to-treatment healthcare mentality (see Pills & Perils below) appeared in Tuesday’s ‘Personal Journal’ section of The Wall Street Journal. This one is a lot simpler: do nothing, just wait. WSJ‘s Melinda Beck is writing less about serious afflictions than about the minor problems that plague us all; still it points once again to our cultural tendency to Do Something, whatever it is.

What cures colds, flu, sore throats, sore muscles, headaches, stomach aches, diarrhea, menstrual cramps, hangovers, back pain, jaw pain, tennis elbow, blisters, acne and colic, costs nothing, has no weird side effects and doesn’t require a prescription?

Plain old-fashioned time. But it’s often the hardest medicine for patients to take.

“Most people’s bodies and immune systems are wonderful in terms of handling things—if people can be patient,” says Ted Epperly, a family physician in Boise, Idaho, and president of the American Academy of Family Physicians.

“I have a mantra: You can do more for yourself than I can do for you,” says Raymond Scalettar, a Washington, D.C., rheumatologist and former chairman of the American Medical Association. But, he says, “some patients are very medicine-oriented, and when you tell them they aren’t good candidates for a drug they’ve heard about on TV, they don’t come back. I have colleagues who say, ‘You can take this pill and get better in two days, or do nothing and get over it in 48 hours,’ ” says Dr. Scalettar.

Of course, we know this. Most of us have some genetic strain of either the leave-it-alone-it’ll-be-better-in-the-morning or the shut-up-and-tough-it-out approach to all aches and pains. But we also have those constant messages from the TV set, and increasingly from the computer screen, that say one little pill will make it all better, right this very minute. And we are a right-this-very-minute society.

Almost all viral infections resolve on their own, unless you have a compromised immune system. As a rule of thumb, Dr. Epperly says, infections in the nose, throat, stomach and upper respiratory tract tend to be viral. Infections elsewhere in the body are likely to be caused by bacteria, and those can get worse without antibiotics. About 80% of urinary-tract infections resolve on their own, for example, but about 20% develop into more serious kidney or blood infections. And even if they don’t, the symptoms can be very uncomfortable.

Some chronic maladies follow predictable courses, according to many medical experts ,whether or not they are treated.

Colic is almost always gone in four months. Some 70% of acne is gone three to four years after it first appears. “Frozen shoulder”—a painful restriction of the shoulder joint—is typically painful for three to six months and stiff for the next four to six months, and resolves completely after one to three more months. Temporomandibular joint (TMJ) pain tends to go away by itself in 18 months. Sciatica resolves on its own in three weeks in 75% of cases.

Not many of us do pain and misery very well. As a repeat TMJ sufferer, I can promise you if I tried to wait it out without pain killers for 18 days, let alone months, my entire neighborhood block would evacuate. Pain (see Caitlin Kelly’s Broadside post a few hours ago) is in a category all its own. Actually, though it is hell to pay, sometimes it can serve a purpose. My good husband wound up in the emergency room with a gall bladder infection that would’ve had anyone else, surely including myself, shrieking in agony; he does not feel pain. That is great when you’re young and macho, not so good when you get a few years on you and could use a signal that something’s wrong.

But for the minor issues, things wrong can often right themselves without outside interference. Now… if I could only start over again with everything I should or shouldn’t have taken…

When Doing Nothing Is the Best Medicine – WSJ.com.

General interest
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Drugs, Perils and Trust

by Fran Johns

Oh great. Now I’ve got to worry about lung cancer.

Recently released findings on hormone replacement therapy now show it nearly doubles the risk of dying of lung cancer for those women who followed this regimen. Already we’ve learned that HRT is linked to increases in breast cancer, heart disease, stroke and who knows what else. It’s giving me a headache.

Hormone replacement therapy was, some 30 or more years ago, generally accepted as being the be-all and end-all for postmenopausal women. No hot flashes! Limitless energy! Avoid cancer! Resist heart disease! Live long and prosper! That was more or less the message. My good physician, now long dead of drug-related causes himself but a wise and decent man he was, enlisted the aid of his nurse, who was also a friend of mine, to convince me to begin HRT. Addictable to anything that comes down the pike and resistant to drug-taking in general, I protested. But they and the general public belief that these drugs (estrogen and progestin) were the answer to every woman’s prayers, convinced me. I took them daily for years, then once weekly, when the formulae were perfected.

I quit in 2006 for the best of reasons: breast cancer.

I am absolutely certain my doctor wanted only the best for me. But I’m still somehow a little comforted now by the knowledge that Kaiser does not let drug company representatives meet with its physicians. Most of us trust our doctors. Some people whom they trusted convinced a lot of doctors, 30+ years ago, that HRT was a wonderfully promising regimen. Oh, doctors also read reports and journal articles, and listened to presentations, and early studies did indicate that HRT was a wonderful thing. I presume even the drug makers sincerely felt — hoped, at least — they were doing good. They had wives and mothers, after all. (Most people in those workplaces at the time were male, I suspect.) But maybe, just maybe, a few more studies would have been in order.

Now we’ve got studies. And a lot of interesting new information thanks to the Women’s Health Initiative. It was the first ever major effort to look at the most common causes of death, disability and poor quality of life in postmenopausal women. WHI was launched in 1991 and covered 161,808 generally healthy women; without yours truly they’d have only had 161,807. In the effort to help the WHI folks collect data on cardiovascular disease, cancer and osteoporosis, we made regular visits to designated clinics for 5 years, giving blood, getting weighed, filling out forms, answering questions. For another 10 years we filled out annual reports (and I think some participants did more; I was purely a control-group person because I didn’t want to alter my HRT regimen and knew I hadn’t enough will power to stick to some rigorous, data-producing diet.) A lot of us died along the way, thus the data. I remain a participant in a follow-up study that runs until 2010.

I await with interest the next release of findings. Some of the questions are along the lines of ‘On a scale of 1 to 10, how happy are you?’ so somebody’s watching for quality of life connections to things like exercise and marital status. And drugs. I know there are great things being done with drugs, but this profit margin business combined with what we keep finding out does give me pause. (I loved the survey question that asked whether, when I entered a room, I thought people were talking about me. There’s a story here.)

But whatever they’re finding out, it’s carefully done, covers a long period and a relatively huge bunch of women, and bless their hearts. Meanwhile, if you’re on HRT, you might want to talk to your doctor. What we didn’t know proved it could hurt us.

General interest/Health/Money/Politics & Causes/USA
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Some Women's Views of Health Reform

by Fran Johns

First Lady Michelle Obama is making the news in support of her husband’s health plan, hoping to tap into the energies of one group who voted for Obama in large numbers: women. Reform is everyone’s concern, but in many ways it occupies a specific gender niche. As reported by Voice of America’s Kent Klein,

Mrs. Obama says health care reform is a women’s issue. “Women play a unique and increasingly significant role in our families.  We know the pain, because we are usually the ones dealing with it,” she said. The first lady spoke Friday to a gathering of women near the White House, and said the state of the U.S. health care system is unacceptable. “For two years on the campaign trail, this was what I heard from women:  That they were being crushed, crushed by the current structure of our health care.  Crushed,” she said.

A host of women’s groups, blogs, newsletters and web writers have also recently joined in. Posting in the National Women’s Law Center blog, Outreach Manager Thao Nguyen told the poignant story of hearing from a friend that she’d just married her long-time hesitant boyfriend. The marriage news was good news, but its terms took the joy out: having lost her job, it was the only way she could get health insurance.

Her point seemed so logical, but the entire idea was couched in such an insane reality I was simply speechless. Lucy is in her early 30s but she has a pre-existing condition so buying individual health insurance and the unfair, overpriced premiums that come with it was out of the question. Lucy has been living with Dan for 10 years, but unfortunately, he works for a company that doesn’t offer domestic partner benefits.

I couldn’t help but think: is this what our broken, unstable health care system means for millions of Americans around the country? As the economy continues to struggle, employers continue to shed jobs, and every day 14,000 more Americans wake up realizing that they are now uninsured and just one illness away from financial ruin. Are reluctant bachelors around the country going to put away their Megan Fox posters, cancel the “poker nights” (aka X-Box marathons we’re on to you), and start settling down?

My own run-in with healthcare weirdness is minor in comparison to most, but I still remember the shock. Making a routine call to renew the prescription for a bone-building drug I had taken for years to stave off osteoporosis, the message center person said she probably should warn me that rather than the $24 co-pay I’d been having per quarter my cost would now be $230. I do need these bones, but couldn’t see them worth $920 a year. I hung up and started drinking more milk. Had to get breast cancer, for which I now take a covered post- cancer drug which my oncologist prescribes… mainly to keep my bones healthy. Something is bizarre here.

Or maybe we women might bend the old macho adage a little: It’s broke, fix it.

VOA News – Michelle Obama Joins Health Reform Campaign.

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