Saturday, March 25, 2017

Living with Chronic Condition: What’s a Good Life for You?

Just read Stop Accepting Death: A doctor rejects medicine’s‘self-righteous’ approach with patients and am inspired by Dr. Diane Meier’s comment I think the question is not one of forcing people to look in the mirror and say, “You’re going to die.” The right question is, “What’s a good life for you? How can I as a clinician wrestle the resources and capacities of the health care system into something that’ll serve what matters most to you?”

Those affected by a chronic condition(s) may be more inclined than most to think about their mortality. What if we took Merier’s comment a step further and asked ourselves how to define “a good life” for all aspects of our life, not just how we might be feeling on a particular day. Would we continue to do the same job? Let others define what we do? Would we even know how to go about answering that question?

So how would you define a “good life” at this stage? Keep in mind this isn’t how you thought life would be when you were 20, or even a few months ago. It’s about the here and now.

Below are things to consider:
• Accept the givens, both positive and negative, (age, abilities, physical restrictions etc.) of your life.
• Understand how limitations may influence your daily life, while recognizing your strengths and abilities.
• Listen to what your body, mind and soul are telling you.
• Let go of being overwhelmed by your present life.
• Let go of things that are beyond your ability to alter or change by your actions.
• Recognize the importance of harmony and balance
• Trust that you do know what’s best for you and not let others define it for you.

Stay with it as it may take some time to figure it out. Also recognize that as things change-and they always do-you may need to modify. Finally, share with your medical provider how you define “a good life” so you can work together to achieve aspects that pertain to your care-such as pain management, relief of symptoms etc.

Tuesday, March 21, 2017

Take a Break: Celebrate Water Day

World Water Day is March 22. Hard to believe that it started in 1933 and many people probably aren’t aware of it. So this year, celebrate World Water Day by trying one of the following:

• See the glass as half full
Check for local events and join in
• Check all the water sources in your house for leaks
• Go for a swim
• Go for a walk near a river, lake, pond, stream, ocean or sea and pick up any debris you see

• Drink water throughout the day

Saturday, March 18, 2017

Journal Watch March 2017

Wireless Stimulation May Ease Migraine Pain as Well as Drugs: A wireless patch that you wear on your arm may help reduce migraine pain as well as drugs. The device uses electrical stimulation to block the pain signals from reaching the brain. The patch uses rubber electrodes and a chip on an armband. The device can be controlled by a smartphone app. Neurology 

 Valium May be Useless for Acute Lower Back Pain: For decades, emergency room staff often gave Valium to patients for an acute bout of bad lower back pain. But a new head-to-head trial in an ER environment casts doubt on the notion that Valium or potent painkillers can really help. As reported Feb. 22 in the Annals of Emergency Medicine, the trial found that Aleve (naproxen) and a "dummy" placebo pill were as effective as naproxen plus Valium (diazepam) in treating ER patients with acute lower back pain.

Proper movements in Muslim prayer ritual can reduce lower back pain: Research finds that pain can be remedied with proper knee, back angles. Five times a day, roughly 1.6 billion Muslims worldwide, bow, kneel, and place their foreheads to the ground in the direction of the holy city of Mecca, Saudi Arabia, as part of the Islamic prayer ritual, the Salat. According to research, the complex physical movements of the ritual can reduce lower back pain if performed regularly and properly. Journal of Industrial and Systems Engineering 

Can staying active help to prevent chronic pain? Physical activity affects pain modulation in older adults. Older adults with higher levels of physical activity have pain modulation patterns that might help lower their risk of developing chronic pain, reports a study. PAIN 

• Is back pain killing us? Older people who suffer from back pain have a 13 per cent increased risk of dying from any cause, research has found. The study of 4390 Danish twins aged more than 70 years investigated whether spinal pain increased the rate of all-cause and disease-specific cardiovascular mortality. European Journal of Pain 

• Mediterranean Diet May Ease Chronic Pain of Obesity: People who are overweight and plagued by chronic pain may find relief in a Mediterranean diet, new research suggests. The study of 98 men and women between the ages of 20 and 78 builds on growing evidence that a diet heavy on fish, fruits, vegetables, nuts and beans provides significant health benefits. It also sheds new light on why eating these foods might reduce pain associated with obesity. Because obese people with chronic pain usually also have a high degree of inflammation, lead researcher Charles Emery suspects the foods' anti-inflammatory properties might explain the reduced pain levels. Pain 

1 in 4 US Adults Disabled by Arthritis: Overall, 54 million adults -- or one in four -- report an arthritis diagnosis. And the number of people disabled by it has jumped 20 percent since 2002, the U.S. Centers for Disease Control and Prevention reported. Almost two of five adults with arthritis are of working age -- 18 to 64 years old. The most common types are osteoarthritis, which is age-related wear and tear; rheumatoid arthritis; gout; lupus; and fibromyalgia. Although narcotic painkillers are often prescribed for arthritis, other options are safer, the CDC added. Instead of opioids, doctors and loved ones can encourage people with arthritis to exercise and watch their weight. Exercise -- such as walking, swimming or biking -- can reduce symptoms by as much as 40 percent. Vital Signs 

Opioid Dependence Can Start in Just a Few Days: Prescribing narcotic painkillers for 3 days or less may lower chances of addiction, study finds.  MMWR 

Phage therapy shown to kill drug-resistant superbug. Phage therapy could offer a safe and effective alternative to antibiotics in the treatment of Cystic Fibrosis lung infections, researchers have demonstrated. Phages are viruses that kill bacteria but are otherwise harmless. A major advantage is that phages only target the harmful bacteria, so there are less side of the effects often associated with antibiotics. Thorax 

• Twice weekly yoga classes plus home practice effective in reducing symptoms of depression People who suffer from depression should participate in yoga and deep (coherent) breathing classes at least twice weekly plus practice at home to receive a significant reduction in their symptoms. The intervention seemed helpful for "people who are not on antidepressants and in those who have been on a stable dose of antidepressants [but] have not achieved a resolution of their symptoms,"  The Journal of Alternative and Complementary Medicine 

Pot Use Tied to Higher Odds for Stroke, Heart Failure: New research analyzing millions of U.S. medical records suggests that marijuana use raises an adult's risk of stroke and heart failure. NORML; American College of Cardiology 

• Brain Training for Cancer Survivors’ Nerve Damage: Learning to control their brain waves with a type of training called neurofeedback seems to help cancer survivors ease symptoms of chemotherapy-caused nerve damage, a new study suggests. Cancer 

Approves Odactra for House Dust Mite Allergies
• Warns against Whole Body Cryotherapy as exposure to ultra low temperatures show no benefits and may be dangerous.

Type 2 diabetes prevented in 80 per cent of at-risk patients thanks to repurposed drug: A weight loss drug has reduced the risk of type 2 diabetes by 80 per cent compared to placebo, report investigators. After three years, the researchers found that the patients given liraglutide were 80 per cent less likely to develop diabetes than those in the placebo group. In 60 per cent of those patients, prediabetes was reversed and patients returned to healthy blood sugar levels. The Lancet 

Heart Risks in Middle Age Boost Dementia Risk Later in Life: People who have heart disease risks in middle age, such as diabetes, hypertension or smoking, are at higher risk for dementia later in life. Stroke Conference 

Exercise Beats Weight Loss at Helping Seniors’ Hearts: Research found that getting active may do more for cardiovascular health in older adults than losing weight does. A 15 year study found that among 5,300 people aged 55-97 at the study’s start, no link was found between their body mass index (BMI) alone and heart disease. BMI is an estimate of body fat based on weight and height -- the higher the number, the more fat. However, the study did find that physical activity was tied to a lower risk of heart disease, no matter what a person's BMI was. European Journal of Preventive Cardiology

 • Hearing Aid Outcomes Found to benefit Older Adults: Hearing aids provide significant benefit to older adults, according to a study published online March 2 in the American Journal of Audiology. Benefits were similar for both the audiologist-fitted devices and over-the-counter aids. But participants whose devices were fitted by an audiologist expressed more satisfaction, the researchers found. 

• Exercise Treatments Best for Reducing Cancer-Related Fatigue: Psychological treatment and education can be useful, too, more so than drugs, researchers find. Exercise and/or behavioral and educational therapy may be more effective than prescription drugs for dealing with cancer-related fatigue, according to a meta-analysis published online March 2 in JAMA Oncology. 

• How much sun is good for our health? Researchers have estimated the duration of solar radiation exposure required in order to obtain the recommended doses of vitamin D. While in spring and summer 10 to 20 minutes in the sun are enough, in the winter months almost two hours would be needed, therefore for the vast majority of the population it is difficult to achieve the optimal values. Every year, studies on the benefits of sunbathing in moderate doses are interspersed with those that confirm the risks of doing it excessively. Science of The Total Environment 

Older Bones Benefit From Dairy Plus Vitamin D: Consumption of milk, yogurt and cheese was associated with higher bone mineral density in the spine and less bone loss in the hip among older adults -- but only if they also took vitamin D supplements. Journal of Nutrition 

Bad Diets Tied to 400,000 US Deaths in 2015: Unhealthy diets may have contributed to as many as 400,000 premature deaths from heart disease and strokes in 2015, a new study estimates. And, it's not just the things you should be avoiding -- such as salt and trans fats -- that are contributing to these deaths. The excess deaths may also be caused by what's missing in your diet -- namely, nuts and seeds, vegetables and whole grains, the researchers said. AHA Meeting 

Downside to Gluten Free Diets: In a large study of U.S. health professionals, scientists found that those with the least gluten in their diets actually had a slightly higher risk of developing type 2 diabetes over a few decades. The findings do not prove that a low-gluten diet somehow contributes to diabetes. But the study raises questions about the long-term benefits of avoiding gluten, which many people assume to be a healthy move. American Heart Association Meeting 

• Soy Safe, Even Protective, for Breast Cancer Survivors: Research involving more than 6,200 breast cancer survivors finds that those who ate the most soy had a lower risk of death from all causes during the nearly 10-year follow-up period. Cancer 

Eight servings of veggies a day is clearly best for the heart A comprehensive meta-analysis of 142 articles from 95 population studies shows that the risk of dying prematurely from all causes was reduced by almost a third, and the risk of cardiovascular disease by about a quarter in people who ate 800 grams of fruit and vegetables-- or eight a day -- compared to those who ate very little or no fruits and vegetables. International Journal of Epidemiology 

Popular heartburn drugs linked to gradual yet 'silent' kidney damage: Most patients don't experience acute kidney problems beforehand. The sudden onset of kidney problems often serves as a warning for doctors to discontinue patients' use of proton pump inhibitors (PPIs), sold under brand names Prevacid, Prilosec, Nexium and Protonix, among others. But a new study indicates that more than half of patients who develop chronic kidney damage while taking the drugs don't experience acute kidney problems beforehand, according to researchers. Kidney International 

 Rheumatoid Arthritis Drug May Not Ease Chronic Fatigue Syndrome After All: A small-scale clinical trial has cast doubt upon the potential usefulness of an anti-inflammatory drug to treat chronic fatigue syndrome. Doctors had hoped that anakinra (Kineret) -- a medication for rheumatoid arthritis -- also could be used to relieve symptoms of chronic fatigue syndrome. But after a month of daily anakinra injections, a group of 25 women reported chronic fatigue symptoms as severe as those experienced by a control group receiving placebo shots, researchers reported. Annals of Internal Medicine 

• Home Beats Rehab for Knee, Hip Replacement Recovery: Patients who go straight home from the hospital following hip or knee replacement surgery recover as well as, or better than, those who first go to a rehabilitation center, new research indicates. And that includes those who live alone without family or friends, one of three studies shows. American Academy of Orthopaedic Surgeons meeting 

  Taking Statins May Boost Heart Surgery Outcomes: Heart surgery patients taking statins should keep taking those cholesterol-lowering drugs, even on the day of their operation, because doing so may improve their chances of survival, a new study suggests. The Annals of Thoracic Surgery 

Intensive Treatment Shows Potential Against Type 2 Diabetes: Instead of managing type 2 diabetes as a chronic condition, what if people could beat the disease? That was the thinking behind a small pilot study, which suggested that intensive treatment with oral medicine, insulin, diet and exercise might knock out the disease, at least for several months, in certain patients. Up to 40 percent of patients who were treated experienced complete or partial remission for three months, the study found. Journal of Clinical Endocrinology & Metabolism 

• Estrogentherapy shown effective in reducing tooth and gum diseases in post menopausal women: Study links benefits of osteoporosis treatment with better periodontal health. Estrogen therapy has already been credited with helping women manage an array of menopause-related issues, including reducing hot flashes, improving heart health and bone density, and maintaining levels of sexual satisfaction. Now a new study suggests that the same estrogen therapy used to treat osteoporosis can actually lead to healthier teeth and gums. Menopause 

• Longer Addiction Treatment is Better, Study Confirms: The only significant factor in treatment success was the length of treatment. After one year, the treatment success rate was about 55 percent for those who underwent a standard 30-day treatment program. But the success rate was about 84 percent for those in treatment programs that lasted more than 30 days, the investigators found. Open Journal of Psychiatry 

• Higher Spending by Docs May Not Buy Better Health: Medicare patients treated by higher-spending physicians are just as likely to be re-admitted or die within 30 days of being admitted to the hospital as patients treated by doctors who order fewer or less-expensive tests and treatments, the study revealed. "Spending more doesn't always mean you get better health." JAMA Internal Medicine

• Common Blood Tests Can Help Predict Chronic Disease Risk: A score based on common blood tests may someday help people gauge their risk of developing a chronic disease like diabetes or dementia within three years of taking the test. The Intermountain Chronic Disease Risk Score was 77 to 78 percent accurate in predicting whether someone would be diagnosed with diabetes, kidney failure, coronary artery disease and dementia, among other illnesses. It's based on the results of a comprehensive metabolic panel, which includes tests for blood glucose and liver function, and complete blood count, which measures the quantity of different types of blood cells. NPR 

Wednesday, March 15, 2017

Take a Break: Celebrate St. Pat’s with Paper Celtic Knots

Just in time for St. Patrick’s Day-making Celtic knot patterns with construction or other types of paper.

 • Would recommend using regular paper for this one. How to Make a Celtic Knot. 

Not interested in today’s activity, go to the Take a Break Pinterest Board. and pick out something else.

Saturday, March 11, 2017

Life with Chronic Conditions: Affordable Care Act-What to Know, What to Do

At the end of February, the President voiced his frustration in dealing with the campaign promise of “repeal and replace” the Affordable Care Act (ACA). "Nobody knew health care could be so complicated," he said. Really?

 On March 6, House Republicans issued a proposed replacement for the ACA. Basically this is a compromise bill, which  reflects how difficult a task it is to reverse a major welfare program, which has significant support by many in the public. Note- there is no precedent in Congress for reversing a major program of social benefits once it has taken effect and reached millions of Americans. If they are successful, what this means for other programs, such as social security and Medicare remain to be seen.

Both sides of the aisle have problems with the bill. Referred to as “Obamacare Lite,” “ Obamacare 2.0,” or “Republican Welfare” by Republican conservatives, Democrats are calling it “Trumpcare.” Four key Republican Senators said they would oppose any new plan that would leave millions of Americans uninsured. Senator Majority Leader, Charles E. Schumer state, “Trumpcare doesn’t replace the Affordable Care Act, it forces millions of Americans to pay more for less care.” ‘Trumpcare’ will make health insurance in America measurably worse in just about every way and likely leave more Americans uninsured. It does, however, greatly benefit the very wealthy and special interests.” Also coming out against the bill are various doctor, nurses and hospital associations, along with state, city and county governments.

While the President has warned the Republicans that they’d be looking at a “bloodbath” in 2018-the next major election- if they don’t repeal and replace, organizations like AARP are in strong opposition. We oppose the American Health Care Act. It would weaken Medicare and raise costs for older Americans. Tell your Member of Congress that you oppose the American Health Care Act:

The Guardian provided a succinct summary, The bill would eliminate the individual mandate, which requires Americans to have health insurance or pay a fine; cut the number of people insured under Medicaid; and allow insurance companies to charge the elderly up to five times more than the young. It would require insurers to cover so-called pre-existing conditions, but would allow them to add a 30% surcharge to premiums if people go without insurance for too long.

• Young adults-up to age 26-can remain on parents health plan
• Insurers cannot deny coverage or impose higher fees on people with pre existing conditions.
• Ends lifetime caps on coverage
• Keeps the same essential health benefits under the current law. Insurance companies would still have to cover 10 health services, including maternity coverage, prescription drugs and mental health care. State Medicaid plans, however, would not have to meet this requirement after Dec. 31, 2019.

• No penalties for American failing to have health insurance. However, for those without insurance, insurers would be allowed to impose a surcharge of 30% for those who have a gap between health plans of more than 63 days.

• Planned Parenthood would be ineligible for Medicaid reimbursements or federal family planning grants. The goal is to force Planned Parenthood to eliminate abortions from their services, which only makes up 3% of their services and receives no federal funding to start with.

• Refundable tax credits would include both age as well as earnings, meaning bigger credits for older and poorer Americans. Tax credits ranging from $2,000 per year for those under 30 to $4,000 per year for those over 60. The full credit would be available for individuals earning up to $75,000 a year and up to $150,000 for married couples filing jointly. The credits would phase out for individuals earning more — for each $1,000 in additional income, a person would be entitled to $100 less in credit, meaning a 61-year old could make up to $115,000 and still receive some credit. Compared with the ACA’s subsidies, the tax credits would go to more people but provide less financial help to lower-income people, according to Larry Levitt, senior vice president of the Kaiser Family Foundation.

•  Medicaid expansion will be phased out and be replaced with a per-person sum paid to the states.

• It delays until 2025, the “Cadillac tax” – a levy on the highest cost employer-provided plans.

• Older people will have to pay more for health insurance. Under Obamacare, insurers can charge older people up to three times more than younger people for insurance. Under the Republican plan, this limit will rise to five times more.

• While Obamacare helped millions of previously uninsured Americans obtain healthcare, the proposal would reverse that trend, leaving many without health coverage. The more market-oriented driven approach of the bill will impact the poor the worst, with the number being reduced under Medicaid.

On Thursday, the bill cleared two House committees, Ways and Means and the Energy and Commerce Committees, while Trump and others tried to deal with the backlash. It will now be heard by the Budget Committee and remains on track to land on the House floor by the end of March. Many, from both parties are questioning the lightning-fast process as well as the content of the bill, to say nothing of the fact that the nonpartisan Congressional Budget Office estimate of how the bill affects the federal deficit and the number of insured Americans has yet to be released.

The Republicans control both the House and Senator by narrow majorities. Already there are indications that more moderate Republicans think it goes too far, while more conservatives think it doesn’t go far enough. Assuming that the Democrats vote against it, just three Republican defections in the Senate would be enough to defeat the bill.

That said, anything can and will happen, so be proactive.

Congress and Elected Officials
5 Calls:  Spend 5 minutes, make calls. Calling is the most effective way to influence your representatives. 5 Calls gives you contacts and scripts so calling is quick and easy. A glance on the homepage shows you how many calls are needed per action item. Then, when you click on an item, the site offers the phone number(s), the reason why it’s important, and the script to use while on the call. The site is also personalized to your location, if you enter your address or zip code. 5 Calls is a volunteer effort and is open sourced.

Call to Action: With a simple user interface that’s accessible via the desktop or mobile web, Call To Action has a singular purpose: it makes it easy to find your representatives and place a phone call to their office. It even provides simple scripts to help you get started.

Calling Congress: Representatives and various committee members primarily respond to voters in their district. Realistically, you can’t vote for them so they don’t feel obligated to represent your viewpoint.  However, you can contact friends, family and anyone else you know that reside in states/districts where they can help influence voting. If you have unique information that helps to support a congressional viewpoint, they may take your phone call or e-mail. While it’s helpful to target who their specific representatives on a given committee might be, you can refer contacts to Senate and House member lists or to use 5Calls or Call to Action.

When You Call: It is important to let them know why you are calling and what issue you are calling about. You will sometimes be able to speak directly to your senator or representative, but more often you will speak to a staff person in the member's office. This person keeps track of how many people called and their positions on issues, and provides a summary to the member. Be assured that your call does count, even if you are not able to speak directly to your senator or representative. A good reference on the importance of calling is How to Stop the ACA Repeal-And Drive Your Congress Representative Crazy 

Indivisible Guide: Former congressional staffers reveal best practices for making Congress listen.

Connect with State and National Condition Specific Groups
• State & National Groups: Organizations like Planned Parenthood,  medical condition organizations e.g. American Lung Association, environmental groups  already have campaigns underway. Indivisible  provides a directory of groups taking action. Just plug in your zip code and how far you want to search. Joining these groups, or even just registering for free e-mail news will help you coordinate local campaigns with national efforts. Be selective in what groups you join as you can quickly be overwhelmed.

Women’s March on Washington:  Check their website as they are now posting 10 Actions 100 Days for specific ways you can make a difference. They even have a free down loadable card to make it easier for you to do that. 

Social Media
• Check Before You Post or Send: There is a lot of misinformation out there and it’s changing rapidly. Don’t be a source of “alternate news.” Get the facts not the emotion. A good site to use is 

• Facebook: Check, check, check. If you see something that you want others to see, Cut and Paste instead of “forwarding” after you’ve checked for accuracy. Don’t over post as people start ignoring you. Avoid a constant barrage of “canned” messages. Check out How to Get the Most Out of Your Personal Facebook page 

• Twitter: The Presidents favorite medium. It’s not for everyone, but if it’s for you than work it.

Introducing the American Health Care Act: Download the bill, plus see the GOP’s over view of it.