November 30, 2013

Colorectal Cancer Screening Numbers Too Low

Are you over the age of 50 years? Have you had colorectal cancer screening? Do you have a history of colorectal cancer in your family? If you answered yes to two of the three questions, then it is time to talk to your doctor about colorectal cancer screening. If you answered yes to all three questions, what are you waiting for, get-r-done. This is serious and needs attention. “Colorectal cancer is the second leading cause of cancer death in men and women in the United States, after lung cancer, yet is "preventable" through screening,” states CDC Director Tom Frieden, MD, MPH.

Current recommendations call for adults aged 50 years and older to be screened with one or a combination of the three following tests:

#1. A fecal occult blood test (FOBT) or fecal immunochemical test (FIT) every year

#2. Flexible sigmoidoscopy every 5 years, with FOBT/FIT every 3 years;

#3. Or, colonoscopy every 10 years.

The above are minimums for the average person, but many doctors will look to family history, grandparents, parents, and siblings before recommending any of the tests. I do not think much of #1 above as most times a positive for these tests indicates you may already have colorectal cancer and may need a section of your bowel removed.

Many doctors think #2 above is sufficient for most purposes, but again this is only doing a partial examination of the colon. If the polyps are beyond the scope of this exam, then colorectal cancer will still develop.

While many people do not like colonoscopies, this is the best test and will prevent colon cancer from developing. I can attest to the value of this, as my first colonoscopy was preformed, on a lark, at age 55 and I had four polyps, one that the oncologist stated from his experience was within about six months of being cancerous. This made a believer out of me and I have had colonoscopies regularly since then at generally every three years.

But you say #3 above says every 10 years. That is correct until the first polyp(s) is discovered. Then the polyp(s) is checked for cancer or the types of cells leading up to cancer and if this analysis is positive, you are scheduled for an exam every three years. When the polyp(s) is clean or free of cancer promoting cells, then you will be scheduled for an exam in five years. If after the first polyp(s) are discovered and you are polyp free on the next exam, you will also be scheduled for another exam in five years. This is what Medicare and most insurance companies require.

I would much prefer one or two days of discomfort every three years to know that I do not have colon cancer. “In 2012, 65.1% of US adults were up-to-date with colorectal cancer screening and 27.7% had never been screened.”

According the Dr. Frieden, “The 2012 data show that colonoscopy is now the most commonly used screening test (61.7%), the CDC said. Colonoscopy was used by more than 53% of the population in every state. There has been a "big increase" in colonoscopy screening in recent years. However, use of the other recommended tests was much lower: 10.4% for FOBT and 0.7% for flexible sigmoidoscopy in combination with FOBT/FIT.”

If you are scheduled for a colonoscopy, please be sure to discuss all medications with the doctor. There are blood thinners that need to halted several days, up to a week or more, before the procedure, Metformin needs to be stopped as well, and these should not be restarted until a few days after the procedure. There may be other medications that require this as well; therefore, please discuss this with the doctor.

November 29, 2013

Technology Might Reduce Doctor Visits

Technology is wonderful, great, and holds many promises. Getting there will be the challenge and making it all work together still has to be worked out. This blog uses two articles and a previous blog of mine to preview some of the possibilities.

The first article points out what nanotechnology has in store for those of us with diabetes. It has had success in monitoring cancer in livestock and work is now being focused on diabetes. Both will require additional testing to pass FDA approval, but the future looks very promising. Using carbon nanotubes, hollow, one nanometer-thick cylinders made of pure carbon is drawing great interest as sensors.

Michael Strano, the Carbon P. Dubbs Professor of Chemical Engineering at MIT has his labs working on sensors for both short-term and long-term usage within the automatic pancreas. His lead person, Nicole Iverson, is working to make the sensors accurate enough to provide glucose readings that can work with the automatic pancreas, but as of yet the results have not been accurate enough. These sensors would be implanted under the skin and would provide data directly to the insulin pump so that it could start and stop when needed. Not only would there be no more finger pricking, but only the removal and re-implanting of new sensors after more than one year of use.
In mobile health apps and home monitoring, doctors will not need to see patients as often for acute problems and follow up visits. Presently, to make this happen, real-world clinical evidence will be needed to confirm the mobile health benefits. Then the apps will be on solid ground for patients, physicians, and payers. The central idea would mean that this would promote patient participation and partnership in their care.

In addition to reducing the number of unnecessary visits to physicians' offices and emergency departments, this would decrease the cost of care. Today, they noted, more than a third of physician office visits are related to an acute condition, and care for up to a quarter of patients presenting at emergency departments could have been managed in the ambulatory-care setting. Most mHealth devices have existed for all of the most common acute conditions and have the potential to allow individuals to forgo an office or emergency department visit through safe, effective and informed management in the home.

On July 18, 2013, I wrote a blog about people with type 2 diabetes that became microexperts. They would be allowed to self prescribe medications and do home A1C tests and have insurance reimbursement. Since then, I have heard from four doctors, two who were very much against this and two more that could accept this provided that the rules were in place and enforced. Three people with type 2 diabetes thought the idea was reasonable, but two were not enthused about the rule idea.

As far as I am concerned, the rules are necessary to prevent abuse and keep the system working properly. With the potential for new technology, mHealth, and other programs, the future does hold out hope for ways to get by even during a doctor shortage. If the new sensor technologies come to fruition, mobile health technologies continue to improve, the patients will benefit, costs may indeed come down and emergency rooms may not be utilized for problems that can be solved at home.

I would encourage everyone to follow the links and read about the possibilities.

November 28, 2013

A Different Thanksgiving

Yes, we normally give thanks on Thanksgiving Day. However, do we really think about diabetes as something to give thanks for? I have heard many people complain about diabetes. I am also aware of some (probably more than I realize) deny that they have diabetes and go off on those that have diabetes and are willing to talk about diabetes. I even have received a two emails over the last three years, telling me that I should not be blogging about diabetes.

The last sentence includes people that I believe are working hard to keep diabetes a secret. Why, because they are afraid of people stereotyping them because they may be overweight, have just received the diagnosis and are in denial. Or they are the complainers of the world.

We normally go through anger, denial, some depression, and finally acceptance of our diabetes. What we do next can affect our attitude and whether diabetes is something we can be thankful for and learn to take ownership in managing. I know in my own life, I accepted it early, but at about the three-year point, I went into denial for some reason along with a minor depression. I was fortunate that I had just remarried and had someone to get me back on course. I can't say that she handled my denial the best way, but it did make me realize that I could not continue to deny my diabetes. I had started adding back the pounds I had lost. I knew I needed to put a stop to that and the sooner the better.

Over the next few years, I would lose and gain the same number of pounds, but I had stopped adding to my weight. It was not until this summer that I have been able to bring my weight down a few pounds and not add it back and I will keep working on this goal for the next several years.

So even if some people will not agree with me, I am thankful for diabetes. I am eating more carefully than I have in many years and probably better foods for me. My intake of whole grains, especially wheat is about 90% less than in the past. I am aware that I could probably eat many different foods, but since my meter agrees with my choices, I am adapting and working to eliminate more foods. Some have come as a result of other health problems and even though one doctor is telling me to increase my whole grains and another is ordering me to reduce my fat intake, I have not found any medically sound evidence to convince me to comply.

Have a thankful Thanksgiving!

November 27, 2013

Thanksgiving Day is 'Tenth Family Health History Day'

This is an idea that should be adopted by every family. Many families do not wish family history to be passed to their children and refuse to talk about it with others. This is not a good thing for their children and grandchildren. However, this secrecy is often difficult to overcome. If it hadn't been for my father, there would probably be many things about my mother's side of the family that I would not know. Even one of mother's sisters was kind enough to affirm what I was told and added a few additional facts.

The following is part of one page on this site to complete the information. Because I will not complete the information or start this, I am not allowed access to additional pages. I will continue to maintain my record book and not use their site. That is my personal preference.

I don't mind how you keep track of your family history records. The important thing is that you do it for your sake and the assistance you will provide for your children. Many people are too stubborn and leave no information for their offspring or for dedicated caregivers. They don't appreciate the fact that people might be spared needless worry and might have a clue that could save a doctor precious time. In addition, this might give the doctor relevant information that could save your life if acted upon timely.

Having covered this information, I am left with one problem. If you chose not to correct the information that your doctor has on you, you may not get the correct treatment when needed. The doctors often believe the information they have in their computers is correct and up-to-date when in fact most electronic medical records (EMRs) and/or electronic health records (EHRs) are far from correct.

I know from reviewing my electronic health record, there are some serious errors. I recently received access through a patient portal (their term) and in reviewing my record discovered several medication errors and medical history errors. Now I am on a mission to get them corrected. The first comment I received from one doctor's office was that it is correct and they were not changing it.

I am now composing a letter and I will hand deliver it with the corrections spelled out. This will start the clock and then if the records are not corrected, I will be forced to contact the correct officials to force the issue. I will also need to update my medical power of attorney to reflect the possible errors and provide the new copies to those I have designated to act for me if necessary.

November 26, 2013

Holiday Gifts for a Person with Diabetes

Rather than wait until close to the holidays, I think before Thanksgiving is about right. Many of us have a hard time giving gifts to people with diabetes, especially when we do not know what they might need or desire. I did post a blog last December too close to the holidays, so I will repeat much of it and add a few more ideas plus some details.

Yes, the Joslin blog from last year is still appropriate and has some great to poor ideas for people with diabetes. Because the cookbooks the ADA promotes often have high carbohydrate low fat recipes, I would not purchase one for myself. In addition, many of the recipes have difficult to locate ingredients and recipes that some people would not make. While many cookbooks have these recipes, this does not justify ADA cookbooks.

If you are a spouse or family member, you may wish to consider a digital food scale that can provide most of the nutritional information, such as the Kitrics Digital Nutrition Scale found at this link. Or, if you have the funds, this digital food scale by Eatsmart, EatSmart Digital Nutrition Scale - Professional Food and Nutrient Calculator (at the same link). It is more expensive than the first one. The least expensive is this one, Newlineny SAD4181-SL Newline Digital Nutrition Calculator Kitchen Food Diet Scale, Silver at this link. There are other scales of varying prices.

For all of the scales, do your homework and read the reviews. For all three scales, the following is sound advice. If portion control is high on your list of priorities then this is the scale for you. It works well for a typical American diet but if you eat ethnic foods, you are bound to be stumped when entering a code for a food that's not there.

If you know the person likes to read, books are always in demand. Use care and make sure the book is one the person will read. Some off hand questions now may point you to a book they would enjoy. Or if you are bold, print out a list and clearly state the limit you are willing to spend. They may say none of them or be happy to know that the book they want is on the list.

One the less expensive side is items like a pedometer or resistance bands. Just be sure that the gift is something that will be of help and that the recipient likes to exercise.

The links in my blog from last year still work as of the date of this post.

November 25, 2013

How Do You Handle Holiday Stress?

Many people are telling us how to minimize the stress of the holiday season. Some pointers are excellent, some are okay, and others almost seem to create more stress than help reduce stress. I am looking at this as a person with diabetes. What works for some may not work for all of us. Stress makes management of blood glucose levels more difficult.

The following are suggestions that may help:

#1. Manage your expectations: Relax, relax, and do not put on perfection, especially if you are the hostess or host. Stay within yourself and you will succeed. Be careful not to expect too much that can lead to creating stress and disappointment.

#2. Add a good night's sleep to your list: It does not matter whether you are the host or just an invitee; make sure to get enough sleep. Being in a bad mood will not serve you well in any case. Do yourself a favor and get the sleep you need.

#3. Mind your sleep schedule over the holidays: Just because it is the holidays, you would be better served maintaining a sensible schedule with regular sleep. Getting the sleep you need will make diabetes management easier. Even my wife found out that I do better and am more at ease with more sleep.

#4. Avoid "crashing": How true this is. You do not need the bloating and spikes in blood glucose during the holidays. When you let this happen, you will most often regret this in the days following. Eating what you need is one thing, but avoid the carb dense foods and maintain a healthy food plan. Select low carb fruits and vegetables that will last until the next meal. A good food plan will include a protein source that contains the fat you need. You will feel better in the days following by sticking to your meal plan.

#5. Know your limits: Stay away from relatives that insist on airing all the dirty laundry at the dinner table. When my great uncle was alive, I never liked family gatherings as I knew what the topic of conversation would be. Twice I refused to go with my parents to family gatherings and finally my mother asked why. I told her I did not like my great uncle and the way he constantly was running someone in the family down. I said it ruined the day for me and I preferred to be happy at home. Surprise, we all stayed home and had a great day. Even today, I generally will avoid gatherings where someone is constantly trying to ruin the day for others.

#6. Make time for you: Yes, make time for yourself and put yourself first for a short time. The holidays seem to make people put others ahead of themselves and this can be harmful if one does this to an extreme. Always set time aside for yourself and allow time to unwind and relax before bedtime. Go for a brisk walk or have a good soak in the tub before bedtime to let the stress of the day melt away.

#7. Still tossing and turning all night?: This is not what you should do. If this is what you are doing, get up and go to another room where you can occupy yourself with something that relaxes you until you are sleepy. You do need to avoid creating the wrong type of atmosphere in the room where sleep is needed.

#8. Start The Day With Exercise: This is the best way to set the right tone for the day when you know you are going to be surrounded by food all day. Any type of exercise will work, but be sure to make it long enough to help burn a few hundred calories. Not only will exercise do this, but for many, it can help suppress your appetite. Next, eating all day will cause less desire to exercise. Finally, the morning exercise will put you in a frame of mind to help you resist the high calorie food in the food available to you for the day. This should put you ahead for the day and by repeating this morning routine, should help immensely during the holidays.

Happy Holidays!

November 24, 2013

Patients 'Overwhelmed' By Diabetes Management

Move over American Association of Diabetes Educators (AADE), pharmacies may soon be taking over your jobs. At least one retail pharmacy chain is stepping up to fill the need and others will likely follow. Meijer, which is located in Illinois, Indiana, Kentucky, Michigan, and Ohio is partnering with the American Diabetes Association to get the program up and help patients with all types of diabetes.

The need is arising because patients are feeling overwhelmed by diabetes management shortly after diagnosis and are generally unable to get help from their doctors for education to say nothing about certified diabetes educators (CDEs) that are not available to assist them. In the five state survey the mass merchandise retailer conducted, it found that nearly 90% of respondents could not fully identify the complications that can result from poor management of diabetes, like cardiovascular disease and blindness.

Meijer drug store VP Nat Love said. "Nearly 40% of those surveyed told us that, in addition to regular doctor visits, they are more willing to talk with pharmacists and find that walk-in clinical services are convenient for getting extra support in developing their personal care plans for diabetes." This has to mean that like so many patients, they do not like the mandates that CDEs use instead of actual counseling.

The challenges of managing diabetes or being at risk for the disease can sometimes seem overwhelming. There are many places consumers can turn to get answers to their questions, like your local pharmacist. I have found this to be true and my local pharmacist answers many questions in a non-judgmental way, which I truly appreciate. I do not get mandates, but a truly concerned and honest answer to my questions. Granted, there are some days when she asks me to write down my question and she will get back to me another day or email for further discussion. And, my pharmacists are not part of the above chain.

The chain is highlighting its services for diabetes patients, like specially trained diabetes pharmacists, free metformin for patients with prescriptions, assistance with Medicare Part B changes, glucose and health screenings and dietitians who can offer advice on diabetes-friendly foods and recipes.