Optimizing Risk Factors of Aging, Make Easy Changes for 2019

A transformation starts with you.   Optimizing risk factors of aging and enjoying life along the way.

Where to start? Well, we always say at the beginning. This is usually the best place to start. In this case since the beginning for us is in the past, let’s start where we are, this is as good a place as any. While setting a goal to start a new goal can lead to procrastination, pick just a few things and start making changes now.  Right this minute.  You know yourself better than anyone, look at the list below. Set your intentions now.  This means really pick one or two things or maybe all things that you INTEND TO DO.  My advice is start small.  What is important is your mindset. You are the vision in your mind’s eye, you are already the person making positive changes.   When you look at the list, imagine yourself already doing it. Push the images out of your mind of past experiences. These memories especially the negative ones are no longer important. Example, your vision of drinking 100oz.of water and reaching your goal is what you see.  See yourself at the end of the day with a big smile on your face and sense of accomplishment with an empty glass.

 

1.     Exercising or moving (see below)

2.     Drinking more water ½ your weight in ounces

3.     Thinking positive thoughts

4.     Being kind to others, cultivate relationships

5.     Eating healthy foods, choose fresh without preventives if possible

6.     Look at food labels for hidden sugar

7.     Give up fast food.  Just say no.

8.     Sleep 7 hours min.

9.     Make a list of the things to do so it is easier to plan

10.   Reach outside your comfort zone and say hello to someone new

11.   Ask your partner or spouse how they are doing and listen until they are finished

12.   Smile, practice smiling does help J

13.   Relax your jaw and shoulders

14.   Remind yourself how lucky you are, don’t take things for granted

15.   Keep your word, if you say you will do it.

16.   Don’t be afraid to ask for help, others will help if they can.

17.   Meditate, focus your mind on a mantra.

 

Let’s start with exercise.  We have scientific evidence that exercising has a positive effect on the aging brain.  Exercise helps different areas of your body in different ways.  There are hormones released in your bones when you exercise, endorphins are directly related to that euphoric feeling during and after exercise. Science has proven your gut reacts to exercise in a positive way.  Even the amount of happiness you feel can be factored in to moving your body!  Some say for as little as 7 minutes. https://well.blogs.nytimes.com/2013/05/09/the-scientific-7-minute-workout/

 

Leaving the Hospital After A Fall or Injury

Often my blog ideas come straight from a new client who is frustrated and needs an advocate. Frustrated with the amount of information given to them. Often clients are needing information about leaving the hospital after an illness or injury.

Being your own advocate is difficult when you are the patient. Having a caring advocate is important. You may have a friend or loved one be the advocate.

Start as soon as possible researching the needs.

1. Is home alone an option? If not will someone be there to care for the patient? Are there monies to cover home care or insurance coverage for help at home?

2. Is a skilled nursing facility (SNF) needed? Start researching SNF’s to get answers to important questions. Based on insurance or cash pay call or Google local choices and see which options best fit your needs.

EMPOWERED PATIENT ® TRANSFER TO SKILLED NURSING FACILITIES (SNF)

1. DISCHARGE TIMELINE: When is the patient expected to be transferred to the SNF? Ask about the possibility of nursing home care as soon as the patient is hospitalized to have time to research SNF’s and to prepare for this transition.

2. SNF CHOICES: Which facilities are available to the patient and do they have an open bed? Can the patient request a single room, and is there an extra fee?

3. TRANSPORTATION TO THE SNF: How will the patient be transferred to the SNF? If transportation by ambulance is needed, are the charges covered by insurance?

4. SNF REVIEWS: Consult Medicare.gov Nursing Home Compare for SNF information. Google the name of the SNF and read any online reviews or comments. Contact your state Department Of Health and ask for the most recent inspection results.

5. SPECIAL NEEDS: Ask the hospital discharge planner or case manager if the patient has special needs that the SNF will need to provide, such as a special diet or onsite physical therapy (PT) or occupational therapy (OT) services.

6. VISITING THE SNF: The patient’s advocate should try to visit the SNF choices in person. Check the toilet and shower facilities, cleanliness, patient activities and food selections. What is the caregiver to patient ratio – especially during evenings and weekends?

7. PATIENT RISKS: Nursing home patients may be at an increased risk of infection, overuse of antibiotics leading to “superbug” infections that may not be curable, falls, malnutrition, dehydration, medication interactions and side-effects, pneumonia and depression. Report any unusual symptoms you may observe in your loved one.

8. COORDINATION OF CARE: Which staff member is responsible for coordinating the patient’s care? Who is the physician in charge and how can he/she be contacted if there is a concern? Will the patient’s regular doctor visit the SNF? How are emergencies handled?

9. VISITING POLICIES: Does the SNF have a written visiting policy? If so, ask for a copy. Can approved visitors stay all night? Is there a policy for bringing food or other comfort items from home?

10. INSURANCE COVERAGE FOR SNF’s: Are there any needed services that are not covered by insurance? Is there supplemental Medicare coverage that needs to be billed? What is the protocol if the patient meets or exceeds their insurance maximum?

©2015 The Empowered Patient Coalition. An Empowered Patient ® Publication in collaboration with Julia Hallisy, D.D.S. and patient advocates Judy Wehrer and Paula Jean.

The Subject You MUST Bring Up

This holiday season take the time to start this conversation.

Advance care planning is not just about old age. At any age, a medical crisis could leave you too ill to make your own healthcare decisions. Even if you are not sick now, planning for health care in the future is an important step toward making sure you get the medical care you would want, if you are unable to speak for yourself and doctors and family members are making the decisions for you.

Start by thinking about what kind of treatment you do or do not want in a medical emergency. It might help to talk with your doctor about how your current health conditions might influence your health in the future. 

If you don't have any medical issues now, your family medical history might be a clue to help you think about the future. 

In considering treatment decisions, your personal values are key. Is your main desire to have the most days of life? Or, would your focus be on quality of life, as you see it? What if an illness leaves you paralyzed or in a permanent coma and you need to be on a ventilator? Would you want that?

There are two main elements in an advance care directive:

 Living will. A living will is a written document that helps you tell doctors how you want to be treated if you are dying or permanently unconscious and cannot make your own decisions about emergency treatment. In a living will, you can say which of the procedures described in the Decisions That Could Come Up section you would want, which ones you wouldn't want, and under which conditions each of your choices applies.

Durable power of attorney for health care. A durable power of attorney for health care is a legal document naming a healthcare proxy, someone to make medical decisions for you at times when you are unable to do so. Your proxy, also known as a representative, surrogate, or agent, should be familiar with your values and wishes. This means that he or she will be able to decide as you would when treatment decisions need to be made. A proxy can be chosen in addition to or instead of a living will. Having a healthcare proxy helps you plan for situations that cannot be foreseen, like a serious auto accident.

Some people are reluctant to put specific health decisions in writing. For them, naming a healthcare agent might be a good approach, especially if there is someone they feel comfortable talking with about their values and preferences. A named proxy can evaluate each situation or treatment option independently.

Other advance care planning documents. You might also want to prepare documents to express your wishes about a single medical issue or something not already covered in your advance directive. A living will usually covers only the specific life-sustaining treatments discussed earlier. You might want to give your healthcare proxy specific instructions about other issues, such as blood transfusion or kidney dialysis. This is especially important if your doctor suggests that, given your health condition, such treatments might be needed in the future.

Medical issues that might arise at the end of life include:

  • DNR orders

  • Organ and tissue donation

  • POLST and MOLST forms

DNR (do not resuscitate) order tells medical staff in a hospital or nursing facility that you do not want them to try to return your heart to a normal rhythm if it stops or is beating unsustainably using CPR or other life-support measures. Sometimes this document is referred to as a DNAR (do not attempt resuscitation) or an AND (allow natural death) order. Even though a living will might say CPR is not wanted, it is helpful to have a DNR order as part of your medical file if you go to a hospital. Posting a DNR next to your bed might avoid confusion in an emergency situation. Without a DNR order, medical staff will make every effort to restore your breathing and the normal rhythm of your heart.

A similar document, called a DNI (do not intubate) order,tells medical staff in a hospital or nursing facility that you do not want to be put on a breathing machine.

non-hospital DNR order will alert emergency medical personnel to your wishes regarding measures to restore your heartbeat or breathing if you are not in the hospital.

Organ and tissue donation allows organs or body parts from a generally healthy person who has died to be transplanted into people who need them. Commonly, the heart, lungs, pancreas, kidneys, corneas, liver, and skin are donated. There is no age limit for organ and tissue donation. You can carry a donation card in your wallet. Some states allow you to add this decision to your driver's license. Some people also include organ donation in their advance care planning documents.

At the time of death, family members may be asked about organ donation. If those close to you, especially your proxy, know how you feel about organ donation, they will be ready to respond. There is no cost to the donor's family for this gift of life. If the person has requested a DNR order but wants to donate organs, he or she might have to indicate that the desire to donate supersedes the DNR. That is because it might be necessary to use machines to keep the heart beating until the medical staff is ready to remove the donated organs.

Learn more about organ and tissue donation.

POLST and MOLST forms provide guidance about your medical care preferences in the form of a doctor's orders. Typically you create a POLST (Physician Orders for Life-Sustaining Treatment) or MOLST (Medical Orders for Life-Sustaining Treatment) when you are near the end of life or critically ill and know the specific decisions that might need to be made on your behalf. These forms serve as a medical order in addition to your advance directive. They make it possible for you to provide guidance that healthcare professionals can act on immediately in an emergency.

A number of states use POLST and MOLST forms, which are filled out by your doctor or sometimes by a nurse practitioner or physician's assistant. The doctor fills out a POLST or MOLST after discussing your wishes with you and your family. Once signed by your doctor, this form has the same authority as any other medical order. Check with your state department of health to find out if these forms are available where you live.

What About Pacemakers and ICDs?

Some people have pacemakers to help their hearts beat regularly. If you have one and are near death, it may not necessarily keep you alive. But, you might have an ICD (implantable cardioverter-defibrillator) placed under your skin to shock your heart back into regular beatings if the rhythm becomes irregular. If you decline other life-sustaining measures, the ICD may be turned off. You need to state in your advance directive what you want done if the doctor suggests it is time to turn it off.

Selecting Your Healthcare Proxy

If you decide to choose a proxy, think about people you know who share your views and values about life and medical decisions. Your proxy might be a family member, a friend, your lawyer, or someone in your social or spiritual community. It's a good idea to also name an alternate proxy. It is especially important to have a detailed living will if you choose not to name a proxy.

You can decide how much authority your proxy has over your medical care—whether he or she is entitled to make a wide range of decisions or only a few specific ones. Try not to include guidelines that make it impossible for the proxy to fulfill his or her duties. For example, it's probably not unusual for someone to say in conversation, "I don't want to go to a nursing home," but think carefully about whether you want a restriction like that in your advance directive. Sometimes, for financial or medical reasons, that may be the best choice for you.

Of course, check with those you choose as your healthcare proxy and alternate before you name them officially. Make sure they are comfortable with this responsibility.

Making It Official

Once you have talked with your doctor and have an idea of the types of decisions that could come up in the future and whom you would like as a proxy, if you want one at all, the next step is to fill out the legal forms detailing your wishes. A lawyer can help but is not required. If you decide to use a lawyer, don't depend on him or her to help you understand different medical treatments. Start the planning process by talking with your doctor.

Many states have their own advance directive forms. Your local Area Agency on Aging can help you locate the right forms. You can find your area agency phone number by calling the Eldercare Locator toll-free at 1-800-677-1116 or by visiting https://eldercare.acl.gov.

Some states require your advance directive to be witnessed; a few require your signature to be notarized. A notary is a person licensed by the state to witness signatures. You might find a notary at your bank, post office, or local library, or call your insurance agent. Some notaries charge a fee.

Some states have registries that can store your advance directive for quick access by healthcare providers, your proxy, and anyone else to whom you have given permission. Private firms also will store your advance directive. There may be a fee for storing your form in a registry. If you store your advance directive in a registry and later make changes, you must replace the original with the updated version in the registry.

Some people spend a lot of time in more than one state—for example, visiting children and grandchildren. If that's your situation, consider preparing an advance directive using forms for each state—and keep a copy in each place, too.

After You Set Up Your Advance Directive

Give copies of your advance directive to your healthcare proxy and alternate proxy. Give your doctor a copy for your medical records. Tell close family members and friends where you keep a copy. If you have to go to the hospital, give staff there a copy to include in your records. Because you might change your advance directive in the future, it's a good idea to keep track of who receives a copy.

Review your advance care planning decisions from time to time—for example, every 10 years, if not more often. You might want to revise your preferences for care if your situation or your health changes. Or, you might want to make adjustments if you receive a serious diagnosis; if you get married, separated, or divorced; if your spouse dies; or if something happens to your proxy or alternate. If your preferences change, you will want to make sure your doctor, proxy, and family know about them.

Talking About Your Wishes

It can be helpful to have conversations with the people close to you about how you want to be cared for in a medical emergency or at the end of life. These talks can help you think through the wishes you want to put in your advance directive.

It's especially helpful to talk about your thoughts, beliefs, and values with your healthcare proxy. This will help prepare him or her to make medical decisions that best reflect your values.

After you have completed your advance directive, talk about your decisions with your healthcare proxy, loved ones, and your doctor to explain what you have decided. This way, they are not surprised by your wishes if there is an emergency.

Another way to convey your wishes is to make a video of yourself talking about them. This lets you express your wishes in your own words. Videos do not replace an advance directive, but they can be helpful for your healthcare proxy and your loved ones.

Be Prepared

What happens if you have no advance directive or have made no plans and you become unable to speak for yourself? In such cases, the state where you live will assign someone to make medical decisions on your behalf. This will probably be your spouse, your parents if they are available, or your children if they are adults. If you have no family members, the state will choose someone to represent your best interests.

Always remember: an advance directive is only used if you are in danger of dying and need certain emergency or special measures to keep you alive, but you are not able to make those decisions on your own. An advance directive allows you to make your wishes about medical treatment known.

It is difficult to predict the future with certainty. You may never face a medical situation where you are unable to speak for yourself and make your wishes known. But having an advance directive may give you and those close to you some peace of mind.

Advance Directive Wallet Card

You might want to make a card to carry in your wallet indicating that you have an advance directive and where it is kept. Here is an example of the wallet card offered by the American Hospital Association. You might want to print this to fill out and carry with you. A PDF can be found online(PDF, 40 KB).

Read about this topic in Spanish. Lea sobre este tema en español.

For More Information About Healthcare Directives

CaringInfo
National Hospice and Palliative Care Organization
1-800-658-8898 (toll-free)
caringinfo@nhpco.org
www.caringinfo.org

Center for Practical Bioethics
1-800-344-3829 (toll-free)
center@centerforbioethics.org
www.practicalbioethics.org

OrganDonor.gov
Health Resources & Services Administration
www.organdonor.gov

National POLST Paradigm
1-202-780-8352
info@polst.org
www.polst.org

Put It In Writing
American Hospital Association
1-800-424-4301
www.putitinwriting.org

Content reviewed: January 15, 2018 

Your Pharmacist- Bound and Gagged

During the past 10 years or more, the costs of prescription drugs seem to have taken on an enlarging life of their own.  Gone are the days of no co-pay. Today even co-pays seem outrageous, yet pharmaceutical drug companies keep raising their prices and we, the patients, are responsible for their bazillion dollar paychecks, whether or not we can afford the drugs we need.

I’ll confess that I have a totally unbalanced sense of awe and loathing for Big Pharma (the moniker given to the whole of large drug companies.)  While on the one hand, I appreciate and applaud the “miracle” drugs some have developed over time, I can’t abide their sales practices, and their pretension that they are trying to help patients. Their goal is only to make money. If they happen to help a patient or two, that’s a pleasant surprise. Sad but true.

As a result, when I came upon this article from the AP, I couldn’t wait to share it with you because it can make a true difference for patients, and it gets around their gag rules.

Gag Rules?

Yes – gag rules.  It turns out, according to the article, that drug benefits companies force pharmacies – all of them from big-box type Walgreens, CVS, Rite-Aid or others… to your small, corner pharmacy – to refrain from telling you ways you can save money when you purchase your prescription drugs.

Example:  you need to pick up your prescription for, say, Lipitor. Your co-pay means you’ll pay $50 because it’s a brand name drug.  Your pharmacist is not allowed to tell you, because of the gag rules, that if you purchase it with cash, it will cost you only $25.

Now – a bit of a disclaimer – not all pharmacies are beholden to gag rules with all benefits companies (called pharmacy benefits managers).  But don’t worry about that – you don’t need to track them.

You can take advantage of this information in one simple way:

Always ask your pharmacist how much it would cost you to purchase your prescription with cash.  That doesn’t commit you to paying cash – it’s simply an information-gathering question. 

Save even more money by shopping around.  Call several pharmacies to ask them both how much a prescription will cost with your co-pay, and how much it will cost in cash. Then make your choice. (If you have to get your doctor to send you prescription to a different pharmacy, just call and ask. If he or she hesitates or won’t do it, then it’s time to find a new doctor.)

Pharmacists are FOPs – friends of patients – in all the very best ways. They hate these gag rules and they are happy to help you pay the least for your prescription, so by all means – take advantage of this advice! You’ll be happier and they will be, too.

And if you aren’t sure you’re doing this the right way, then it’s time to reach out to a Professional Patient Advocate to help you


gaggedpharmacist-538x218.jpg

The Folly Of Driving to the ER

Hugh, a gentleman of about 68 years, lived alone. Hugh wasn’t feeling well. It was just a general feeling that something – who knows what? – just wasn’t right.

After a short while, Hugh walked over to see Phil, his next door neighbor. Phil agreed to drive Hugh to the Emergency Room.

It took them about 30 minutes to get there. Hugh signed in, and together he and Phil sat down in the waiting room. Within 15 minutes, Hugh keeled over, out of his chair, and onto the floor. He had “coded.” 

Nurses and doctors immediately rushed over with the “crash cart” to jump start Hugh’s heart; they brought him back from the brink of death. He was immediately admitted to the hospital and had surgery that afternoon…

But Hugh died a few days later, never having regained consciousness from the attack he had suffered in the ER.

Hugh was my friend. He was my neighbor. He left behind his wonderful dog, his adult children (who all lived out of town and we didn’t know them), and many of us who just adored him.

Now we are all angry at Phil.

You might wonder why we would be angry at Phil. Afterall, Hugh asked Phil to drive him to the ER. What a neighborly thing to do – right?

No. Wrong. Absolutely WRONG!

The thing is – Phil has had two heart attacks himself. He should have known better than to drive Hugh to the hospital himself. He should have insisted on dialing 9-1-1.  And that is why we are angry at Phil.

When you, or someone you care about has odd symptoms that could involve something life-threatening, never drive them to the ER yourself.

Let’s suppose Phil had insisted on dialing 9-1-1.  Let’s even suppose Hugh had dialed 9-1-1 himself.  The EMTs would have arrived very quickly, and realized immediately that Hugh was in the midst of a heart attack, or cardiac arrest. They would have treated him immediately, stabilized him, and then transported him to the hospital. There would not have been that delay in getting treatment which was then too little too late. It’s entirely possible Hugh would have survived and we would all still have our friend among us.

I know… you’re thinking “Yeah, but what if it’s nothing?  How embarrassing and possibly expensive that would be!”

That’s very true. That’s your choice. Let it be “nothing” and reluctantly pay the bill.  Or find out it was something – and be happy to live long enough to pay the bill.

I know which one I would choose! Both those possibilities are better than not surviving at all.

There are so many people, especially those of us who are a little older, who know whether we are at risk to suffer a heart problem, or a stroke, or some sort of episode that can ride that line between life and death. Every one of us needs to talk to our loved ones and neighbors to be sure they know to dial 9-1-1.

If you aren’t sure if you are one of those folks, who needs to know the difference,  I won’t make decisions for you; instead I will help you walk through scenarios yourself so your friends or loved ones will know what to do – or so you will know what to do for them.

Don’t risk death!  Dial 9-1-1. The life you save may be your loved one’s – or your own.

Posted by: AdvoConnection

 

Soft Drinks and Disease

Soft drinks are the beverage of choice for millions of Americans, but sugary drinks increase the risk of type 2 diabetes, heart disease, and other chronic conditions.

·       People who consume sugary drinks regularly—1 to 2 cans a day or more—have a 26% greater risk of developing type 2 diabetes than people who rarely have such drinks. (46)

·       A study that followed 40,000 men for two decades found that those who averaged one can of a sugary beverage per day had a 20% higher risk of having a heart attack or dying from a heart attack than men who rarely consumed sugary drinks. (47) A related study in women found a similar sugary beverage–heart disease link. (48)

·       A 22-year-long study of 80,000 women found that those who consumed a can a day of sugary drink had a 75% higher risk of gout than women who rarely had such drinks. (49) Researchers found a similarly-elevated risk in men. (50)

·       Dr. Frank Hu, Professor of Nutrition and Epidemiology at Harvard School of Public Health, recently made a strong case that there is sufficient scientific evidence that decreasing sugar-sweetened beverage consumption will reduce the prevalence of obesity and obesity-related diseases. (51)

Soft drinks and diabetes

Strong evidence indicates that sugar-sweetened soft drinks contribute to the development of diabetes. The Nurses’ Health Study explored this connection by following the health of more than 90,000 women for eight years. The nurses who said they had one or more servings a day of a sugar-sweetened soft drink or fruit punch were twice as likely to have developed type 2 diabetes during the study than those who rarely had these beverages. (52) Learn more about diabetes.

 

A similar increase in risk of diabetes with increasing soft drink and fruit drink consumption was seen recently in the Black Women’s Health Study, an ongoing long-term study of nearly 60,000 African-American women from all parts of the United States. (53) Interestingly, the increased risk with soft drinks was tightly linked to increased weight.

In the Framingham Heart Study, men and women who had one or more soft drinks a day were 25 percent more likely to have developed trouble managing blood sugar and nearly 50 percent more likely to have developed metabolic syndrome.

Soft drinks and heart disease

The Nurses’ Health Study, which tracked the health of nearly 90,000 women over two decades, found that women who drank more than two servings of sugary beverage each day had a 40 percent higher risk of heart attacks or death from heart disease than women who rarely drank sugary beverages. (48)

People who drink a lot of sugary drinks often tend to weigh more—and eat less healthfully—than people who don’t drink sugary drinks, and the volunteers in the Nurses’ Health Study were no exception. But researchers accounted for differences in diet quality, energy intake, and weight among the study volunteers. They found that having an otherwise healthy diet, or being at a healthy weight, only slightly diminished the risk associated with drinking sugary beverages.

This suggests that weighing too much, or simply eating too many calories, may only partly explain the relationship between sugary drinks and heart disease. Some risk may also be attributed to the metabolic effects of fructose from the sugar or HFCS used to sweeten these beverages.

The adverse effects of the high glycemic load from these beverages on blood glucose, cholesterol fractions, and inflammatory factors probably also contribute to the higher risk of heart disease.  Read more about blood sugar and glycemic load.

Soft drinks and bones

·       Soda may pose a unique challenge to healthy bones.

·       Soda contains high levels of phosphate.

·       Consuming more phosphate than calcium can have a deleterious effect on bone health. (54)

·       Getting enough calcium is extremely important during childhood and adolescence, when bones are being built.

·       Soft drinks are generally devoid of calcium and other healthful nutrients, yet they are actively marketed to young age groups.

·       Milk is a good source of calcium and protein, and also provides vitamin D, vitamin B6, vitamin B12, and other micronutrients.

·       There is an inverse pattern between soft drink consumption and milk consumption – when one goes up, the other goes down. (41)


5 Quick tips: Building strong bones

1. Look beyond the dairy aisle.

You can get calcium from sources besides dairy foods. Calcium-rich non-dairy foods include leafy green vegetables and broccoli, both of which are also great sources of vitamin K, another key nutrient for bone health. Beans and tofu can also supply calcium.

2. Get your vitamin D.

Vitamin D plays a key role along with calcium in boosting bone health. Look for a multivitamin that supplies 1,000 IU of vitamin D per day. If your multi only has 400 IU of vitamin D, consider taking an extra supplement to get you up to 1,000 IU or 2,000 IU per day. Some people may need 3,000 or 4,000 IU per day for adequate blood levels, particularly if they have darker skin, spend winters in the northern U.S., or have little exposure to direct sunlight. If you fall into these groups, ask your physician to order a blood test for vitamin D.

3. Get active.

Regular exercise, especially weight-bearing exercise such as walking or jogging, is an essential part of building and maintaining strong bones.

4. Be careful about getting too much retinol (vitamin A).

Don’t go overboard on fortified milk, energy bars, and breakfast cereals, all of which can be high in bone-weakening vitamin A. Many multivitamin makers have removed much or all retinol and replaced it with beta-carotene, which does not harm bones.

5. Help your kids build strong bones.

Youth and young adulthood is the period when bones build up to their peak strength. Helping youth lead a bone-healthy lifestyle—with exercise, adequate calcium, and adequate vitamin D—can help them keep strong bones through all their adult years.

References

41. Vartanian LR, Schwartz MB, Brownell KD. Effects of soft drink consumption on nutrition and health: a systematic review and meta-analysis. Am J Public Health. 2007;97:667-75.
46. Malik VS, Popkin BM, Bray GA, Despres JP, Willett WC, Hu FB. Sugar-sweetened beverages and risk of metabolic syndrome and type 2 diabetes: a meta-analysis. Diabetes Care. 2010;33:2477-83.
47. de Koning L, Malik VS, Kellogg MD, Rimm EB, Willett WC, Hu FB. Sweetened beverage consumption, incident coronary heart disease, and biomarkers of risk in men. Circulation. 2012;125:1735-41, S1.
48. Fung TT, Malik V, Rexrode KM, Manson JE, Willett WC, Hu FB. Sweetened beverage consumption and risk of coronary heart disease in women. Am J Clin Nutr. 2009;89:1037-42.
49. Choi HK, Willett W, Curhan G. Fructose-rich beverages and risk of gout in women. JAMA. 2010;304:2270-8.
50. Choi HK, Curhan G. Soft drinks, fructose consumption, and the risk of gout in men: prospective cohort study. BMJ. 2008;336:309-12.
51. Hu FB. Resolved: there is sufficient scientific evidence that decreasing sugar-sweetened beverage consumption will reduce the prevalence of obesity and obesity-related diseases. Obes Rev. 2013;14:606-19.
52. Schulze MB, Manson JE, Ludwig DS, et al. Sugar-sweetened beverages, weight gain, and incidence of type 2 diabetes in young and middle-aged women. JAMA. 2004;292:927-34.
53. Palmer JR, Boggs DA, Krishnan S, Hu FB, Singer M, Rosenberg L. Sugar-sweetened beverages and incidence of type 2 diabetes mellitus in African American women. Arch Intern Med. 2008;168:1487-92.
54. Malik VS, Schulze MB, Hu FB. Intake of sugar-sweetened beverages and weight gain: a systematic review. Am J Clin Nutr. 2006;84:274-88.

Terms of Use

The contents of this website are for educational purposes and are not intended to offer personal medical advice. You should seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The Nutrition Source does not recommend or endorse any products.

 

https://www.hsph.harvard.edu/nutritionsource/healthy-drinks/soft-drinks-and-disease/

Relationships, Excuses and Family

This blog is based on the past Easter and Passover vacation.  I had so many of my clients comment and question their adult situations as they related to the nuclear family grew up in.  Excuses, blame and more excuses.  This is one family stress model and there would be no reason for changes just because we grow up, moved across the country or continued living in the same home..

Family Stress model

A= equals stressor

B = equals definition of stressor

C= equals perception of stressor

X =equals the families adaptation of event and resilience of the family.

It is important for no one to be a victim in the situation.  The best outcome in a family is characteristics of joint cause and good problem solving skills.

Maybe this didn't happen in your family.  If you can let go of the attachment you have with the past outcome and be proactive to let the past go.  

Stress is a reaction to crisis.  A crisis is a crucial situation; anything that is not normal is considered a crisis, if you are a young  family member this can be endless.  If you are in a family situation where there is a lot of stress going on daily, sometimes it is just plane unavoidable.  Major illness, unemployment and the death of a family member are the top three.  Drug abuse is next. If you are in the thick of it now, pay attention to this.

There are survival techniques for the entire family.

Make a point to get out for a break.  Daily gratification is important.  Sounds cliché’ but listing what you do have helps.  It is important to share with people, bosses, co-workers, social workers, kid’s teachers etc. who can help you with life flexibility to do what is needed in accessing residual resources to the family unit.  Stress management strategies are exercising, biofeedback, religion and spirituality, getting enough sleep, being involved in something other than the stressful situation, having a sense of humor can help when you have nothing else but yourself , let out a belly laugh.

Trying to control a situation is not going to give everyone a chance to be heard.  Communication with as many members involved is the key.

Generic Prescriptions Concerns Lead to New Symptoms

Be your own Advocate- Psychotropic Drugs and Generic Substitutes

I started on this topic by chance.  What I found my surprise you, it certainly did me. I appreciate the cost saving by a generic made drug as much as anyone.  I do see a need to manage the information for each individual if they have sudden symptoms or changes.

Forty percent of American drugs consumed are generic drugs made in India.  The only thing that needs to be the same is the active ingredient.  This means the other ingredients like binders can be anything the drug company chooses.  No test is done on the efficacy of the additives and binders or if it lessens the efficacy on the active ingredients.  The only test is done to are to see if the active ingredient is in the drug and in the correct amount. 

One of my clients told me she had been experiencing some strange mental behavior like repeating herself that was not normal at all for her.  Her husband and her friend who is a nurse both commented on it.  She started considering what may have caused this sudden change.  After considering her past few weeks she had not changed any medications or her diet.  The only thing that changed was the Wellbutrin she takes, she was given a generic brand instead of the brand name. 

Here is the strange part, I also take a generic form of a similar drug and about the time I started the research for her I noticed some of my chronic pain symptoms returning after a long absence.  Thinking I was crazy and having a sympathy symptoms I checked and I had a different manufacturer of Cymbalta. This was from TORRENT Pharmaceuticals.  As soon as I switched back to the old genetic formula from Lupin I was fine again.  Both factories are in India.  This may be ok for some drugs but we are talking about psychotropic drugs that cross the blood brain barrier or maybe not cross the blood brain barrier in which case this is a problem. 

The drugs tested and approved by the FDA are the original patent.  When the patent runs out other companies make a similar drug with the active ingredient.  Because most of my clients are geriatric and are very sensitive to drugs I see this as a big problem. Geriatric patients become more sensitive as they age.

The Food and Drug Administration approved a record 763 generic drugs in the year ending in September 2017.  I can see the need to keep our drug prices down as much as possible but at the expense of people they are claiming to help is not right.  FDA Commissioner Scott Gottlieb has vowed to tackle a lack of competition he has said is “a root cause of high drug prices.” How do we know we are receiving the same quality and quantity? Generic drugs are supposed to be deemed "bioequivalent" by the FDA, which means they should have the same amount of active ingredient as their brand counterparts as demonstrated on healthy volunteers.  Testing on healthy volunteers?  What about patients that have symptoms? 

Just before finishing this I had a friend tell me she got very dizzy from a drug she never had a problem with.  The pharmacy did tell her “this is the same drug but it is a different color and shape”.  This means she got a different formula.  We are still waiting on the outcome.

If your insurance (or the pharmacist) tells you "it's not covered" even after your doctor has checked the "dispense as written" box, find out if brand name can be approved with a "prior authorization", or "PA".  Many times, a pharmacy will insist something is not covered but unless they call the insurance (i.e. not just input into the computer) you don't know for sure.  If the pharmacist won't call, you can call yourself or look it up online.  You can also download prior authorization forms from your insurance company's website.  

 

https://www.psychologytoday.com/us/blog/mental-wealth/201203/brand-vs-generic-when-it-matters-and-what-do-when-it-does

 

https://www.bloomberg.com/news/articles/2018-01-05/plan-to-slash-u-s-drug-costs-leans-on-problem-plagued-factories

 

https://www.fda.gov/Drugs/DevelopmentApprovalProcess/HowDrugsareDevelopedandApproved/ApprovalApplications/AbbreviatedNewDrugApplicationANDAGenerics/ucm584749.htm

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Why Women Age Faster Than Men

Intrinsic: Hormones

Estrogen has many anti-aging effects on the skin. As women enter menopause and lose estrogen, they experience a decrease in collagen, antioxidant protection and moisture content. Estrogens also have anti-inflammatory properties, so menopausal women may experience inflammation of the skin and/or exacerbation of rosacea. The number of small blood vessels feeding the skin also decreases with a loss in estrogen, resulting in pale skin and less well-nourished skin. All of these add up to rapid aging with menopause. Men do have small amounts of estrogen and encounter the same issues, but usually not until they are in their 70s or 80s.

I have experienced the results of liquid collagen and it is amazing not just for your face but the entire body!  Ask me how to order the most advanced form.  Jan.newman@gmail.com

http://www.skininc.com/skinscience/physiology/What-Happens-to-Skin-With-Age-

Moving Away From Home

Keeping Control Is Still An Option With An Involved Caretaker


Don't wait for a crisis and have to do things quickly.  Urgency is sometimes unavoidable but planning ahead is always the better choice.

When the time comes to move your loved one into an assisted living, nursing home or board and care,  when it is unsafe to leave your love one alone for any amount of time, you must look at the possibilities.

Word of mouth is a great way. Start by asking anyone you know who visits someone in a facility. Ask your primary care physician where they go and see if that is a possibility. Ideally the closer to you is going to be less stressful for you to visit. You want to have a checklist.

 

What to Ask and What to Look For: A Facility Checklist

The following is only a partial list of things you should look for when selecting a retirement or nursing facility.

  1. ___ Look closely at the facility or home inside and out.
  2. ___ Ask to see the facility license.
  3. ___ Ask to see the admission agreement.
  4. ___ Take a look at the food menus.
  5. ___ Take a look at the kitchen.
  6. ___ Talk to the facility residents. Do they like their home?
  7. ___ Do the residents look comfortable and well cared for?
  8. ___ Talk to the staff.
  9. ___ Talk to the administrator. Is he or she helpful in discussing the facility or home with you?
  10. ___ Is there an odor in the facility or home?
  11. ___ Are the bedrooms clean and neat?
  12. ___ Are there activities for the residents?
  13. ___ Does the facility or home provide transportation?
  14. ___ Does this home specialize in difficult cases?
  15. ___ Do the residents appear to be clean and dressed?

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Daily Routines

Daily Routines- Coffee with room for (skin) Cream!

Skincare should be a natural extension of your morning routine along with brushing your teeth and shaving.  I put together an easy kit https://kit.com/jannewman/great-drugstore-products  Integrate it seamlessly into your day-to-day flow of morning and evening by keeping simple, easy to use cleansers in the shower and lotions and sunscreen at arms reach. Take advantage of scientifically advanced formulations professional skincare members offer. I use and recommend both internal and external anti-aging assistants.  Dietary supplements of is great for teens, men and women, (doubles as shave cream), A day cream if extra moisture is needed end with a must include sunscreen, physical element protection with amazing adaptable skin tone, for men and women, all lighter skin types helps hide discoloration.  At night, one ounce liquid collagen juice, lip therapy before turning in for beauty sleep.  I can order for you.  Try to visit your dermatologist for professional advice.

Medical grade products have a clinical added value from protecting skin to supporting recovery from sun damage along with any procedures at an office visit.   Your skincare is your strongest complementary asset you can count on to maintain long-term results of healthy glowing skin.

With the rapid pace in most of our lives, it is important to have a professional take into account the histology, the various difficult environments, skin tone, allergies, etc. on each individual patient. Understanding your skin’s needs will help you improve your skins anti-aging properties just as your body may need coffee in the morning to get you going. With just a little time and patience these products I recommend can make a difference in the texture, tone and visual appearance.  

 

3 ways to seamlessly integrate skin care into your routine!

1. Cleansers in the shower 

2. SPF and complimentary products on your counter, in your car- arms reach!

3. Bedside table moisturizer- skin heals over night, best way to use recovery products!

Janet Newman

Jancareadvocate.com

Try these on for size!

 https://kit.com/jannewman/great-drugstore-products