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. 

Journal Watch December 2018

CHRONIC PAIN

Extract from sour sopleaves can prevent the symptoms of fibromyalgia: The consumption of extract of Annona muricata L. leaves in pharmaceutical form and in the correct dosage can reduce the chronic pain, anxiety and depression that accompany this disease. Journal of Ethnopharmacology 

Functional Nasal Surgery Can Improve Headache Symptoms: For appropriately selected patients, functional nasal surgery is viable for improving headache symptoms, according to a review published in the December issue of Plastic and Reconstructive Surgery.

Joint Mobilization Plus Exercise Beneficial for Knee: Patellar mobilization therapy (PMT) plus exercise has the potential to reduce pain and improve function and quality of life for patients with knee osteoarthritis, according to a phase 2 study published Nov. 12 in the Annals of Family Medicine.

Refractory Back Pain Responds to CT-Guided Pulsed RF: Computed tomography (CT)-guided pulsed radiofrequency (pRF) is effective for patients with acute or subacute neuroradicular low back pain that is refractory to usual care, according to a study presented at the annual meeting of the Radiological Society of North America.

AI-Based Smartphone App Can Help Cut Cancer Pain Severity: An artificial intelligence (AI)-based smartphone app, called ePal, can reduce the severity of cancer patients' reported pain and hospital admissions, according to a study presented at the annual Palliative and Supportive Care in Oncology Symposium.

Treatments Appear No Better Than Placebo for Tennis Elbow: At best, all treatments provide only small pain relief for tennis elbow, according to a review published online Oct. 31 in the American Journal of Sports Medicine. Only local corticosteroid injection improved pain at short-term follow-up; however, it was associated with pain worse than placebo at long-term follow-up. Laser therapy and local botulinum toxin injection improved pain at midterm follow-up. Extracorporeal shock wave therapy provided pain relief at long-term follow-up. Only laser therapy showed better outcomes for grip strength compared with placebo. All treatments increased adverse events compared with placebo. After receiving placebo, most patients experienced pain resolution within four weeks of follow-up.

Smoking Linked to Cognitive Dysfunction in Fibromyalgia: Smoking tobacco is a risk factor for cognitive dysfunction in patients with fibromyalgia (FM), according to a study presented at the 17th Annual Pain Medicine Meeting, a meeting of the American Society of Regional Anesthesia and Pain Medicine.

Recommendations Developed for Psoriatic Arthritis Treatment: Recommendations have been developed for pharmacologic and nonpharmacologic treatment of psoriatic arthritis (PsA); the evidence-based guideline was published online Nov. 30 in Arthritis & Rheumatology. 

Early PT Can Reduce Risk, Amount of Long Term Opioid Use: Patients who underwent physical therapy soon after being diagnosed with pain in the shoulder, neck, low back or knee were approximately 7 to 16 percent less likely to use opioids in the subsequent months, according to a new study. Science Daily

COMPLEMENTARY & ALTERNATIVE MEDICINE

Hypnotherapy Beats Education for Relief of IBS Symptoms: For patients with irritable bowel syndrome (IBS), individual and group hypnotherapy are more effective than educational supportive therapy in relieving symptoms, according to a study published online Nov. 22 in The Lancet Gastroenterology & Hepatology. 

Cannabis-based drug in combination with other anti-spasticity: Drugs may help to relieve symptoms of motor neuron disease Oral spray containing two compounds derived from the cannabis plant reduced spasticity compared with placebo in patients already taking anti-spasticity drugs. The Lancet

FDA ACTION

• Updating the US system for approving medical devices.

• Lifted advisory on Romaine Lettuce Check Labels for lettuce that is grown outside of the Central Coast growing regions of northern and central California

• Will take steps to limit or ban access to flavored electronic cigarettes, menthol cigarettes and flavored cigars

• Issued a warning letter to Zhejiang Huahai Pharmaceutical Co. Ltd. (ZHP), in Linhai, Taizhou Zhejiang China, the manufacturer of the active pharmaceutical ingredient (API) found in valsartan that is the subject of an ongoing FDA investigation into probable cancer-causing impurities in certain commonly prescribed heart medicines.

• Cleared an app to help increase retention in outpatient treatment program for individuals with opioid use disorder

• Approved first treatment for Lambert-Eaton myasthenic syndrome

• Approved Xospata (gilteritinib) tablets for the treatment of adult patients who have relapsed or refractory acute myeloid leukemia (AML) with a FLT3 mutation

• Approved Truxima (rituximab-abbs) as the first biosimilar to Rituxan (rituximab) for the treatment of adult patients with CD20-positive, B-cell non-Hodgkin’s lymphoma (NHL) to be used as a single agent or in combination with chemotherapy

• Accelerated approval to Vitrakvi (larotrectinib), a treatment for adult and pediatric patients whose cancers have a specific genetic feature (biomarker).

• Approved Daurismo (glasdegib) tablets to be used in combination with low-dose cytarabine (LDAC), a type of chemotherapy, for the treatment of newly-diagnosed acute myeloid leukemia (AML) in adults who are 75 years of age or older or who have other chronic health conditions or diseases (comorbidities) that may preclude the use of intensive chemotherapy.

• Approved Gamifant (emapalumab-lzsg) for the treatment of pediatric (newborn and above) and adult patients with primary hemophagocytic lymphohistiocytosis (HLH) who have refractory, recurrent or progressive disease or intolerance with conventional HLH therapy.

• Approved Aemcolo (rifamycin), an antibacterial drug indicated for the treatment of adult patients with travelers’ diarrhea caused

PREVENTION

Inflammatory bowel disease linked to prostate cancer: Men with inflamed guts are four to five times at risk for prostate cancer European Urology

Is being a night owl bad for your health? Night owls may have a higher risk of suffering from heart disease and type 2 diabetes than early risers. Advances in Nutrition

Patient Education Can Improve Chronic Disease Management: An educational intervention can improve patients' ability to self-manage their chronic diseases, according to a study published in the November issue of the Journal of the American Osteopathic Association. 

Less Than One Hour of Resistance Training Weekly Tied to Lower CVD Risk: Less than an hour a week of resistance exercise (RE) is associated with decreased risks for cardiovascular disease (CVD)-related events and all-cause mortality, independent of aerobic exercise. Medicine & Science in Sports & Exercise. Weekly RE frequencies of one, two, and three times or a total of one to 59 minutes was associated with approximately a 40 to 70 percent decreased risk for total CVD events, independent of aerobic exercise, compared with no RE. For weekly RE of more than four times or ≥60 minutes, there was no further significant risk reduction.

Limiting Social Media May Improve Psychological Well-Being: Limiting social media use to 30 minutes per day may lead to significant improvement in well-being, according to a study published in the December issue of the Journal of Social and Clinical Psychology. 

Flu Vaccine Linked to Reduced Risk for Death in Heart Failure: After extensive adjustment for confounders, influenza vaccination is associated with a reduced risk for all-cause and cardiovascular death among patients with heart failure, according to a study published online Dec. 10 in Circulation. Compared with intermittent vaccination, annual vaccinations, vaccination early in the year (September to October), and a greater number of vaccinations were correlated with larger reductions in the risk for death.

Sleep Length, Quality Linked to Risk for Falls, Fractures: Women with less than five, more than 10 hours of sleep, poor sleep quality at increased risk for falls. Journal of Bone and Mineral Research 

AHA Guidelines Stress Healthy Lifestyle for Lowering Cholesterol: A healthy lifestyle for lowering cholesterol should be emphasized for reducing cardiovascular risk across the life course, according to a guideline published online Nov. 14 in Circulation to coincide with the annual meeting of the American Heart Association, held from Nov. 10 to 12 in Chicago.

Performance on exercise test predicts risk of death from cardiovascular disease and cancer:Performance on an exercise test predicts the risk of death from cardiovascular disease, cancer, and other causes, a new study finds. Good performance on the test equates to climbing three floors of stairs very fast, or four floors fast, without stopping. The findings underline the importance of fitness for longevity. EuroEcho-Imaging 2018

Study takes stand on true health benefits of getting up out of your chair: The study, published in the journal Medicine & Science in Sports & Exercise, reveals that the 'benefits' of standing over sitting equate to little more than 9 calories an hour -- the equivalent of just one stalk of celery. In fact, purely for weight gain perspective, it would take individuals who opted to stand nearly the entire day to burn just one cup of coffee. 

Physical activity in the evening does not cause sleep problems: Contrary to popular belief, there is no reason to avoid exercising in the evening, an analysis of the scientific literature has revealed. Sports Medicine 

NUTRITION/SUPPLEMENTS/VITAMINS

Low-Carbohydrate Diets Linked to Increase in Calories Burned: Low dietary carbohydrate intake is associated with increased energy expenditure during weight-loss maintenance. The BMJ 

New evidence that females might benefit most from a low-salt diet: A low-salt diet may be more beneficial in lowering blood pressure in females than males, report scientists who found that while actual salt retention isn't higher in females, there is still an effect that drives pressure up.  Hypertension 

New review of scientific studies confirms food cravings can be reduced: Food craving, the intense desire to eat certain foods, can sabotage efforts to maintain healthy eating habits and body weight, no matter the time of year. However, an examination of 28 current peer-reviewed scientific studies largely substantiates findings that changes in diet, prescription medications, physical activity and bariatric surgery reduce craving. Current Opinion in Endocrinology & Diabetes and Obesity 

Weight cycling is associated with a higher risk of death: Weight cycling, or the constant losing and gaining of weight (usually from diet), leads to adverse health outcomes. By some estimates, 80 percent of people who lose weight will gradually regain it to end up at the same weight or even heavier than they were before they went on a diet. The Endocrine Society's Scientific Statement on the causes of obesity found this was because once an individual loses weight, the body typically reduces the amount of energy expended at rest, during exercise and daily activities while increasing hunger. This combination of lower energy expenditure and hunger creates a "perfect metabolic storm" of conditions for weight gain. Journal of Clinical Endocrinology & Metabolism. 

Intermittent fasting: No advantage over conventional weight loss diets: Intermittent fasting helps lose weight and promotes health. However, it is not superior to conventional calorie restriction diets, scientists have found out in the largest investigation on intermittent fasting to date. The scientists conclude that there are many paths leading to a healthier weight. Everybody must find a diet plan that fits them best and then just do it!  The American Journal of Clinical Nutrition

TREATMENT

Blood pressure: Early treatment advised by US guidelines has no survival benefits: When is high blood pressure dangerous? Medical associations offer widely differing answers. In the USA, for example, patients are seen as hypertensive much sooner than in Germany. A team has concluded that treating patients sooner does not reduce the risk of deadly heart disease. It could even negatively affect their mental health.  European Heart Journal 

Low Risk of Side Effects for Statins: Statins are associated with a low risk for side effects, according to a scientific statement from the American Heart Association (AHA). he risks for statin-induced serious muscle injury and serious hepatotoxicity are <0 .1="" 0.001="" 0.2="" a="" about="" and="" between="" cancer="" cataracts="" causal="" cognitive="" convincing="" diabetes="" diagnosed="" dysfunction="" erectile="" evidence="" for="" is="" mellitus="" nbsp="" neuropathy="" newly="" no="" of="" or="" p="" per="" percent="" peripheral="" relationship="" respectively="" risk="" seen="" statin-induced="" statins="" tendonitis.="" the="" treatment.="" was="" year="">

Sex-specific effects of DHEA on bone mineral density and body composition

Among older women, the naturally occurring hormone DHEA may preserve bone and muscle mass when compared with placebo, study suggests. Clinical Endocrinology

OTHER

Fear Impacts Quality of Life for Young Adults With Type 1 Diabetes: Fear of complications and frustration at the amount of time required to manage type 1 diabetes impact the quality of life of young adults with the disease, according to a study published in the December issue of The Diabetes Educator.

Some E-Cigarette Liquids Contain Erectile Dysfunction Meds: Consumers should not use two electronic cigarette liquids that contain erectile dysfunction drugs because they may pose health risks, according to the U.S. Food and Drug Administration. Lab tests revealed both sildenafil and tadalafil in E-Cialis HelloCig E-Liquid and sildenafil in E-Rimonabant HelloCig E-Liquid. The e-liquids are made by HelloCig Electronic Technology Co. Ltd., based in Shanghai. 

Recalled KotexTampons Can Unravel Inside Body: Certain Kotex tampons are being recalled by Kimberly-Clark because they can unravel and leave pieces inside women's bodies. There have been "a small number of reports of infections, vaginal irritation, localized vaginal injury, and other symptoms" among users of U by Kotex Sleek Tampons, Regular Absorbency, according to the company, CBS News reported.

Online Tool Helps Patients with Advance Care Planning: The patient-facing PREPARE advance care planning program plus an easy-to-read advance directive significantly increases documentation of advance care planning and patient-reported engagement, according to a study published online Oct. 29 in JAMA Internal Medicine.

Name-Brand Medications Driving Spike in U.S. Drug Spending: "Total prescription drug spending increased 10 percent annually since 2010," and 82 percent of prescriptions were for cheaper, generic drugs, according to the Blue Cross Blue Shield study, NBC News reported. But the study also showed that expensive "branded prescription drugs accounted for only 17 percent of total prescriptions filled, but 79 percent of total prescription drug spending [$79.5 billion]." The biggest costs were from three rheumatoid arthritis drugs -- Humira, Remicade, and Enbrel -- a quick-acting insulin called Novolog, and Neulasta, an immune system-strengthening treatment for cancer patients, NBC News reported.

Take a Break: Scandinavian Christmas-St. Lucia’s Day

December 13 is St. Lucia’s day. This feast honors the saint, who, according to legend brought food and aid to Christians hiding in the catacombs using a candle lit wreath to light her way thereby leaving her hands free to carry as much food as possible. 

A celebration dating back to the middle ages, it’s a time to bring light at the darkest part of the winter. Watch the video below to learn more about this tradition. 

If you would like to try one of the recipes for the special buns served, try King Arthur’s recipe.

May this day bring joy and light as we await the coming winter solstice and Yule!

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

Being Seriously Ill Can Bankrupt You

In the last month I’ve been working with a family that has been brought to their knees by medical bills. One would think that a combination of Medicare and supplemental insurance would take care of most needs, but it’s become crystal clear that even those who have put aside what they believe is plenty of money for retirement can quickly find themselves in a dire straights.

And it’s not just those who are retired. Anyone with a serious condition can find themselves in financial trouble in no time due to lost wages, high out of pocket costs for both health insurance as well as for services not covered by the insurance they may be paying top dollar for.

The number of people and agencies I’ve interacted with lately, where they just don’t understand, is astonishing to me. It’s quite simple unless you qualify for a combination of Medicare and Medicaid, medicine, eye care, dental, medical supplies, personal care etc., can deplete savings and then some. Of course if you qualify for Medicaid you most likely have other sets of issues from housing to mobility.

It’s time we start having frank discussions at all levels about the real costs of being seriously and/or chronically ill and why just looking at income is inadequate to evaluate need.

Instead of my trying to map this out, I’m encouraging people to watch. Being Seriously Ill in the U.S.: Financial and Healthcare Impacts, from the Forum at the Harvard T.H. Chan School of Public Health that took place in November.

Let’s start the solution conversation.

Take a Break: Scandinavian Christmas-Woven hearts

The classic red and white woven heart baskets are very popular throughout Norway, Sweden and Denmark. The origins of the heart is unknown but by 1860, the famous Danish writer, Hans Christian Anderson, was making them.

The easiest thing to do is download a template 

You can make your own patterns, as the basic template is a square with an arch on one side.  Use any type of material-paper, construction paper, card stock, Duct tape, felt etc. However, for starting out, use copy paper since it’s light and easier to weave. The more complex the pattern you wish to weave, the lighter your paper should be. If you wish to do more complex designs, you can forgo the basket feature and do single sheets of paper. Keep in mind the smaller the hearts and the more intricate patterns, the harder it will be to weave.

For different patterns, check out the video below. 

 

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

Life with Chronic Conditions: A Very Helpful Comment

 This past week has been exceedingly challenging for a number of reasons, so when a friend asked if I were able to do one more thing, I came close to loosing it. My friend replied with the following comment, “Remember this is an elective activity. Feel free to say, "Help, I've lost my mind and my body no longer follows my orders.  Could YOU take care of it, Dave?"  I can and will.”  

It’s one of the most reassuring things I’ve heard in a long time.  Not only did it help me calm down and reassure me, I actually was able to complete one more task.

So, the next time you encounter someone who is “over the top,” consider some variation of Dave’s comments. It really helps.