Saturday, February 27, 2010

Taking Medications: Part II Vitamins

Many people, particularly those with chronic disease, take vitamins. This is done for a variety of reasons: counterbalancing medications; don’t always get the required vitamins and nutrients from diet; recommended by medical provider; read an article etc.

If you are taking prescription drugs, make sure you read the packaging so you know if a particular vitamin or supplement could interfere with its effectiveness or if there is a better time to take vitamins so there isn’t a problem. Tell your provider about the vitamins you are taking and in what doses.

As a general rule, vitamins supplements work best when taken at the same time daily and with or close to a meal, especially a healthy meal containing natural vitamins and minerals. Note that some vitamins are better taken on an empty stomach.

To learn more about vitamins, recommended doses, possible interactions etc., check out the following resources:

Medline PlusDrugs, supplements and herbal information

University of Maryland Medical Center’s Complementary and Alternative Medicine Index (CAM)

Wednesday, February 24, 2010

Take a Break: Fold a Dollar

Dollar origami is a lot of fun. Whether you are leaving a tip, making a donation or giving a gift, a folded dollar, or two, makes it a lot more interesting. Below are sites and videos with good directions:

Money Origami Shirt Folding Instructions

Lisa Shea Dollar Bill Money Origami

Origami Resource Center’s Money Origami

Tuesday, February 23, 2010

Regular Exercise Reduces Patient Anxiety by 20 Percent, Study Finds

ScienceDaily (Feb. 22, 2010) — The anxiety that often accompanies a chronic illness can chip away at quality of life and make patients less likely to follow their treatment plan. But regular exercise can significantly reduce symptoms of anxiety, a new University of Georgia study shows.

In a study appearing in the Feb. 22 edition of the Archives of Internal Medicine, researchers analyzed the results of 40 randomized clinical trials involving nearly 3,000 patients with a variety of medical conditions. They found that, on average, patients who exercised regularly reported a 20 percent reduction in anxiety symptoms compared to those who did not exercise.

"Our findings add to the growing body of evidence that physical activities such as walking or weight lifting may turn out to be the best medicine that physicians can prescribe to help their patients feel less anxious," said lead author Matthew Herring, a doctoral student in the department of kinesiology, part of the UGA College of Education.

Herring pointed out that while the role of exercise in alleviating symptoms of depression has been well studied, the impact of regular exercise on anxiety symptoms has received less attention. The number of people living with chronic medical conditions is likely to increase as the population ages, he added, underscoring the need for a low-cost, effective treatment.

The researchers limited their analysis to randomized controlled trials, which are the gold standard of clinical research, to ensure that only the highest quality data were used. The patients in the studies suffered from a variety of conditions, including heart disease, multiple sclerosis, cancer and chronic pain from arthritis. In 90 percent of the studies examined, the patients randomly assigned to exercise had fewer anxiety symptoms, such as feelings of worry, apprehension and nervousness, than the control group.

"We found that exercise seems to work with just about everybody under most situations," said study co-author Pat O'Connor, professor and co-director of the UGA Exercise Psychology Laboratory. "Exercise even helps people who are not very anxious to begin with become more calm."

Exercise sessions greater than 30 minutes were better at reducing anxiety than sessions of less than 30 minutes, the researchers found. But surprisingly, programs with a duration of between three and twelve weeks appear to be more effective at reducing anxiety than those lasting more than 12 weeks. The researchers noted that study participants were less likely to stick with the longer exercise programs, which suggests that better participation rates result in greater reductions in anxiety.

"Because not all study participants completed every exercise session, the effect of exercise on anxiety reported in our study may be underestimated," said study co-author Rod Dishman, also a professor of kinesiology. "Regardless, our work supports the use of exercise to treat a variety of physical and mental health conditions, with less risk of adverse events than medication."

Saturday, February 20, 2010

Taking Medications: Part I

Along with the diagnosis of a chronic condition often goes the prescribing of medications that need to be taken at home. Today’s post looks at things to think about and do when medications are first prescribed.

Keep a notepad with you at medical appointments and/or ask a “Friend with a Pen” to take notes for you. When your provider prescribes a new medication:

• The name of the drug, correct spelling, and the reason it is being prescribed for you.
• How long will it be before the medication works?
• The best time to take the medicine. Should it be taken on an empty stomach, with meals, after meals, bedtime etc.?
• How often should you take it and how long will you need to take it?
• Foods that need to be avoided while the medicine is being absorbed by the body.
• Whether the new medication interferes with other medications you might be taking
• Could vitamins, supplements and other “over the counter medications” you are taking (e.g. aspirin) or could take (e.g. cold medicine) have an impact on the medication?
• How should you store the medication-does it require refrigeration
• What side effects should you look for? Are there side effects that require you to get immediate medical attention?
• How will you know if the medication is working?
• If you forget a dose, what should you do?
• Other precautions that need to be taken while on a particular medication.

Ask about the cost of the prescribed drug. If it is more than you can pay for, ask if there is a cheaper drug they can prescribe. Will a generic, which is usually much less expensive, work as well as the brand drug? If a generic isn’t possible, ask about samples and drug assistance programs. Websites where you can learn more about patient assistance programs include:

Rx Assist
Partnership for Prescription Assistance 1-888-477-2669
Needy Meds
Condition Based Assistance

When you pick up your prescription from the pharmacy check the label.
• Is your name on the label?
• Is the medication, dosage and instructions identical to what your provider said they were prescribing?
• If there is any difference, talk to the pharmacist.
• If there is a difference between what the pharmacist is telling you and what your provider told you, call the provider immediately.

Read and save information that comes with your medicine.

Take your medication as prescribed.

Thursday, February 18, 2010

Positive Emotions Protect Against Heart Disease

Don't Worry, Be Happy! Positive Emotions Protect Against Heart Disease

ScienceDaily (Feb. 18, 2010)
— People who are usually happy, enthusiastic and content are less likely to develop heart disease than those who tend not to be happy, according to a major new study published February 17.

The authors believe that the study, published in the Europe's leading cardiology journal, the European Heart Journal [1], is the first to show such an independent relationship between positive emotions and coronary heart disease.

Dr Karina Davidson, who led the research, said that although this was an observational study, her study did suggest that it might be possible to help prevent heart disease by enhancing people's positive emotions. However, she cautioned that it would be premature to make clinical recommendations without clinical trials to investigate the findings further.

"We desperately need rigorous clinical trials in this area. If the trials support our findings, then these results will be incredibly important in describing specifically what clinicians and/or patients could do to improve health," said Dr Davidson, who is the Herbert Irving Associate Professor of Medicine & Psychiatry and Director of the Center for Behavioral Cardiovascular Health at Columbia University Medical Center (New York, USA).

Over a period of ten years, Dr Davidson and her colleagues followed 1,739 healthy adults (862 men and 877 women) who were participating in the 1995 Nova Scotia Health Survey. At the start of the study, trained nurses assessed the participants' risk of heart disease and, with both self-reporting and clinical assessment, they measured symptoms of depression, hostility, anxiety and the degree of expression of positive emotions, which is known as "positive affect."

Positive affect is defined as the experience of pleasurable emotions such as joy, happiness, excitement, enthusiasm and contentment. These feelings can be transient, but they are usually stable and trait-like, particularly in adulthood. Positive affect is largely independent of negative affect, so that someone who is generally a happy, contented person can also be occasionally anxious, angry or depressed.

After taking account of age, sex, cardiovascular risk factors and negative emotions, the researchers found that, over the ten-year period, increased positive affect predicted less risk of heart disease by 22% per point on a five-point scale measuring levels of positive affect expression (ranging from "none" to "extreme").

Dr Davidson said: "Participants with no positive affect were at a 22% higher risk of ischaemic heart disease (heart attack or angina) than those with a little positive affect, who were themselves at 22% higher risk than those with moderate positive affect.

"We also found that if someone, who was usually positive, had some depressive symptoms at the time of the survey, this did not affect their overall lower risk of heart disease.

"As far as we know, this is the first prospective study to examine the relationship between clinically-assessed positive affect and heart disease."

The researchers speculate about what could be the possible mechanisms by which positive emotions might be responsible for conferring long-term protection from heart disease. These include influence on heart rates, sleeping patterns and smoking cessation.

"We have several possible explanations," said Dr Davidson. "First, those with positive affect may have longer periods of rest or relaxation physiologically. Baroreflex and parasympathetic regulation may, therefore, by superior in these persons, compared to those with little positive affect. Second, those with positive affect may recover more quickly from stressors, and may not spend as much time 're-living' them, which in turn seems to cause physiological damage. This is speculative, as we are just beginning to explore why positive emotions and happiness have positive health benefits."

She said that most successful interventions for depression include increasing positive affect as well as decreasing negative affect. If clinical trials supported the findings of this study, then it would be relatively easy to assess positive affect in patients and suggest interventions to improve it to help prevent heart disease. In the meantime, people reading about this research could take some simple steps to increase their positive affect.

"Like the observational finding that moderate wine consumption is healthy (and enjoyable), at this point ordinary people can ensure they have some pleasurable activities in their daily lives," she said. "Some people wait for their two weeks of vacation to have fun, and that would be analogous to binge drinking (moderation and consistency, not deprivation and binging, is what is needed). If you enjoy reading novels, but never get around to it, commit to getting 15 minutes or so of reading in. If walking or listening to music improves your mood, get those activities in your schedule. Essentially, spending some few minutes each day truly relaxed and enjoying yourself is certainly good for your mental health, and may improve your physical health as well (although this is, as yet, not confirmed)."

In an accompanying editorial by Bertram Pitt, Professor of Internal Medicine, and Patricia Deldin, Associate Professor of Psychology and Psychiatry, both at the University of Michigan School of Medicine (Michigan, USA), the authors pointed out that, currently, no-one knew whether positive affect had a direct or indirect causal role in heart disease, or whether there was a third, underlying factor at work, common to both conditions. Nor was it known for certain whether it was possible to modify and improve positive affect, and to what extent.

"Randomised controlled trials of interventions to increase positive affect in patients with cardiovascular disease are now underway and will help determine the effectiveness of increasing positive affect on cardiovascular outcome and will provide insight into the nature of the relationship between positive affect and cardiovascular disease," they wrote.

"The 'vicious cycle' linking cardiovascular disease to major depression and depression to cardiovascular disease deserves greater attention from both the cardiovascular and psychiatric investigators……..These new treatments [to increase positive affect] could open an exciting potential new approach for treating patients with known cardiovascular disease who develop depression. If Davidson et al.'s observations and hypotheses stimulate further investigation regarding the effect of increased positive affect on physiological abnormalities associated with cardiovascular risk, perhaps it will be time for all of us to smile."

Wednesday, February 17, 2010

Take a Break: Read Poetry of Langston Hughes

In keeping with February being Black History Month, take a break today and read the poetry of Langston Hughes.

Read more about Black History month at the links below:

African American History Month from the Library of Congress

Black History Month from the History Channel

Sunday, February 14, 2010

It’s All About the Love

In keeping with Valentine’s Day, I thought it was fitting to write about the importance of love. Simply put, the most important lesson I’ve learned from my years of working in AIDS is that at the end of our days, the only measure of true wealth is having people in your life that you love and who love you. Jobs, career, degrees and money not so much. In fact Warren Buffett, the financial wizard, put it quite succinctly when he said, When you get to my age, you'll measure your success in life by how many of the people you want to have love you actually do love you. That's the ultimate test of how you've lived your life."

There are numerous studies that show the positive and healthy aspects of being in loving relationships. It’s also important to note that illness can certainly put a strain on that love. But for today, let’s focus on ways we can share love and let those people who we do care about know it. So, this doesn’t mean you have rush right out to your local convenience store or pharmacy and buy a box of Whitman Samplers. Instead, you can:

• E-mail, call or text
• Write a Valentine’s Card. It doesn’t matter if it gets their late, you wrote it on the day itself
• Make a special meal (or make a reservation to a favorite restaurant)
• A hug
• Write a poem and leave for them to find
• Spend time together doing something you like
• Share the poetry of Rumi (considered by some to have written the best love poems of all time)

And simplest of all, tell the people in your life that matter, that you love and appreciate them.

Happy Valentine’s Day!

Wednesday, February 10, 2010

Take a Break: Valentine’s Paper Basket

I learned to make Swedish Paper Heart Baskets as a child. While I’ve seen them with a little bit of wheat tucked in them as a Christmas tree ornament, for Valeninte's Day we filled them with Conversation and cinnamon hearts. Go to for the heart basket directions.

The Conversation Heart candies were first produced in 1902. This year, the Necco Company has made changes to the hearts. They have all new sayings as well as new flavors. The candy is also softer and doesn’t taste as good as the old formula. Learn more about this Valentine treat at

Saturday, February 6, 2010

Choice/Decisions Part II

I had planned to make the Part II a Sunday feature last weekend, but so many things kept occurring, new articles, conversations etc., that I’ve written and rewritten this segment. This morning, I decided that I just need to post it; otherwise I could keep tinkering with it forever.

In response to the “choice” survey, that I sent to friends and colleagues over a week ago, and blogged about on Jan. 30, one person responded with an interesting article from the New York Times, “An Ill Father, a Life-or-Death Decision.

In the article a reporter describes how she dealt with a choice in the care of her very ill and compromised father. The outcome was the father made a choice to continue very aggressive treatment, even though there was no chance of a recovery, and the man ultimately died six months later after considerable intervention.

Among the responses to the survey on choice in health care, more than one wrote of concern about the incredible costs of care when there is no chance of survival. In direct response to the article, one person estimated that the cost of care for the last six months of this man’s life was probably close to a million dollars and would be tapping an already strained medical staff. Ultimately, the writer felt that no one probably benefited from these extra six months.

The high costs of care, particularly in the last six months of life, is a hot topic among health professionals, legislatures, insurers, condition based organizations, i.e. The American Cancer Society, and just about anybody who has to pay health insurance. This is a very touchy subject, as “health care rationing” is not a popular idea in the United States.
I read an article this week in the newsletter from my state’s independent living organization that stated, “VCDR opposes any legislation legalizing physician assisted suicide (sometimes called “End of Life Choices” or Death with Dignity” legislation). We would prefer to see policy and legislative efforts focus on making real improvements in and increasing and equalizing access to needed end-of-life and chronic pain services.”

It may appear that assisted suicide is not the same thing as limiting interventions in patients with terminal health issues, but I can assure you that these topics are very much linked in many people’s mind. First you limit the care that can be provided, then you sanction assisted suicide and ultimately the ground work is laid for what happened to the disabled, mentally ill, and aged during the Nazi regimen.

There is considerable data that shows that the highest medical expenses occur in the last six months of a person’s life. Interestingly, when I was working with employers on an AIDS related project, they were very clear that having employees with HIV/AIDS wasn’t their biggest concern as far as health insurance and premiums. Instead, they explained that the high and continuing costs for an employee’s premature baby could destroy their health insurance program.

During the AIDS epidemic in the 80s, a number of hospitals and community groups did talk to people with AIDS about the fact that the costs were quite high with ICU care and the chances of their coming out of one was slim. Consequently, many men signed advance directive forms that indicated they did not want any type of medical intervention that would prolong their life, including admission to an ICU.

Many hospitals, health centers and public health clinics have implemented prenatal programs to reduce premature births. Whether people like it or not, rationing does occur as insurers wont pay for procedures and treatments in certain situations. For those requiring transplants, there are all sorts of restrictions on who can be a candidate.

These measures do save money. However, where does the money saved go? Is it redistributed? If so, how and where? In short, there is no guarantee that money saved by not prolonging lives, in situations such as the one described in the NY Times article, would be put towards something better.

Particularly in this economy, I understand why people are questioning the high costs of health care at the end of life. However, I’m not so sure that’s the critical question. Maybe the place to start is trying to understand what decisions go into people choosing, or not choosing, to prolong life where there is no chance of recovery.

From what I’ve seen, there is a process that people go through before they can accept that it’s time to let go. For some, it’s a short time frame, for others it seems to take forever. A friend with extensive cancer absolutely wanted to continue chemotherapy even though the oncologist was clear that there was no hope and the treatment could kill him. However, he went ahead with it and when it made him even sicker, he was maintained for almost three months on blood transfusions every few days.

While it would be easy to look at this situation and wonder why, I quickly began to realize that there were clearly some items on his “to do list.” Once he was able to take care of it, he basically said I’m done and died within three days. In those three months he was not only able to settle personal matters, he established a legacy program for youth, whose impact will last for many generations. If this were looked at in terms of a cost benefit analysis, society benefited by this man having those last three months of life. For him, this time was priceless.

I’ve seen various aspects of this over and over again. Probably my most moving account of someone extending life long after she ever said she wanted it to be was a mother who knew that as long as she was dying, her daughter would be stationed stateside and out of the Gulf War. Another person I worked with knew that his benefits for his wife would end with his death, left very clear instructions to keep him on every possible means of life support. When that time came, his wife was the one who said “enough.”

One study indicates that families come to the decision to withdraw treatment when they both recognize and come to terms with the futility of continuing treatment. Advance directives and good communication from medical providers were two factors that helped in making these hard choices more acceptable to families. Journal of Family Nursing Vol. 5, No. 4 pages 426-442 (1999)

An English study of gender differences among those 63-93 making choices about technologies extending life found that older women voiced more opposition to extending their lives then men, as they did not want to be a burden on others. Older men’s attitudes were primarily “self-oriented,” reflecting a concern to stay alive for as long as possible with fewer expressing concern about consequences for others. Journal of Aging Studies, Vol 22, Issue 4, December 2008, pages 366-375

At the same time I was reading the various articles on choice and decision making, I came across an article by John Selby, executive counselor, “Death is Your Real Life Coach." He writes Life is mystery enough; death is the ultimate mystery, and we naturally tend to fear the unknown.

Thus most of us tend to be chronically anxious about our own coming demise -- we run away from death, and when we do finally die we tend to run up a giant last-minute medical bill that does no one any good.

The biological truth is that no one gets out of here alive. There might be life and transformation after we die (we won't know until we do), but we must first experience the process of biological death before discovering if there's anything beyond. Therein lies the rub….

As therapists regularly point out, trying to avoid the fact that at some point we are going to physically cease to exist is counter-productive, because it generates doubt-plagued denial syndromes and free-floating anxiety about our future. This anxiety in turn permeates every moment of our lives, turning heaven on earth into earthly hell. I never worked with a client in therapy whose root anxiety wasn't their buried fear of their coming death.

So how many people insist on extensive treatment and intervention even though it’s not going to improve quality of life and only postpone death by days, because of their fear of death? I suspect that’s the case for more people than we realize.
What is clear is that most people need help in closing out their lives. While I have had such conversations with clients, when it was my close friend that so was ill, I found it difficult to engage in those conversations, wanting desperately to believe the stories about people who were cured at the 11th hour. Clearly, I wasn’t the person to have that conversation. My friend was fortunate to have a really good physician who could talk about it.

In December, there was a big to do over allowing Medicare visits to discuss Living Wills and other end of life matters. I’ve been the advocate for any number of patients and have watched doctors, nurses and social workers try to discuss end of life issues with compassion, understanding and concern. This has not always been favorably received by the patient and their families.

Ultimately, while we can strive to train the medical profession, make programs available such as hospice and palliative care, the American public also needs to do it’s part in coming to terms that we are after all mortal.

Wednesday, February 3, 2010

Take a Break: Groundhog/Chinese New Years

Before getting to the “take break” item of the day, I couldn’t help but notice the big weather story of the week. Yesterday was Groundhog’s Day and yes, Punxsutawney Phil saw his shadow and so there will be six more weeks of winter. Living in northern New England, I’d be happy if it were just six more weeks.

So where did this custom come from? It turns out that a number of Germans settled in Pennsylvania, the home of Phil, and noticed how similar the groundhogs (woodchucks) were to the European hedgehog. In Europe, when clear skies occurred on Candlemas Day (Feb. 2), an extended winter was forecast-“For as the sun shines on Candlemas Day, so far will the snow swirl in May.” The German’s noted that if the sun shown on Candlemas, a hedgehog would cast its shadow, thus predicting six more weeks of winter.

In view of Phil’s latest prediction, take a break this week and watch Bill Murray in “Groundhog Day.”

In tribute to my mother’s love of the February holidays, Gong Hei Fard Choy or Happy New Year. 2010 is the Year of the Tiger and February 14 is the first day of the year 4707.

New Year’s is a time for families to gather, celebrating a fest on New Year’s Eve. The Lantern Festival is held on the fifteenth day of the first lunar month. Glowing lanterns are hung in temples and are carried to an evening parade under the light of the full moon.

In keeping with the Lantern Festival, make your own Chinese lantern. Directions can be found at the following websites:

Chinese Lantern from Enchanted Learning

Easy and Intermediate Chinese Paper Lanterns

If you were born in the Year of the Tiger (2010, 1998, 1986, 1974, 1962, 1950, 1938, 1926 or 1914) learn more about your sign at