Friday, March 6, 2009
Health Care Reform: Health of All Americans Should Improve
Some of us in the health care profession have some of the answers already: don’t get sick.
It is cheaper for everyone in our society for all of us to stay healthy and well than to be sick. Obviously. Of course, we will get sick or need to see a medical professional, occasionally. A slip of the knife while slicing the apple, a fall from the stool or strep throat are just part of life, no matter how careful or healthy we are.
But there are services that should be included in health care reform that is not part of our health care system now: wellness related services.
We want the health of all American to improve – regardless of their current health status or their current insured status. We currently serve the sick population. We don’t help people in the early stages of disease to keep them from getting sicker. We don’t catch them in the pre-sick stages and help them reverse it. That just isn’t what our system is set up to do.
Registered dietitians, true nutrition experts, can help with this. If only physicians would refer and health care plans would cover the cost. Nutrition plays a role in improving so many disease states, but also preventing many as well. Proper nutrition can improve the health of everyone: children and adults, young and old.
Nutrition services from a registered dietitian and other wellness related needs to be part of the new health care policy in the United States – part of every insurance plan, available for every American.
Friday, February 27, 2009
Heart Health Part V: Manage Stress
Stress management. It seems like a silly thing to some people and downright impossible tp others. Unfortunately the people who are most likely to stress out about things are probably the ones who are at higher risk for heart disease.
People who are “type A” personality, the ones who stress easier than others, are more likely to have the heart disease as a result. I’ve noted before, it isn’t the stressor that causes the stress, but the individual response to the stress that causes it.
There is some research indicating there is a relationship between heart disease risk and the amount of (perceived) stress in ones’ life.
Health behaviors can contribute to stress. Smoking, inactivity, and/or high fat diet can contribute more to the stress. However exercise and a healthy diet can help the body physically deal with stress as well as help us relieve some stress (a walk around the block perhaps).
High stress can lead to high blood pressure. Chronic stress can lead to chronically elevated blood pressure, a risk factor for heart disease.
Find some coping strategies to help when you are stressed. Find a hobby and work on it for an hour or two. Plan to take a day off – tomorrow or in a few weeks. Don’t tell anyone and relax and read a book or see a funny movie or be alone in a bath. Go for a very long, relaxing walk. Even if you can’t take a day off, take an hour or two to read, watch a movie and be distracted from your thoughts for a while.
Develop some coping strategies to deal with intermittent stress that you can’t walk away from such as counting to ten or a mantra such as “a year from now, will this matter?” Sometimes it will, but a lot of times it won’t.
It takes practice, and moving from a high stress person, to lower or even moderate stress person doesn’t happen overnight or even in a couple of weeks-months. It takes time and patience. But keep working on it. I often tell people who say they don’t have time to do these stress management techniques: you will have plenty of time when you are in the ICU following your by-pass surgery. Take time today to relieve your stress.
Sunday, February 22, 2009
Heart Health Part IV: Quit Smoking
Cigarette Smoking is the leading cause of preventable death in the United States and a significant independent risk factor for heart disease. Aside from the obvious cancer risk, cigarette smoking also contributes to heart disease, including increasing the risk of developing plaques in the arteries.
Even if you are not overweight and eat healthy, you are at significant risk for heart disease if you smoke.
If you are able to exercise, yet still smoke, you are still at significant risk for heart disease.
Smoking increases blood pressure and increased the risk of a blood clot.
Smoking decreases HDL-cholesterol (the one you want to be HIGH).
If YOU don’t smoke, but live with someone who does: premature deaths from heart disease are still significant even when it comes from other people’s smoke.
Need assistance in quitting? Ask you primary care provided about prescriptions for quitting, or contact 1-800-QUIT-NOW for more assistance on how to quit. Your life or the life of your family may depend on it.
Thursday, February 12, 2009
Heart Health Part III: Leisure time Physical Activity
Physical inactivity is a risk factor for heart disease. If you are not a smoker and eat healthy, but don’t engage in regular physical activity, you are putting yourself at risk. If you choose the parking lot or parking space closest to your office or the entrance to the store, the thought of going for a walk is misery, or riding a bike is a childhood memory, your are putting yourself at risk.
I’ve mentioned it before, and it will likely be mentioned again, your leisure time physical activity:
- needs to be consistent. It should not last for a few days or a few weeks and then be forgotten until next New Years or health scare.
- needs to be moderate-vigorous. It should not be a stroll around the mall or sauntering around the park while your dog is running around sniffing everything. The more vigorous, the better.
Now, this is not saying to go from couch potato to hot potato, but work on becoming a moderate to vigorous exerciser. It does take time, several weeks to several months, to work up to the vigorous activity. If you start out vigorous, you will very likely end up back on the couch and vow to never return to activity again.
Even if you never get to “vigorous” but remain at “moderate” just go at it regularly and forever. Vow to be that person at the assisted living facility who is the first person to sign up for the guided walks and other activities and beat out the other folks on the 1-mile walk, because if you are one of the Americans who starts engaging if leisure time physical activity you can prevent or control your personal risk of high blood cholesterol, diabetes and most likely will lose weight and prevent or reduce your risk of becoming obese.
Don’t want to run or ride a bike? No one said you needed to. Just get outside and walk. Walk for 15 minutes at least 4 days a week. Do this for 2 weeks; the following week work towards 20 minutes on each of those 4 days. As you feel comfortable with it, keep moving up by 5-10 minutes each week or two until you have reached a minimum of 30 minutes, 5 days a week and ideally 60 minutes, 5 days a week. This is consistent with the 2008 Physical Activity Guidelines for Americans that I blogged about back in November 2008.
This is so good for your heart, good for your weight, good for your blood pressure, good for your cholesterol, good for your blood sugar control, good for your bones, good for your joints, good for your stress levels, and great family time or alone time depending on which you choose.
If it is cold, bundle up. If it is hot, go early in the morning or in the evening and wear a hat. Either way, take water if you are going out more than 30 minutes.
NO EXCUSES! Heart disease has painful consequences if you wait too long, so get moving now.
Thursday, February 5, 2009
Heart Health Part II: Are You Obese?
A major independent risk factor for heart disease is obesity. Simply put, obesity is defined as too much body fat, which unfortunately about a third of the country is classified as obese and another third of the country is overweight – making fully two-thirds of the nation with a risk factor for heart disease that they can do something about. And NO most of these people are not big boned or very muscular.
Previously I mentioned that you should know your numbers – blood pressure, cholesterol, and blood glucose – and take some steps to improve those numbers. Being overweight or obese can increase blood pressure, increase total cholesterol, LDL cholesterol, and triglycerides, lower HDL cholesterol, and increase blood glucose. So the first step to improve those numbers: Lose Weight…
Even if these numbers are in “normal” ranges, obesity is still a risk factor for heart disease. The heart has to work harder every minute of every day to circulate the blood to the entire body.
How do you know if you are in the obese or overweight category? Generally speaking people who are in this category can do one of two things: calculate their BMI (aka Body Mass Index) or measure their waist circumference.
BMI measures and calculated a number based on your weight to your height and does not distinguish between men and women or lean body mass (bones, muscle, and water weight for example) and fat mass. It is your weight in kg divided by height in meters squared (kg/m2). There are many places on the web that can calculate it for you and tell you what it means. My favorite is the National Heart Lung and Blood Institute, but you can “google” BMI to find one. A BMI value between 25.0 and 29.9 is overweight, and a BMI value of 30.0 or greater is considered obese.
Waist circumference is another way to measure your risk. Measure at your belly button, just so you know for next time where to measure again. Do not measure where you wear your pants, especially if you are a man, since many people wear their pants way below their fat/waist! IF you measure greater than 35 inches as a woman or greater than 40 inches as a man – you have a fat problem and need to do some work…Oh and if you want to suck it in when you measure, go ahead, but you are only sucking in air, not fat.
Do you need to lose weight? First thing, know you can reduce your risk by losing just 7-10% of your current body weight initially. That may not seem to daunting!
How do you lose the weight? Step 1: Don't do a silly crash diet. Step 2: Cut down on calories – don’t worry about cutting carbs, bread, white foods, blah, blah, blah…You HAVE to cut down on calories, so cut those portions down!
Step 3: Next post…will tell you another big key to help you with your weight/fat loss goal.
Thursday, January 29, 2009
Heart Health Part I: Know Your Numbers
Since 1963 congress has required the president to proclaim February as “American Heart Month.”
On both this and my other blog NewMexicoRD.blogspot.com, I will be dedicating the rest of January and all of February to heart disease issues.
From the Wellness perspective, there are modifiable risk factors for heart disease and non-modifiable risk factors. The non-modifiable risk factors, genetic, gender, and age you are just stuck with and as much as you may want to deny them, change them, and/or lie about them you can’t. So let’s discuss the ones you can change or modify.
The first one is your blood. Not your blood type, but the things about you and your risk for heart disease your blood can tell us.
Here is the first thing you need to do to lower you risk for heart disease: Know your numbers – and do something about those numbers.
- Blood pressure – two numbers – the systolic and diastolic – current recommendations say that you want it to be less than 120/80 mm Hg.
- Cholesterol numbers (aka lipid panel) taken after a 12 hour fast and you want ALL four numbers – and don’t accept any less than the four! You want to know the values of your:
a. Total cholesterol – currently less than 200 mg/dl is desirable
b. LDL (low density lipoprotein) – currently less than 100 mg/dl is optimal
c. HDL (high density lipoprotein) – less than 40 mg/dl is not good, greater than 60 mg/dl is protective
d. Triglycerides – less than 150 mg/dl is normal - Fasting blood glucose (FBG) taken after a 12 hour fast and you get – one number which should be anywhere between 70 – 100 mg/dl.
Each of these numbers being high, except HDL, is a risk factor for heart disease. A low HDL is a risk. The more numbers that are high, the more you are at risk. High blood glucose is also a risk for diabetes.
When you go to your health care provider for a check up, you should always have your blood pressure checked. When they do that, ask them to tell you or write down the numbers for you!
During your check-up each year or two you should be getting blood work done and it should include the lipid panel/profile and the glucose. About a week to ten days after the test is done, you should get a call from your provider with the results. Ask for the numbers, the results. Or better yet, ask them to mail or fax you a copy of the results or offer to go by and pick them up. These are your results and your records, so there is no reason why you shouldn't have a copy. This way you don’t have to worry about writing the numbers down wrong.
Keep track of these numbers and see how they are changing each year or two. You don’t want them to get worse/higher. You want them to get better (or stay the same if they are already good).
What to do to improve those numbers? Just keep checking in all through February…
Thursday, January 22, 2009
What Is Skinny?
Of course this was a fantastic event and not to undermine the day, but the media does like to take a good-great thing and just wring the heck out of it…
One of my co-workers mentioned that one news commentator brought up, again, that President Obama was “too skinny.”
A terrible, and insulting word in my opinion, however, luckily for the President, he is NOT considered “skinny.”
If the reports are to be believed, he is a 6’2” and approximately 190 pounds. With only that to go on, that gives him a body mass index (BMI) of 24.4, placing him in the “normal” weight category.
If our dear president gains a mere five pounds and becomes 195, giving him with a BMI of 25.0 and in the overweight category America! One does not go from skinny to overweight with a five-pound weight gain.
What is wrong with someone that states a man of 6’2” and 190 pounds is “skinny.”
He may be “lean” – with a low body fat percentage for sure, emphasizing one reason that BMI is not the best way to measure a persons “health” or “weight.” However it still indicates that he is in a healthy weight range for now – and should not be concerned about gaining weight.
He does need to keep in mind his smoking habit…and how it affects his health
Sunday, January 18, 2009
Stress Part: IV Alcohol and Stress
That is the big one – if consumed in moderation!
Moderation defined: one drink per day for women and two drinks per day for men, and NO carry over from one day to the next.
But what is the ONE drink – that is the key!
- 12 fluid ounces of beer (not 16 or 20 or 24 ounces)
- 5 fluid ounces of wine, any color (not 8 fluid ounces, or half a bottle)
- 1½ ounces spirits (one shot)
While this amount of alcohol can provide health benefits, it can also help relax and relieve some stress in some people as well.
However, it can increase stress among some individuals and to those that surround us when consumed in excess.
Excessive alcohol consumption can increase stress from the social consequences of bad or embarrassing behavior. But there are also the potential health consequences that accompany over-consumption of alcohol, best defined as chronically consuming MORE THAN moderate amounts of alcohol for several weeks, months, or years.
- Increase risk of stroke
- Increase risk of high blood pressure
- Increase risk of cancers of the pancreas, mouth, pharynx, larynx, esophagus and liver
- Increase risk of breast cancer
- Increase risk of heart damage
Of course if you are pregnant, there is no know safe amount. It is suggested/recommended that you not consume alcohol during your pregnancy.
If you have a family history of alcoholism, it is also suggested that you use caution when consuming alcohol and know your risk regarding your family history and alcoholism.
Bottom line: Alcohol can relieve stress in small-moderate amounts, but it can increase stress in greater amounts.
Be Well - and have only that one (or two) drink(s)...
Thursday, January 8, 2009
Stress Part III: Time, Time, Time...
The funny thing is that already nine years into the 21st century and we have more things today that help us save time than our parents did when they were our age.
I the 1970s and 80s we had two phones in the house (and had no idea who was calling). No phone went with us to the store. My mother hand wrote letters, birthday cards, and invitations and my brother and I had to write thank you cards. They generally took a week to get there. We took turns having to open the garage door for the one family car. We didn’t go out to dinner more than once every month or two. And most startling of all: we had one television and NO cable and NO computer. How on earth did we survive without cell phones, email, garage door openers, programs to balance our checkbook and pay our bills?
Now if my mother had time to do all those things, feed us dinner, correspond regularly with family by hand and snail mail, and be present at my school on a unnerving regular basis, and work, then how come she had time to do it all and without the "time savers" we seem to have today.
Unfortunately the “time savers” have increased the stress in our lives, in addition to all those things we “have” to do.
I often tell people, as long as “American Idol” or “Dancing With the Stars” is the number one show on television, trust me, you definitely have time to ______ .
I have suggestions for people to help lower stress levels. First you have to step back a bit and really determine what is important to YOU. For example, I do really like TV, but have decided that I am "allowed" one 60-minute TV show a night in addition to the 60 minutes of local and national news. For example, I used to be a fan of CSI: NY, but when Pushing Daisies came along on the same night I had to choose. Now ABC is moving Life on Mars to Wednesdays, but it looks like Pushing Daisies may be gone. I have to choose a show on Wednesday and I don’t get two hours.
I have other priorities, including maintaining a healthy happy home. It is tough, but I have found by limiting things like television shows that do not enrich my life, have cut down on me being stressed on other things because I have TIME for other things.
Another thing I do around maintaining my home: instead of tackling the cleaning on a Saturday or Sunday in a massive 2-3 hour block, I have split it up into 30 minute bits Monday through Thursday. Usually it comes down to two chores each night that are scheduled for 15 minutes each – such as cleaning the bathroom and dust bedroom. Generally they don’t take 15 minutes anymore, but I can usually to it during the TV show I’m watching (the dusting) or during the commercials (the bathroom). Come the weekend the only thing left is the laundry and that’s a family chore. Since it is the family’s laundry, all three of us are there when it comes out of the dryer to sort, fold and put away.
Major points on time management to ease stress:
- Prioritize and eliminate the unnecessary – how much reali-tv to you need?
- Spread it out – it is less tiring to do 20 – 30 minutes of cleaning than 2 – 3 hours!
- Make sure the whole family helps – especially when it is their stuff.
Think about it - even if you don't act on all of it.
Maybe stop watching that TV show you really aren't interested in anymore?
Or clean dust the living room while you do watch it?
It will be one less thing you have to do later!