Life with Chronic Conditions: Medicine vs Lifestyle

I love archeology, particularly the paleoindian period, which is over 11,000 years old. I’ve been working on various digs and am amazed to hold the tools these people made. Now with the advent of DNA research, we’re getting a better handle on who these people were, how they lived and yes their life expectancy.

I was fascinated when Vermont’s state archeologist, Jess Robinson, spoke about how farming was the undoing of the Paleoindians as they had it made with their hunter-gatherer lifestyle. So this week I was immediately drawn to an article in the Huffpost Does Medicine Actually Make People Live Longer?

In spite of the research I’m actively involved with, I had no idea that the paleoindian lifespan (for those surviving childhood) was pretty similar to today's. Once people started cultivating crops, longevity suffered. Populations boomed, unsanitary conditions arose, humans and domestic animals lived in close proximity and it wasn’t long before infectious diseases significantly impacted life expectancy. Note that children, up to the 20^th century and the arrival of vaccines, were at high risk for early deaths.

Life expectancy did not start rising again, and finally attain similar levels as our 10,000 year old ancestors, until about 100 years ago. Sanitation/public health was the primary reason. Due to a better understanding of germs, significant changes in drinking water, improved hygiene of those attending births and caring for the sick, building sewers etc. all contributed to a spike in life expectancy. By the mid 20^th century, vaccines helped to eradicate many childhood diseases so more people achieved adulthood and the arrival of antibiotics helped to stop some of the diseases that have plagued humans since they began farming.

While heart disease, which hunter-gatherers rarely develop, is the leading cause of death, with cancer in 2^nd place, I was surprised to learn of the 2016 British Journal of Medicine study  that found medical error is the third leading cause of death in the US. Interestingly medical error is not included on death certificates or in rankings of cause of death.

I find it fascinating that people are obsessed with a vegan diet, swearing it improves life expectancy, while at the same time there are many who find they feel healthier eating a Paleo diet. In truth, we’re not going to be adopting a hunter-gatherer lifestyle anytime soon-and no they were definitely not vegans.

But let’s not throw the baby out with the bath, medicines have definitely saved lives and they are important. My question is simple, does medicine deserve the power that society today gives it? Might we do better if we had as much promotion for healthy lifestyle choices as we do medications? Would we do better to invest in communities to make the healthy choice the easy choice?

I’ve written about this many times in this blog, but we only need to look at the Blue Zone cultures to see that lifestyle makes a far bigger impact on longevity and quality of life than access to medical care. Programs  are underway in the US to bring the Power Nine lifestyles of the Blue Zones to the US.

The research is showing that it’s not too late to make changes as significant advantages are happening in communities where they are making the healthier choice the easy choice. However, many health professionals I talk to have never heard of the Blue Zones studies and would rather promote medicines (cause it’s easier and people are more likely to do it) than lifestyle changes. Interestingly though, when you look at who is sponsoring a lot of the Blue Zones projects it’s health insurers. They’re not stupid as they save money when people adopt healthier lifestyles and therefore don’t need a lot of medical care.

Ultimately medicine today is a “sick care” model. If we want to be active and healthy for as long as possible we need to start shifting our focus at creating healthy communities. Clearly the early public health pioneers did this when they worked to implement sewers and other measures that resulted in improved lives and life expectancy. We need to be building on that model by creating communities that promote walking; places for people to gather and socialize; ways for people to be involved so they have a sense of purpose; public gardening and more.

Take a Break: Make Soup!

It’s cold, snowy, sleety and just plain nasty out. What a wonderful pick me up to have a bowl of nice warm soup that you make yourself. The house smells cozy delicious while it's bubbling away and you can include whatever ingredients you like.

The simplest soups have the same basic method for cooking:

• In a soup pot (Dutch oven) sauté aromatic veggies (onion, garlic, celery, carrot, garlic) in some type of fat (butter, olive oil, bacon drippings)

• Cook your meat if your using it

• Add the base (except for milk or cream), veggies, meat and spices. Your base can be chicken, beef, fish or veggie stock or broth. In general you want your broth to just cover the veggies and meat. Can add tomatoes.

• Allow to simmer for an hour or two. However Instant Pots are great.

• Taste and adjust seasonings as you go.

• Add cream or milk before serving. Another way to get a thicker soup is to take some of the soup and puree it. This will thicken the soup, without using milk or cream,  particularly if you have potatoes in the recipe.

I like roasted vegetable soup. Put cauliflower, garlic cloves skin on, onions and carrots in a sheet pan, sprinkle olive oil, salt & pepper. Mix and bake at 450 for about a half hour or until they start to brown up nicely. I’m pretty casual so I’ve been known to turn the oven off after 20 minutes and let them sit in the oven for a couple of hours. I then put the roasted veggies, removing the skin from the garlic, in a soup pot adding some potato, 4 cups of chicken stock with additional spices if it needs it. After the potatoes are fork tender, I puree in a blender until smooth. Add whatever toppings you like. Crispy Fried Onions are pretty tasty. I also make this soup using butternut squash in place of cauliflower and add a sweet potato instead of white potatoes.

There are many recipes on-line. Check out The Best Soup Recipes of 2018  to get started.

Not interested in today’s activities, try the Take a Break Pinterest Board.

Life with Chronic Conditions: Buying/Borrowing or Modifying a Recliner

It feels great to kick back in a comfy chair after a long day, watch a little TV, read a book or take a nap. The bane of interior designers, many people have recliners in their homes for just that purpose. Hospitals, same day surgery centers and other medical facilities find them very useful in helping patients to relax and even recover from procedures.

Recliners are generally considered chairs that slide back with a footrest and a headrest. These can include “zero gravity chairs.” Glide rockers (great for nursing moms and colicky babies) come with separate ottomans that also glide and there are plenty of lounge chairs with ottomans that are quite comfortable.

Prices vary significantly based on materials and features. You can certainly pick one up at your local thrift store, or may even know someone who wants to get rid of one. If this is something you wont be using for a long time-e.g. recovering from surgery-you’d do well to check around to see if someone has one that fits and that you can borrow. Don’t borrow a chair that doesn’t fit you as in the long run it could cause you more problems.

 Before buying, loaning or modifying a recliner consider the following:

Types of recliners: There are a lot of different designs of recliners that can fit your needs, wallet as well as decor. Check out Wall Hugger Recliners  for the pros and cons of lift recliner, zero gravity and many other types.

Note that zero gravity chairs are very popular for their sleek design but also because they are comfortable. I’ve known a number of patients, particularly those with pain issues, who prefer them to the conventional recliner as they take pressure off the body and are excellent for circulation issues. During the summer months you’ll often see them advertised as the outdoor chair of choice for as low as $50. These can be modified with cushions and blankets for indoor use. However, they can be hard for some people as they require that you lean back in order to achieve the zero gravity position. Also, the cheaper the chair the more likely it will “slip” so it’s important to get one that locks and has a variety of position options. The outdoor varieties are good for traveling, sitting by the pool etc. If you want this to be a more permanent feature, it’s worth spending the money to get one that fits properly and is made of more durable fabrics.

Proper Fit: There are two “proper fits” you need to consider. The first is where the recliner will sit in your house. Measure carefully and understand how much space the chair will take when it’s in the recline position. A standard or basic recliner typically requires at least 1 foot of travel space in front of the wall to open completely. Give a little more room so when the chair is in fully reclined position it’s not almost toughing the wall.

The second is how it fits your body. You don’t want a chair that is too high where your feet dangle or too low, where your knees rise above the seat. Feet should fit flat on the ground.
While it’s recommended that you try out a chair before you purchase it, it may not be possible and/or if you are purchasing a chair for someone else, measure carefully before shopping. In order to get the best fit, use a tape measure and write down the distance:
• from the back of your knee to your heel
• from your tailbone to the back of your knee
• from your elbow to the end of the palm of your hand, where your fingers attach
• from your right hip to the left hip.

For the correct back support, no gap should exist from your tailbone or lower back when seated against the back and seat cushions, so the measurements from your tailbone to your knees should equal the length of the recliner's seat cushion. When seated -- not reclined -- your feet should rest flat on the floor and not dangle or extend to where your heels are resting on the ground. This will create ample knee and back support as well as allow circulation in your legs and feet. The armrest should extend from your elbow to your hand resting at the end of your palm for wrist support -- so the armrest equals your arm length from your elbow to hand -- and the width of your chair should have at least a small gap -- about 1 inch -- from the armrest to both hips. Finally, when the chair is reclined, the heels of your feet should fit comfortably at the edge of the footrest, not dangling over or stopping in the middle; otherwise, the chair will not provide the correct support for your back and legs.
If it’s possible to test out the recliner do so. Sit on the recliner. Raise the leg platform. Press the back to its most reclining position. If it’s comfortable and you find yourself snuggling into the seat, then consider purchasing the recliner. In a sitting position, be sure your thighs are supported completely, and when sitting and reclined, note the lumbar support. Make sure you can’t feel the frame when your arm presses on the armrest. 

Ask the sales person for the “foam density rating,” meaning the density of the filler. You want a recliner with a rating greater than 1.9 for a long-lasting and comfortable seat.

Manual vs. Motorized: Clearly motorized are more expensive and you can have more mechanical issues with them. However, if it’s going to be hard to operate a side lever or you don’t have the strength to push back into a reclining position, it will be worth the money to get a motorized chair.

Modifying a Recliner: This is a very common practice when a person has a recliner to modify it while they recover from hip or other type of surgery. Watch the video below to learn about modifying one as well as additional tips on selecting a chair that fits your body.

Take a Break: Learn something new today and everyday

Last week’s Take a Break, honoring the approaching New Year, was about capturing a Second Everyday via photograph, journal entry or video. Today, being January 2, here’s another way to inject creativity and inspiration into one’s daily life-learn something new each day.

Whether it’s five minutes, 15 or whatever amount you can spare, the Internet offers a lot of options including items delivered daily to your in box, or websites you can check, or pod casts you can listen to. It might be helpful to set up a special bookmark folder and consider some of these site to check out if you want to learn something new daily:

• Daily Infographic

• TED Talks

• Curiosity

• Zidbits

• Hackaday

• Wikipedia’s Featured Article List: Every day, Wikipedia posts an article selected from its vast repository of entries to it’s Daily-article-l subscribers.

Radio Open Source http://radioopensource.org/

• Open Yale Courses

• Reedsy Learning: Free short publishing courses, delivered to your inbox.

• 5 minute Crafts Utube Facebook

• Our Time  Radio broadcasts, pod casts of varying lengths

• Radio Open Source

• Free Education Online

• Freakonomics

 Not interested in today’s activities, try the Take a Break Pinterest Board.

Life with Chronic Conditions: Impact of Government Shut Down

With the Federal governments shutdown extending into the New Year, many wonder if it will impact Medicare, Medicaid, disability benefits and Social Security. Fortunately, the shutdown will not effect these programs as they are considered “mandatory spending.” However, if you are applying for these services, you may experience delays in processing. Also, as non-essential employees are being furloughed, you can expect longer lines than usual at local offices or when calling. Benefit verification and the issuing of new Social Security cards will temporarily halt.

The longer the shutdown, the more chances are it could impact you. Below are possible ramifications:

• 41% of the FDA (Food and Drug Administration) is now furloughed. However, the FDA will continue specific activities within the scope of its user fee–funded programs, including those for prescription drugs, generic drugs, biosimilars, medical devices, and tobacco products. Existing critical public health challenges, including drug shortages and outbreaks related to foodborne illness and infectious diseases, will continue to be addressed. AJMC 

• Five days into the shutdown, the office of Food and Nutrition Services cut staff by 95%. Eligible households will still receive monthly SNAP benefits for January. But other domestic nutrition assistance programs such as the Commodity Supplemental Food Program, WIC, and the Food Distribution Program on Indian Reservations will only be operational based on available resources. Additional federal funds and commodities will not be provided during the shutdown. Child nutrition programs including School Lunch, School Breakfast, Child and Adult Care Feeding, Summer Food Service and Special Milk will continue through February.

• You may find it difficult to get a new passport or Visa. Please note that if you wish to fly internationally, your passport must be valid for at least six months beyond the completion of a trip. If your passport expires sooner that that, you must have it renewed.

• Nearly all of the Department of Housing and Urban Development employees will be furloughed during the partial shutdown. That means fair housing enforcement, issuance of new development grants, and housing quality inspections will stall. New home buyers might also feel the effects because loan processing and approvals could be delayed.

The longer the shutdown lasts, the more it will create a “domino effect,” impacting the economy and most people will begin to notice changes.

Take a Break: Capture a Second on Your Life

With the New Year starting in less than a week, I was struck by Ceasr Kuriyama’s project of videoing 1 second of everyday. He found that it helped him remember many aspects of his life that he normally would have forgotten, making him more mindful and improving his quality of life. People for years have done this with one or two lines in a daily journal, while in my case, I prefer a photograph per day. 

Between now and New Year’s Day, watch Kuriyama’s TED talk and experiment with how you might be most comfortable capturing a daily reminder. 

Oh and there is an App for that  just to make it easier to store and watch.

 Not interested in today’s activities, try the Take a Break Pinterest Board.

Life with chronic conditions: I’ve fallen but I can get up

People with chronic conditions are more likely to be adversely impacted in the event that they fall. Not only is there the risk of breaking a hip, sustaining a brain injury or getting cut, but it maybe so frightening you’ll avoid certain activities for fear of falling. Therefore consider the following:

Know your risks for a fall

•  Do a medication review to determine if anything you are taking-prescription or over the counter-could make you more at risk for falls. Medications like sedatives and some types of antidepressants can make you tired or affect your thinking.

• Understand if you condition might make you more at risk for a fall. Dizziness, joint pain, shortness of breath, numbness in feet and legs can increase your risk for a fall, as can low vision, hearing loss, and use of alcohol and nicotine. Discuss this with your provider.

Fall Proof your Living space

• Get rid of the clutter. Stacks of magazines, books and papers on hallways, staircases and even next to the bed can be a real problem, as can unstable chairs and tables. Need help with de cluttering, check out The Kon Mari Method for Tidying When Affected by a Chronic Condition

• Remove tripping hazards: Remove loose carpets and throw rugs etc. Check for loose floorboards, uneven tiles, stray cords. Low coffee tables and footrests can be a problem so make sure they aren’t located in areas where you could trip or bump into them.

• Secure rugs with double-sided slip resistant backing, and consider carpeting concrete, ceramic or marble floors to cushion falls on these hard surfaces.

• Install safety devices such as grab bars and handrails.

• Avoid clothing and shoes that could cause you to trip: Baggy sweat pants may be comfortable but if they’re so loose they drag on the ground they could cause you to trip. The same is true for ill-fitting shoes.

• Wear shoes or socks with grips: Walking around in stocks can make slipping and falling easier.

• Avoid chairs that are too low, making it difficult to get up

• Light your way to safety-Night lights in bedrooms and bathrooms can be very helpful, as well as making sure hallways and stairs are well it. Keep flashlights handy in several locations so that in the event of a power failure you can still see where you are going.

• Limit the need for stairs by living on one level. If that’s not possible, limit trips up and down stairs. Use handrails. Avoid using patterned or thick carpets on stairs since these make the edges of the stairs harder to see and easier to trip on.

• Use easy to reach shelves and cabinets. If you must use a step stool, make sure it’s sturdy with handrails for balance.

• Move mindfully Pause after going from lying down to sitting and from sitting to standing. Pause walking up and down stairs.

Exercise!!

Exercise is a proven way to strengthen your body to prevent falls while improving your balance. Mix it up with aerobic (walking, biking, running, swimming, dancing etc.); balance; strength and resistance training. Check out Harvard’s Simple Exercises to Prevent Falls

Know what to do if you do fall.

Watch the following video. Practice getting up. Always have someone with you when you practice.