Thursday, December 31, 2009

Ginkgo Biloba Does Not Appear to Slow Rate of Cognitive Decline

ScienceDaily (Dec. 30, 2009) — Older adults who used the herbal supplement Ginkgo biloba for several years did not have a slower rate of cognitive decline compared to adults who received placebo, according to a new study.

"Ginkgo biloba is marketed widely and used with the hope of improving, preventing, or delaying cognitive impairment associated with aging and neurodegenerative disorders such as Alzheimer disease," the authors write. "Indeed, in the United States and particularly in Europe, G biloba is perhaps the most widely used herbal treatment consumed specifically to prevent age-related cognitive decline." However, evidence from large clinical trials regarding its effect on long-term cognitive functioning is lacking.

Beth E. Snitz, Ph.D., of the University of Pittsburgh, and colleagues analyzed outcomes from the Ginkgo Evaluation of Memory (GEM) study to determine if G biloba slowed the rate of cognitive decline in older adults who had normal cognition or mild cognitive impairment (MCI) at the beginning of the study. The GEM study previously found that G biloba was not effective in reducing the incidence of Alzheimer dementia or dementia overall. The randomized, double-blind, placebo-controlled clinical trial included 3,069 community-dwelling participants, ages 72 to 96 years, who received a twice-daily dose of 120-mg extract of G biloba (n = 1,545) or identical-appearing placebo (n = 1,524). The study was conducted at six academic medical centers in the United States between 2000 and 2008, with a median (midpoint) follow-up of 6.1 years. Change in cognition was assessed by various tests and measures.

In this study, the largest randomized controlled trial of G biloba to report on outcomes to date, the researchers found no evidence for an effect of G biloba on global cognitive change and no evidence of effect on specific cognitive domains of memory, language, attention, visuospatial abilities and executive functions. They also found no evidence for differences in treatment effects by age, sex, race, education or baseline cognitive status (MCI vs. normal cognition).

"In sum, we find no evidence that G biloba slows the rate of cognitive decline in older adults. These findings are consistent with previous smaller studies examining prevention of decline and facilitation of cognitive performance and with the 2009 Cochrane review of G biloba for dementia and cognitive impairment."

Beth E. Snitz, PhD; Ellen S. O%u2019Meara, PhD; Michelle C. Carlson, PhD; Alice M. Arnold, PhD; Diane G. Ives, MPH; Stephen R. Rapp, PhD; Judith Saxton, PhD; Oscar L. Lopez, MD; Leslie O. Dunn, MPH; Kaycee M. Sink, MD; Steven T. DeKosky, MD; for the Ginkgo Evaluation of Memory (GEM) Study Investigators Evaluation of Memory (gem) Study Investigators. Ginkgo biloba for Preventing Cognitive Decline in Older Adults. Journal of the American Medical Association

Wednesday, December 30, 2009

Take the Day Off-It’s a “Beach Day”

While the holidays can be a lot of fun, they can also become overwhelming and you need a break from them. It may sound a bit odd to recommend a “beach day,” particularly if you live in the Northeast where heavy snow is in the forecast and it’s currently zero degrees. However, a day at the beach is the best example I can think of for taking a day off.

Similar to getting ready for a day at the beach, prepare for what you’ll need. This may include getting some special foods and drinks, as well as things to do, such as a good book to read.

Wake up when you want to, and spend as much time as you want getting dressed (or not), eating, reading the paper etc. Phones, computers, faxes and other devices should be turned off. You wouldn’t want these items at the beach.

Just as you would set up camp with your umbrella and chair, map out your space at home. Place your favorite pillow on your reading chair or couch. Maybe position it to take advantage of the sun. Play music that sets the mood. Read, do a crossword puzzle, or any activity that you find relaxing. Drift off to sleep now and again.

When you are at the beach you can’t do chores or deal with work or home problems. Leave those issues for another day.

Instead of taking a dip in the water, pamper yourself with a long bath. If you were at the beach, you might stare out at the water and the distant horizon. Watch the birds in your yard or notice how the trees and shrubs have changed because of the winter season.

At some point during a beach day, you might go for a walk, fly a kite, play a round of mini golf, or play volleyball. Include the equivalent in your day by taking a walk around the block, weather permitting, or do some simple exercises.

No matter our age, you can’t help but find yourself pilling up sand and creating patterns with your finger. While you aren’t going to be able to make a sand castle, respond to the urge of creating something and sketch, draw, doodle, write a poem, or engage in a hobby or craft that you enjoy. Keep in mind that this is a de stress day, so don’t engage in an activity, though enjoyable, which could cause you a lot of stress.

On your day off, respond to the idea of a beach day by keeping it simple, leaving problems, concerns and decisions for another time, and totally immerse yourself in the moment.

Saturday, December 26, 2009

Tips for Staying Healthy During the Holidays

The holidays are now upon us and so are a zillion and one foods we’d be better off not eating. So to avoid unnecessary pounds, and to stay healthy this season, try the following:

Cooking Light’s 5 Best and Worst Holiday Foods

Loose Weight over the Holidays

New York Times Recipes for Health

The Best and Worst Holiday Foods (Eat This Not That)

In addition to watching what you eat, you can also add 10 minutes to the cardio portion of your workout during the holidays to help keep the weight gain down. If you are laughing and saying “as if,” well now is a good time to think about exercise. Just walking for 30 minutes burns about 180 calories for the average person. If you are walking up hill, carry weights or use ski poles you burn even more. Of course one of the easiest and most effective exercises is pushing away from the table.

Which Exercises Burn the Most Calories

Because the holidays are a stressful time, take regular yoga breaks courtesy of Kripalu.

Wednesday, December 23, 2009

Take a Break: Make Snow/Do Qigong Now

Whether there is snow on the ground where you live or not, it’s nice to have a way to accent craft projects or even floral arrangements with what appears to be snow. An easy recipe for fake snow is mixing small amounts together of white acrylic paint, glitter and sand. Dab on to various objects and let dry.

Another idea is to make Snowy Balloon ornaments. A variation to the directions is to sprinkle on the glitter after you’ve applied the glue so you save a step.

RELAXATION TIP: Do Qigong Now

Sunday, December 20, 2009

Death: Thinking about it during the holidays

Death is a topic that everyone thinks about. But why write about it during the holiday season?

Once my siblings and I had moved out of the house, my mother would always say, “this may be the last time we’re together for Christmas.” For her, and many others, the holidays are a time to reflect on who is no longer with us, our health, and in short, it’s a time of year when we take stock of our lives. Therefore, it’s no surprise that several interesting articles and books have recently appeared.

Many of us fear death. We believe in death because we have been told we will die. We associate ourselves with the body, and we know that bodies die. But a new scientific theory suggests that death is not the terminal event we think. Thus begins an interesting article by Robert Lanza M.D. entitled “Does Death Exist? New Theory Says No.” Dr. Lanza is Chief Scientific Officer at Advanced Cell Technology, and a professor at Wake Forest University School of Medicine and has several hundred publications and inventions, and over 20 scientific books.

Dinesh D’Souza, a policy analyst in the Reagan White House, is the bestselling author of many books about politics, patriotism, and religion. His latest book is “Life After Death: The Evidence.” In an article about his new book he writes, In my research I also explored evidence from physics, biology, and brain science to see if life after death is consistent with or even corroborated by these fields of study…. In considering the question of life after death, I moved from why it's possible to why it's probable to why we should embrace the idea. Since we are dealing with a future event, I acknowledge that we cannot have certainty. I don't claim to prove my case beyond a reasonable doubt, but I do claim to prove it by a preponderance of the evidence. In the end, we have to resolve this residual uncertainty by asking a practical question, "Is it good for me to believe?"

Saturday, December 19, 2009

Generics: Not all Drugs are the Same After All

New York Times
December 19, 2009

PATIENT MONEY

Not All Drugs Are the Same After All

By LESLEY ALDERMAN

LET me start by saying I’m a fan of generic drugs. They save Americans billions of dollars each year and give us access to wonderful drugs at affordable prices. I’ve recommended generics in this column many times and use them myself when possible.

But there is a gnawing concern among some doctors and researchers that certain prescription generic drugs may not work as well as their brand-name counterparts. The problem is not pervasive, but it’s something consumers should be aware of — especially now that more insurers insist that patients take generic medications when they are available.

Let me also prepare the groundwork for what I hope will be full and frank reader comments, by acknowledging that this issue is controversial.

Joe Graedon, who has been writing about pharmaceuticals for three decades and runs a consumer advocacy Web site, the People’s Pharmacy, was 100 percent behind generics for many years.

“We were the country’s leading generic enthusiasts,” he told me recently. But over the last eight or nine years, Mr. Graedon began hearing about “misadventures” from people who read his syndicated newspaper column, also called The People’s Pharmacy.

The stories were typically from patients who were switched from a brand name drug to a generic one and had side effects or found that their symptoms returned — or even became worse than before they were medicated. Most recently Mr. Graedon has been hearing complaints on his Web site about generic forms of the antidepressant Wellbutrin XL 300 (known as Budeprion XL 300 in one generic form), the heart medicine Toprol XL (metoprolol succinate) and the antiseizure medicine Keppra (levetiracetam).

“Consumers are told generics are identical to brand name drugs, but that is clearly not always the case,” Mr. Graedon said.

Some specialists, particularly cardiologists and neurologists, are concerned about generic formulations of drugs in which a slight variation could have a serious effect on a patient’s health. The American Academy of Neurology has a position paper that says, in part, “The A.A.N. opposes generic substitution of anticonvulsant drugs for the treatment of epilepsy without the attending physician’s approval.”

But insurers tend to argue otherwise. On Thursday, ExpressScripts, which handles drug insurance for big employers, put out a news release announcing results of a study it sponsored that found no difference in hospitalizations or emergency-room visits for people on brand-name epilepsy drugs compared with those taking generics.

The Food and Drug Administration, meanwhile, says it stands behind generic medications and its methods for approving them.

“We have not seen any scientific studies that show generics do not hold up as well as brand name drugs,” says Gary J. Buehler, director of the agency’s office of generic drugs. “We believe the generic drugs we approve work in everyone.”

The American Medical Association concurs. A spokeswoman for the group told me in an e-mail message, “the A.M.A. position is that as a whole generic drugs do work as well as name-brand drugs.”

Yet, after hundreds of consumers posted messages about problems with the generic drug Budeprion XL 300 on the People’s Pharmacy Web site, Mr. Graedon worked with an independent laboratory, ConsumerLab.com, to test the drug, which in other generic versions is typically known as bupropion.

The lab found that Budeprion XL 300 released the active drug at a different rate than the brand name Wellbutrin XL 300. Mr. Graedon and the lab conjecture that the different dissolution rates might be to blame for the reported side effects and lower effectiveness of Budeprion.

But Mr. Buehler at the F.D.A. explained to me that over the course of 24 hours a patient ends up with the same amount of the drug in the bloodstream, so there should be no reason for a variation in effectiveness. “We remain puzzled,” he said.

The maker of Budeprion XL 300, Teva Pharmaceutical Industries, recently announced that it would conduct a clinical trial comparing its product against the original, Wellbutrin XL.

A Teva spokeswoman said in an e-mail message that the company was working with the F.D.A. on a study “specifically designed to answer the questions raised following the recent anecdotal commentary on generic budeprion.”

“We believe the study and the resulting data will provide further scientific support for the product’s bioequivalence to the innovator drug,” she said.

To parse that statement — or at least understand “bioequivalence” — it is worth taking a step back to consider what a generic drug is and how it gets approved.

When a name-brand drug’s patent expires, other manufacturers are generally free to create their own version of that product. If a drug is popular, a dozen or more companies may rush in to create a copy of it.

According to F.D.A. rules, the new generic version must “have the same active ingredient, strength and dosage form” as the brand name or reference product.

A generic medication must also be bioequivalent to the brand name drug, meaning that it must “be shown to give blood levels that are very similar to” the brand name product, according to a fact sheet on the F.D.A.’s Web site. Generally, the only test that a maker of a generic medication must perform to receive F.D.A. approval is one that establishes the “bioequivalence” of the product. This test is done on healthy volunteers and compares the blood levels of the reference drug to the generic one.

According to Mr. Buehler of the F.D.A., to be considered bioequivalent, the generic drug must reach a blood serum level that is 80 to 125 percent of what the reference product achieves. But Mr. Buehler said that in reality the spread was not nearly that large. He noted that the F.D.A. conducted a large study and found that the average difference in absorption into the body between a generic and brand name drug was only 3.5 percent.

Some specialists, though, worry that the allowable range for bioequivalence is too wide, especially for patients who are taking medication to control problems like arrhythmias or seizures.

If a patient with the heart arrhythmia known as atrial fibrillation who also has risk markers for stroke gets a blood thinner for which the levels are too low, “there is risk for stroke, and if the levels are too high it could result in bleeding,” says James A. Reiffel, a cardiologist and professor of clinical medicine at Columbia.

Neurologists who treat epilepsy have similar concerns. Two studies published last year in the journal Neurology found that patients who switched from a brand-name product to a generic one had more seizures or higher hospitalization rates.

“For many drugs, generics are just fine,” said Kimford Meador, a professor of neurology at Emory University.

“But when you’re taking a seizure medication, the therapeutic window is narrow,” Dr. Meador said. “If the absorption of the drug is slightly different between brand and generic or between generics, then the patient could have a seizure, and that seizure could lead to serious injury or perhaps even death.”

The problem is not just in changing from a name-brand drug to a generic, Dr. Meador said, but also switching from generic to generic. And the patient may not even know the change is happening.

When patients are on maintenance medication for which a generic is available, they might be given a different version of the generic drug when refilling their prescriptions. A pharmacy might stock one generic for a few months, and then switch to another a few months later, if the store is offered a better deal on it.

A pharmacist is not required to notify the patient of the change, although some choose to do so.

So for a few months you might receive a drug that was on the low side in the bioequivalence test, and then be switched to one on the high side of the test.

Stephanie Ford, 29, who spoke on condition that she not be otherwise identified, had been taking Lamictal to control her bipolar disorder. When a generic version came out two years ago, her insurer switched her to it.

Ms. Ford found that the generic drug, lamotrigine, worked just as well as the name brand and cost her just $10 a month instead of the $45 copayment she had been spending on the brand name. (For a person without insurance, Lamictal can cost about $300 a month, depending on the dosage.)

But when her insurer then urged her to order her medication by mail, she received another generic version of Lamictal and her symptoms returned.

“After about a week,” she wrote in an e-mail message, “I noticed a difference in my emotional state (and nothing changed in my life) and by a week and a half, I had digressed to the state I had been before being on medication.”

Ms. Ford has found a local pharmacy that carries the original generic. She now buys the medication directly from that store. Because her insurer charges her a $5 penalty for not using mail order, her copayment is now $15.

She says her condition has once again stabilized.

Friday, December 18, 2009

American Dietetic Association Releases Updated Position Paper on Nutrient Supplementation

December 7, 2009

CHICAGO – While supplements can help some people meet their nutrition needs, eating a wide variety of nutrient-rich foods is the best way for most people to obtain the nutrients they need to be healthy and reduce their risk of chronic disease, according to a newly updated position paper titled "Nutrient Supplementation" from the American Dietetic Association. This paper is an update of ADA's "Fortification and Nutritional Supplements" position paper, published in 2005.

ADA's updated position paper, published in the December issue of the Journal of the American Dietetic Association, represents the Association's official stance on nutrient supplementation:

It is the position of the American Dietetic Association that the best nutrition-based strategy for promoting optimal health and reducing the risk of chronic disease is to wisely choose a wide variety of foods. Additional nutrients from supplements can help some people meet their nutrition needs as specified by science-based nutrition standards such as the Dietary Reference Intakes.

ADA's position and accompanying paper were written by registered dietitians Melissa Ventura Marra, a nutrition consultant in Boynton Beach, Fla., and Andrea P. Boyar, associate professor of dietetics, foods and nutrition and chair of the department of health sciences at Lehman College, City University of New York.

According to the authors, supplement sales in the United States in 2007 totaled $23.7 billion, due in large part to "the aging of the population and consumer desire to maintain good health and prevent disease." Sales of supplements such as calcium, B vitamins, vitamin C, vitamin A/beta carotene, magnesium and iron have grown, while vitamin E supplement sales declined slightly.

The increase in sales of supplements may not have been accompanied by an increase in consumers' knowledge about what they are taking, according to the authors, who add that registered dietitians have the knowledge and experience to educate consumers on safe and appropriate selection and use of supplements.

The authors write: "Although many Americans use dietary supplements, a 2009 report from the U.S. Government Accountability Office stated that ‘according to experts, consumers are not well-informed about the safety and efficacy of dietary supplements and have difficulty interpreting labels on these products.' The Government Accountability Office expressed concern that the uninformed use of dietary supplements may expose consumers to health risks. The expertise of dietetics practitioners is needed to help educate consumers on safe and appropriate selection and use of dietary supplements, including nutrient supplements."

ADA's position paper reaffirms the importance of obtaining nutrients from the consumption of a variety of nutrient-rich foods while acknowledging that nutrient supplements may be needed to help fill dietary gaps for some. The paper discusses the effectiveness of nutrient supplements in helping to fill dietary gaps as well as the potential for nutrient excesses. It also highlights issues to consider when assessing the need for supplementation and provides updates on federal regulations. And ADA's position paper identifies roles and responsibilities of food and nutrition professionals such as registered dietitians in making evidence-based recommendations and provides key resources to keep RDs informed.

Wednesday, December 16, 2009

Take a Break: Garlands and Mandalas

With Christmas being less than10 days away, if you haven’t started decorating, today’s a good day to make garlands and snowflakes to hang. Below are ideas that are simple enough to do with a child, but can be complex enough to challenge most adults.

Paper Snowflakes Some of the patterns are based on William Bentley’s photographs. Bentley was called “The Snowflake Man” because he was the first person to photograph ice crystals from snow on his farm in Jericho, Vermont.

3-D Snowflake

Popcorn Garland This can be a treat for the birds after the holiday season ends.

Paper Chains

If you like to fold and cut, try making a Christmas Tree with a star using the technique Kirigami.

RELAXATION TIP
Use colored pencils, crayons, markers, pastels or even watercolors to color a holiday mandala. As noted in the October 21 post on mandalas, coloring is a great way to meditate and relax. You can download a variety of holiday designs from http://www.kids-n-fun.com/coloringpages/kleurplaat_Mandala-Christmas_360.aspx

Saturday, December 12, 2009

Sexuality and Chronic Disease

As administrator on call for a large University hospital, I met a woman in her late 60’s who was dying. Her husband was quite upset about the care she was receiving, which is why I was called. When the husband left the room, She told me that he had just brought her favorite perfume. She then shyly said, “it makes me feel sexy.”

It was one of those “ah-ha” moments, as I realized that we are sexual beings from the “womb to the tomb.” I was to learn this lesson over and over again in the years that I worked with people with HIV/AIDS. Sexuality became more important for many as it was the most “alive” thing they could do. Others used sex as a way to deaden the pain from so much loss. As one person noted, “the only thing strong enough to make the humans forget that they die is sex.”

In the video Sex and Chronic Disease-Can Women Still Feel Sexy, Dr. Brotto, Assist. Professor, Dept. of Obstetrics & Gynecology, UBC discusses why women may be more sexual after learning of a life threatening condition.

All people are sexual and therefore deserve a sexuality that is safe and pleasurable to them, regardless of age, gender, sexual orientation, disability or ethnicity. What may be needed more than anything else is a new way to discuss sex, which promotes not only healthy behaviors, but a better understanding of what sex is and how it fits within one’s life.

Keep in mind that sex happens between the ears not the legs. People are entitled to define what they mean by sex and to develop a relationship with it that is appropriate for them.

While the usual recommendation is to “talk to your doctor” about various health related issues, this is one area where I find medical providers to be less than well equipped to answer questions. Certainly discuss any medical concerns relating to your sexuality, but for the “how tos” below are a list of resources to help you find some of your answers.

Sexuality and Disability from Disability Resources

Moss Rehab Sexuality and Disability Internet Resources

Disability and Illness from Sexual Health.com

Tantric Sex-A Different Perspective: Instead of rushing toward a climax, a Tantric practitioner slows down, remaining in the moment, and travels toward deep relaxation. In the medical model, sexual energy builds, then is lost. In Tantra, energy is not lost but gained. Instead of using a partner for one_s own gratification, Tantric partners provide vital energy to each other.

Good Vibrations Magazine’s Archives for Sex and Disability: Note that Good Vibrations is an extremely sex positive company that carries very reliable products.

Sexuality for the Woman with Cancer from the American Cancer Society

Sexuality for the Man with Cancer from the American Cancer Society

Wednesday, December 9, 2009

Make a Zen Garden/Rake a Garden

Make a Zen Garden/Rake a Garden

Karesansui, or the “dry-landscape” style Japanese gardens have been in existence for centuries, but it wasn’t until the late sixth century with the advent of Zen Buddhism did “dry style” gardens began to evolve. The earlier gardens were created where one could enter and walk around and much larger in scale. Around the eleventh century, Zen priests adopted the “dry landscape” style and began building gardens to serve a different purpose. They were to be used as an aid to create a deeper understanding of the Zen concepts. Not only was the viewing intended to aid in meditation but the entire creation of the garden was also intended to trigger contemplation. By the late 1200’s, the basic principles had been established and up to the present day, they have been refined and extended. The garden created by the Zen priest are called “kansho-niwa” or contemplation garden and termed by many today as “ Zen gardens “. From http://www.newsfinder.org/site/more/zen_gardens/

The Photo Gallery of Japanese Zen gardens, Kyoto shows various types of rock gardens as well as flowers and other features.

You can create a small desktop Zen garden, which not makes a wonderful gift, but it can have a very calming effect.

Find a shallow container, such as a bowl or tray. You can use a picture frame, first removing the glass and then gluing the back to the frame.  Fill it with fine sand- playground sand or the sand used for filling bottles. Craft stores will carry the latter, while your local hardware store can provide playground sand.

Select an odd number of small polished stones for the garden. A tiny rake can be found at hobby and craft shops, should be placed by the side of the garden so you can rake different patterns. You can also make your own rake with dowels. In a pinch, use a small fork.


Monday, December 7, 2009

Knowing What’s Worth Paying for in Vitamins

The December 4 New York Times has an interesting article, "Knowing What's Worth Paying for in Vitamins." If you are paying a lot for supplements, read what this author has found. ConsumerLab.com says it has found a few patterns that consumers may find helpful. Products sold by vitamin chains tend to be more reliable than drugstore brands, and Wal-Mart and Costco’s vitamin lines are usually worth considering. In a recent test of multivitamins, ConsumerLab.com found that Equate-Mature Multivitamin 50+ sold by Wal-Mart was just as good as the name brand Centrum Silver, but at less than a nickel a day is half the price.

Saturday, December 5, 2009

Know What to Look For: Understanding the Diagnosis

In the Hospitalized posts, the importance of being a patient advocate when a family member or friend is in the hospital, was identified as the number one way you can help. Since the nurses and doctors will most likely be meeting this person for the first time, you can assist them by letting them know what’s normal for the patient.

In addition, it’s important that the advocate, as well as the person who is living with the chronic condition, have an understanding of the diagnosis and the treatment they may be taking place in the hospital. This also extends to home, and in the weeks following the initial diagnosis.

Regardless of whether you are the person living with the condition, the advocate or the caregiver, ask the nurses and doctors for information and to explain things you don’t understand. There are no stupid questions.

The most frequent way people learn about their health condition is the Internet. Therefore it’s important that users realize that not all information is of equal value. In fact, people with chronic conditions are the primary target of scams and “snake oil” websites. If it sounds too good to be true, it probably is.

When you Google, check the who, what and when of the website

WHO sponsors the site and who can I contact if I have a question? Sites that end with .gov, .edu and .org are generally more reliable. However, there are a growing number of. org’s that are actually sales pitches. Pharmaceutical companies are .com sites. Some of them have excellent resource information about side effects, tips on taking medications, and/or opportunities to obtain a drug for reduced or no cost.

WHAT is the purpose of the site and what is the source of information? If this is a site that is pushing a particular item to buy, be wary of it.

WHEN was the last time the site was updated? If a site isn’t being well maintained, and it’s offering information about a specific condition, be mindful that medical information that's more than a year old can already be outdated.

To learn more, check out Get the E-Facts

Sites with good information include:
• A national organization for the specific condition such as the American Cancer Society. For a list of organizations go to MedLine Plus

Medline Plus Health Topics: In addition to information and treatment about a specific condition, it includes interactive tutorials, research, clinical trials, current research etc.

Mayo Clinic Diseases and Conditions: This site includes the following information- definition, symptoms, causes, risk factors, tips for preparing for your appointment, treatments and drugs, lifestyle and home remedies, alternative medicine and prevention.

Resources for more information about drug and vitamin supplements
Physician’s Desktop Reference for Consumers

Medline Plus Drugs, Supplements and Herbal Information

Resources for Complementary and Alternative Forms of Medicine
National Center for Complementary and Alternative Medicine

NIH Office of Dietary Supplements

Explore Healing Practices from the University of Minnesota’s “Taking Charge of Your Health”

Wednesday, December 2, 2009

Take a Break: Duct Tape/Music


There are many uses for Duct Tape. One of my favorites is making items like wallets shoulder straps etc. Below are ideas for making holiday presents from the wide array of Duct Tape that is available.

• Wallet
• Rose, Bracelet or Tie 



MUSIC: Make it part of your life
The Holidays are filled with music, but often it is in the background and we hardly notice it. Take time to listen to favorite recordings, discover a new artist or dust off the keyboard, guitar or other instrument and play. Below are links to help enhance your listening pleasure

Pandora Radio Create your own radio station of only music you want to hear. You can select by artist, song or genre.

Benjamin Zander : Don’t think you like classical music, watch this presentation from the TED Conference and you’ll see that classical music is for everyone. You may also learn more about living a “one-butt life.”

Tuesday, December 1, 2009

House Cleaning Resources

When someone is acutely or chronically ill, house cleaning can easily fall by the wayside. This is one activity that friends and family can help with. When someone offers to help, specify what you'd like them to do. Having someone to count on to take care of your trash each week can be a real help.

You may qualify for a program that offers housekeeping services. However, with increasing demand and less funding, programs can't always deliver the service. Other resources which may offer help with cleaning include:
•Many schools (from grade school through college) have programs where students help with heavy chores, including the seasonal ones of cleaning windows, stacking wood, raking leaves, mowing the lawn etc.
• Church groups
• Civic organizations, such as Rotary, Lions Club etc.
• Community Action Agencies

A good way to find out what's available in your community is to call 211, the information and referral service helpline for your state. You can also look on-line through your state's 211 directory However, many communities will have services that are not necessarily listed in the directory so also check with your social worker or case manager, members of a support group, and people you may know connected with churches, civic groups etc.

A friend passed along the following information, which might be useful for some women. If you know any woman currently undergoing Chemo, please pass the word to her that there is a cleaning service that provides FREE housecleaning - 1 time per month for 4 months while she is in treatment. All she has to do is sign up and have her doctor fax a note confirming the treatment. 'Cleaning for a Reason' will have a participating maid service in her zip code area arrange for the service. This organization serves the entire USA and currently has 547 partners to help these women.

Saturday, November 28, 2009

Hospitalized 3: Consumer Reports Study

The Consumer Reports National Research Center recently completed a study of what subscribers (13,450) to Consumer Reports had to say about their own or a loved one’s recent hospitalization and what nurses (731 nurses working in patient care areas) reported on their most recent week at work. Responses varied considerably. For example
• While 13% of patients said their care wasn’t coordinated properly, 38% of nurses said that was a problem.
• 4 % of patients said the facility wasn’t clean, compared with 28% of nurses asked a similar question.

In interviews with hospital personnel, including doctors, nurses, social workers, dietitian and hospital pharmacists, suggestions were made about the best ways to get through a hospitalization safely and minimal confusion.

Do your Homework
- Check your health plan for its rules on hospitalization
- Research hospitals on-line
- Ask about a surgeon’s experience with unusual or complex treatments
- Ask about nurse-patient ratios.

Plan for a Smooth Admission
- Know what medications you are taking; write them down and bring them to the hospital
- Keep your regular doctor in the loop
- Understand the hospitalist’s role (A hospitalist, usually an internist or pediatrician, who has received advanced training in the practice of in-hospital medicine. Usually takes over from your regular outside doctor during your stay.)
- Avoid the ER except for genuine medical Emergencies

Avoid Chaotic Care
- Have a friend or relative with you as much as possible during your stay
- Keep a bedside log of tests, treatments, and consultations
- Identify a single individual to coordinate your care, whether a physician, hospital social worker, case manager or patient advocate
- When using the call button, be specific about your needs
- Be respectful to the staff, but don’t hesitate to ask to speak to a nursing supervisor if you feel your needs aren’t being met

Stay vigilant for problems
- Make sure caregivers wash their hands
- Check medications and doses before you take them
- Be insistent if you’re unhappy with your care or don’t understand something

Plan ahead for discharge
- Make sure you understand plans for your patient discharge
- If you’re not satisfied, ask for help from your hospital’s advocate, social worker or case manager
- Insist on medication reconciliation between home and hospital drugs
See your primary care physician within a week of your patient discharge and arrange for him or her to get copies of your hospital records.

Wednesday, November 25, 2009

Cards/Relax/Family History

While this coming Friday is the National Day of Listening (see Nov. 22 post), since 2004 the Surgeon General has declared Thanksgiving to be National Family History Day. Over the holiday or at other times when families gather, the Surgeon General encourages Americans to talk about, and to write down, the health problems that seem to run in their family. Learning about their family's health history may help ensure a longer, healthier future together. To help families organize their health history, the US Dept. of Health and Human Services has developed a web based tool called My Family Health Portrait

Thanksgiving ushers in the holiday season. For the next six Wednesdays (Take a Break Day), I will be including both “art breaks” (things you can make as presents or for your own enjoyment) as well as ideas for taking a break from the hustle of the season.

Today’s post is all about cards, how to make them or what to do with ones you’ve received. The “relaxation tip” is creating a spa bath at home.

MAKE YOUR OWN CARDS

Postcards: Cheaper to mail than a greeting card, there are a variety of options to consider:
Premium Postcard A service of the US Post Office, you create a picture postcard on-line, which is then mailed for you. You don’t even have to stamp it.

• Postcards from Your Photographs: There are now a variety of products on the market to help you turn your photographs into post cards.
- The 2 Buds Vintage Postcard Shop offers backings you can peel and stick on your photographs.

- Avery makes a Postcard for various types of printers, so it’s possible to print off a selection of your photographs. Not only can you send them as a greeting card, but you can print off different photographs and give a stack as a present. Most office supply stores, such as Staples, carry Avery postcards.

Potato Printing: A simple project that not only results in beautiful cards, but it can also be used to make T-shirts, napkins etc. Cut a large potato in half, cut out your design, apply paint and start stamping. Simple cookie cutters can be used to cut out the design.

Martha Stewart’s Card Making Center

E-Cards: Here’s an option that requires no postage. There are many free sites.
My Card Maker
Blue Mountain
Funny E-Cards
Care2 E-Cards

MAKING THINGS WITH CARDS
Gift Tags: Or To/Froms as we use to call them, can easily be made by cutting the card into tag size and either taping them to the package, or using a hole punch, string a bit of ribbon through it. Using pinking shears, or other type scissors, gives the tag a fancier look.

Bookmark: Depending on the size of the card and the weight of paper, you can several things:
• cut a 8-inch by 2-inch strip of the card if size and weight permit
• take a strip of cardboard or poster board and cut up the card, gluing it to the board. To make it more durable, cover with contact paper or laminate it.

Create a Gift Box

Ornaments

RELAXATION TIP
Create Your Own Spa Bath

Sunday, November 22, 2009

National Day of Listening

This coming Friday, Nov. 27 is National Day of Listening. National Public Radio (NPR) has a website that can provide a number of resources to help you conduct a successful interview. Since this is the day after Thanksgiving, family and friends may still be around and you can take turns interviewing each other.

If you haven't already done so, along with family stories and lore, ask about your family's health history. Make sure the information you gather is available to other members of the family.

Saturday, November 21, 2009

Holidays: OVER-DO THE LAUGHTER AND UNDER-DO THE STRESS

The “holiday season” seems to be starting earlier and earlier each year. With the hype of “black Friday,” the day after Thanksgiving and the number one shopping day of the year, already building to a feverous pitch, I thought it might be helpful to dust off a piece I wrote several years ago about coping with the holidays.

While the strains of “Chestnuts roasting on an open fire” may bring a smile to some, for others it makes their skin crawl. Whether you are caring for, or living with, chronic health problems, or have no health problems at all, the holidays, starting with Thanksgiving and running through January 1, can be a reminder that life is now different and old expectations or ideas no longer fit. With limited finances, changes in relationships, to say nothing of the piling snow in your driveway; it’s not surprising that many people become depressed, bored, frustrated, angry, and/or resentful.

For a time of year that is supposed to be about peace, love and good will, we over indulge, have unrealistic expectations, over spend our budget, try to do more than we can realistically do, which ultimately results in a “Holiday Hangover” that can last until Valentine’s Day. With that in mind, here are some tips for a Healthy and Happy Holiday season.

Humor: Being able to laugh will help you get through some of the difficult situations.

Alone: The holidays are about being together. If you need time to yourself, take it. However, if you are feeling lonely, reach out to family, friends, neighbors, your support group, church or social services. Consider volunteering at a community or religious function. Getting involved and helping others can lift your spirits and broaden your social circle. You don't have to be alone.

Pace: Set the pace for what you feel comfortable doing, and what’s important to you. It’s ok to change traditions or let some go. Plan ahead as much as possible. However, if things change, be flexible and “go with the flow.”

Presents: Set a limit on what you can spend and don’t exceed it. Consider reducing the number of presents you need to make or buy by drawing names or holding a Yankee Swap. Give gift certificates of your time, or make special treats that you know people like. If it’s difficult to get out and shop, order from catalogues or on-line. A donation to a non-profit organization, or charitable group, is a gift that will last throughout the year.

Check out the Wednesday posts for things to make that you can give as presents.

Yesterday: “Don’t look back in anger, or ahead in fear, but around in awareness.” James Thurber You can’t change the past, or predict the future, so live in the present.


Health: You’re still in charge of your health care so you need to continue to exercise, take medications as prescribed, and watch what you eat and drink. Have a healthy snack before holiday parties so that you don't go overboard on sweets, cheese or drinks.

Options: No is an option. People will understand if you can't do certain projects or activities. If you say yes only to what you really want to do, you'll avoid feeling resentful and overwhelmed.

Let others do. Reduce stress by asking for help, and accepting it when it’s offered.

Ideal: The ideal holiday is the one you enjoy.

Differences: Try to accept the people in your life as they are, even if they don't live up to your expectations. The holidays are a stressful time for all, so let things slide and wait until after the first of the year for the discussions you’d like to have.

Acknowledge your feelings: It's okay now and then to take time just to cry or express your feelings. You don't have to force yourself to be happy just because it's the holiday season. If you find that you continue to remain sad, anxious, unable to sleep, feel hopeless, or unable to do routine activities, for several weeks, talk to your doctor.

You: Take care of yourself. If you don’t take care of yourself, you can’t take care of others. Find the balance that allows you to be present for those that you love and care about, but not at the expense of harming yourself.

Sleep. Take time to get the rest and relaxation you need. Stay on your schedule so that you do have the energy for the fun and laughter. De stress with a massage, a bubble bath or curling up on the couch with a good book.

Wednesday, November 18, 2009

Take a Break: Feed the Birds

There is something very soothing and mesmerizing about watching birds up close. At this time of year, putting out food is one way to ensure they’ll be some to see.

As a child, my mother liked to make sure the birds had a Christmas present, so she’d take suet, put it in mesh bag, and hang it in the tree by the dinning room window. My Aunt’s approach was to scatter day old bread in the backyard. One of my favorite summer activities is to watch the birds flock to our yard just after the grass has been cut.

There are a wide array of bird feeders and bird feed. To learn more about the different type of feeders and ways to attract a variety of birds go to Project Feeder Watch

Monday, November 16, 2009

Hospitalized: Take 2

I’ve continued to hear from people about what to do when a friend or family member is hospitalized. There is no doubt that patient advocacy is critical. As for supporting patients in the hospital, I'm for the 24/7 approach. I can't imagine leaving loved one in the hospital alone.

One person wrote of their experience with a family member who has Parkinson’s Disease as well as her own issues following surgery. Sometimes a particular diagnosis requires some extra special attention, and so I have included the comments, eliminating identifying information.

When J was in hospital for extended stays, I found that monitoring his PD (Parkinson’s Disease) medications was extremely important. Often meds are given at the convenience of the pharmacy and the nursing staff, and PD meds in particular have to be administered according to the patient's schedule. The problem is often that every change of nursing staff ( 2 - 3 times a day, and especially on weekends or holidays when there may be brand new people with no experience with this whatsoever) requires constant monitoring. I once gave J his meds from my own supply in the ICU when no one could tell me whether or when he last had his meds, and I knew he had been in the ICU through a complete meds time schedule, not a good situation at all.

Be aware of cognitive changes, changes in behavior, attitude, etc. J experienced severe depression and suicidal behavior in reaction to a new prescription (this was at home) and a severe psychotic reaction to a morphine-derivative painkiller given while he was in the hospital after surgery. No one on the staff seemed to be aware that he was acting very strangely. This is an important point, as you will know what’s normal for the patient and staff wont necessary know.

Be there to help the patient with getting comfortable, changing the bed position, moving pillows, tightening or loosening top sheets, helping with drinking, using the nurse call button. The patient may not be able to do these things or even be aware that there is a problem. When I was recovering from my surgery and was alone, I wanted a walker and was told by the nurse that it would take three days to get a PT evaluation to even discuss getting the walker. I enlisted the aid of a young med student to get the walker, and was out of the hospital two days later, a full day before the scheduled PT evaluation. Help the patient to order food and to eat if necessary. Eating in bed is not easy.

The bottom line is that your patient is one of many to the staff; he is your one responsibility and you are his advocate.

Saturday, November 14, 2009

Hospitalized: What Family and Friends can do

Recently, I experienced a situation that prompted me to send the following survey to colleagues and friends “Based on your experiences, as patient, friend, family member, and/or provider, what are the top five things you would list that someone could do to ensure that the inpatient receives the care he or she needs.”

The responses were identical - the number one response was-BE AN ADVOCATE.

From my experience as an inpatient as well as the daughter of one, there must be someone at the bedside to advocate for the patient. If it can't be 24/7, then perhaps shifts can be taken by people who care. I don't know of any other way, given the situation at most hospitals or perhaps all of them. ..I've literally saved the person's life, because no one was around to notice there was an abrupt change…”

Too weak to advocate for myself, the whole process of "saving" me happened only because of the chance timing of a visit from a neighbor(s) -one a retired nurse the other a retired social worker.

My friend and colleague Grace outlined five ways to be an advocate:

1) Be an advocate for the person who is ill. Speak with (polite) authority to his/her medical providers and make it clear what you know the patient needs and what you reasonably expect them to offer.

2) Question procedures and prescriptions, making sure that what the provider is doing is not going to have a detrimental impact on the patient.

3) Explain the patient’s home situation to the doctor so (s)he will prescribe outpatient care and prescription medicines that are realistically affordable for the patient and can actually be realized; it does no good to recommend physical therapy or “third tier” medications if the person can’t afford them or has no access to get treatment.

4) Act as or organize an information conduit so the patient doesn’t have to answer dozens of phone calls from friends asking the same questions over and over again about the state of her/his health. Make sure other family and friends are informed as much as the patient wants them to be and request that calls be limited to encouragement and support instead of asking for daily healthcare updates from the patient. Also, be willing to return calls on behalf of the patient so (s)he isn’t overwhelmed with inquiries when (s)he doesn’t feel up to talking.

5) Offer to take care of some of the daily responsibilities the patient may have at home or organize a group of volunteers to help out: feed the pets, mow the lawn, shovel the snow, take in the mail, do the laundry, clean the house, do whatever makes sense to alleviate the patient’s worrying about what (s)he will find upon coming home.

One respondent noted, Sometimes I've found that people, including close friends and loved ones, can't deal with illness and such. These people feel helpless and family/friend don't even realize that all they need to do is hold the hand of their loved one, who feels so alone, vulnerable and frightened to death.

Several respondents noted the need for possible volunteer programs to help with advocacy. Personally I think this is a huge need - not only in hospital but in outpatient. I have pondered if there might be some way for a group of savvy women to start and advocacy team.

In doing an on-line search, I found that the University of Minnesota’s Taking Charge of your Health has information for the patient and family and friends on ways to help during a hospitalization. Similar to my survey findings, their number one recommendation is to “Have someone with you at all times.”

A tight economy, budget cuts, an aging population and sicker inpatients are causing considerable stress on an already stressed system. As noted in Have Healthy Hospitalizations from the University of Minnesota’s Taking Charge of Your Health While it may seem ironic, hospitals are not necessarily healthy environments. According to a 1999 Institute of Medicine study, as many as 98,000 people die each year due to medical errors.

Therefore to help your family for friend obtain the best possible care, be an advocate, use Grace’s tips above and/or those offered by the University of Minnesota’s Health Hospitalizations.

If you are not able to be with a friend or family member, the patient and/or their designee, should check with the hospital to see if they have a program where a volunteer can sit with them.

I know that several people have said they’ve tried to join the blog but weren’t able to do so. Please don’t hesitate to e-mail margoc@tds.net me directly with your comments and suggestions.

Thursday, November 12, 2009

AAD Guidelines on Vitamin D, Sun Exposure, Sunscreen

Dermatologists Can Help Separate Fact From Fiction for Sun Exposure, Sunscreen and Vitamin D

American Academy of Dermatology Increases Minimum Sunscreen Recommendation from SPF 15 to SPF 30
NEW YORK (Nov 10, 2009) — When it comes to vitamin D, consumers are bombarded with mixed messages about the best source for this essential nutrient. While some may argue that small doses of intentional sun exposure are safe, dermatologists point out that the risk of developing skin cancer from ultraviolet (UV) radiation far outweighs the benefit of stimulating vitamin D production – particularly when enriched foods and supplements are safe and effective sources of this vitamin.

Speaking today at the American Academy of Dermatology’s SKIN academy (Academy), Washington, D.C., dermatologist Elizabeth L. Tanzi, MD, FAAD, clinical faculty in the department of dermatology at Johns Hopkins Hospital Center in Baltimore, addressed common myths about sun exposure, sunscreen and vitamin D, and announced the Academy’s increased recommendation on the minimum Sun Protection.

Factor (SPF) of sunscreen.
“Despite years of ongoing public education efforts on the dangers of UV radiation, a number of misconceptions remain as to how to best protect ourselves from this known carcinogen and whether or not we absolutely need sun exposure for vitamin D production,” said Dr. Tanzi. “The fact is these myths are harmful because sun exposure is the leading cause of skin cancer, and the consequences of this misinformation could be potentially fatal.”

Myth: Sun exposure is the best source of vitamin D.
Vitamin D is an essential nutrient that is vital for strong bones and a healthy immune system. Deficiency of vitamin D is associated with bone softening in adults, rickets in children and, more recently, with high blood pressure, arthritis, type I diabetes and certain cancers.

While UV radiation is one source of vitamin D, dermatologists argue that it is not the best source because the benefits of obtaining vitamin D through UV exposure cannot be separated from an increased risk of skin cancer. Instead, the Academy recommends that an adequate amount of vitamin D should be obtained from a healthy diet that includes foods naturally rich in vitamin D (e.g., dairy products and fish), foods/beverages fortified with vitamin D (e.g., fortified milk and fortified cereals), and/or vitamin D supplements.

“Although studies showing the benefits of increased vitamin D intake have caused some to propose ‘sensible sun exposure’ or intentional sun exposure as a cost-effective method for preventing vitamin D deficiency, increased sun exposure is not the answer,” said Dr. Tanzi. “UV radiation is the most preventable risk factor for the development of skin cancer, which is the most common form of cancer in this country. There are more than an estimated 1 million new cases of skin cancer every year. Despite this fact, there remains a tremendous amount of misinformation about UV exposure – especially in relation to vitamin D.”

Myth: All sunscreens are created equal.
While on the surface most sunscreens may look the same, they are in fact quite different. One of the things that makes sunscreens different is the level of protection from UV exposure that they provide. Dr. Tanzi explained that a common misconception is that the SPF rates the degree of protection from both UVA rays (which pass through window glass, penetrate into the deepest layer of the skin and are associated with premature aging and melanoma) and UVB rays (the sun’s burning rays, which are blocked by window glass, are the primary cause of sunburn, and also are linked with skin cancer). In fact, the SPF number on sunscreens only reflects the product’s ability to deflect the sun’s burning rays (or UVB). Sunscreens labeled broad-spectrum provide coverage against both UVA and UVB light.

“SPF may create a false sense of security about the level of protection a person is getting, because many sunscreens do not adequately protect against harmful UVA rays,” said Dr. Tanzi. “The main challenge in providing effective protection from UVA rays is that traditional chemicals used in sunscreens that absorb UVA light degrade quickly and become ineffective.”

Fortunately, there are ingredients that can be added to traditional sunscreen ingredients to keep them stable and provide broad-spectrum protection. For example, Dr. Tanzi noted that the ingredient oxybenzone can help stabilize avobenzone (one of the best absorbers of UVA rays that, while highly effective, breaks down quickly), which provides a longer duration of effective protection from UVA rays. Other effective ingredients that help provide broad-spectrum UV coverage include ecamsule, cinoxate, menthyl anthranilate, octyl methoxycinnamate, octyl salicylate, and sulisobenzone.

For those with sensitive skin, sunscreens with non-chemical ingredients work best and will prevent irritation. Dr. Tanzi said the ingredients zinc oxide and titanium dioxide provide both UVA and UVB protection.

Myth: Using a higher SPF will ensure you don’t burn.
Dr. Tanzi explained that those who use sunscreen with a higher SPF may think they will not burn when exposed to UV light, but she said that is not true. In fact, actual sunscreen protection depends on many other factors – including skin type, the amount and frequency of sunscreen application, and the impact of activities (such as swimming and sweating). As a result, sunburn can occur even when wearing a higher SPF sunscreen.

Another important factor Dr. Tanzi emphasized is that UVB protection does not increase proportionately with a designated SPF number. For example, an SPF of 30 screens 97 percent of UVB rays, while an SPF of 15 screens 93 percent of UVB rays and an SPF of 2 screens out 50 percent of UVB rays. However, not applying enough sunscreen or not covering all exposed areas may result in a lower SPF than the product contains.

“For adequate protection, sunscreens are best applied 15-30 minutes prior to going outside, approximately every two hours or immediately after swimming or sweating,” said Dr. Tanzi. “Research demonstrates that most people only apply 25 to 50 percent of the recommended amount of sunscreen, which is one ounce for the entire body or enough to fill a shot glass. Therefore, if only half the proper amount of SPF 15 is applied, the SPF has been reduced to an SPF of approximately 5, which is then inadequate protection. ”

To address the issue of people not using enough sunscreen or reapplying improperly, the Academy recently increased its recommended SPF to a minimum of 30 for proper sun protection. Dr. Tanzi said that while sunscreen is important to protect against skin cancer, it is only one part of what should be an overall sun-protection program. To minimize your risk of skin cancer, the Academy recommends that everyone Be Sun SmartSM :

• Generously apply a broad-spectrum water-resistant sunscreen with a Sun Protection Factor (SPF) of at least 30 to all exposed skin. “Broad-spectrum” provides protection from both ultraviolet A (UVA) and ultraviolet B (UVB) rays. Re-apply approximately every two hours, even on cloudy days, and after swimming or sweating.

• Wear protective clothing, such as a long-sleeved shirt, pants, a wide-brimmed hat and sunglasses, where possible.
Seek shade when appropriate, remembering that the sun's rays are strongest between 10 a.m. and 4 p.m. If your shadow is shorter than you are, seek shade.

• Protect children from sun exposure by playing in the shade, using protective clothing, and applying sunscreen.
Use extra caution near water, snow and sand as they reflect the damaging rays of the sun which can increase your chance of sunburn.

• Get vitamin D safely through a healthy diet that may include vitamin supplements. Don't seek the sun.

• Avoid tanning beds. Ultraviolet light from the sun and tanning beds can cause skin cancer and wrinkling. If you want to look like you've been in the sun, consider using a sunless self-tanning product, but continue to use sunscreen with it.

• Check your birthday suit on your birthday. If you notice anything changing, growing, or bleeding on your skin, see a dermatologist. Skin cancer is very treatable when caught early.

Check the Academy’s Web site for the latest list of sun protective products that meet the stringent, evidence-based criteria of the AAD SEAL OF RECOGNITION®.

For more information about skin cancer, please visit the “SkinCancerNet”, a Web site developed by dermatologists that provides patients with up-to-date information on the treatment and management of disorders of the skin, hair and nails.

Headquartered in Schaumburg, Ill., the American Academy of Dermatology (Academy), founded in 1938, is the largest, most influential, and most representative of all dermatologic associations. With a membership of more than 16,000 physicians worldwide, the Academy is committed to: advancing the diagnosis and medical, surgical and cosmetic treatment of the skin, hair and nails; advocating high standards in clinical practice, education, and research in dermatology; and supporting and enhancing patient care for a lifetime of healthier skin, hair and nails. For more information, contact the Academy at 1-888-462-DERM (3376) or www.aad.org.