July 17, 2015

Are You Getting “Best Care” From Your Doctor?

This is a question that needs an answer! When a doctor resorts to using engaged and other words to mask communication, this is when you, as the patient, need to find another doctor. Even this doctor, that in general I respect, has to muddy the communication waters by using words other than communication.

The truth is that as patients, we have to learn in the health care atmosphere of today. Thirty to sixty years ago, we often could depend on the doctors to be more careful and spend the time necessary to give us the care we needed. Little by little, the insurance industry has taken time away from the doctors and forced them to become less caring, more time conscious, and often less proficient in treating patients.

Medical care today needs to meet the following criteria:
  1. It should be grounded in the most recent medical knowledge, which is generally reflected in the relevant expert guidelines, as well as in peer-reviewed clinical resources. This doesn’t mean that doctors should follow guidelines blindly, practice “cookbook medicine,” and go on autopilot. It does, however, mean that for you to get better health care, your doctor should be aware of recent recommendations for how a given condition should be evaluated and managed. When doctors decide that your circumstances merit a different approach, they should be prepared to explain their reasoning.

  1. These recommendations should be adapted to your preferences and values when it comes to medical care. In most cases, especially when it comes to people who are middle-aged or older, “one size fits all” medicine is not optimal. That’s because often there are a number of reasonable ways to manage a certain health problem.

  1. An optimal medical recommendation should be made after informing a patient of the options for treatment and involving the patient in the medical decision-making process. The doctor should also tell you about these two approaches, and then you’d decide together which to start with. This is called shared decision-making. Unfortunately most doctors will never consider this and their egos insist that they are all the patients needs.

Many medical recommendations don't even come close to measuring up to these criteria. The reason is that many doctors have not been trained to practice this way. Then you need to remember that the insurance cartel influences how doctors practice. Under the Affordable Care Act, many doctors know that they are the only doctor in the area that your insurance authorizes and they act accordingly and you can be forced to follow their directions and their way as you will pay higher by going out of the network. The drug companies continue to spend a lot of time and money to influence doctors to prescribe their products. Finally, doctors tend to develop habits and do whatever takes less mental and emotional energy.

The fact is that medicine is usually practiced according to the doctor’s preferences, rather than according to what the best evidence and best practices recommend. Now that you know the truth, here are some ideas of what you can and should do (providing your insurance does not limit you in your choices):

#1. If you can, look for doctors who seem open to discussing options with you. A doctor who gets defensive when you ask about guidelines or alternatives is probably not a good choice.

#2. Do your homework when it comes to your health conditions and treatment options. There is really no substitute. Even if your doctor is progressive and used to shared decision-making, you’ll participate better in the process if you’ve done a little preparation beforehand. Prepared patients and families generally get better health care.

To learn more about your health conditions and your options for evaluation and management, go to reputable websites. I find that the Mayo Clinic website is generally quite good. You can also get useful information and support by accessing online communities of people with the same health problem. SmartPatients.com (for cancer) and PatientsLikeMe.com (general medical problems) are two well-established sites. Remember, your goal is not to be a doctor yourself, but to arrive at your doctor's office with good questions and to have a good discussion.

#3. Be prepared to ask about alternatives. When the doctor makes a medical recommendation, be sure to ask what other alternatives are available. You may want to specifically ask about non-drug options for treating a problem. These often exist and are even often now recommended as first-line treatment. But busy doctors may not think to suggest them unless you ask them.

#4. Consider a second opinion. Especially if you’re considering a treatment of significance, such as a major surgery, it can be good to get a second opinion (if your insurance will allow this). Maintaining your own copies of your medical information in a personal health record can facilitate this.

Taking care of your health, or helping your parents with their health, is like investing energy in maintaining or even renovating your home. You don’t have to be super involved in monitoring the people involved in the process and things very well might turn out okay. But then again, they might not. The people working on your home, after all, have less at stake than you do. For them, it’s one of many jobs. For you, it’s your home and your money.

The body is like your home, except you have much more at stake. For better health care, plan to do your homework, prepare to ask questions and remember that the medical care should be based on your preferences, not the doctor’s preferences when appropriate.

July 16, 2015

Being Screened for Prediabetes and Diabetes

One-third of adults with diabetes don't know they have it, according to the National Institutes of Health.

This is scary! The blog at the Mayo Clinic about is taking a pro-active point of view and calling for people meeting the following criteria to be tested for diabetes or prediabetes.

The NIH says that you are at greater risk of developing prediabetes and type 2 diabetes if you:
  • Are age 45 or older
  • Have a family history of diabetes
  • Are overweight
  • Have an inactive lifestyle
  • Are members of a high-risk ethnic population (e.g., African American, Hispanic/Latino American, American Indian and Alaska native, Asian American, Pacific Islander)
  • Have high blood pressure: 140/90 mm/Hg or higher
  • Have HDL cholesterol less than 35 mg/dl or a triglyceride level 250 mg/dl or higher
  • Have had diabetes that developed during pregnancy (gestational diabetes) or have given birth to a baby weighing more than 9 pounds
  • Have polycystic ovary syndrome, a metabolic disorder that affects the female reproductive system
  • Have dark, thickened skin around neck or armpits
  • Have a history of disease of the blood vessels to the heart, brain, or legs

If you're age 45 or older, ask your healthcare provider about testing for diabetes or prediabetes. If you are younger than 45 and overweight, and have another risk factor, you should also ask about testing.

If you have prediabetes you can often prevent or delay diabetes if you lose a modest amount of weight by cutting calories or increasing physical activity. If you're overweight and lose just 5-7 percent of your body weight, you can lower diabetes onset by 58 percent. That is why early detection is so important.

Why doctors will not test more people is a puzzle, but many doctors are trying to keep costs down and therefore do little diabetes testing until forced into it. They seem to care less about the health of their patients until there is an actual problem and then many will dismiss diabetes by saying, “Watch what you eat as your blood sugar is a little high.”

If your doctor says this, then it is time to ask for a copy of the test results and really take a look at the tests. If your blood glucose level is above 125 mg/dl, then chances are good that you have diabetes or prediabetes and should be having a serious talk with your doctor. If the doctor just repeats the above statement, then it is time to look for another doctor – seriously.

A.J and I are having a discussion with an acquaintance of ours that is overweight and the last time he went to the doctor A.J did ask him to obtain a copy of his tests. When he showed us the sheet, A.J told him he was probably a person with diabetes and then A.J asked if I agreed. When I saw the results, I said he is even higher than you (A.J) were when you were diagnosed – 209 mg/dl.

The fellow said it was not fasting and his wife had fixed his favorite breakfast of pancakes before he went to the doctor. I asked how long from breakfast until they drew blood and he answered about three hours. I answered that if he did not have diabetes, his reading would have been at or below 100 mg/dl at two hours. Because his reading was still that high at three hours, he could count on having diabetes. A.J said he agreed with me and asked him which doctor he wanted to see and gave him three names.

The fellow said not at this time and he would need more proof than one test. A.J started to encourage him and I shook my head. When the fellow moved off, A,J asked why I had discouraged him. I said you did not see the recording device he had on record and he will probably replay it several times and then call one of the three doctors you gave him. I said I had watched his body language change drastically when I said if he did not have diabetes, his blood glucose level would be at or below 100 at two hours. He was alarmed and it showed. A.J said he would not push and see what happened. With that we went out separate ways.

July 15, 2015

Questions for Your Doctor

If you were recently diagnosed with type 2 diabetes, ask your doctor these questions at your next visit. In the meantime, I will give you my answers and possible things for you to think about when you ask your doctor.

#1. Does having diabetes mean that I am at higher risk for other medical problems? My answer is yes. Think of heart disease, neuropathy, and the diabetes complications. There are other possibilities and your doctor may be aware of your family history, which could affect the answer.

#2. Should I start seeing other doctors regularly, such as an eye doctor? My answer again is yes. I had several doctors that I saw on a regular basis – some were quarterly and others were 2 times a year. There should be no doubt about this and the doctors you may need to see will depend on your medical history and how well your doctor knows diabetes. I often see the dentist as a doctor to see on a regular basis and especially if you have type 2 diabetes.

3. How often should I test my blood sugar, and what should I do if it is too high or too low? This will depend on the medication you are taking. I test about six times per day as I only eat twice a day and use insulin. The two “experts”, Dr. Ratner of the ADA and Dr. Garber of the AACE don't believe we need to test if on oral medications and that we should rely on the A1c. Even some professional organizations do not believe we should be testing. To this I say BS and I know better to operate completely in the dark to manage diabetes effectively. Read my blog here about testing.

4. Are there any new medications that I could use to help manage my diabetes? I will only use metformin or insulin. Every oral diabetes medication has side effects to be concerned about. Your doctor should discuss the side effects with you. If the doctor does not do this or side steps the question, refuse the new medication.

5. Does diabetes mean I have to stop eating the foods I like best? My answer is – maybe.  There are some foods you will probably eliminate such a potatoes and rice.  By using your blood glucose meter before (preprandial) and after (postprandial) your meal is the best way to discover what to restrict or eliminate from your meal plan.  

6. How can exercise make a difference in my diabetes? It can help make blood glucose easier to manage, is my answer. Do realize that for some people, other medical conditions may prevent most types of exercise.

7. If I'm overweight, how many pounds do I have to lose to make a difference in my health? This will depend on how much you are overweight. I say if you are greater than 10 percent overweight, then the full amount needs to be lost. The “experts” all agree that 5 to 7 percent of the weight will help reduce the problems and help in diabetes management.  The best thing to do is lose the weight.

8. Are my children at increased risk for the disease? This will depend on whether you pass the genetic properties for diabetes, but in general your children will have the opportunity to avoid diabetes if they learn how to eat properly and exercise at a young age.

9. What is the importance of diet in diabetes? Diets are worthless because they fail. It is the food plan that you develop using your blood glucose meter that work. Generally, a low carb food plan may be the best for many.

10. Do I need to take my medications even on days that I feel fine? This will depend on the medication you are taking, how often you are taking it, and what your blood glucose level is at the time you are to take the medication. Generally, unless your blood glucose level is above 150 mg/dl when you are to take your medication, you should not. The best answer is to have this conversation with your doctor.

July 14, 2015

Being Safe in Hot Weather

Many people over 65 forget how to take care of themselves during hot weather. This often happens for the older generation that has diabetes. Face it, folks, our bodies just don't adjust as fast as they used to and we need to remember this when the weather warms up. Then add to this the change in humidity and we can really get heated up – literally.

Hyperthermia (being overheated) is serious and is caused by a failure of the heat-regulating mechanisms of the body. Heat fatigue, heat syncope (sudden dizziness after prolonged exposure to the heat), heat cramps, heat exhaustion and heat stroke are forms of hyperthermia. If heat stroke is suspected, call 911 and get treatment to save a life. Older adults are at risk for these conditions, and this risk can increase with the combination of higher temperature, individual lifestyle and general health.

Lifestyle factors often are in play for the older adults (and young children). Older adults often do not drink enough fluids, live in housing without air conditioning, and lack mobility and access to transportation. I have found some older adults overdressing for the weather and then not responding to the hot weather by taking coats and sweaters off.

Older people, particularly those with chronic medical conditions, like diabetes, should stay indoors in cooler spaces on hot and humid days, especially when an air pollution alert is in effect. People without air conditioners should go to places that do have air conditioning, such as senior centers, shopping malls, movie theaters and libraries. Cooling centers, which may be set up by local public health agencies, religious groups, and social service organizations in many communities, are another option.

Factors that increase the risk of hyperthermia may include:
  1. Dehydration.
  2. High blood pressure or other health conditions that require changes in diet. For example, people on salt-restricted diets may be at increased risk. However, salt pills should not be used without first consulting a doctor.
  3. Heart, lung and kidney diseases, as well as any illness that causes general weakness or fever.
  4. Use of multiple medications. It is important, however, to continue to take prescribed medication and discuss possible problems with a physician.
  5. Reduced sweating, caused by medications such as diuretics, sedatives, tranquilizers and certain heart and blood pressure drugs.
  6. Age-related changes to the skin such as poor blood circulation and inefficient sweat glands.
  7. Being substantially overweight or underweight.
  8. Alcohol use.

Heat stroke is a life-threatening form of hyperthermia. It occurs when the body is overwhelmed by heat and unable to control its temperature. Signs and symptoms of heat stroke include a significant increase in body temperature (generally above 104 degrees Fahrenheit), changes in mental status (like confusion or combativeness), strong rapid pulse, lack of sweating, dry flushed skin, feeling faint, staggering or coma. Seek immediate emergency medical attention for a person with heat stroke symptoms, especially an older adult.

If you suspect that someone is suffering from a heat-related illness:
  1. Get the person out of the heat and into a shady, air-conditioned or other cool place. Urge them to lie down.
  2. If you suspect heat stroke, call 911.
  3. Encourage the individual to shower, bathe or sponge off with cool water if it is safe to do so.
  4. Apply a cold, wet cloth to the wrists, neck, armpits, and/or groin. These are places where blood passes close to the surface of the skin, and the cold cloths can help cool the blood.
  5. If the person can swallow safely, offer fluids such as water, fruit and vegetable juices. Avoid alcohol and caffeine.

As a reminder read this blog if you have diabetes.

July 13, 2015

Protein Favorites

Everyone has a protein favorite and I am no exception. In reading for this blog, I came across several articles that were written by registered dietitians and I had to scrap each article as the suggestions all included whole grains. I admit I like meat, but I will keep this blog away from meat.

A big concern for me has always been; Are these meat-free protein sources complete? The term "complete protein" refers to amino acids, the building blocks of protein. There are 20 different amino acids that can form a protein, and nine that the body can’t produce on its own. These are called essential amino acids—we need to eat them because we can’t make them ourselves. In order to be considered “complete,” a protein must contain all nine of these essential amino acids in roughly equal amounts.

Yes, meat and eggs are complete proteins, but beans and nuts aren’t. Humans don’t need every essential amino acid in every bite of food in every meal they eat; we only need a sufficient amount of each amino acid every day. Most dietitians believe that plant-based diets contain such a wide variety of amino acid profiles that vegans are virtually guaranteed to get all of their amino acids with very little effort.

Some people want complete proteins in all of their meals. No problem—meat’s not the only contender. Eggs and dairy also fit the bill, which is an easy get for the vegetarians, but there are plenty of other ways to get complete proteins on your next meatless day.

#1. Hempseed. This hemp won’t get anyone stoned. Protein is 10 grams in a 2-tablespoon serving. This relative of the popular drug contains significant amounts of all nine essential amino acids, as well as plenty of magnesium, zinc, iron, and calcium. They’re also a rare vegan source of essential fatty acids, like omega-3s, which can help fight depression without the need to get high!

#2. Chia seeds. No longer used to grow fur on boring clay animals, chia seeds are the highest plant source of omega-3 fatty acids, and they contain more fiber than flax seeds or nuts. With just 2 tablespoons of dried chia seeds, you can add up to about 3 grams of protein to any meal.

And they’re packed with fatty acids, namely omega-3 and omega-6—essential fatty acids that we can get only from the foods we eat (the body can’t create them on its own). Some studies show that these beneficial fatty acids may help reduce inflammation and heart disease. Chia is also a powerhouse of iron, calcium, zinc, and antioxidants, but the best thing about these little seeds is that they form a goopy gel when combined with milk or water. This makes them fantastic for making healthy puddings, thickening smoothies, or replacing eggs in vegan baking.

#3. Mycoprotein (Quorn). Originally developed to combat global food shortages, mycoprotein is sold under the name “Quorn” and is made by growing a certain kind of fungus in vats and turning it into meat substitutes that are packed with complete protein. It has 13 grams of protein per ½ cup serving

Mycoprotein is sometimes considered part of the mushroom family, and while there are some allergen concerns, only one in 146,000 people experience adverse reactions. To the rest, it’s pretty darn tasty. Since it’s usually bound together with free-range egg whites, Quorn is not technically vegan-friendly.

#4. Rice and Beans. One of the simplest, cheapest, and vegan-est meals in existence is also one of the best sources of protein around. Most beans are low in methionine and high in lysine, while rice is low in lysine and high in methionine. Put them together, and you have a protein content on par with that of meat. Subbing lentils or chickpeas for beans produces the same effect. These meals are a great way to load up on protein and carbohydrates after an intense workout.

#5. Asparagus. I bet you didn’t expect this delectable green to make the list! But a cup and a half of cooked asparagus has over 6 grams of protein – that’s about the same as a large egg. This versatile veggie also supplies folic acid (an important B vitamin, particularly for women of childbearing age) as well as vitamin C, iron, and more than 2 grams of fiber per cup. Grilled or steamed, asparagus make a wonderful side dish. Just season and drizzle with olive oil. Or for a lunch that will help you meet your daily veggie servings.

#6. Pistachios. You might think that all nuts are the same when it comes to protein, but they’re not. Pistachios have 6 grams of protein per serving, more than most other tree nuts. In addition to protein, pistachios have plenty of fiber, potassium, vitamin B6, iron, antioxidants and other nutrients. Plus, they won’t wreck your diet. Studies show that in-shell pistachios are great for waistline-watchers. Research conducted at Eastern Illinois University and published in the journal Appetite found that people who snacked on in-shell pistachios consumed 41% fewer calories compared to those who ate shelled pistachios. The researchers suggest that the empty shells may be a helpful visual cue to help you be a more “mindful” snacker.

The above foods did not have a carbohydrate listing, and number 4 above could be a problem for those of us with type 2 diabetes. I admit that this is one of my favorites, but I do limit the quantity I consume.