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Fixin' Healthcare

Thursday, November 30, 2006

The Lifestyle Chronicles - Go YMCA Go

The YMCA has not received nearly enough attention for their Activate America project. They are promoting healthy communities by bringing together various partners at the local level. The project deserves all the help and support each community can give. Read about the project here and here.

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Wednesday, November 29, 2006

The Lifestyle Chronicles - Health Of The Public (Public Health)

The cholera epidemic of 1854 in London created an interface between Public Health and Urban Planning leading to decreased health risk and improved health status that permitted the subsequent development of large cities. That was just the beginning for Public Health, which has been the dominant factor contributing to longer life and improved health status over the past 150 years.

Arguably the improvement of health status has slowed during the past 25 years and health care has become a conspicuous example of diminishing returns for resources expended. The situation has elevated health care reform to the top of the public agenda.

The expanding gap between public health and clinical medicine should be a consideration during the debate on health care reform. It would be useful if several academic institutions considered merger of their schools of medicine and public health. My guess is that it would open a new arena and create an era of increased productivity for health care.

NYC has just announced an effort to increase access to healthy food in low-income communities. Think about it.

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Tuesday, November 28, 2006

The Lifestyle Chronicles - High Tech Machine

The Short Physical Performance Battery (SPPB) is used to assess physical capability of senior citizens. People with lower scores are more likely to die earlier, have health problems, be institutionalized and have limited mobility. Even a small difference of a half point on the SPPB scale of 0 to 12 represents greater or less ability of an elderly person being able to perform the tasks of daily living , such as walking across the room, bathing and dressing. A score of 0 to 4 is a strong risk factor for disability and death.

A study reported at the Gerontological Society of America meeting in Dallas and appearing in the November issue of the Journal of Gerontology: Medical Sciences demonstrates that structured physical activity improves SPPB scores for people ages 70 to 89 years who had been previously sedentary.. The physical activity consisted of walking at a moderate intensity for at least 150 minutes weekly, leg stretches, balance exercises and leg strengthening exercises. A control group was given instructions on good nutrition, proper use of medications, foot care and preventive services. The physical function of both groups was tested before the intervention and twice during the one year intervention.

The structured physical activity was shown to be safe for elderly people at high risk of becoming disabled. Participants in the structured physical activity group increased their SPPB score from a baseline average of 7.5 to 8.5 , whereas many participants in the control group experienced a decline in their score. And, the structured physical activity group outperformed the control group in the ability to walk 400 meters.

The human body is high tech biology. This study demonstrates the need to rethink health and health care in a manner to utilize the remarkable capabilities of the human body. These capabilities have been underestimated and misunderstood.

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Monday, November 27, 2006

The Lifestyle Chronicles - Learning To Serve Others

Representative Charles Rangel's call to reinstitute the draft has stirred some strong emotions and serious opposition. There are so many cross currents around this issue and the war in Iraq ranks near the top of the list.

However, what if the draft was to be defined broadly as two years of public service in an approved organization at the federal or state level and applied equally to everyone with very limited exceptions? Would that be so bad? Might it change the American culture and improve health status in America?

Maybe not, but it couldn't hurt. Might even inspire a few people and contribute to a national idenity. Oh, well, I'm showing my age, but it was a positive experience for me.

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Monday, November 20, 2006

The Lifestyle Chronicles - Musings Of An Old Fart

The viewpoints recently expressed about Grand Rounds are a sign of growing pains. Traditionally, grand rounds in the academic setting has been case and/or topic oriented and limited within the boundaries of a department. The medical blogger Grand Rounds is much more diverse and with time will exhibit enormous growth.

It has been obvious for some time the large commitment undertaken by a host. That the host has the discretion to edit and present Grand Rounds to their chosing should be understood. Already, there are groups that have established related carnivals and perhaps this should be encouraged, as well as coordinated to create a network. The early stages will be touch and go; two steps forward and one or two back. Somewhere along the way a new direction will take place. Meanwhile, anyone who commits to the task of host should exercise their prerogative to mold Grand Rounds as they see fit.

Back for a moment to my exchange with Topher about the last Grand Rounds. His email took me back to the days when I was a medical student and my perspective of health care was focused entirely upon sick and injured people. This past summer I was hiking a portion of the Applachian Trail near Erwin, TN and met a young man who is a medical student in Charleston. When I inquired about his experience so far, he responded in a fashion that indicated the perspective is largely unchanged from my early days long ago at another institution.

I am "retired" and, therefore, somewhat free to practice medicine in a manner that my experience has taught me. All of my activities are office and community based. The patient load runs from 25 to 40 people daily with the majority referred by other physicians. The usual presentation is an unhealthy lifestyle, overweight or obese, and suffering with type-2 diabetes, systemic hypertension, degenerative arthritis, dyslipidemia, heart disease, acid reflux, irritable bowel syndrome, polycystic ovary syndrome, endometriosis, chronic fatigue, fibromyalgia and/or depression. Everyone has a label. Almost everyone is on at least one medications and most are taking three or more.

With patience, persistence and encouragement these people can be taught a more healthy lifestyle. Ninety percent of them show improvement in their medical condition(s), decrease or eliminate the need for medications and they feel better. One-third of the population end up taking no medications.

Keep in mind that the improvement in the disease did not come about due to the medical therapy for the disease. It is a result of healthy nutrition, increased physical activity, sleeping well and managing stress. This is personally directed health care and it is hard work for these people. I warn them the solution is simple but it is not easy. And, the problem needs continued attention or it will relapse.

Many, if not most, of these people could have avoided their medical problems if they pursued more healthy lifestyles. Everyone needs to be reminded that the goal of life and health care is good health. Sick care is for those times that fall short of the goal and there is always a need for sick care but it is not the goal.

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Saturday, November 18, 2006

The Lifestyle Chronicles - Host Prerogative Understood

Absolutely you can publish it.

On 11/18/06,
Marcus wrote:

Topher, Please forgive me for not responding sooner to your thoughtful email about my submission to Grand Rounds. You exercised your prerogative as host and editor, and whatever disappointment I might have felt was overcome by the excellent Grand Rounds you produced.

After more than 40 years in clinical medicine, I started my blog because there is a need to constantly remind health care practitioners and patients that roughly half of health problems can be prevented. It may not be a message that everyone wants to hear. But, it is a necessary starting point for health care reform, which otherwise has become a series of financial gymnastics bringing misery both to practitioners and patients.

I bring this message to Grand Rounds because I am a practicing physician. It is my belief that health care practitioners have a responsibility for achieving and maintaining optimum health of individuals and the community. That responsibility extends far beyond responding to sickness after it occurs.

I wish you every good fortune with your future in medicine and look forward to reading about your progress.

Unless you object, I would like to post this email on my blog.

Best regards,Marcus----

RWT wrote:

Thanks Marcus for your submission. I have decided to not include your post in this week's Grand Rounds. While I applaud your mission statement, I feel that the issue of prevention as the next hurdle for the medical world has been adequately covered elsewhere. For Grand Rounds I'm looking for original literary pieces about the life of medicine, patient encounters and experiences, and educational pieces aimed at those already within medicine.

Sorry to disappoint, topher.

On 11/12/06,

Blog title: Fixin' Healthcare
Blog URL: http://fixinghealth.blogspot.com/
Post title: The Lifestyle Chronicles - Acute To Chronic, Symptoms And Causes
Post URL:

My blog is about lifestyles, health promotion and disease prevention. This post proposes that the science of prevention has outpaced the practice of prevention. And, the most significant aspect of prevention is healthy lifestyle.

Thank you for your consideration.


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Sunday, November 12, 2006

The Lifestyle Chronicles - Don't Worry, Be Happy

A group at Carnegie Mellon University and the University of Pittsburgh has provided further evidence that a positive emotional style is good for health. In this study positive emotions such as happy, pleased and relaxed protected against upper respiratory symptoms resulting from infection with rhinoviruses.

Sort of makes sense that happy people might have less in the way of symptoms or would not complain if they did. However, this study demonstrated there were indeed less symptoms of a cold, and things that make sense still need to be proven.

Dispositional optimists are people who naturally believe more good things than bad will happen to them. When success appears to be highly likely, then energy and time will be devoted to pursuit of the goal.

In her book "Breaking Murphy's Law", psychology professor Suzanne Segerstrom discusses how exercising personal strengths, making progress towards goals and achieving success bring immense pleasure. She outlines a positive feedback loop to develop optimism.
  • Break free from the inertia of self-doubt
  • Pay attention to unexpected positives
  • Plan well and work hard
  • Resist the temptation to give up
  • Celebrate small achievements

Then, there is the story of two boys wishing for a pony on their birthday. When each was confronted with a room full of horse manure, one began crying and the other dove in looking for the pony.

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Saturday, November 11, 2006

The Lifestyle Chronicles - Inspiration Trumps Legislation For Health

Members of Congress are expected to approve laws and create public policy that will improve the health of the nation. This complex responsibility often boils down to consideration of mechanisms that provide accessibility to medical care at an affordable cost. However, I wonder if members of Congress ever consider how they might contribute in a more direct fashion to the health of the nation.

For example, the political campaign season is a grind on everyone from the candidates to the public. The media consultants run roughshod and there is not much to lift the mood or the spirits of the nation.

[My opponent filed a late income tax return (once in the distant past), (might be) suspected of embezzelment, (once might have) spoke(n) poorly of women, was observed in a nightclub, (could be) in favor of taxes and (might be) weak on defense.

I am Want R. Vote and I approve of this message.]

And these are the guys who are supposed to understand the nature of health enough to vote for programs that will improve the health status of the nation. No wonder their deliberations are occupied by the mechanisms and means to provide sick care.

There is an abundance of evidence indicating a relationship between positive mental health and physical well-being. Research by Dr. Paule Miquelon at McGill University suggests that people who pursue goals because of personal choice experience less stress and display greater improvement in physical health over time than those who pursue goals due to external pressure or a sense of guilt. Inspiration beats legislation to achieve and maintain optimum health status.

Is there any group other than Congress that has a greater impact upon the mood and spirit of the nation. Perhaps members of Congress could demonstrate how they pursue a healthy lifestyle and take every opportunity to promote healthy lifestyles in their sphere of influence.

Yes, by all means, provide for the care of those who are sick but take steps to reduce the incidence of sickness.

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Tuesday, November 07, 2006

The Lifestyle Chronicles - More Is Unknown Than Is Known

The only thing you can know for certain is that new information will always be discovered, which leads to new insights and changes in the slope and/or direction of progress. Do not to be discouraged, this is one aspect of the human condition offering promise for the future.

Some assumptions and conventional wisdom about marathon running have been contradicted by more careful analysis of the facts. Analysis of the best weather conditions and the role of hydration and elecrolyte balance did not support previous thinking. This changed the treatment for muscle cramps and postmarathon collapse.

New information and improved insights have altered the role of hydration, which will prevent some deaths during and after marathons. Coaches understood the role of lactic acid in muscle metabolism and physical conditioning before the medical scientists.

So, what is the message? Be humble and keep an open mind. Science is a method. The facts will change and insights are based upon the facts. The challenge is to keep up with the pace (pun intended).

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Sunday, November 05, 2006

The Lifestyle Chronicles - Acute To Chronic, Symptoms And Causes

Medical care during the last half of the 20th Century witnessed a surge in the incidence of chronic diseases. Many of these problems have been around for a long time and studied extensively. For example, Alzheimer's disease was described 100 years ago.

The common thread throughout this history has been advancement of knowledge about the nature of the diseases and improvement in therapy for relief of the manifestations of the diseases, but no cures. However, each turn of the screw comes closer to understanding how these diseases get started and develop (pathogenesis).

Whether it is longevity, inactivity, food supply, trace toxins, stress, something else or all of the above, it cannot be ignored that something(s) happened during the 20th Century that is impacting health in a different way.

As these things become more evident, there will be a change in the mind-set about health care and where the emphasis should be placed. The current health care system came about under the influence of a different set of conditions.

The science of prevention is growing steadily. The practice lags behind. One reason is that it does not fit the system already in place. The search for cures will reveal that prevention is achievable at far less cost over the long run and a better quality of life.

At least, that is my dream and I am sticking to it because the alternative is too terrible to comtemplate.

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Saturday, November 04, 2006

The Lifestyle Chronicles - The Holiday Spirit(uality)

The average person gains one to two pounds in weight from Thanksgiving through Christmas. Those who are not overweight and continue to exercise gain the least and overweight people who are sedentary gain the most. Eating more calorie rich food is commonly blamed for the weight gain and there are tips about how to prepare Holiday food to decrease this risk.

The Holidays are a time for travel and gathering with family and friends. People are removed from their usual routine and placed in situations where food is the rallying point. Most likely the increased consumption of calories, sugar and fat comes from frequent grazing more than overeating at meals. Even those who exercise regularly are knocked out of their routine in order to be social. And, let us not forget about the stress generated in these situations.

Keep in mind that almost everyone is concerned about this seasonal weight gain. Pay attention to the snacking and the grazing. How about hummus on celery, on hard boiled egg-whites or on pita bread instead of dry roasted peanuts, cheese on crackers or candy? Cottage cheese with grape tomatoes might appeal to some. Keep a pot of soup on the stove for snacks.

The Holidays can be the best time of the year for the buddy system. People find that walking and talking is an enjoyable way to visit. What better things to talk about than sights in the neighborhood or the town. Not only is this good exercise but it gets people out of the house, away from food and relieves stress.

Love of family and friends, and the spiritual meaning of the Holidays are a central aspect of healthy lifestyle. The rest is small stuff.

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Wednesday, November 01, 2006

The Lifestyle Chronicles - Hello Cortisol, My Old Friend

Life experiences influence hormone levels. For example, getting up on the "good" side of the bed is associated with an elevation of cortisol.

To be elderly and lonely is not good for cortisol levels, but difficult to avoid in all cases. The preferred treatment is a few minutes of time to call or visit, a kind word and a smile. Everyone is so busy these days.

Reminds me that I need to call my mother.

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