Get Preventive Health Tests You Need

If you are at risk for some disease whether or not it is inherited, why not check for it early? Get checked for everything you possibly can that is available.  Make this a lifestyle change like weight control, exercise, and proper diet.  Help yourself and your health care with preventive tests.
Many doctors are concerned that tests obtained by patients on their own will lead to unnecessary procedures. Often these tests may show abnormal things that are “normal” meaning that the abnormal finding is something that is just there. It is benign, and not life threatening.

What does the doctor do when a patient comes in with a test that they have done on their own? The patient has decided that I may need this test because heart disease, and /or cancer runs in my family, plus heart disease is the number one killer. Should I have a heart scan, or a virtual colonoscopy? Patients are often told that tests may find things that are benign, but something serious may show up. It could be something that would turn up in a few years that could have been prevented if detected early.
What does the doctor do when a patient comes in with abnormal test results from a test they orders and paid for themselves?
1. Repeat the test
2. Refer the patient to a specialist
3. Do more tests to check it out
4. Scold the patient and say “It’s okay. There’s nothing to worry about.”

What does the patient do? What is best for your good health.  Best health!

Shoppimg for Health Insurance Limited Time Only!

Health insurance open enrollment time is here again.  For something so important, it is quite a quandary instead of a clear, concise issue.  First of all, open enrollment implies that you must wait for a certain time once a year for a sixty to ninety day period when you can shop for insurance. This is exactly what it is.  Unlike most nonmedical services you need or want, you can only shop for and get it for a limited time.  Without it you could get sicker, and pay more for your healthcare.  It would be healthier, more convenient, and make more sense to have open enrollment all year long. At one time many years ago, you could shop and get health insurance all year. Time for shopping for your health and insurance should be like shopping for other things you need.  If you had to wait to buy a car during a once a year open enrollment period, and you were without a car, what would you do? 


Health insurance is too important to have such limited access. Though the cost is high for some, most are able to procure enough to prevent bankruptcy from healthcare costs.  Once you have health insurance, you know and feel what is like to have healthcare provisions.  This is a major issue if you have been without it.  The health insurance experience is a healthy way to learn about your healthcare, and what you can do to make yourself healthier.  Many find it to be a security blanket in case of catastrophic illness, but it is also a prevention guide.


If the objective is to insure more people, limited open enrollment time once a year seems to be a contradiction to getting more people insured.  This could better serve everyone if it were provided in a timely, sensible manner if open enrollment was ongoing.  After all, your health is your most important asset.  You should be able to shop, and buy what you need when you need it beyond a limited time.  Best health!


 

Part 1: Basic Diagnostic Health Tests

These basic health tests can help your doctor with your diagnosis and treatment. Know what they are so you know that you are getting it when it is needed. These can be baseline, and routine screening tests as well. 
The EKG, also known as an electrocardiogram, gives information about your heart. It is usually done by the primary care doctor as part of a routine physical, especially if heart disease runs in your family. Typically, this test is done on anyone complaining of chest pain or discomfort. Small patches with adhesive on the back are placed on the chest, arms, and legs while the patient lies on her or his back. The electrode patches are attached to the wire cables running from the EKG machine. The heart’s electrical activity is recorded on paper. By looking at this “heart tracing” graph, the doctor can tell if there are any abnormalities like irregular heartbeats (called arrhythmias), damage to heart muscle from a heart attack, poor blood flow to the heart that causes chest pain (called angina), and heart enlargement. The doctor has been trained to know what changes or abnormalities need further testing, treatment, or hospitalization.
The X-ray test uses small amounts of radiation through an X-ray machine to make pictures. It can be done on almost any part of the body to check out a patient’s symptom, and/or the doctor’s findings during the physical exam. Many primary care doctors have X-ray equipment in the office. If not, the patient may be referred to a special office (diagnostic center) that performs X-rays or to a local hospital radiology department.

X-rays are most commonly done on the chest, abdomen, back, joints, and extremities (arms and legs) and are done either with the patient lying down or standing up, depending on the part of the body being checked. After you have been positioned, the X-ray film cassette is placed in the machine next to the body part being X-rayed. The radiation from the machine will pass through the body part being X-rayed onto the film. The radiology technician (the person who operates the X-ray machine) will then move to a closed space in the same room and press the buttons to take the X-ray.

During this test it is important that a protective lead shield apron be placed over the reproductive parts of the body.  Usually the technician will need to take more than one view, and so you will be asked to move a certain body part or turn a certain way. Different X-ray views give the radiologist (the doctor who reviews and interprets X-rays) a more complete view of the body part. Using the information from this test and the information from your history and physical, your doctor will be able to determine the proper diagnosis (what the problem is), treatment, and/or more tests, if needed.

There is some concern that the radiation from X-rays may be harmful. Studies have shown that small amounts of radiation are not linked with an increased risk of health problems. Over the years the amount of radiation used for X-rays has been decreased.



If you are uninsured, these tests are still available at affordable rates.  Check and compare prices by phone or Internet to find lowest prices.  Your healthcare provider may also be able to direct you to a clinic, hospital or testing center that fits your budget.  Some providers also have payment plans that allow payment over time.  Make your own healthcare plan affordable rather than go without.  Best health!

Part 2: Basic Diagnostic Health Tests

These basic health tests can help your doctor with your diagnosis and treatment. Know what they are so you know that you are getting it when it is needed. These can be baseline, and routine screening tests as well.


The ultrasound is also referred to as a sonogram or sound wave test. It uses sound waves to make images of body parts. This changes electrical energy to sound waves that go through the skin into your body. When the waves contact the body’s organs, they reflect to the transducer, producing echoes. The echoes are then converted into still or moving images by a computer that makes a picture of your organs. The technician is able to see this on the monitoring screen and to make an X-ray or Polaroid-type picture. The ultrasound uses no radiation.  In this test the technician applies gel to the area to be tested. A transducer held by the technician is moved back and forth against that part of the body. This sends out the sound waves that go back into the computer.



The sonogram is commonly used to look at your internal organs in the abdomen (such as the gallbladder, kidneys, liver, spleen, and pancreas), prostate, uterus, and ovaries. It is also used to look at blood vessels (arteries and veins), the thyroid gland, breasts, and the skull. In a pregnant patient, actual moving images of the fetus can be seen. As there is no radiation exposure, the sonogram is very valuable in following fetal development in pregnancy. It is also able to detect and diagnose other conditions related to pregnancy. Sonograms are also useful in checking the heart. These are called echocardiograms or Doppler echos.
Computerized axial tomography, CT or CAT scan is another way to make images of body parts. The CT scanner uses X-ray beams that rotate around the body. These beams then go through a detector, and a computer analyzes and processes the data into an X-ray film. The CT machine has a table that is pulled in and out of the machine, which is a large hollow tube (like a doughnut) that can surround the body. During the test the patient lies down on the table. The scanner (inside the hollow tube) then rotates around the patient.  The CT scan is able to image many parts of the body. It detects more than a regular X-ray and produces two-dimensional views. This test is commonly used to pick up tumors, infections, enlarged organs, and many other abnormalities.


The MRI (magnetic resonance imaging) scan is another diagnostic test that does not use X-rays. Instead, it uses magnetized energy. The images produced are extremely detailed pictures of the body part scanned. It is very much like looking at the pictures in an anatomy book or almost like looking at a person internally. The MRI machine is designed much like a CT scan machine, except a magnet is in the hollow tube instead of X-ray beams. The test is also done while the patient lies down on a table that moves in and out of the machine. The MRI scan takes about thirty minutes to an hour. The MRI is not recommended for persons with metal or electronic implants (such as pacemakers, joint pins, prosthetics, artificial heart valves, metal fragments, shrapnel, IUDs, etc.), as those might interfere with the machine. Be sure your doctor and technician are made aware if you have any such implants. For the claustrophobic person, the closed space of the MRI machine may create some anxiety.  Again, alert your doctor and technician. A mild sedative may be necessary prior to the test to help relax you, or you may be sent to a facility that has an open MRI. MRI scans are useful for scanning almost any body part for almost anything. Tumors, cysts, aneurysms, herniated back discs, and orthopedic conditions are among the many abnormalities that can be detected with this test.

The mammogram is a plain X-ray picture of the breast. It requires a special machine that compresses each breast against X-ray film to take the picture. The X-ray passes through the breast tissue and shows how the breast looks inside.  This test is excellent for detecting tumors and cysts. It may also show if the area is benign (no cancer) or malignant (cancer). The mammogram is able to pick up cancers that are too small to be felt or seen. It is a valuable cancer screening test.


Medical diagnostic tests are screening as well as diagnostic tools.  Along with a thorough history and physical, these tests can help make a correct diagnosis. Best health!

Minding Your P & Q: Peace and Quiet Help Heal

Patient privacy is a right of every person.  When you get acutely ill, it is very important to have your privacy and quietness.  Healing is a delicate, critical process that needs the body's full attention without extra stress.  Your mind must be clearly focused on the healing process.  Research shows that a private, quiet surroundings promote healing and allow the body to repair and recover.  Unnecessary outside distractions should be curtailed to your comfort level. Aside from key healthcare providers contact should be limited to family and friends. Since most healing occurs during quiet, private times, it is important to maintain a quiet, private environment with scheduled visitation like that seen in hospitals. As Florence Nightingale says in Notes on Nursing, "Unnecessary noise is the most cruel abuse of care which can be inflicted on either the sick or the well." Privacy is your right to a quiet, uneventful healing.  Best health!

Money and Your Medication

The 2015 United States median income was $56,516.  This is $4719  a month.  After taxes this is approximately $3140 for basic living expense including rent/ mortgage, utilities, food, clothing, healthcare, insurances (home. car, health, etc.), transportation, taxes, and miscellaneous.  Ten percent, $314, could be the price of one medicine you need.  If one of your medication cost this much it is one-tenth of your income.  If you are one other medication , you could be paying as much as 20% just for medication. 
Are you having concerns that your $314-a-month medicine your doctor just prescribed is unaffordable? Is it worth it to overextend your budget?  Can you really afford it?  Do you really need it?  What else must you think about cutting back on?  These are just a few of the thoughts that run through a patient's mind when faced with the dilemma of high prescription prices.  A bigger concern is if the medicine will work and make them better.  If it does not they are possibly sicker plus out of money to pay for the medicine and treatments that do work.


Long gone are the days when patients take everything the doctor gives them or says to them as the final say.  Patients have become more empowered in all ways, but especially with health information.  Once diagnosed you can look up almost everything on your diagnosis including medicine side effects, new treatment options, and even an actual surgical procedures. Multiple treatment options are available that may work better than just prescription or non-prescription medication at much less cost.


When you get that expensive over-your-budget medication, discuss it with your doctor before you get price shell shock at the pharmacy counter.  Many doctors have access to medication prices, and may be able to prescribe something affordable within your budget that will help you.  If you have access to Internet while at your appointment, you can look it up via your local pharmacies website, and/or drug price check websites.  Discuss this and other alternative integrative treatment options with your doctor to find what works best for you and your pocketbook.  Best health!

Healthy Eating Precision Diet

One of the best ways to cut costs is to cut unnecessary expenses.  You invite good health when you manage your money well.  When you start with your health, you create more wealth.  One of the best ways to save money is to create wellness in your life.  One of the best ways to do both is to eat healthy, more precisely, precision eating.  Studies have shown what I have seen.  Those who consume a healthy diet, with emphasis on foods necessary for their illness, feel better and consume less medication.  Weight tends to stay stable when this occurs over the years.
Those with hypertension can decrease their medication and even stop it as their blood pressure becomes normal on their precision diet.  This would include vegetables especially carrots, beans, bananas, broccoli, garlic, and onions five times a week.  These are a few foods of the many that help lower blood pressure and decrease heart disease. The same foods also increase brain power, decrease cholesterol, improve digestion, and more.  Tumeric seasoning is an excellent way to add anti-inflammatory pain relief in arthritic neuromuscular states. Cinnamon helps with diabetes control as do beans.  Beans supplies fiber which helps keep bowel habits regular and stress free. 
When you buy these basic good foods, you are very likely to save more at the grocery checkout monthly than if you were buying three or more medications per month.  Over time you will feel better and see health improvements.  As this occurs less money will go towards medication.  The multivitamin is likely to be one of the first since a healthy selection of food will include all you need.  This healthy food will decrease most bowel distress thereby alleviating the need for gastrointestinal medication.  When blood pressure or blood sugar get in normal range, there is little need for pills.
Healthy food leads to good health.  Saving money on your health becomes greater wealth in many ways.  Study and read about what you need to make your precision food prescription for better health.  Eating healthy is eating good.  Best health!
                                                                                                                                                                                                                                             

It's Teal Time! Ovarian Cancer Awareness Month

September is teal time for Ovarian Cancer Awareness Month.  Ovarian cancer kills many women quickly and silently.  It is one of the cancers that is hard to detect.  The treatment is pure hell and the vague symptoms become unbearably painful.  Ladies, there is something we can do! The pelvic and transvaginal sonogram (also called ultrasound) is a simple test that every woman should have just because you are a woman. Like the mammogram, this medical test is inexpensive and non-invasive (unless vaginal insertion is considered so) as far as no IVs or contrast dye.  Consuming mass amounts of water until you have to urinate (but must hold) is the least discomfort you should experience.

Talk to your doctor about pelvic sonogram screening after a thorough gynecology exam.  Most gynecologists have them in their office which is excellent standard of care and convenient for the patient.  It can be done and read the same day by your gynecologist, possibly by the time you sit down to talk after the exam.  The pelvic and/or transvaginal sonogram becomes part of your medical record for easy reference as needed thus providing consistency and, if necessary, for future comparison.  These tests are also becoming more readily available for direct consumer purchase without prescription at diagnostic centers and through health fairs.

The CA-125 blood test may be useful; however, it is nonspecific and may be seen with other conditions like endometriosis, pregnancy, fibroid tumors, diverticulitis, and liver cirrhosis.  It has been proven to be a reliable tumor marker once ovarian cancer is diagnosed. CA-125 tests, like the pelvic songram , is not recommended for women at average risk of ovarian cancer.  High risk patients like those with a family history of the disease, mutations in BRCA1 or BRCA2 genes, or suggestive symptoms are encouraged to get tested.

Early detection of ovarian cancer saves lives as well as fertility especially for women of childbearing age.  For these reasons alone sonograms should become part of every woman's prevention schedule on a routine basis like the mammogram.  The patient's quality of life can be saved in a cost effective manner.  The nonspecific symptoms of pelvic pain, low back pain, abdominal pain (bloating, fullness, distension), changes in bowel or bladder habits are surely worth looking into, but can lead your doctor into a quandry with many other diagnostic tests before ovarian cancer is suspected. The time this takes can definitely delay diagnosis. 

Speak up before the silence of ovarian cancer quiets your life.  Though unpreventable there are things you can do to lower your risk.  This includes genetic counseling, and removal of ovaries (oophorectomy).  Seek care and advice from experts in these areas via your gynecologist. The National Ovarian Cancer Helpline is very good for locating local resources.

Without an actual early detection test for ovarian cancer, we still must do all we can to detect early and prevent the rampage of this deadly disease.  The pelvic and transvaginal ultrasound along with a thorough pelvic exam can reduce the sounds of suffering that ovarian cancer shouts out in silence. It's teal time!  Best Health!


For more information on pelvic exams being done routinely, see "Asymptomatic Symptomatic Static on Routine Pelvic Exams" http://bit.ly/1DlarBR

Diabetes Defense Is Good Offense

Diabetes is on the rise around the world.  Current global statistics reveal that 1 in 11 persons had diabetes in 2015.  This is about 415,000 million people.  A recently published study by JAMA found that almost 50% of Americans have pre-diabetes or diabetes.  About one-third of these patients were unaware they had either condition, and were already showing signs of diabetes.  National cost was almost $300 billion in 2012.  International cost in 2015 was $673 billion which is 12% of global health expenditure.


Pre-diabetes and diabetes are often discovered during the routine physical, or in the emergency room with severe hyperglycemia or complications secondary to the disease.  Patients may present without any symptoms or the classic triad of polyuria (increased urination), polydipsia (increased thirst), polyphagia (increased hunger).  Blood tests that confirm diabetic disease include: FBS (fasting blood sugar) / FPS (fasting plasma glucose) over 126 mg/dl; two hour plasma glucose over 200 mg/dl HgbA1c over 6.5.  Weight loss and dehydration may be apparent clinically as the heavy glucose molecule depletes the body's water volume.


Comorbidities associated with diabetes include hypertension, heart disease, stroke, kidney disease, and general vascular disease.  These are all chronic disease states as is the eye disease (diabetic retinopathy) which may lead to total blindness.   Diabetic neuropathy involves nerves especially those to the extremities causing numbness, tingling, and decreased sensation.  If vascular disease is present, this may lead to poor circulation.  As a result diabetic foot ulcers may emerge.  Due to lack of sensitivity these may go unnoticed until an infection occurs which left untreated may lead to amputation.


Treatment includes diet, exercise, and medication.  Surgery is also a consideration.  It is of utmost importance that the proper diet is followed.  Counseling with a dietician provides necessary nutritional information to keep and help keep blood sugar in normal range.  Weight maintenance at a  healthy level is beneficial as overweight states have been correlated with an increased risk of diabetes.  Excess weight can make diabetes more difficult to control.  Adherence to diet leads to better control overall even if on medication.  Along with routine exercise this helps maintain a healthy weight.  If you are losing weight and eating the right foods, diabetes may come into control without medication.  It is important to check your blood sugar often when lifestyle changes are being made.  Keeping your blood sugar within normal limits will help defend against secondary complications.  Most important, you will feel better.  Best health!

Use Your Medical History As Guide Guideline

Preventive health guidelines were developed to improve one’s health using things that prevent disease and detect it early.  They are based on credible research in which the criteria have been studied extensively.  The United States Preventive Services Task Force (USPSTF) is a leading resource for preventive health guidelines along with doctor specialty organizations like the American Academy Of Family Physicians and American Academy of Pediatrics.  There are so many that it can become confusing as to what you should do.  Like one size fails to fit all so do the guidelines. How will you know what you need and when you need it?
 
Use your medical history as your guide in deciphering through different health organization guidelines.   Though they may address the same thing, there will be similarities and differences.  If you have a history of cancer, you may want to get a mammogram or colonoscopy more often. If there is a family history, you may want to get tests sooner than the guidelines suggest.  Abnormal physical exam findings warrant testing regardless of guidelines.
 
Be sure to review guidelines from different organizations. This gives you a broader view of what you need.  Look at the pros and cons as they fit you.  Focus on those that concern you and your condition.  Discuss them all with your doctors and healthcare providers to plan your guidelines. Your medical history is your guide to the guidelines right for you.  Best health!

Zapping Zika to Zero

The Zika virus is here. This Aedes species mosquito-borne flavivirus continues across the Americas.  Zika is spread primarily by mosquito and/or sexual transmission.  In pregnant females it may be transmitted to the fetus and infant. Blood transfusion transmission has also been a cause.  Known new cases are reported almost daily.  States and U.S. territories with the most reported infections are Puerto Rico (primarily unrelated to travel), New York, Florida, Texas, California, and Pennsylvania


Common symptoms include fever, rash, conjunctivitis, joint and muscle pain.  They have been described as flu-like and mild lasting up to one week.  This usually occurs within 1-2 weeks after being bitten by an infected mosquito or having sex with someone who carries the virus.  The symptoms, travel history, and living in specific infected areas help make the diagnosis.  Blood and urine tests for Zika confirm the diagnosis.  Screening asymptomatic individuals is not recommended at this time.  Major complications include Guillan-Barre syndrome, fetal defects (microcephaly, hearing loss, eye defects), delayed infant growth, and pregnancy loss  Treatment is much the same as flu including rest, fluids, and analgesics.  The vaccine is in experimental stages as are Zika anti-virals.


You should protect yourself from Zika virus as much as possible. This includes the following:

• stay indoors (better with air conditioning) as much as possible especially during early evening, night, damp/rainy days
• wear long sleeves, long pants in light colors
• avoid highly scented perfumes, lotions, soap
• use insect repellant (e.g DEET, oil of lemon eucalyptus, picardin, essential oils like basil, catnip, lavender, neem) on exposed skin, permethrin on clothes (or wear permethrin treated clothing)
• use insecticide yard spray, citronella incense/ candle products liberally around your home when outside (if inside use fogger or spray made for indoors)
• plant mosquito repelling plants in yard like geraniums, lemon balm, citronella
• use mosquito netting over stroller, carriers, outdoor venues (over beds if open area to mosquitos)
• keep windows, doors screened or closed to prevent mosquito entry
• avoid local areas that have yet to spray insecticide especially if a known endemic area

If bitten by mosquito apply cool compress and rubbing alcohol to areas involved.  If itching persists, try calamine lotion or topical diphenhydramine to areas.  Severe allergic reactions may require professional attention in the emergency department.  If Zika is suspected, see your healthcare provider or go to your local health department as soon as possible.  Zap Zika!  Best health!

Timely Tip: Your Medical To-Do List

As  you think over things to discuss with your doctor, you may be amazed to see how many are unresolved, and fortunately not life-threatening. It can be a task to try to get them all taken care of in a timely manner.
Make your medical to-do list before doctor visits. Update it after your doctor visits.  Keep your notes together in a folder (off computer and/or on computer), or notebook.  This creates an overview of your medical issues.  It will also help you keep up with the unresolved as well as resolved issues. Best health!

Stroke Awareness: Know Your Risk Factors

As more people are diagnosed with hypertension the incidence for stroke increases.  Currently about 1 in 3 persons worldwide has been diagnosed with hypertension.  This indicates that the incidence for stroke is more likely than ever before. Diabetes, high lipids, obesity, and cigarette smoking are also risk factors.

Strokes are cerebrovascular accidents, CVA for short.  Strokes may occur from uncontrolled high blood pressure, but may also occur when blood clots block the major arteries to and in the brain cutting off oxygen.  Hemorrhagic strokes may cause bleeding in the brain secondary to a ruptured artery.  The most common cause is from severe hypertension.  Other causes include aneurysm and malformations of arteries and veins in the brain.  Ischemic or thrombotic strokes happen when blood clots block the carotid arteries or arteries in the brain because of fat deposits in the vessel lining (atherosclerosis).  This cuts off or decreases blood flow to the brain.  Embolic strokes usually result from blood clots elsewhere in the body like pulmonary embolism (PE) or deep vein thrombosis (DVT).  Clots from the area involved migrate to the brain and block blood flow. 

Mini strokes called transient ischemic attacks, TIAs for short, usually last a few hours.  If longer than 24 hours, it is considered a CVA.  The impairments that occur are not permanent.  TIAs signal that one is at risk for a potential stroke with lifelong impairment. 

Signs and symptoms of strokes include:

• Dizziness, lightheadedness
• Weakness or loss of function  in arm, leg, face on one side
• Slurred speech or loss of speech
• Blindness 
• Mental  confusion or loss of consciousness
• Unsteady gait

 

The pseudonym FAST is a simple way to recognize general stroke symptoms. Face droops; Arm weakens; Speech difficulty; Time to call 911. 

Risk factor reduction is a good way to protect yourself and prevent strokes.  Keep your blood pressure in normal range.  Eat low fat dpet to keep lipids low.  Refrain from smoking.  Stay active with regular exercise.  Make less stress a priority as well. Best health!

Keep Your Medical Records Current

The best way to find the medical care you need and deserve is to be informed and prepared starting with your complete medical history.  Your medical record is the foundation of your health maintenance.  Collecting your records from your PCP (primary care physician) and each healthcare provider helps you stay current and up to date with your medical care and treatment.  Keeping track of the vast amount of medical information that concerns you is very important.  


A medical release authorization form is required to have your medical records released to you.  Medical record release forms are available through your doctors' offices, hospitals, clinics, and insurance providers.  Many providers have them available on their websites.  Internet searches will bring up medical release forms that can be used anywhere.  Once your form is completed, mail or fax to the healthcare provider. Charges may be incurred for copying and mailing records. 


Electronic health records (EHRs), also called electronic medical records (EMRs), are computerized versions of your medical records.  This format is replacing hard copy medical records. Patients are able to access their records anytime through secure patient portals to look at health provider reports and test results. You can also directly email your doctors, make appointments, get medication refills, and much more.  This can eliminate unnecessary visits and phone calls. 


Once you have obtained your medical records, it is important that you check for accuracy.  If any information is inaccurate, report it immediately to your healthcare providers so it can be corrected.  Make a request to the provider to correct the medical record.  If this fails, submit a statement verifying the mistakes so it can be added to your medical record.  This can prevent future medical errors.


As EHRs become more prevalent, it will be easier to see and access yours on a routine basis.  You will be able to print your records at home.  As you gather your medical record information, keep it in a folder off the computer.  Make a cover sheet listing your medical conditions, medication, allergies/ adverse reactions, operations, family history, social history, and any other pertinent information. This medical summary can then be used on your doctor visits, especially an initial one with a new doctors.  


Help your health care providers provide you with optimal health care.  Keep up with your medical records to enhance and improve your health decisions.  Best health! 

Losing Weight Sensibly

Here are some things you can do to lose weight and keep it off sensibly:

• Make good eating habits part of your life long health maintenance plan.  Avoid yo-yo dieting.  This often results in recurrent weight gain - each time!
• Learn good eating habits.
• Eat small portions.  Five small meals a day will be less caloric and give you more energy with less hunger.
• Enjoy foods you like that may more unhealthy less frequently. 
• Exexrcise routinely.  Frequent intervals of 10 minutes 2 to 3 times a day a few times a week is adequate.  Start slow like with five minutes for first week.  This will help encourage a positive attitude and more activity.

Ask your primary care health provider to refer you to dieticians and nutrition specialists for more details.  Weight loss surgery is an option that can be considered if obesity is causing and making other health problems more serious; however, serious side effects can occur and you can gain the weight back.  Talk to a doctor that specializes in bariatric surgery for details.

Healthy weight is always great. It is one time when less is more.

Best health!

Ways to Protect Your Skin From Sun Damage

As summer approaches more of your body is exposed to sun.  Remember to practice good skin care by keeping your skin safe from those damaging UVA and UVB rays that cause serious, irreparable sun damage and skin cancer. Simple things you can do include:

• Limit sun exposure – avoid 10AM to 3PM, spend less than one hour in direct sun - less or none if fair complexion, burn easily, prone to skin cancer.
• Wear protective clothing – wide brim hats, long sleeves, long pants, skirts and/ or clothes made with sun protection fabric.
• Umbrella and shade.
• Use sunscreen SPF 15 or greater. Put on every hour if sweating or swimming. Put on every area exposed to sun, and be sure to remember behind those ears and on the neck.
• See your family doctor and/or dermatologist for moderate to severe sunburn, or any suspicious skin spots that fail to heal.

Home remedies to ease the suburn: gel from aloe plant; oatmeal bath; ice pack in soft cloth; powder on bed sheets; vinegar & baking powder paste. Keep yourself well hydrated by drinking lots of water. Also, do a self skin exam monthly to keep track of any abnormal skin lesions.  Best health!


by J. L. Richardson, MD, family practice physician, patient advocate, and author of Patient Handbook to Medical Care: Your Personal Health Guide. http://amzn.to/13m51UU

Patient Doctor Commuincation: Listening Is Primary

In this ever changing world of new technology conversations with your doctor face to face are becoming less frequent.  Prior to modern technological advances, most talking to your doctor was done in person during the office or home visit.  Any talk after the visit was by phone, fax, and/or postal mail.  Today this has expanded to e-mail, electronic health records (EHRs), and telemedicine.  Many patients feel that face doctor time is too short and often overshadowed by intense study of the chart and other distractions.  Many doctors overlook the fact that what you have to say will help them diagnose you. 

Studies have shown that missed diagnoses are more likely if the doctor has failed to listen to the patient.  Distractions like patient chart review, interruptions during the office visit, leaving the room to take care of something else, and more decreases the patient’s time.  This unprofessional, unmannerable behavior leaves the patient at a disadvantage.  After getting ready for the appointment and being transported and possibly waiting over one hour to see the doctor, the patient gets an average of less than five minutes of fifteen minute visit to talk.  This is a major faux pas. Patients are able to help lead the doctor to correct diagnoses and treatment over 90% of the time if they listen to the patient.  Less listening invites more unnecessary tests, procedures, and incorrect diagnoses than one can imagine as the doctor tries to rule out what is wrong.

Listening to patients’ history and doing a comprehensive physical exam contributes more to getting the correct diagnosis.  Blood and diagnostic tests add to this; however, if the patient doctor communication is unclear, these could be the wrong tests.  For the patients’ best interest (and less misdiagnosis for patients, malpractice for doctors) communication must be a priority.  The following suggestions for doctors will help:

• Avoid distractions when you are with a patient.
• Give more time for those that need it like hearing impaired, elderly, illiterate.  If hearing impaired, write down conversation to each other.
• Listen intently to patients without interruption when they are talking.  More important information and more information will be obtained that way.
• Take more time to answer questions.  Use patient information handouts as applicable (include books, CDs, websites, etc.on pages)) for more reliable factual information
• Review patients’ medical record before you see them.  The more you see them the better you will get to know them requiring less chart review before each visit.

Doctor and patient communication is important in every patient’s health care.  Miscommunication can lead to adverse outcomes, inaccurate diagnosis, improper treatment, and poor overall health care.  Listening is a primary diagnostic tool that should be used all the times.  Best health!

Reading For Your Health

Read. Read some more. The good healthy feeling that comes from reading is a natural healer and wellness booster.  Like eating nutritious foods, reading good books enhances your health.  Your body, mind, and spirit reap benefits.  Your body is at one of its most relaxed states of rest when you are reading even for last minute midterms!  Reading is actually one of the best natural stress relievers available.  It nourishes the mind in so many healthy ways.  This in turn nourishes the body and spirit.

Research shows that readers are more likely to have better health and better health outcomes just from reading.  Of course, it only makes sense that reading about basic health and your health concerns contributes to that. Educating yourself through the written word allows you the opportunity to make the best health choices for you.  You can become your own precision medicine specialist!

Make reading a daily exercise throughout the day.  Read different sources of content that interest you.  Find more topics you have little knowledge in and read about them.  The learning and fulfillment gained is enough to increase your pleasure, teach you something, and promote wellness when you read.  Read.  Read some more.  Best health!

HEALTH INSURANCE PRICES RISING

Your health insurance price is going higher.  Since July 2015 there have been reports of health insurance premiums rising in 2016.   Prices have risen by 25 per cent or more with many health insurance plans.  It may actually be cheaper to be uninsured especially if you are healthy and stay that way.  Since the Affordable Care Act took effect in 2014, insurance premiums are on the rise again.  If deductibles are included, it resembles prices of yesteryear.  The premium may be less, but adding the deductible balances out to about the same yearly amount as before the health law was passed. 

With premiums likely to rise as much as 25% again next year this could set the stage for more uninsured as patients find they may be able to do better without insurance. The 2016 yearly penalty imposed if one declines to be insured by a health plan is $695 per adult and $347.50 per child but can be no more than $2085 per family or 2.5% of family yearly taxable income.  This increased over 50% from $325 and $162.50 respectively in 2015 with total to be no more than $925 or 2% of yearly taxable income. In 2014 when the Affordable Care Act went into effect the penalty started at $95 per adult and $47.50 per child with total to be no more than $285 or 1% of yearly taxable income. 

Many are paying between $200 to over $1000/ month for “affordable” health insurance.  If health care could be attained at less than $2085 a year, could it be to your advantage to opt of health insurance coverage and pay the health premium penalty? The choice is yours to make for health coverage.  With or without it, price increases continue. Though it may appear cheaper and healthier to be uninsured it may be more risky.  One unexpected consultant visit or diagnostic test can easily exceed $2085 for the year! 

If you are without any major illnesses or chronic disease, and have a healthy genetic predisposition, do you really need health insurance?  Should you save your money in a medical fund until you need it instead of having health insurance?  There are folks doing this, and they are spending less on their medical care than the price of what health insurance would cost.  Many are able to afford their medicines (if they are taking any) and other treatments as well as routine screening tests that may be needed.  Their own health savings account is their “insurance”.  Saving enough money for your health care is difficult because health changes as unexpected health challenges arise especially with aging. 


Should you have health insurance?  Do you have enough money in your budget for health insurance and/or a health savings account? It is prudent to have some type of coverage solely because your health is so important.  Health insurance is prevention intervention as well as diagnosis and treatment coverage.   As more insurance companies focus on wellness and prevention, more services are covered at much less than what you will pay for them yourself. Health insurance benefits do seem to give you more bang for your buck and your body.
The choices for your personal health maintenance are there.  Health insurance is important like home and car insurance.  You are your most important asset.  To keep the car and house  while maintaining financial stability, you must stay in good health.  Find a plan to fit your needs medically and financially.  Even if you have health insurance, unless it's the "gold" plan you will most likely have to pay some out of pocket as well (deductibles, copays, full pays for services not covered).  Saving your health can help save your money. Best health!

10th ANNIVERSARY PATIENT HANDBOOK TO MEDICAL CARE THANK YOU

This year marks the tenth anniversary since publication of Patient Handbook to Medical Care: Your Personal Health Guide.  Thank you all for reading my book and nine year old blog.  This book was written to help each and every one of you for we all are patients at some time in our lives.  The primary intent and purpose for writing Patient Handbook to Medical Care: Your Personal Health Guide was to help patients learn the basics involved in seeing your doctor and healthcare providers.  It was far too much to tell in a short office visit so I decided to write it down and self-publish!
Since 2006 publication, Patient Handbook to Medical Care: Your Personal Health Guide has become available in many libraries and bookstores (on and off line). There is a Kindle e-book with plans for the audible version.  The blog has been viewed by so many!  Book giveaways, sales, and blog reads are an indication of the patient interest in health facts and information. Health literacy improves your health care in all ways. It helps you make the right choices for you and your family.

Again much thanks to you all! Best health!

Dementia Risk and Prevention

Findings from a 40 year research study found that dementia is decreasing.  The average age of occurrence, if ever, has risen from 80 t0 85.   As you get older, your chances of developing dementia increase.  Age and inheritance are two of the strongest known risk factors.  Cardiovascular risk is also associated with increased risk as are diabetes, tobacco use, and many other factors.

Of the 40 million plus people in the United States over 65 years of age (about 560 million worldwide), about 5.2 million have some type of dementia.  In the United States this is expected to double or more by 2050.  Alzheimer’s disease is the most common form of dementia.  Other types include: vascular, Lewy body, Huntington’s disease, dementia secondary to disease (e.g. Parkinson’s disease, HIV, multiple sclerosis) or trauma (usually repeatedly like sports head injury in football, boxing), nutritional deficiencies, medication induced, inherited forms, and many more. 

Signs and symptoms of dementia include memory problems, decreased cognitive ability, and decreased physical activity whereby activities of daily living (bathing, dressing, eating, household chores, etc.) may require assistance. Personality changes like agitation, inattentiveness and irritability are common.  Dementia diagnosis begins with a thorough history (of patient and family) and physical examination including blood tests.  Brain scans (MRI, CT, PET) are important in helping make the diagnosis.  Neurologic evaluation by a certified neurologist is also indicated for suspected dementia.    
Treatment includes behavioral, occupational, and physical therapy as well as medication. In some cases such as medication induced dementia from vitamin deficiency or low thyroid levels after proper medication is given.  If a drug is the cause, it will resolve by stopping the medicine. Dementia drugs can lessen the symptoms of cognitive decline, in spite of the fact that disease will usually continue to progress. Regular exercise has been shown to do improve function, also.

Preventive measures include:

• Nutritious food especially those aimed at brain health
• Physical movement and exercise
• Restful sleep
• Daily routine to include self care, meals, etc. at same time
• Intellectual stimulation like reading, conversation, brain exercises, music
• Social activities especially with family, friends
• Avoidance of smoking, too much alcohol
• Good maintenance of high blood pressure, diabetes, high cholesterol and any other diseases you may have
• Prayer and meditation

As dementia progresses, it can debilitate to the point of total disability and lack of all function to the point where care must be provided by others full time.  This is usually done in the comfort of their home, or in a fully supervised care facility.   Caregivers in the home setting may include family, friends, and hired health care providers that may be necessary.  Caregivers are very important in dementia care. They provide most of the care necessary to keep the patient functional. 

Keep your brain and body as healthy as possible in an effort to prevent dementia.  It may be decreasing, but as we live longer the likelihood increases.  Best health!

Mobile Healthcare:Telemedicine Telehealth

If you could visit your doctor 24/7 how much money and time could you save?  Telemedicine healthcare makes this possible.  Telemedicine makes virtual reality a reality as real as visiting your doctor in the office.  Through your smart phone, tablet or computer you can make a doctor visit.  No travel time. No wait time. Just quality doctor time.

Telemedicine is a billion dollar business that is becoming a trend in our connected world of convenience and crucial time management.  It entails the use of electronic communications to monitor and improve a patient’s health status.  In addition to saving money for patients and all providers (including insurance companies, hospitals, clinics), there is better access for everyone. Studies have shown that overall quality of care improves as patients are given more of the attention they deserve to make their healthcare experience more beneficial. .  It is helpful for patients in remote areas with limited or no transportation and those with chronic conditions that limit their ability to make an in person office visit.   

As telehealth develops, doctors and patients will find even greater access with connectivity via personal electronic health devices and applications (apps, for short).  Telemonitoring allows patient and doctor to check and follow together such parameters as blood pressure, blood sugar, and much more in real time together.  If that noon time blood sugar is too high, your doctor can be aware and advise accordingly at the time of occurrence instead of on the next appointment in 2 weeks.  This alone saves the patient’s health as well as travel time, office visit wait time, and the money to do all of this.  It potentially avoids an emergency room visit and hospital admission. 

In addition to patient care, doctors are able to communicate in a more timely, efficient manner with other doctors and health facilities.  The CT scan you had this morning is can be viewed by your doctor within minutes after completion instead of days after. Mobile collaboration allows your doctor to discuss your health case with other healthcare professionals like specialists (in the same or different locations) to determine the plan for your care.  This can actually happen the same day a test is done!  This eliminates delays in care that could be life threatening to a patient. 

As costs for telemedicine access decrease and more insurance companies/plans reimburse, it will become the portal of choice for many patients, doctors, and other healthcare providers.  Your doctor visit time can be more about you at your convenience in your home.  Best health!

Chronic Non-Malignant Pain Opiate Options

You got pain?  Take a pill to ease the strain.  Chronic nonmalignant pain affects everyone.  It can be a major cause of personal and family distress.  In addition to the pain of pain many live with secondary effects such as depression which leads to family chaos, work absenteeism, and decrease in activities of daily living to the point of depression.  Prescription medication like nonsteroidal anti-inflammatory drugs (NSAIDs include ibuprofen, naproxen, celebrex and more) and opiates (oxycodone, hydrocodone, codeine, morphine and more) are the gold standard for acute and chronic pain management.  Once you have seen the doctor you are most likely to get one or both of these depending on the etiology of the pain.  Once the cause of the pain is found and treated the need for pain medication may cease.  If this fails to work, the pain meds continue.  This can be a hazard to your health.

In 2012 there were about 183,000 deaths worldwide.  In 2014 there were over 47,000 lethal drug overdoses making it the leading cause of accidental death in the United States (2012 statistics: United Kingdom: 3,200, South America/Latin America/ Caribbean: 7300, European Union: 6100, Oceania: 1900).   This exceeds the number of deaths in road accidents in most countries. Research from studies done in 2013 revealed that opioid analgesics were the primary cause of most drug overdoses in the United States.  Over three-quarters of these deaths were accidental or unintentional.  Opioids (75%) were the most common drug followed by benzodiazepines, antidepressants, and antipsychotics.  Prescription pain relievers accounted for over 18,000 overdose deaths.  Misuse of these medications often leads to illicit heroin use.  Why?  It is easier to get and less expensive than prescription opioids even though the rate of prescribing opioids has almost tripled since 1994.  This has increased the mortality rate from overdosing over 400% in women and over 200% in men from 1999 to 2010.

Pain can be managed in ways that use less prescription pain medicine.  The pill may be the easiest way and is usually the first thing a patient is offered.  There are many options to finding relief while decreasing your risk of opiate dependence or overdose. Your doctor can do the following:

• advise on other treatments and refer to appropriate specialists
• discuss risks, side effects, etc of prescription pain drugs
• educate, provide resources for education on the diseases, pain management (articles, books, videos, agencies like Partnership for Drug Free America)
• prescription drug monitoring (doctor-patient contract, drug tests)
• use of non medicinal treatment
• identify risky drug use patterns
• require visits for refills
• referral to pain management specialist
• behavioral therapy consult

Opioid dependence and overdose can be prevented.  Using opioids responsibly is the patient’s responsibility.  It is up to you to recognize what these types of drugs can do to you.  Relief of pain is the objective; however, the addictive potential must be taken into consideration.  It is important to get a correct diagnosis of the pain as there is probably non opiate treatment that can make it tolerable or resolve it totally.  Make opiates the option instead of the treatment of choice.  Best health!

Personalized Precision Medicine

As we look forward to medical breakthroughs of the future, precision medicine becomes more of a reality in your medical care. Precision medicine uses treatment and intervention based on a person’s genetic and non-genetic (e.g. lifestyle, environment).  Unlike the present but ever changing protocols for wellness and disease management that are used on everyone, precision medicine is individualized just for you.  It will be your own prescription for staying well and treating your ailments. 

The basis of precision medicine is genomics.  Sequencing of your genome is done.  This molecular process identifies normal and abnormal genes.  Genomic mutations are studied and tested for different characteristics.  The results of this testing allows for prevention, diagnosis, and treatment based on your molecule makeup within your genes that have been influenced by family history, lifestyle, and environment.  DNA analysis of your genes in addition to a thorough history and physical will help your doctor determine what you have and what health risks may be present.  This information will then be used for further diagnosis and treatment.  Prevention of conditions that you are prone to develop may be less likely to develop if at all.

Precision medicine has become prevalent in drug treatment as well as disease diagnosis.  Clinical pharmacogenetics makes use of patient’s genetic data as a guide for drug therapy.  This information can then help your doctor pick the right medication for you. Pharmacogenetic information for blood thinners like coumadin and clopidogrel can be helpful in choosing which will work best for you with least complications.  Neonatal (newborn) diabetes and mature onset diabetes of the young (MODY) are rare causes of diabetes.  The cause of these types of diabetes is from an inherited mutation of one gene (monogenic).  Genetic testing can make the correct diagnosis that would otherwise be missed or misdiagnosed.  Some cancers have specific gene mutations that can be detected and treated successfully based on this information.  Drugs are made to target these and eradicate the cancer.

Thousands of disease genes and genetic tests have been discovered since the Human Genome Project of 2003.  As costs go down and precision medicine improves, personalized medicine will get more precise.  Prevention instead of treatment will be more likely.  Genetic tests and treatments for the individual will be precisely what the doctor orders for you.  Best health!