Category: Health

Education/General interest/Health/Lifestyle/seniors/USA/Women
Posted on

Diet, exercise and Alzheimers

by Fran Johns

These paragraphs are a segue from talk of holiday festivities, over the past several days,  into the very un-festive subject of Alzheimer’s disease.

Part of the conversation at the very festive Thanksgiving dinner I was lucky to enjoy (without having cooked a single dish!) centered around food for the brain. One argument was that the good stuff for one’s neurotransmitters — egg yolks, broccoli, soy, starches — should be meticulously watched. I heard my mother’s voice in my head in response. “If you have three meals a day that look pretty on the plate,” she liked to advise, “you’re getting the proper diet.” When pressed she would explain that “pretty” equates to “color-coordinated,” i.e.: toast/bacon/scrambled eggs with parsley; or broccoli/carrots/potatoes/hamburger. I can’t remember whether our plates were 9-inch or otherwise.

Then there is the larger issue of exercise. Fitness, and occasionally brain exercise, have been contemplated several times in this space over the past few months (10/5: How’s your brain fitness today?; 9/7: The new best thing.) These theories hold that it is possible to strengthen, possibly even build anew, those neurotransmitters.

The definitive word on all this has not been written, and answers surely won’t originate with someone who barely passed Science I-II for the math/science requirement of her BA in Art. But some fascinating studies are being done, and new American Recovery and Reinvestment Funds will be going to projects that will be the focus of this space tomorrow.

Meanwhile, Alzheimer’s and various forms of dementia remain the ultimate tragedy in millions of lives, diet and brain exercise and clean living in general notwithstanding.

One of the most poignant insights into this disease you’ll be likely ever to see is currently offered by the PBS series Life (Part 2.) It follows a beautiful, articulate woman named Mary Ann Becklenberg as she confronts her own decline with incredible courage. What science may find answers for in the next few years, Mary Ann Becklenberg is exploring in real time. Schedules and clips are on the Life (Part 2) website.

Chances are, whether you’re over 50 or not, your life will be impacted by dementia. I, for one, am grateful for science and for Mary Ann Becklenberg.

California/General interest/Health/Lifestyle/Politics & Causes/USA
Posted on

The after-Thanksgiving 9-inch plate diet

by Fran Johns

At a very special holiday feast yesterday, one super-health-conscious guest chose a small plate for his buffet serving rather than the elegant-size plates of the rest of us. It was, he maintained, a matter of not having seen the table around the corner where the elegant-sizes were laid out, but he did manage to mention something about smaller portions being sufficient…

So. Now that you are, perhaps, stuffed with stuffed turkey, this space is pleased to pass along a novel idea passed along several days ago by Washington Post writer Jennifer LaRue Huget:

The holiday season brings with it an overabundance of advice on how to avoid gaining weight in the face of all those festive meals, cocktail parties and plates of cookies brought in by co-workers. Depending on whose advice you’re inclined to heed, you can cut back on carbs, mind the glycemic index of the foods before you, fill up on fat or count every calorie.

Or maybe you could just use smaller plates.

That’s the premise of “The 9-Inch ‘Diet’ ” (PowerHouse), a book published last November by a pair of advertising executives that makes a strong visual and verbal argument that much of America’s weight problem stems not from eating the wrong foods but from eating too much.

Alex Bogusky, who wrote the book with Chuck Porter, is best known for his work on the “Truth” anti-tobacco ad campaign. He starts the book with a simple tale. Having just bought a lakeside cottage built in the 1940s, he and his wife went out to stock up on dinnerware. But the plates they bought (regular ones from somewhere like Target) didn’t fit, no matter which way he tried to jam them in the cupboards. Slowly it dawned on him that those cupboards had been built with much smaller plates in mind. Further research revealed that while most dinner plates today measure 12 inches, in the middle of the past century the standard was nine inches.

And so a “diet” was born. (Bogusky notes that it’s not a diet at all — and thank goodness, as most diets don’t work in the long run, he observes.) Bogusky replaced his plates with vintage nine-inchers, and he and his family adjusted their serving sizes accordingly. “Research has proven,” Bogusky told me in an e-mail, “the mind is a much bigger trigger for how and when we feel satisfied and full than anybody had formerly realized. More so than the stomach.” As a result, he says, he’s eating considerably less food at every meal.

And you can, too.

“The 9-Inch ‘Diet’ ” is a fun read, chock-full of images that show how the continual super-sizing of American food-serving vessels has led to our consuming ever-increasing portions. Obviously, the diet is just a way of exercising portion control. But it’s an elegant and adaptable way.

Huget explains the subtleties of this system: you take smaller portions, which means you select and cook foods that will work (forget the 12-oz steaks and indivisible barbecued ribs…), and explains why, as the book in question has been around for a year, she is now bringing it up:

…I know it works, and I knew so even before reading the book. Last Thanksgiving, feeling sentimental, I dug out of my attic my Grandma LaRue’s 1950s-era dinnerware, including her nine-inch plates, in a pattern my husband and I have long referred to as “Hideousware.” They looked kind of Thanksgiving-y, so we used them at our celebration. The plates were indeed tiny. And we all ate less than usual — without really noticing.

I have to admit, I noticed what my very fit and healthy friend was consuming on his 9-inch plate.  Maybe a little bit less than I had on my elegant one. But if one were also to pass on the offering of seconds, and then not sneak extra bites when helping clean up, or pick friends whose dinners aren’t as delicious as my friend Liz’ …  There may be another diet book here.

Meanwhile, you might want to stimulate the economy by getting a new set of 9-inch plates before the next holiday season.

Jennifer LaRue Huget – Eat, Drink and Be Healthy: 9-inch plates are key to diet success – washingtonpost.com.

California/General interest/Health/Politics & Causes/seniors/USA/Women
Posted on

Doctors making house calls? An old idea whose new time has come

by Fran Johns

Could house calls make a comeback? It’s already happening. The University of California at San Francisco, for one success-story example, started the UCSF-Mt. Zion Housecalls Program in 1999 with a philanthropic gift. Its original goal was to teach medical students about home care, but with the exploding need for primary care for homebound elders it has evolved into filling that need throughout San Francisco — while still teaching the new generation about house calls.

In an article in the San Francisco Chronicle, staff writer Victoria Colliver details some of the many advantages that such programs have.

June Hagosian’s brain tumor has made it difficult for the 77-year-old San Francisco woman to leave her house in recent years, keeping her mostly confined to her bed.

For someone like Hagosian whose medical needs require frequent doctor visits, that would usually pose a problem. But because of a program run by UCSF, the doctor comes to her. She has had to leave her bright yellow home in the Richmond District to go to the hospital just three times in the past seven years.

“This program has been so wonderful,” Hagosian said during a recent home visit with her physician, Rebecca Conant, director of UCSF’s Housecalls Program. “I wish everyone could have it.”

Conant, who had just 15 patients when she took over the program in 2001, is one of five part-time UCSF physicians who spend all their clinical time outside the office, traveling from home to home visiting frail and elderly patients. Housecalls currently serves nearly 100 San Francisco residents and has an eight-month waiting list.The Housecalls physicians visit patients whose conditions make it so hard for them to go to the doctor’s office that they might otherwise put off seeking medical care. By then, they would be so sick they would need an ambulance and end up in a hospital emergency room. The program takes patients regardless of whether they have insurance or an ability to pay, which separates it from private practices that offer home visits as a convenience but at an added cost.

UCSF’s 10-year-old Housecalls Program is an old idea that has gained new traction. Both the House and Senate versions of the health reform bills contain proposals to examine whether home-based care improves the health of chronically ill patients and saves the government money by reducing hospitalizations and ER visits.”There’s no question there is both a medical need and substantial cost savings to the Medicare program,” said Constance Row, executive director of the American Academy of Home Care Physicians.

The Department of Veterans Affairs’ Home-Based Primary Care program, which has been operating for more than two decades, has showed a 24 percent reduction in costs for those patients, and some studies suggest savings as high as 40 percent, Row said.

UCSF’s Housecalls Programs operates on an annual budget of $300,000, almost all of which is devoted to physician salaries. That’s an average cost of $3,000 per patient, which does not include the cost of hospital care when needed. Medicare spends a national average of $46,412 per patient over the last two years of life, when patients typically have several chronic illnesses, according to researchers from the Dartmouth Institute for Health Policy and Clinical Practice.

But new technology – the ability to X-ray patients using portable machines, conduct blood tests and provide other services using mobile devices – allows doctors to offer a much higher level of care in the comfort of the patient’s home.

Conant, an associate clinical professor at UCSF, said she uses mobile devices to aid in her patient care, but she finds home visits offer other advantages like allowing her to see patients’ physical environments, meet their caregivers and better understand what kind of care they need.

“Not only does that improve medical care, but it’s based in reality,” she said.

The UCSF program is not the only home-based primary care program in the Bay Area. Kaiser Permanente, for example, serves some 370 members in San Francisco as part of its 13-year-old Community Care Program, which is handled by physicians, nurse practitioners and social workers.

Reinstituting and reinforcing in-home care, considering the significantly improved care for patients and the reduced cost to the taxpayer, would seem a no-brainer. But brains are losing out to politics a lot these days.

via UCSF program shows house calls’ time returning.

California/Education/General interest/Health/Lifestyle/Money/seniors/USA
Posted on

On learning at 30… or 40… or…

by Fran Johns

True/Slant contributor Gina Welch, on turning 30 just now, posted a fine list of 20 things she learned in her twenties, at the precise moment when I’d been musing about the passage of time myself. A somewhat more elderly muse, that is, since mine was prompted by the realization that day before yesterday marked the 85th anniversary of my parents’ marriage. In case that doesn’t sound elderly enough, my parents were both born in 1897, whew.

So in response to Gina’s wisdom here are six things I learned in my sixties (which are way past, at that.) It was terribly hard not to plagiarize, especially Gina’s Listen to your mother, even if it’s only to her long-departed voice in your head, or Wallow not, advice that improves exponentially with age.

1 – Get up early in the morning. It’s way more fun when you aren’t doing it because the baby’s crying, the school bus is waiting or the boss is calling… but just because the To-Do list actually contains stuff you want to do. Plus, days have fewer hours in them.

2 – Go back to school. Classmates a generation or two younger can be wise beyond your years. After a lifetime of writing for newspapers and magazines (you remember print journalism?) I joined the Class of ’00 at the University of San Francisco to pick up an MFA in short fiction. Who knew? If you run into anyone ready to publish my short story collection, let me know. A few of them have actually seen the light of publication, but I’m going to publish The Marshallville Stories in full if I live long enough… or perhaps if I learn enough in my 70s.

3 – Medicare is good. Imagine not having to freak out at every bodily suggestion that fatal expenses could be right around the corner. Imagine everybody having that unfreakable experience. How about we pass health reform?

4 – Listen to your daughter. She can probably teach you a LOT about changing mores, gender identities, adventure travel and how to see the world. Not to mention low fashion, hair styling, organic food and living well.

5 – Listen to your granddaughter. She can definitely teach you about computer programs, digital photography, what 18-year-old college art students are doing, and teenage music. You can close your ears when the teenage music part comes.

6 – Count your blessings. Seriously. If you’re still able to get up in the morning and remember how to count, this is good exercise. And if you count forwards and then repeat the same numbers backward you have exercised your brain, which is increasingly important. At a certain point in life it is tempting to reflect on the world when nobody locked their doors and you dashed onto airplanes just as they were pulling up the steps. And people apologized if they inadvertently used the D-word in front of your mother (there’s her voice again in my head…) So it’s okay to count nostalgic blessings, too; just don’t forget about par courses or contemporary chamber music or sunsets over the Pacific or that grandson who speaks Mandarin and Spanish at 17…

Thanks, Gina. Happy Birthday.

General interest/Health/seniors/USA/Women
Posted on

New Cancer Guidelines: One Good Message

by Fran Johns

News about changing guidelines for cervical and breast cancer screening have some women cheering, a lot of women fuming, and most women feeling confused. Or betrayed, or mistreated or worse.

There is one universal message in it all: every woman has to be her own advocate.

For most of us, that is no big deal. We’ve known for a long time that no two of us (and surely no four collections of breast tissue or no two histories of sexual activity) are alike, and most of us have gotten used to asking a lot of questions. It’s unfortunate that so many changes have been announced at almost the same time, and especially that the issue has become politicized.

New York Times health writer Denise Grady summed up the latest developments, and the issues that have caused confusion and anger in a November 20 article:

New guidelines for cervical cancer screening say women should delay their first Pap test until age 21, and be screened less often than recommended in the past.

The advice, from the American College of Obstetricians and Gynecologists, is meant to decrease unnecessary testing and potentially harmful treatment, particularly in teenagers and young women. The group’s previous guidelines had recommended yearly testing for young women, starting within three years of their first sexual intercourse, but no later than age 21.

Arriving on the heels of hotly disputed guidelines calling for less use of mammography, the new recommendations might seem like part of a larger plan to slash cancer screening for women. But the timing was coincidental, said Dr. Cheryl B. Iglesia, the chairwoman of a panel in the obstetricians’ group that developed the Pap smear guidelines. The group updates its advice regularly based on new medical information, and Dr. Iglesia said the latest recommendations had been in the works for several years, “long before the Obama health plan came into existence.”

She called the timing crazy, uncanny and “an unfortunate perfect storm,” adding, “There’s no political agenda with regard to these recommendations.”

Dr. Iglesia said the argument for changing Pap screening was more compelling than that for cutting back on mammography — which the obstetricians’ group has staunchly opposed — because there is more potential for harm from the overuse of Pap tests. The reason is that young women are especially prone to develop abnormalities in the cervix that appear to be precancerous, but that will go away if left alone. But when Pap tests find the growths, doctors often remove them, with procedures that can injure the cervix and lead to problems later when a woman becomes pregnant, including premature birth and an increased risk of needing a Caesarean.

Still, the new recommendations for Pap tests are likely to feed a political debate in Washington over health care overhaul proposals. The mammogram advice led some Republicans to predict that such recommendations would lead to rationing.

It boils down to this: every woman will need to pay close attention to her own health care. That is bad news for the less educated, the less aggressive, and those with less access to care, and not particularly good news for many older women who grew up with “The doctor knows best” excuse for not paying attention.But it’s good news for those of us, particularly older women, who have questioned what sometimes seemed too-frequent testing and screening.

Asking questions just got more respectable.

Guidelines Push Back Age for Cervical Cancer Tests – NYTimes.com.

General interest/Health/Money/seniors/USA
Posted on

Facing Up to Dental Terrors

by Fran Johns

The only thing worse than toothache/jaw pain, to be cruelly specific, is toothache/jaw pain without insurance. Most of us are without such insurance. It has not even been on the radar of health reform advocates, which is just as well — if you add dental terrorism to abortion and public options we won’t see reform for another few decades.

Nevertheless, tooth reform, euphemistically referred to as full mouth restoration in some circles, is ahead for increasing numbers of Americans sooner or later. It comes down roughly to a choice between fixing the mouth or buying a yacht, but if your jaw aches, you forgo the yacht.

New York Times health writer Jane Brody traced the new path of dental repair journeys in a thoughtful article yesterday, explaining her own costly route from tooth decay to bridges to implants, and throwing out an estimate of approximately $3,500 to $4,000 per tooth for the now-preferred latter. Multiply this by at least three or four times if you have other issues, which most of us do once things start going south in the mouth, needing attention. That would be gum problems, repair to surrounding teeth or necessary attention to bone.

I write with authority. Some years ago, facing all of the above, I visited an assortment of dentists with an assortment of solutions that frequently had me in tears when contemplating the time, details (one would have had screws in my jawbone which I would tighten every few days for months as it rebuilt itself) and costs. Like Brody, I grew up before the days of fluoridated water and have had more repair work since childhood than the Bay Bridge. It was a mess in there.

Finally my husband, whose best wives have been born in 1933 but with bad teeth, said, “Just do it all. Don’t be going patch-patch-patch; do it all.” I proceeded to choose the most sympathetic and understandable (most of them were, except for the screws-in-the-jaw guy) dental professionals, assembled a team and went to work. Or rather, I scrinched my eyes shut while they went to work. Some 18 months and $40,000 later we were free at last.

(Out of this experience, during which I was doing a great deal of entertaining just to keep us happy and sane, came one of my finer unpublished books, Cooking for the Dentally Impaired: Recipes and Menu Suggestions for the Impaired and Unimpaired in Difficult Times. I think it’s a book whose time has come; my agent disagrees.)

Brody’s article is a must-read for anyone stewing over this issue. The following are abbreviated tips for anyone with teeth and plans to keep them:

1 – Consider early-decision. The sooner things like gum surgery, crowns, implants-v-bridges or bone issues are dealt with, the likelier all can be made well and kept that way.

2 – Get second opinions. You may even choose the screw-in-the-jaw route, but there are many different procedures and it is good to find one suited to your temperament and bank account.

3 – Ask questions. I asked so many that I was fired by one team; a polite letter said they did not believe they should take my case. It’s just as well. Those I wound up with answered my questions and seemed happy to do so.

4 – Ask for references. Brody suggests this, and I agree. Because I already knew several people who had been patients of the dentists with whom I eventually invested all that time and money, talking with them about their experiences helped keep me from any surprises.

5 – Talk finances. Several friends of mine have had major dental expenses that were far outside their budget, but worked out payment schedules with their dentists so that necessary work could be done sooner rather than later.

Meanwhile: floss.

Health/Women
Posted on

Skip mammograms, quit breast self-exams, and maybe lighten up on 'defensive medicine' while we're at it

by Fran Johns

All those mammograms, self-exams and dutiful attention to catching breast cancer at the very first sign? Forget it. Might even do more harm than good.

As summarized by Associated Press writers Stephanie Nano and Marilynn Machione late Monday,
Most women don’t need a mammogram in their 40s and should get one every two years starting at 50, a government task forcesaid Monday. It’s a major reversal that conflicts with the American Cancer Society‘s long-standing position.

Also, the task force said breast self-exams do no good and women shouldn’t be taught to do them.

For most of the past two decades, the cancer society has been recommending annual mammograms beginning at 40.

But the government panel of doctors and scientists concluded that getting screened for breast cancer so early and so often leads to too many false alarms and unneeded biopsies without substantially improving women’s odds of survival.

“The benefits are less and the harms are greater when screening starts in the 40s,” said Dr. Diana Petitti, vice chair of the panel.

The new guidelines were issued by the U.S. Preventive Services Task Force, whose stance influences coverage of screening tests by Medicare and many insurance companies.

But Susan Pisano, a spokeswoman for America’s Health Insurance Plans, an industry group, said insurance coverage isn’t likely to change because of the new guidelines. No changes are planned in Medicare coverage either, said Dori Salcido, spokeswoman for the Health and Human Services department.

Maybe, just maybe, a clearer look at breast cancer screening could be accompanied by a good look at a little of the other possibly unnecessary and extraordinarily pricey “defensive medicine” going on around the country. What a fine way that would be to hold down costs and save a lot of time and angst. In another recent article (November 5) published in the San Francisco Chronicle, Associated Press reporter Steve LeBlanc wrote of how the costs of “defensive medicine,” along with malpractice insurance and lawsuit awards, are adding significantly to the soaring costs of health care.

LeBlanc illustrates the issue with a story that rings sadly true:

Dr. James Wang says he tries to tell his patients when medical procedures aren’t necessary. If they insist, though, he will do it – not so much to protect their health as his own practice.

After being sued for allegedly failing to diagnose a case of appendicitis, Wang says he turned to what’s known as “defensive medicine,” ordering extra tests, scans, consultations and even hospitalization to protect against malpractice suits.

“You are thinking about what can I do to prevent this from happening again,” he said, adding that he did nothing wrong but agreed to a minor settlement to avoid a trial.

We have, LeBlanc explains, doctors battling malpractice premiums and lawyers saying malpractice suits discourage bad medicine — meanwhile, the costs of it all add up to some ten percent of health care expenditures.

We the public, healthy and sickly alike, are caught in the middle. Could we not somehow declare a truce? We’ll quit rushing to sue, lawyers back off from chasing ambulances, doctors go about the business of practicing medicine according to patient need rather than fear of consequences. Seems like a good idea to me, but I’m not holding my breath.

I’m also not having any more mammograms any time soon.

New advice: Skip mammograms in 40s, start at 50 – Yahoo! News.

California/General interest/Health/Politics & Causes/Women
Posted on

Doctors oppose abortion cuts in health bill

by Fran Johns

The San Francisco Medical Society has come out in opposition to removal of abortion coverage in the health reform bill, pointing out the potential danger to women’s lives if they are denied access to such care. Charles Wibbelsman, MD, President of SFMS, writes in today’s San Francisco Chronicle that the board of directors will urge congressional representatives to find a compromise.

It is a shame that such a complex issue as health care reform has been hijacked in the form of the Stupak amendment, which would ban all public funding for abortion (“Amendment to House bill reignites abortion debate,” Nov. 10).

Experience has shown that denying coverage of abortion does not stop or even curtail it, but rather shifts the costs elsewhere, and threatens to delay a woman in seeking and obtaining this medical procedure, thus potentially endangering her.

The San Francisco Medical Society’s board of directors has voted to urge our elected officials, particularly Sens. Dianne Feinstein and Barbara Boxer, to find a compromise that will not ban such funding and keep women with unwanted pregnancies safe.

Women’s lives should not be held hostage to politics.

At last, a ray of sanity from the medical community. I, for one, am proud of SFMS for standing up for the uncounted thousands of women, most of them poor and disadvantaged, who will suffer harm from denial of access to care should the conservatives and the U.S. Conference of Catholic Bishops win the day on this matter.

via Stupak amendment hijacks health care reform.

1 … 28 29 30 31 32 … 37