Chronic Conditions and Depression/Finding Treatment that Works

Over a year ago, I wrote Is Counseling Necessary to Cope with a Crisis?.  I wrote this out of frustration as I was watching a “mental health” response in my state regarding Irene, which seems to be more about people making money versus anything that I’ve read in the literature as far as effectiveness. In addition,  I was friends with several people dealing with significant loss and couldn’t help but notice the number of people whose first reaction was to tell them to see a therapist. Not only didn’t that advice appear to be helpful, but it seemed to make them doubt their own ability to heal.

People with chronic conditions are more likely to suffer from depression. Whether they are depressed because of their health or they develop a chronic condition because of their depression is unknown. What is clear is that there are effective treatments for depression, but whether someone receives them is another matter.

According to an article in this week’s New York Times “Looking for Evidence that Therapy Works,” Over the last 30 years, treatments like cognitive-behavioral therapy, dialectical behavior therapy and family-based treatment have been shown effective for ailments ranging from anxiety and depression to post-traumatic stress disorder and eating disorders.

The trouble is, surprisingly few patients actually get these kinds of evidence-based treatments once they land on the couch — especially not cognitive behavioral therapy. In 2009, a meta-analysis conducted by leading mental-health researchers found that psychiatric patients in the United States and Britain rarely receive C.B.T., despite numerous trials demonstrating its effectiveness in treating common disorders. One survey of nearly 2,300 psychologists in the United States found that 69 percent used C.B.T. only part time or in combination with other therapies to treat depression and anxiety.

If depression or another mental health issue affects you or the person you are caring for, take a few minutes to read the New York Time's article and consider their recommendations for questions to ask a prospective therapist-or a current one for that matter. These are the same type of questions we’d be asking someone treating us for a medical issue. Keep in mind that you may have to shop around to find someone that is a good fit for you.

• What kind of trainings have you done, and with whom?

• What professional associations do you belong to? (If you’re looking for a Cognitive Behavioral Therapist (CBT), for instance, ask whether the therapist belongs to the Association for Behavioral and Cognitive Therapies, where most top C.B.T. researchers are members.)

• What do you do to keep up on the research for treating my condition?

• How do you know that what you do in treatment works?

• Do you consider yourself and your approach eclectic? (Therapists who subscribe to an eclectic approach are less likely to adhere to evidence-based treatments.)

• What manuals do you use?

• What data can you show me about your own outcomes?

Cheap Prescription Drug Secrets from Consumer Reports

By Katie Moisse
@katiemoisse
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Mar 28, 2013 6:00am

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A little research can save you a lot of cash on prescription drugs, according to a secret shopping study by Consumer Reports.

The magazine called more than 200 pharmacies across the country to request retail prices for five best-selling drugs: The diabetes drug Actos; the antidepressant Lexapro; the cholesterol-lowering pill Lipitor; the blood thinner Plavix; and the asthma treatment,Singulair; all of which are available as generics.

Depending on the pharmacy, costs varied by as much as $749 for a month’s supply of all five drugs.

“A consumer can’t assume that the price of their prescription medications is set in stone,” Lisa Gill, prescription drugs editor for Consumer Reports, said in a statement.

A person without insurance could pay as much as $150 a month for generic Lipitor at CVS, compared to just $17 at Costco, the study found.

“Big-box stores such as Costco and Walmart use the pharmacy as a traffic builder for their stores, whereas traditional chain stores, such as CVS, Rite Aid, and Walgreens, make the majority of their revenue and profits from the pharmacy,” Stephen Schondelmeyer, a professor of pharmacy economics at the University of Minnesota, wrote in the report.

A spokesman for CVS took issue with the study, telling ABCNews.com in an email that “pricing surveys do not accurately reflect what most pharmacy customers pay for their prescriptions given various value, discount and third-party insurance programs.”

Independent pharmacies had some good deals, too. But their prices varied widely from $131 to $1,073 for all five drugs.

“One of the big takeaways is that you have to ask for the best price and see if your pharmacist will work with you. Especially for the independent pharmacies, if they want to retain your business and loyalty, they will help you get the best price,” Gill said.

Click here to read the report. And read on for more tips for saving money at the pharmacy:

Go With Generics

Choosing a generic instead of its brand-name relative can save you thousands of dollars a year, according to Gill. “If your doctor prescribes Lipitor, you may be taking it for the rest of your life.  So it can really pay to shop around,” she said. ”Talk to your doctor about lower cost alternatives in the same class of drug. And make sure you have that talk when your doctor is about ready to write the prescription.  Once you’re taking a drug and tolerating it well, your doctor might be less inclined to try alternatives.”

Aim Low

Shoppers weren’t always given the lowest price, Consumer Reports found. It never hurts to ask the pharmacist for a better deal.

Ditch the City

Some urban pharmacies had higher prices than rural ones, Consumer Reports found. A month’s supply of generic Actos at a pharmacy in Raleigh, N.C., cost $203 compared to $37 outside the city.

Load Up
Some pharmacies offer discounts on a three-month supply, so ask for a 90-day refill.

Do Your Homework

Big-box drugstores and pharmacy chains offer discount generic-drug programs, which can land you some generics for as little as $4 a month, Consumer Reports found. Just make sure to check the fine print.

Take a Break: Make a Peep or Peeps 2013

I’m continuing my obsession from last year at this time [Take a Break with Peeps]. Last year was about making things from Peeps this year is creating your own Peeps.

To get started, check your Dollar Store, Job Lots or a store of that sort to see if they have a Play Dough set of Peep cutters and stamps. You can also download a chick peep template, or a bunny template

 Of course your can draw one or cut out the Peep on the side of the box. Once you have the basic shape, you can make T-shirts, garlands, signs, pins, ornaments for your egg tree or whatever strikes your fancy.

If you decide to make a T-shirt or sign, some ideas for wording:

• Give Peeps a Chance

• Hanging with my Peeps

• Chillin’ with my Peeps

• Peeps be with You

• Me and My Peeps

• Happy Easter to All my Peeps

• Shout out to my Peeps

• Peep This

• Talk to my Peeps

• 4 of Peeps (any number can be substituted)

• What the Peep

• Peep Show

• R.I.P. (Rest in Peeps)

If ya gotta try it, Miss Martha has a recipe for making Peeps. 

Other ideas

• Peep Cake 

• Pop Art Peep Pillows 

• Peeps Bunny Bunting and Door Hangers 

• Peeps Bunny Pin 

The Bitter Pill of Health Costs/What you can do

This past week, there has been a lot of discussion about  the Time magazine article by Stephen Brill Bitter Pill: Why Medical Bills are Killing Us,”  and the video about why he wrote the article

Brill’s conclusion is that hospitals and other providers can simply charge what they want because consumers – patients and their families – are simply participants in a “fixed poker game that [they are] forced to play in the worst of times with the worst of cards.” I have heard from colleagues who say that hospital costs are what they are because of all the people that have to be paid, and it’s the fault of the pharmaceutical companies. Others blame insurers and still others blame lawyers and lawsuits. Bottom line is that everybody has a finger pointed at somebody. It’s time we point it as ourselves and realize that as a health consumer there are things we can do:

• Use an advocate who knows your wishes and can help you understand what is being said about your situation and who can help you make the choices you want. They can also verify what did or did not happen during a medical appointment, trip to the ER or during a hospitalization. Have them take notes. 

• Keep a personal health notebook and take it with you to appointments and to the hospital. It can help in avoiding duplication of tests, prescribing drugs you’ve had reactions to and provide information that may be relevant to your medical situation, but not readily available in your chart. 

• Make sure that the treating hospital, medical provider, pharmacy and lab facility are covered by your insurance.

• Before tests, treatments, procedures, hospitalizations or medications are ordered, ask about anticipated outcomes, and less expensive options. Don’t be afraid to decline something that you don’t want or feel is necessary. If the course of treatment will be the same whether you have a test or not, maybe you’d like to opt out of the test. Be sure and let the provider know up front if you have limited or no insurance coverage.

• Since 8 out of 10 bills for health services contain errors, go through your medical bills with a fine tooth comb. It can literally save you thousands of dollars. That means asking for an itemized bill. According to Alice Park, author of Tips for Lowering Your Medical Bills,  do the following

- Ask for an explanation, in writing, from the hospital’s billing department for any disputed charges.

- If you go to the hospital at night and end up being admitted after midnight, make sure your charges for the room start on the day you start occupying the room.

- Check the level of room for which you were charged. Hospitals charge for ER services by level, depending on the amount of equipment and supplies needed, with Level 1 requiring the fewest (e.g., a nosebleed) and Level 5 representing an emergency (trauma, heart attack). Question the level indicated on your bill and ask for a written explanation of why that level was billed. Hospitals have their own criteria for determining levels and should make this available upon request. “They don’t freely hand this information out, but they will send it to you if you ask for a written response,” says Pat Palmer, founder of Medical Billing Advocates of America.

- Doctors also charge for ER services by level, also ranging from 1 to 5. Their levels are standardized, and physicians are required to meet three criteria to justify billing at each level. Question the level listed on your bill and ask for a written explanation of why that level was billed by your physician.

- The hospital level should be equal to or lower than that of the doctor-billed level; if it’s higher, that’s a red flag that there may be a billing error.

- Question charges for what seem like routine items, such as warm blankets, gloves and lights. These should be included as part of the facility fee.

- Question any additional readings of tests or scans. You should be charged only once for one doctor’s reading of a scan, unless it is a second opinion or consultation.

- If you received anesthesia, check that you were charged for only one anesthesiologist. Some hospitals use certified registered nurse anesthetists (CRNAs) but require that an anesthesiologist supervise the procedure, so some bills will contain charges from both, which amounts to double billing.

- If your anesthesiologist is out of your insurer’s network, ask him or her to accept in-network reimbursement.

- You can also ask your insurance company to send reimbursement for anesthesia services directly to you, and then you can resolve the bill directly with the anesthesiologist. In most cases, the anesthesiologist will accept the in-network rate rather than engage in a protracted negotiation with you about payment.

For more on this topic check out Controlling Out of Pocket Medical Expenses 

Take a Break: Photograph the First Day of Spring

So what does the first day of spring look like in your neighborhood?

Here in Vermont it’s been snowing for the last couple of days and more is in the forecast. The picture of the robin in the sumac bushes was taken by my husband.

Take a break and celebrate the first day of spring by taking photographs of your neighborhood, or wherever you happen to be. Post them to the Healing Whole Facebook page so others can enjoy.

Not much on photography? Watch and listen to Igor Stravinksy’s The Rite of Spring (Le Sacre du Printemps).

When you see a need for help but they reject it, what can you do?

Last winter I found one of our very elderly neighbors (93 or older) on her roof shoveling snow. While the stories of stoic New Englanders doing for themselves abound, no matter how you slice it, this isn’t a good situation. One of the neighbors was trying to convince her to go inside, and he’d finish clearing her roof,  but she was having none of it. I walked home thinking “how do you help those who need help, but reject it?”

Whether it’s working in first aid at our local ski area, helping out with the relief effort after Irene, or dealing with people with various issues, health related or other wise, there are many times where I see others reaching out to help, and it’s rejected.

As the most frequently read posts on this blog addresses how people can be helpful to others- Unique Gifts for Hospital Patients and What to Do When Someone is Ill or Injured it’s clear that many do want to help.

So can you, or should you even try to help someone that says that don’t want it?

Like many of the things discussed on this blog, there isn’t one answer that fits all circumstances. Consider the following:

• Why might the person be rejecting the offer? Any of these might be possible

-       Accepting help in some way could be demeaning,  making them feel inferior, dependent or defeated

-       They may not feel they are worthy of help. They feel “guilty” accepting it

-       To accept help is to become “beholden” to someone. If you do this for me, what will I have to do for you down the road.

-       By taking help they have to acknowledge the situation is really bad.

-       They may not really need the help.

-       Complaining may be their way of getting attention and they like thinking they are beyond help.

-       They may be in such crisis that decision making is difficult for them and they have no idea what they are rejecting.

By understanding the situation a bit better, it may help you decide what you can or can’t do. However, unless they are a danger to themselves or others, if they say “no,” accept it.  That noted, you can-

• Redefine how you might be helpful. I recently had a conversation about a mutual friend that has sustained a major set back in their business. The person I was talking to wants to help, has made suggestions and come up with rejection. Truthfully, there isn’t anything we can do to help with the business issues, at least not at this point, yet my friend has a feeling of wanting to do something. What to do?

One strategy is acknowledging it’s a stressful time and provide a well thought out card and enclose a gift certificate to help de stress-massage, certificate to a favorite restaurant, gas cards etc. Sometimes this type of support can be the most helpful.

• But what if they are in danger? Since they’ve rejected your help, you need to evaluate the level of danger. If it’s an immediate threat, call the police or ambulance. If they are not in immediate danger, but you think they are still at high risk, call adult or children protective services or call your local police department for a “wellness check.” If you find yourself saying, “well it’s not like that, but if they don’t do something now, they’ll be in real trouble later,” keep in mind that if they are capable of making choices and decisions, you need to let it go. It’s their life and they will ultimately have to live with the decisions they make now.

• What if they are in crisis? It all depends on the crisis. When we had a house fire and were displaced for several months, the first week we were in shock. The morning after the fire, my husband told me he didn’t want anyone to come by. He was embarrassed and is a typical Yankee, “I can do it myself.” I was quite clear that we needed all the help we could get and so I told him to let that thought go and be grateful for our friends and neighbors. After a day of non stop help, my husband said, “I now understand all those other brain cells that don’t get used. They are actually other peoples’ ideas. They may not think like you, but sometimes they have much better ideas.” He was incredibly grateful and consequently is one of the first to show if a friend or neighbor is in trouble. In situations like this, if there is a need and you can fill it, do it.

• Do they really need help, or is this about your need to be needed? This is a tough question, but answer it honestly. If you come to the conclusion that this is more about your needs than theirs, step aside. 

Take a Break: Make it Green (Celebrate St. Patrick’s Day)

In spite of my mother’s green oatmeal, I grew up loving St. Patrick’s Day. So today’s “take a break” is all about creating some festive items for Sunday, March 17, St. Patrick’s Day 2013.

Pour Painting Rainbow Vases, Glasses: Since there’s the lovely myth of the pot of gold guarded by the leprechaun at the end of the rainbow, you can either use the colors of the rainbow or various shades of green.  Since this is basically dripping acrylic paints over glass; if you want to use these for drinking, make sure you seal off the top so no liquid gets into it. You can use this same technique to make some fun votives.

St. Patty’s Cups Made from Airheads 

St. Brigid’s Cross 

Irish Soda Bread 

Celtic Knots 

Quick St. Patrick’s Day Glassware: Check out your local Dollar Store for some peel and window stick “clings.” These are reusable, so don’t throw away the sheet they come on. Pick up some cheap glassware, peel off the clings and attach to the glass. Add some ribbon if you like.

Shamrocks

Shamrock Pinwheel 

St. Patrick’s Day Ice Cream Jello 

Let People Know What You Want

About 18 months ago, I went to the funeral of one of our oldest residents in town. Her son spoke about how she wanted to live to be a 100 and that from childhood, his mother had told him that when it came time to die, a priest needed to be with you for it to be a good death. When at 96 his mother had a heart attack and was rushed to the hospital, he continued to okay extreme measures, per her living will, until the priest could get there. Once he arrived, the son had all interventions stopped. Ultimately, his mother, while not making it to 100, had the death that she would have deemed “good.”

This past week the news media has been filled with stories of the 87 year old woman who collapsed in the dinning area of a senior living center, and for seven minutes, a 911 operator begged a staff member  to either perform CPR or get someone else to do it. The replaying of the 911 tape was horrific to listen to and/or watch. Needless to say it has created quite the media sensation.

The woman’s family was very clear that their mom wanted a “natural death” and would not have wanted CPR or any other measures taken. In fact she choose this particular independent living center knowing the facility did not have medical staff. Long story short, while the family isn’t interested in suing, all sorts of investigations are ongoing. The staff member who made the initial call is now on “voluntary” leave.

The Bayless family sent the Associated Press the following statement, "It was our beloved mother and grandmother's wish to die naturally and without any kind of life prolonging intervention. We understand that the 911 tape of this event has caused concern, but our family knows that mom had full knowledge of the limitations of Glenwood Gardens and is at peace."

In both situations, the person ultimately had the type of death they wanted because they had made their wishes known and had taken measures to ensure that it would happen by putting it in writing, in the first case and in the second instance by selecting where they lived.

The Bayless family also stated, "We regret that this private and most personal time has been escalated by the media," and called it “a lesson we can all learn from.” So what is the take away point? 

Clearly people will differ on this. My point would be that, while “putting it in writing”(file a living will) is important, we significantly improve your chances of getting what we want if we have conversations with family and friends about final wishes and act according to our beliefs. 

Take a Break: Make Spring Pinwheels

Snow, snow and more snow, has me longing for spring. Even if it’s due to arrive on March 21, I wont see the first flowers until well into April. I wanted to do something different, since I’m forever making flowers out of paper or scraps of felt. The answer was simple “pinwheels.” Easy to make and so much fun to play with on a windy March day-even if it is snowing.  Make them small or large using an array of materials-from a brown paper bag to felt.  Make a group of them and place in a vase. Wear one in your hair or turn it into a pin. You can even make a very large one for a bridal bouquet.

Pinwheel wreath

 

Flower Pinwheel 

Five Blade pinwheel

Six Blade Pinwheel 

Snowflake Pinwheel 

Shamrock Pinwheel 

Don’t forget we “spring forward” this weekend. Day light savings time goes into effect, so move your clock forward one hour before going to sleep Saturday night. 

Calcium Supplement: A “do” that’s now a “don’t.” So What’s Next?

I received an e-mail early this week from my brother, a doctor, with the subject heading of “Don’t take calcium supplements” Attached was the latest journal article BMJ 2/13/13  that showed that calcium supplements were doing more harm then good for older women. After years of being told to take calcium and vitamin D to protect their bones from osteoporosis, along comes a study that shows that women who get too much calcium via supplements (1,400 mg a day or more) are twice as likely to die from cardiovascular disease. But those who take 600 mg or less are also at an increased risk of death.. “If you have a normal diet, you don’t need to take calcium supplements,” said the lead author, Dr. Karl Michaelsson, at Uppsala University in Sweden.

Also out this week, and also e-mailed to me by my brother, is a recommendation from the US Preventive Services Task Force that healthy older women shouldn’t bother with relatively low-dose dietary supplements of calcium and vitamin D, as taking 400 international units of D and 1,000 milligrams of calcium doesn’t prevent broken bones but can increase the risk of kidney stones. Annals of Internal Medicine 

So first things first, let’s discuss the calcium supplement piece. According to the NIH’s Office of Dietary Supplements, the recommended daily allowance (RDA) of calcium for women 50 and up is 1,200 mg. Yet, this study indicates that somewhere between 600 and 1,000 milligrams might be a better target range.  Next consider that most Americans believe that the primary source of calcium is milk, when in fact, calcium appears in many different foods, including fortified cereals, nuts, beans etc. Water is also a source, if you live in an area with hard water, If you want to get some idea of how much calcium you are actually getting, try the Calcium Food Calculator. 

Now for the bigger issue. Things come in and out of vogue in healthcare. A quick look at the Choosing Wisely list of tests and treatments you may either not need or should use sparingly points to how things that were once common practice are being thought of in different ways. Mammography and prostate cancer screening, once the gold standard for cancer prevention are undergoing radical shifts in how they are administered.  Hormone replacement therapy (HRT) was once widely prescribed not only because it reduced or eliminated menopausal symptoms,  but it was believed to have other health benefits. However, this practice came to a halt when the Women’s Health Initiative found an increase in breast cancer in women taking HRT, particular those who had taken it for a long time.

When you see studies, such as the ones my brother e-mailed, it gives one pause. What am I doing now, believing it to be healthy, that will be found to be problematic in a few years?

“Whoopsies” in health care practices have always occurred. They just may be a bit more loudly announced then in previous generations thanks to the internet and social media. Consequently, we need to continually adjust our thinking based on new knowledge and information. 

So in the face of all of this, how does one pick and choose what to do?

Consider the following:

• Understand that no matter what you eat, drink or do, we all come with an expirations date. …. health rules can mislead you into halfway believing that if you eat only the right things, or exercise in the proper way, you can escape not just run--of--the--mill illnesses but death itself. This way of thinking leads to a distorted set of priorities: Instead of trying to be healthy so that you can enjoy life, you squander your happiness in the pursuit of more health.. Live a Little! Breaking the Rules Won’t Break Your Health by Susan Love and Alice Domar 

• Listen to your body and notice how it responds to changes in diet, exercise, new medications, supplements etc. and act accordingly.

• Know your family’s medical history. If there are certain diseases that are prevalent in your family, understand what can be done to help prevent them or reduce their impact by using food, exercise and other non invasive strategies first before you try medications, supplements or other measures.

• Use common sense and caution. There are a lot of charlatans out there, so be a smart medical consumer.  Scam, Frauds and Quacks 

• Look at the sources of information and research. Talk show hosts, celebrity doctors-even though they have an MD after their name, and advertisements aren’t the best sources of information.

•  Think of food as your primary source of healing and eat accordingly. Try not to rely on supplements for getting the necessary nutrients your body needs.

• Exercise wisely, working to incorporate movement through out your day.

• When you have questions and concerns, talk it over with your medical provider.