Listening Is Primary for Effective Quality Healthcare

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!

Patient & Doctor Value Visit

Visits to your doctor or any healthcare provider can be frustrating and time consuming for all involved.  These are some things you can do to make it an easier and more productive.

One of the first things you want to do is make a written or typed medical history to take with you, especially if this is your first visit to a new doctor. Make a copy for you and your doctor. You both will be able to refer to it as needed. This will save valuable time, and give you and your doctor more time to talk instead of flipping through your medical record. It can be difficult trying to "remember" what test or procedure you had 10 years ago or even last year.

It is a good to make appointments when you are well and stable.  Keep a list of things you want to talk to your doctor about. Update the list before each visit. This way you will be able to keep track of what has been discussed, and what needs to be discussed. Try to talk about the most important things first especially those that need immediate attention. Each time you go for your visit, you can refer to your list and take up where you left off. Be sure to express your immediate concerns first. We all know how short a doctor visit can be.

Request copies of your medical records from all your doctors. "The medical record is the cornerstone of keeping track of everything pertaining to your health." This gives you a complete assessment of all your medical problems. You will be able to check the accuracy of your records, and bring any errors or absent information to your doctor's attention. Let your doctor know about anything you do not understand, or if there is something you are unable to read due to poor handwriting. It is surprising to see how many doctors are often unable to read their own writing.

Schedule your appointment for first available times in the morning or afternoon.*  This will likely ensure that you will be seen on time with a shorter wait time and longer visit.  It will help you and your doctor focus on your total health care versus acute, intermittent health concerns that can easily take up your whole time. Unless an emergency arises, the wait should be less than 15 minutes.  If there is an emergency you should be notified and given the option of waiting or rescheduling, or going elsewhere for treatment. 

The easiest thing you can do is be on time.  Best health!

*How to Make Your Doctor Appointment http://bit.ly/akMrpX

by J.L, Richardson, M.D., family medicine expert and author of Patient Handbook to Medical Care: Your Personal Health Guide, honorable mention of Writer's Digest International Self-Published Book Award** and Indie Excellence Award finalist.

(**Written by a reliable source, this book is the perfect quick reference for all of those squeamish people who hate going to the doctor. I am one of those people. I hate wondering why a certain test was performed, exactly what a common diagnosis may mean, what the proper specialist for my malady might be called, and negotiating the maze of health insurance forms and other paperwork that seems to accompany my ailment; thereby adding insult to injury. To avoid the mystery, misery, and tedium of the wellness process, I often remain sick in order to forego or delay much needed medical appointments. The author writes for people like me; she writes in a calming, professional tone and explains, in as simple and non-threatening a manner as possible, what I can expect along every step of the healing process. By learning to keep a medical diary, knowing what to expect of my medical staff as well as how to decode their complicated language, and then by understanding the basics of the complex American healthcare system, I can take charge of my own healthcare. This little book provides me with all the tools necessary to do just that. ~Writer's Digest)

Educate Your Body: Know & Learn Your Blood Pressure

Do you know your average blood pressure reading? Do you know a normal blood pressure should be? High blood pressure, also called hypertension affects 1 in 3 adults worldwide.  It affects more people than any disease in the world. Untreated hypertension leads to unhealthy feelings and symptoms.  It causes heart disease, strokes, kidney failure, blindness, poor circulation, and more. 

A normal reading is 120/80.  For more accurate measures of your blood pressure and what affects it, you should do home blood pressure monitoring. Buy a blood pressure monitor for home use. Wrist and arm monitors are available in many stores on and off line. Record your blood pressure readings daily starting with morning, midday, and night. Make a note of your activity and how you are feeling. You may notice that extreme anxiety makes it go up. The correlation to your pressure will help you manage the things that make it go up. Share your results with your doctor so medication and lifestyle changes can be made if necessary.

You may find that while your blood pressure is high in the doctor's office, it may be normal in everyday activity. Remember, the doctor's result is a one time reading every one to four or more months. With normal home results, and high results at your doctor visits you may have "white coat" hypertension. There is much controversy over whether this should be treated. Check with your primary care doctor and cardiologist.

If your blood pressure is above 120/80, you want to start a low salt, low fat diet. One of the best is the DASH diet. Integrating healthy food, exercise, weight control, and stress reduction in your treatment plan improves the way you feel.  It also controls blood pressure. For higher blood pressure readings, medication may be necessary. Be sure to take your home blood pressure results in to your doctor. This will help in deciding on the best treatment for you. Best health!

White Coat Hypertension: Is It Really High Blood Pressure?  http://bit.ly/1cGaeMj

Be Thankful! Appreciate Good Health

Thanks giving is giving thanks every day.  This in itself a great way to appreciate your health.  Keep your personal banks filled with thanks.  Do good for your health all the time.  Be thankful and 
show it in your health.  Best health!

Morning Hypertension Tension

Tension in the morning can be stressful. Hypertension may be contibuting to this.  It may cause symptoms often associated with starting a new day and all you have to do.  This should  be less stressful than many choose to make it.  Normal blood pressure at this time of day is associated with better health and less comorbidity.  

Hypertension in the morning may start as early awakening, anxiety. headache, chest discomfort, and general fatigue.  Studies have shown heart attacks are more likely to occur this time.  High blood pressure in the morning should be recognized.  Many times it is associated with normal blood presuure for most of the waking hours without symptoms.  

Treatment must be specific for each person.  It is good to begin with simple common sense things like restful sleep, healthy diet, and exercise.  Meditation, yoga, and prayer are beneficial as well as easy to do upon waking up.  Reading books and watching instructional videos is an easy, inexpensive way to learn.  As these are made routine, stress reduction is also enhanced.  

Maintaining a healthy weight and BMI are important as well.  Foods specific for cardiac health like beans, greens, and grains are very beneficial. Lack of response to these may indicate a need for medication especially if blood pressure is elevated more than four hours upon and after awakening. Specific herbs and supplements may also be added.

Home blood pressure checks remain beneficial for keeping track of daily blood pressure measurements.  A record of these should be kept along with notes on present activity and treatment.  After two weeks or sooner, you will be able to see patterns, and what is working.  Continue your hypertenson diary for at least three months or longer.  It will become apparent what you can do to keep a normal blood pressure without symptoms and hypertension tension.  Best health!

Your Medical History & Preventiuon Guidelines

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!

Blood Pressure Home Checks

Do you know your average blood pressure reading? Do you know a normal blood pressure should be? High blood pressure, also called hypertension affects 1 in 3 adults worldwide.  It affects more people than any disease in the world. Untreated hypertension leads to unhealthy feelings and symptoms.  It causes heart disease, strokes, kidney failure, blindness, poor circulation, and more. 

A normal reading is 120/80 with borderline at 130/85 to 140/90.  For more accurate measures of your blood pressure and what affects it, you should do home blood pressure monitoring. Buy a blood pressure monitor for home use. Wrist and arm monitors are available in many stores on and off line. Record your blood pressure readings daily starting with morning, midday, and night. Make a note of your activity and how you are feeling. You may notice that extreme anxiety makes it go up. The correlation to your pressure will help you manage the things that make it go up. Share your results with your doctor so medication and lifestyle changes can be made if necessary.

You may find that while your blood pressure is high in the doctor's office, it may be normal in everyday activity. Remember, the doctor's result is a one time reading every one to four or more months. With normal home results, and high results at your doctor visits you may have "white coat" hypertension. There is much controversy over whether this should be treated. Check with your primary care doctor and cardiologist.

If your blood pressure is borderline at 130/85, you want o start a low salt, low fat diet. One of the best is the DASH diet. Integrating healthy food. exercise, weight control, and stress reduction in your treatment plan improves the way you feel and controls blood pressure. For higher blood pressure readings over 140/90, medication may be necessary. Be sure to take your home blood pressure results in to your doctor. This will help in deciding on the best treatment for you. Best health!

White Coat Hypertension: Is It Really High Blood Pressure?  http://bit.ly/1cGaeMj

Heart Month Health Tips

Check your heart list:

___Heart and vascular exam by health care provider
___Blood pressure, pulse, weight, height
___EKG


For further evaluation especially if symptoms are present, and/ or a strong family history of heart and vascular disease see a cardiologist. Tests may include:
___Doppler echocardiogram
___Stress test - nuclear, doppler or exercise
___Heart MRI scan
___Interventional studies like cardiac catherization


Heart health habits:
Maintain a healthy weight.
Eat healthy small portions.
Exercise regularly - every little bit counts! Just do it regularly.
Keep blood pressure under control.
Keep stress level low.
Get adequate sleep.
Take an aspirin a day if in a high risk group. Check with your health care provider.

Love, laugh, and let go! Have a happy, healthy heart!

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! 

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!

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!

High Blood Pressure: How Loud It Can Be

High blood pressure (HBP) is louder than you may think.  Often called the “silent killer”, hypertension has symptoms to let you know it is present.  Symptoms may include headache, dizziness, fatigue, weakness, blurred vision, seizures, unexplained anxiety, and more.  Though nonspecific these signs and symptoms do correlate with high blood pressure. If you have a family history of HBP and heart problems, it is very likely the symptoms will be present. Untreated hypertension may lead to more serious conditions like heart attacks and strokes.

When you experience symptoms suggestive of hypertension, it is important to get it checked.  This should be done by a health care professional, but can be done at home, also.  Consistent readings above 140/90 call for assessment and treatment.  A complete physical exam, complete blood tests, and EKG should be done to check for overall good health and findings that are seen with hypertension. 

On physical exam the eye exam may reveal retinopathy and artery narrowing.  This is associated with decreased vision and can proceed to blindness.  Bruits over the carotid arteries in the neck and over the abdomen area suggest vascular disease that can block the arteries off.  This can lead to strokes, chronic kidney disease, peripheral vascular disease (poor circulation in legs), sexual dysfunction and more.  Heart findings and EKG changes can show signs of heart disease that accompany hypertension.  Blood tests provide further information and can even help assess if there are secondary causes.  Your doctor correlates all the information to assess a treatment plan. 

Initial therapy includes lifestyle changes like a healthy, nutritious diet, good sleep, low stress, and exercise.  If your blood pressure reading consistently remains elevated medication may be needed.  This may be temporary or lifetime depending on your lifestyle health habits.  For example, weight loss and eating the right foods especially those known to decrease blood pressure, can totally eliminate the need for medication and its side effects that can create new chronic problems. The best part is that you will feel better, and hopefully prevent any problems from untreated high blood pressure.  Best health!

Living with Arthritis - Keep Moving!

Arthritis is an inevitable part of the aging.  It affects 1 in 3 people worldwide. Age-related arthritis usually starts at about 40 with increasing incidence as one gets older.  The more joints it affects the more likely it may become disabling and painful.  The joints most commonly affected are the hands and feet followed by weight bearing joints like the hip and knee.  The spine is also affected causing low back pain, one of the top five reasons for doctor visits.

Arthritis, also called degenerative joint disease (DJD), is just that – degeneration of bone surfaces from years of wear and tear and or occupational overuse.  Over time joint spaces throughout the body become narrow and less mobile leading to a progressive decline in affected joints.  The narrowing of the joint spaces involves an inflammatory process.  Severe degeneration causes bone surfaces to rub against one another in places where cartilage and synovium used to be. All of this can lead to disabling pain and limited movement. 

 Symptoms of arthritis include stiffness, pain, and joint swelling.  This can lead to decreased, limited movement affecting your activities of daily living.  If arthritis worsens, it can lead to mobility issues and may require surgery.  Chronic, debilitating pain may also make all activities more difficult and less enjoyable.

Is this avoidable?  No.  Is it treatable? Yes.  Some studies postulate that cartilage damage induced by inflammatory arthritis that chondroitin sulfate may at least delay progression.  Antiflammatory medications like aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs) help with inflammation and pain.  Further pain contol may be achieved with narcotics which are potentially addictive.  Dietary adjustments include increase calcium and Vitamin D.

The most beneficial treatment is movement. When it’s hard to move, efforts to move must be made to keep from moving even less.  Ironically so, when you feel like you are having a hard time moving, it’s time to keep moving!  Ask your doctor for an orthopedic doctor consult and a physical therapy evaluation for treatment.  You will be able to implement your own home exercise program. 

Best health!

Family Health: Allergy vs. Adverse Reaction

Do you know the difference between an allergy and adverse reaction?  When taking medication of any type, prescription or non-prescription, reactions from a single or multiple drugs may occur.  An allergic reaction usually involves allergy symptoms which may include difficulty breathing, hives, and itching.  Adverse reactions may include this and much more essentially indicating your body is unable to tolerate the medicine.

It is important that your health care team is aware of any reactions to medication you have taken.  When asked about allergies be sure to include adverse reactions as well.  It is also important to note any drug-drug and drug-food interactions you may have experienced.  Medication in the same drug class are often offered as alternatives. These can also be adversely tolerated.

Be aware of your medication history and include it in your medical history.  Share this with all of your healthcare providers.  This will assure that you will be unlikely to be prescribed anything that may cause an allergic or adverse reaction.  Best health!

Read and Learn for Your Health

Read what you need. Learn about what you need to maintain good health and well-being.  Health literacy is an important part of your self-care health care.  It helps promote better health and quality of life. 

Medical science progresses so rapidly!  It is impossible for health care providers to keep up with all these new developments. Be aware of treatments your doctors and healthcare team have yet to hear about or are unlikely to ever find out about.  The overwhelming amount of new health information that comes out is far too much for many to stay current on every disease and treatment.  This should not stop you the patient from finding out all you can.  The same goes for wellness.  Participating in your health care is mandatory to maintain good health, achieve wellness, and overcome illness.

There are so many different treatments and modalities that compliment traditional medicine.  As many lack training in these areas they are unable to tell the patient.  Asking your doctor is a good starting place as is telling your doctor about the things you have read about or tried that helped.  In turn this may evoke a response by your physician to find out more, and even share with other patients and colleagues who may in turn share their “new” information which your doctor can share with you.

Reading and learning are vital to good health.  Informed choices based on fact have proven to yield better health outcomes.  Best health!

Keep a Happy Heart, Be Heart Smart

A healthy heart is a cheerful heart.  Keep your heart smart and happy with this quick, easy to understand information.

Check your heart list:
___Heart and vascular exam by health care provider
___Blood pressure, pulse, weight, height
___EKG

For further evaluation, especially if symptoms are present, and/ or if there is a strong family history of heart and vascular disease see a cardiologist.

Tests may include:
___Doppler echocardiogram (checks heart valves, size, etc.)
___Stress test - nuclear, doppler or exercise (heart function)
___Heart MRI scan (artery disease)
___Interventional studies like cardiac catherization, angiogram (checks artery blockage, valve function)

Heart health habits:

1. Maintain a healthy weight.
2. Eat healthy small portions.
3. Exercise regularly - every little bit counts! Just do it regularly.
4. Keep blood pressure under control.
5. Keep stress level low.
6. Get adequate sleep.
7. Take an aspirin a day if in a high risk group. Check with your health care provider.
8. Love, laugh, and let go!

Have a happy, healthy heart! Best health and love!

J.L. Richardson, MD, family medicine, is the author of the award winning Patient Handbook to Medical Care: Your Personal Health Guide.

How You Can Save on Health Costs

Rising health care costs are one of the biggest reasons many people refrain from getting medical care when they need it.  Medical care costs deter many from doing what is best for their health. The following suggestions will help you spend your health dollars more wisely.

1. Eat proper foods. This is more healthy and less expensive especially if dining out or ordering in is eliminated.  Deleting junk food reduces expenses as well.  Home cooking is better for you and less costly.
2. Keep weight stable. It is the healthy thing to do. This will save on grocery and clothing expenses as well as long term savings on medical expenses.
3. Get prescription medicines in bulk quantity of 100 versus thirty day supply especially if you are paying outright. Buy nonprescription medication in bulk when on sale. You will be amazed at your savings when you buy a six to twelve month supply on sale. This tip is also effective for emergency preparedness.
4. Talk with your doctor by phone, fax, and email to save on the cost of an office visit payment. Just think about the number of office visits you have been to where all you did was talk (after waiting for a long while). This will save your time and money.
5. Monitor blood pressure at home.  Call in, email, or fax your readings to your health care providers. Many doctors will discover that your blood pressure is actually stable when the stress of the doctor's white coat is absent. For diabetics, a home glucometer is very useful for monitoring blood sugar.
6. Maintain healthy lifestyle changes long term.
7. Do routine health maintenance check-ups and testing.  Prevention and early detection have proven cost effective and good for overall health.

Invest in your most important asset - YOU. Maintaining your good health is one of the best ways to prosper into longevity.  Best health!