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One Nation – Under Pressure

May 1, 2012 Dr. Pullen

By Brooke Douglas, RD, CD

High blood pressure. The words don’t exactly strike fear into most American’s hearts. After all, it’s not painful, like cancer. It doesn’t sound deadly, like heart disease. But it’s literally a time bomb in our blood vessels that threatens our heart, brain and kidneys. Make no mistake – it’s a killer! So what makes our blood pressure rise? Too much salt, extra body weight and spending too much of your time sedentary. But wait! Don’t blame it all on the salt shaker. Only 7% of the excess salt in the average American’s diet comes from the salt shaker. The remaining 93% comes from all the processed and convenience foods we buy at the vending machine, at the local corner store, at the grocery store (for quick dinners) and at fast food and dine-in restaurants.

If your doctor has told you to cut back on your salt intake…you will have to do more than put the salt shaker away.

As for extra body weight (lose weight) and inactivity (begin a modest exercise program and spend less of your day sedentary), applying the following tips may help you on your quest to lower your blood pressure.

Here are some sodium-cutting tips you can try today:

Introduce additional flavor to your foods with herbs and spices like garlic, oregano, basil, pepper, thyme and sesame. These all add flavor without the extra sodium. If a recipe calls for salt, cut the amount called for in half and taste it before adding more.

Make healthy choices at the grocery store. Processed foods (anything in a box or bag) tend to be high in sodium because it helps preserve foods longer and increase flavor. Always read labels for the foods you buy, including the sodium content on the nutrition facts label and the ingredients list.

Remember that “low-fat” or “low-calorie” doesn’t mean healthy. These diet foods can also be higher in sodium because manufacturers hope that added sodium, a flavor-enhancer, will bring back the flavor that is missing since fat and other higher-calorie ingredients are removed. This is especially true for frozen dinners, which are often loaded with extra salt.

Choose low-, no- or reduced-sodium versions of your favorite soups, frozen meals, canned foods, and snacks. Even butter is available without added salt!

Choose fresh or frozen veggies over canned varieties, which often contain added salt to help increase shelf life. If you can’t find sodium-free varieties of canned vegetables, rinse the can’s contents in a colander under water before cooking to remove excess salt.

Olives, pickles and other items packed in brine are saturated in salt, as are many smoked and cured meats, like salami and bologna. Limit your intake of these high-sodium foods and be on the lookout for lower-sodium varieties.

Fast foods are high in more things than just fat. Many of these meals, sandwiches and fries contain more than your daily recommended intake of sodium in just one serving. When consulting restaurant websites to make healthy choices, pay attention to sodium levels as well. By keeping your portions in check (order a junior burger or small French fry instead of the big burgers and super fries) will help control your sodium (and caloric) intake.

Thanks much to Brooke for returning as our first-of-the-month guest contributor. She does a great job with nutrition advice, so if you are concerned about your or a loved one’s blood pressure give her a call. Did you know that your insurance might cover several visits with a Registered Dietitian? Let Brooke help you navigate the insurance maze to determine whether your insurance will pay for you to having some nutrition coaching with a Registered Dietitian. You can find her at Nutrition Authority.

High Five from Dr. P. Vol. 1 #1.

April 26, 2012 Dr. Pullen

As I search the world over for inspiration and ideas I come across some pretty good stuff, and a whole lot of pretty bad stuff too. I’m going to spare you the ugly, and bring you the best I see with the first of my “High-Five” posts. Let me know what you think:

1. At Common Sense Family Doctor Kenny Lin MD gives a much more personal and insightful take on the recent Annals of Internal Medicine article on the costs of an appendectomy in California. Be sure to check out:

How much does it cost to have an appendectomy?

A few years ago, a good friend of mine who holds bachelor’s and law degrees from Ivy League schools lost his job and became one of the estimated 50 million medically uninsured persons in the U.S. Over the course of several days, he developed increasingly severe abdominal pain, fever, and vomiting. Though reluctant to seek medical attention, he finally was persuaded to visit his local hospital’s emergency department, where he was diagnosed with acute appendicitis. Read more

2. Dr. Rob Lambert is back now with More Musings (of a Distractible Kind) blog and is a funny and poignant as prior to his mysterious time away from his blog. You’ll like the Llama photos, and I found this post so right on that the humor is just an added bonus:
The Origin of Feces:

When I first read it, I thought it said, “Your mother always reminded you to wash your behind…”, which makes sense, given the advertising subject material. I haven’t read the remainder of the deal, so we can only guess what the last sentence reads: read more

3. There is no free lunch in life, and healthcare is no different. Dr. Wes at his eponymous blog sets us straight about claims of “free healthcare services” being advertised by our U.S. government of all sources.

When Health Care is Promoted as Free:
Health expenditures in the United States neared $2.6 trillion in 2010, over ten times the $256 billion spent in 1980. The rate of growth in recent years has slowed relative to the late 1990s and early 2000s, but is still expected to grow faster than national income over the foreseeable future.
So imagine my surprise when I saw this Medicare commercial last night that stated preventative health care services provided by Medicare were “free:” read more

4. In a post I just came across on the blog Whatever by John Scalzi is an anonymous post by a physician outraged by the coercive laws demanding women have a transvaginal ultrasound prior to an abortion. Whatever views you have on abortion this post is worth reading to see an impassioned physician’s take on this issue:

Where is the Physician Outrage?

Right. Here.

I’m speaking, of course, about the required-transvaginal-ultrasound thing that seems to be the flavor-of-the-month in politics.

I do not care what your personal politics are. I think we can all agree that my right to swing my fist ends where your face begins.

I do not feel that it is reactionary or even inaccurate to describe an unwanted, non-indicated transvaginal ultrasound as “rape”. If I insert ANY object into ANY orifice without informed consent, it is rape. And coercion of any kind negates consent, informed or otherwise. Read more

5. In a guest editorial on KevinMD Dr. Steven Reznick MD writes a compelling plea to medical journals to present information statistics in a form non-statisticians can comprehend. I’m all for this and the KISS (keep it simple stupid) rule of thumb should apply to getting info to physicians too. I’d have changed the by omitting primary care. I don’t think subspecialists are more knowledgeable statisticians than me as a general rule.

Keep statistics simple for primary care doctors

“As a primary care physician, out of medical school for 36 years, let me make a suggestion. Keep It Simple Stupid. Medical school was a four year program. The statistics course was a brief three week interlude in the midst of a tsunami of new educational material presented in a new language (the language of “medicalese”) presented en masse in between students being used as cheap labor at all hours of the day to fill in drawing bloods, starting intravenous lines and running errands for the equally overworked interns and residents who were actually being paid to perform these tasks.” Read more

I hope to post annotated links to great stuff I come across as I come across it. Let these bloggers know that you appreciate their work by leaving them a comment on their sites. Enjoy.

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Exercise -The Unknown Warrior In The Battle Against Cancer

April 23, 2012 Dr. Pullen

Cancer touches every soul in one-way or another. There are many treatments available for both the mind and the body when living with this disease but the most important treatment option can often be overlooked. With chemotherapy, radiation, surgery, medications and rehabilitation, it is easy to forget that exercise can be a cancer patient’s greatest ally.

Extreme Fatigue is one of the most common complaints heard from patients during chemotherapy treatments but there are ways to help alleviate this uncomfortable side effect without adding additional medications into their day. Numerous studies have shown the merits of exercising throughout treatment to help maintain a normal level of activity. These studies have also shown that continuing to follow an exercise program after treatment may help cancer survivors maintain a quality of life similar to that found before diagnosis.

Exercise can do more than just help reduce fatigue. It can also help many patients address the emotional issues that come with a cancer diagnosis and treatment. Issues such as weight gain, muscle loss, and postoperative healing can create a distorted body image, which may lead to depression. It is widely known that exercise can aid in weight loss and that weight bearing exercises can increase muscle mass but during exercise, the body also releases endorphins that create an elevated mood. This elevated mood could help patients see their situation in a more positive light and aid in their recovery.

Although some form of activity is recommended daily, each patient will require a different exercise program dependent on his or her disease and current treatments or if they are currently in a survivorship plan. For example, a patient receiving Mesothelioma treatment must be more cautious of activities that apply a greater strain on the heart or lungs while a patient being treated for Bone Cancer would avoid any high impact exercises that could lead to a fracture.

Because of these risks, many people choose to have a trainer help them design an appropriate exercise routine. This is a wonderful idea but it is important to remember that the trainer must understand the specific requirements of cancer patients. According to an article published on the National Cancer Institute’s website, the American Cancer Society has developed a certification program for trainers wishing to help cancer patients and survivors. This program ensures that cancer patients and survivors are receiving the best care possible.

by David Haas. David is a writer for the Mesothelioma Cancer Alliance. Please follow David on Twitter @haasblaag.

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Healthy Snacks: Sensible Snacking for 9 to 5’ers

December 1, 2011 Dr. Pullen

The clock ticks to 3 pm on a Monday, and your office’s vending machine calls out for you to sabotage your healthy habits with an oh-so-tempting Reese’s candy or a Doritos bag of chips – and what do you do? Even if you have no problem turning down fatty foods throughout the day, many people, while at work may have trouble winning the healthy food fight when surrounded by unhealthy options all week.

BRAKE FOR BREAKFAST – Even though mornings may leave you sprinting for the door, taking time to eat breakfast has been shown to decrease unhealthy snacking and overeating later in the day. If you try to get as much sleep as you can, therefore creating the habit of “I don’t have time to eat breakfast”, why not keep some healthy items in the office? Foods like oatmeal and walnuts, natural peanut butter on whole wheat toast, or low fat cottage cheese and fruit are easy to prepare and store. If you go to work hungry you may be surrounded by unhealthy options, which increases the chance you will eat those unhealthy options. On another note, if you are one to say “I’m never hungry in the mornings” – the only reason for this would be if you overate the evening before. It is in your own best interest to trust the research about the benefits of breaking your nighttime fast and beginning your day with ‘food fuel’ for your brain!

PLAN AHEAD – Preparation is the key to healthy workplace munching and integral to helping you make successful food choices for both mealtime and snack-time. You know you are going to be hungry, so plan for it. Instead of running to the fast-food outlet across the street or relying on the junk foods brought in by coworkers, make a plan to have healthy foods available for your meals and snacks. It is too easy to get into trouble when we wait to look for something to eat when we are already hungry.

If you think you are too busy to pack snacks daily, pack once, eat for five days. In other words, pack up a bag of snacks for the week to take to work with you on Monday. Most offices have a refrigerator and a toaster oven or microwave, so use them.

HEALTHY DESK DRAWER SNACK IDEAS

Whole wheat fig bars

Individual servings of fruit

Raw almonds, walnuts, peanuts – ¼ cup

Dried fruit and nuts – limit to ¼ cup each

Instant soup cups – low salt variety

Plain granola bars (no mix-ins/candy)

Fresh, crisp vegetables in a baggie

Natural peanut butter on WW crackers

Whole wheat crackers and hummus

Nonfat yogurt with ground flaxseed

High-protein, high-fiber snack bars

Apple and low-fat string cheese

Oatmeal in a baggie (not instant)

Hard boiled egg and fresh fruit

Whole grain pretzels

Healthy, homemade muffins

Baked potato and tortilla chips

Single-serving pouches of tuna

Snacking should be purposeful. Snack to avoid overeating at meals and to keep your metabolism working along with you during the day. Appropriate and strategic snacking can help bridge the hunger gap between meals and keep you better focused, more productive and help with health and weight goals.

Brooke Douglas is a registered dietitian who contributes an article to this health blog on the first of every month. Have you had a ‘Nutrition Checkup’? You know who your doctor is. But who is your Registered Dietitian (RD)? If you would like to meet with a registered dietitian and schedule your ‘nutrition check-up’, contact Brooke Douglas, RD by logging on to her website at www.NutritionAuthority.com or call Brooke at 253.227.8284.

Also see:

Healthy Fruits – Healthy Vegetables. Brooke Douglas Tells it All

How to Eat Healthy on Vacation

Inflammation and Diet: Inflammatory and Anti-inflammatory Foods

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The Real Costs of Defensive Medicine

November 15, 2011 Dr. Pullen

by Brittany Lyons

With estimates ranging from $35 billion to a whopping $850 billion, the true costs of “defensive medicine” are difficult to pinpoint. A variety of government reports, physician surveys and studies have attempted to pinpoint exactly how much of U.S. healthcare costs are generated by defensive medicine, but the varied definitions of “defensive medicine” make the real number hard to determine.

Defensive medicine refers to the costs associated with doctors protecting themselves from medical malpractice lawsuits. These costs include liability insurance premiums, malpractice judgments and settlements, and sometimes extend to unnecessary testing or other physician services provided to patients solely to avoid malpractice claims. Indirect costs associated with defensive medicine can also include “assurance behaviors,” such as ordering tests or delivering additional services that have only marginal medical value, or no value at all, to discourage malpractice lawsuits—which can cost more than even earning PhDs. A 2005 study published in the Journal of the American Medical Association discovered that doctors may perform these unnecessary services in the hopes that if a malpractice claim were to arise, the court would be satisfied that the physician met the standard of care.

A Look Behind the Numbers

The Congressional Budget Office estimated that defensive medicine accounted for $35 billion—or 0.2 percent—of the total U.S. healthcare expenditures for 2009. This figure is significantly lower than the estimated $650 to $850 billion in annual expenditures attributed to defensive medicine by Gallup and Jackson Healthcare surveys of physicians. The Jackson Healthcare survey gathered data from thousands of physicians across the United States on the indirect and direct costs generated by defensive medicine, concluding that physicians considered defensive medicine the primary driving force behind rising healthcare costs—the result of an overly litigious healthcare environment.

Nine out of ten surveyed physicians said they practice defensive medicine, and general estimates predicted an average of 34 percent of overall healthcare costs arise from defensive medicine. A subsequent Gallup poll of physicians found that approximately 73 percent of surveyed physicians admitted to practicing defensive medicine within the past year, but estimated overall costs at only 26 percent. The 2005 JAMA study by researchers from Columbia and Harvard Universities also revealed that for physicians practicing in “high-risk” specialties, these monetary figures may be much higher; 59 percent of the physicians surveyed admitted to ordering more diagnostic tests than medically necessary to prevent malpractice litigation. Plus, the physicians avoided caring for high-risk patients, referred patients to other specialists, prescribed more medications than medically necessary and suggested unneeded invasive procedures—all to avoid malpractice lawsuits. Another study by the American Academy of Orthopedic Surgeons discovered that defensive medicine accounts for a startling 20 percent of all imaging orders, and half of these imaging orders were for expensive MRIs.

Why the Disparities?

So why is the Budget Office’s number so low when the Jackson Healthcare survey is so high? Because physicians aren’t regularly logging every single expenditure arising from defensive medicine, and no one is entirely sure what even qualifies as “defensive,” quantifying the costs with exact accuracy is nearly impossible. The great differences in estimated costs, however, is likely due to the particular expenditures included in the figures for defensive medicine. For instance, the CBO’s low estimate of $35 billion includes “malpractice insurance premiums together with settlements, awards and administrative costs not covered by insurance,” but does not include unnecessary procedures, medications and other services, so long as they are covered by insurance. This difference in accounting is more than enough to explain the disparity.

The Jackson Healthcare survey adds a myriad of other direct and indirect costs to the CBO’s numbers, including all the excessive diagnostic testing and medical services provided in the spirit of defensive medicine. The survey results then translate the percentages into dollar amounts using the calculations of estimated overall U.S. healthcare spending released by the Centers for Medicare and Medicaid Services. Thus, this number includes more items than the CBO’s report, and bases its numbers on another estimate.

With healthcare costs rising rapidly in the United States, combined with increasing tort reform and malpractice fears, defensive medicine is becoming a more and more expensive slice of the healthcare-cost pie. Regardless of the actual monetary amount, defensive medicine practices strain not only Medicare and Medicaid, but also the insured and uninsured healthcare consumer alike, contributing to increasing prices for medical services and greater costs to insurance companies. Unless something is done to relieve the legal pressures placed on physicians, defensive medicine will continue to generate billions of dollars in healthcare expenditures every year.

Brittany is a blogger-in-residence at PhDs.org

When No Immediate Treatment is The Best Option for Prostate Cancer

October 3, 2011 Dr. Pullen

“Don’t Just Do Something, Stand There!” When No Immediate Treatment is The Best Option for Prostate Cancer

by Patrick Maguire, MD

As we near the end of Prostate Cancer Awareness Month this September, hopefully many of us have learned a thing or two that we didn’t know about the disease in August. Just last week, a major study of predictors of sexual function after prostate cancer treatment was published in the prestigious Journal of the American Medical Association (JAMA). I found some important info in the paper and recommend it highly to men who are considering their options for treatment. The link for the full document is: http://jama.ama-assn.org/content/306/11/1205.full.pdf. An in-depth discussion of the topic can be found at on my blog The Cancer MD. As opposed to various treatment choices, one option for men after a prostate cancer diagnosis that we don’t hear too much about in theU.S. is active surveillance.

Many terms have been used to describe what is now most often called active surveillance. These include: watchful waiting, close observation, and expectant management, among others. Given the right circumstances, the option of avoiding prostate cancer treatment altogether is often best. Which men are candidates for watchful waiting after their diagnosis?

To be sure, prostate cancer is a spectrum of disease that can range from indolent to extremely aggressive. Men with low-risk prostate cancer may be good candidates for no immediate treatment. These cancers can’t be felt or are only felt in part of one side (lobe) of the prostate, produce a low level of prostate specific antigen (PSA) in the blood, and appear not too aggressive under the microscope (Gleason score of <7). Among this group, younger, healthier men are usually the best served by treatment.

Men with low-risk disease who are either older or in poor overall condition should strongly consider expectant management. In general, it takes more than a decade for early prostate cancer to spread to other sites in the body (metastasize) and ultimately kill a man. Therefore, men who have a life expectancy less than 10-15 years should think long and hard about the option of no treatment. In medical school, we docs agree to abide by the Hippocratic Oath, a major principal of which is “primum non nocere” (do no harm). We don’t want to put a man at risk for possible side effects of treatment, unless we have reason to believe that the treatment has a good chance to improve survival or quality of life.

So, if you or your loved one has been diagnosed with prostate cancer that’s found very early, ask your urologist or radiation oncologist whether active surveillance or watchful waiting is a reasonable option. Sometimes, though it may feel strange, you might have to tell him or her, “Doc, don’t just do something. Stand there!?

Dr. Maguire regularly posts on TheCancerMD.com and is the author of a book that I have enjoyed reading that helps laypersons understand the language, facts and treatment options for the most common cancers. When Cancer Hits Home: Cancer Treatment and Prevention Options for Breast, Colon, Lung, Prostate & Other Common Types.

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Healthy Fruits – Healthy Vegetables:Brooke Douglas RD Tells All

October 1, 2011 Dr. Pullen

Brooke Douglas RD is back with her first of the month post, this time telling us about healthy fruits and healthy vegetables. Don’t miss a word.

Almost Everything You Ever Wanted to Know About Fruits and Vegetables

Research shows that people who eat even 2½ cups of fruits and vegetables a day have only half the cancer risk of those who eat less than one cup a day. Hundreds of studies show that increased fruit and vegetable consumption may also help prevent heart disease, stroke, hypertension, birth defects, cataracts, diabetes, obesity and other serious conditions.

Healthy Fruits and vegetables are nutritional powerhouses which:

Are excellent sources of vitamins and minerals and contain disease fighting fiber
Contain antioxidants and phytochemicals
Are virtually fat-free (exceptions: coconut, olives & avocado) and cholesterol-free
Are helpful in weight management, due to their high-fiber, high-water, and low-fat content

Vitamins and minerals: Are essential in maintaining the health of the brain, heart, bones, teeth and nerves; making/repairing red blood cells; regulating body’s balance of fluids; and in other vital functions.

Many healthy fruits and vegetables are particularly good sources of vitamins A, C, E and K, some B vitamins, and many important minerals needed for healthy bodies. Beta-carotene and related compounds called carotenoids are converted by the body to Vitamin A. Carotenoids are found in high concentrations in carrots and other orange and yellow vegetables and fruits such as winter squash and cantaloupes. Dark green, leafy vegetables, such as spinach, kale, broccoli, and other members of the cabbage family, also contain high concentrations of carotenoids.

Dark green vegetables are also excellent sources of folic acid (a B vitamin needed during pregnancy to reduce the risk of neural defects in the fetus), Vitamins E and K, and minerals such as calcium, magnesium, manganese, iron, and potassium. Many fruits are also a good source of minerals, such as chromium (grapes), iron (cherries), manganese (pineapple), and potassium (apricots, bananas, orange juice, peaches and prunes).

Citrus fruits are good sources of Vitamin C, as is the family of plants that includes tomatoes, red and green peppers, potatoes, and eggplant. Other good sources of Vitamin C include papayas, strawberries, kiwis, cantaloupe, and the cabbage family, including broccoli, cauliflower and Brussels sprouts.

While there is overlap in the vitamins/minerals supplied by fruits and vegetables, you need a wide variety of colorful healthy fruits and vegetables to fully benefit from the various nutrients they contain.

Antioxidants: Disease-fighting compounds found in many foods, especially healthy fruits and vegetables. Antioxidants neutralize free radicals (compounds that damage cells and lead to cardiovascular disease, cancer, cataracts, premature aging, and impaired immunity.) Antioxidants include vitamins A, C, and E; beta carotene, minerals (selenium, copper, zinc, and manganese) and some of the phytochemicals.

Phytochemicals: From plants, “plant chemicals” are recognized as powerful disease-fighting compounds. Fruits and vegetables contain thousands of different phytochemical compounds. Categorized as carotenoids, flavenoids (compounds that give flavor/colors to fruit/veg), and other compounds, such as allicin, indoles, lycopenes, lutein, and phenols. Scientists studying phytochemicals are finding an impressive range of health benefits.

Color & Examples	Phytochemical Examples	Potential Benefits
Red: apples, cherries, strawberries, watermelon, beets, red peppers, radicchio, tomatoes	Lycopene, anthocyanins	Maintain memory function, heart health urinary tract health; reduce blood pressure, fight infections, and reduce risk of some cancers
Orange/yellow: apricots, mangos, oranges, peaches, pineapple, cantaloupe, carrots, corn, winter squash	Carotenoids, bioflavonoids	Maintain health of heart, eyes, and immune system, slow aging, and reduce risk of some cancers
Green: leafy greens, asparagus, broccoli, green beans, peas, spinach, honeydew, kiwi, avocados	Lutein, indoles, carotenoids	Improve vision, strengthen bones and teeth, and reduce risk of some cancers
Blue/purple: blueberries, blackberries, purple grapes, plums, eggplant, purple cabbage	Anthocyanins, phenolics, resveratrol	Facilitate healthier aging, enhance memory function, urinary tract health and cardiovascular health and reduce risk of some cancers
White/tan/brown: onions, garlic, cauliflower, turnips, mushrooms, potatoes, bananas, pears, dates	Allicin, quercetin, sulphoraphane	Improve heart health, maintain healthy cholesterol levels, and reduce risk of some cancers

Not all foods listed above, even within the same group, have the same health benefits. Foods with the same phytochemicals may contain different concentrations of the phytochemicals, and the compounds may be absorbed differently. Even different varieties of foods within the same category (such as different varieties of apples or lettuce) may contain widely varying concentrations and kinds of phytochemicals. However, those darker in color usually contain higher concentrations. So think “more color and more variety” in making your selections!

What is considered one serving of fruit?

• 1 medium whole fruit (apple, banana) • ½ cup of fresh, frozen or canned fruit
• 6 oz. (¾ cup) 100% fruit juice • ¼ cup of dried fruit

What is considered one serving of vegetables?

• 1 cup of raw, leafy vegetables • ½ cup cut up fresh, frozen or canned vegetables
• 6 oz. (¾ cup) 100% vegetable juice • ½ cup cooked beans, peas, or lentils

How Can I Get More…Healthy Fruits and Vegetables in My Diet?

At home:

• Top your hot or cold cereal with fresh fruit.
• Enjoy a glass of 100% real fruit or vegetable juice with breakfast.
• Make smoothies with fresh or frozen fruits and juices for a great breakfast or lunch choice.
• Choose hundred percent fruit and vegetable juices as delicious alternatives to soft drinks.
• At dinner, include salad/raw veggies; use low-fat or non-fat dressing to reduce fat and calories.
• Steamed vegetables are always a good side dish.
• Add vegetables to your favorite entrees, like tacos, lasagna, casseroles, and pasta dishes.
• Add pureed vegetables to sauces to fortify them.
• Try more vegetarian meals, like tofu, rice or pasta with vegetables, and Asian stir-fry dishes.
• For dessert, bake sweet potatoes, apples, peaches, pears, or bananas, or make fruit cobblers.
• Discover some of the many cookbooks that specialize in fruits and vegetable recipes.
• For a snack or when you’re on the go:
• Choose fruits and vegetables that can be eaten out of hand, like apple wedges, baby carrots, broccoli spears, or cherry tomatoes, grapes, bananas, and seasonal items like peaches and plums.
• In place of candy, choose dried fruit (easily packs in a bag/take on the road or eat at office.

When dining out:

• Order a dinner salad to begin your meal.
• Request an extra serving of vegetables as a side dish.
• Order meals that include vegetables or fruits as a major component. To keep fat and calories in check, request vegetables steamed without the addition of butter, oil or cream sauce.
• Ask for extra lettuce and tomato (or other vegetables) on sandwiches and burgers.
• Choose healthful desserts; fresh fruit, sherbet, sorbet, or angel food cake topped with fruit.
• Choose dishes on the nutrition charts of Healthy Dining Finder that have more servings of fruits/vegetables.

You can read more by Brooke on this health blog just look under the nutrition category. I especially like her post on intuitive eating and eat five a day. Also check out her site at Nutrition Authority.

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What is Hospice: A Hospice Volunteer Point of View

September 26, 2011 Dr. Pullen

by Christina Lufkin, Hospice Volunteer and Author.

What is Hospice?

Hospice is not a death sentence. It is an opportunity to live life to the fullest until you die.

I have been a Hospice volunteer since 1994. It is my passion. To be of service to others during such an important and intense time of life is an honor. The more I give, I am repaid tenfold. In order to qualify for Hospice a patient must be diagnosed with a terminal illness that if it were to progress at the normal rate, would only have six months to live. To be eligible a patient can’t be involved in treatment to try cure the illness. Their doctor must write a referral for the patient to be evaluated for Hospice care.

Once enrolled, if the patient lives to the six month timeframe they can be evaluated and reinstated in the program. Hospice provides many services that assist both the patient and the family. I have had many conversations with family members and friends of terminally ill patients who were anxious because of unresolved issues with the patient or because they just felt they needed to share something and had not done so. I always encourage them to make time to talk about the issues. It will be too late once the patient has passed. If left unresolved these situations can lead to the survivor feeling regret, sadness, guilt or frustration. Grief is natural but adding the pressure of not talking openly before someone dies can make the grieving process much harder.

Many patients have talked with me about the importance of relationships in their life. They have never expressed regret about wishing they had more money, possessions or fame. It is so important to most people to know that they don’t have any unfinished business, which allows them to pass peacefully. Once a patient has been diagnosed with a terminal illness, Hospice is the best way to have their wishes met. The Hospice team; Nurse, CNA, Chaplain, Social Worker, Medical Director, Volunteer Coordinator and Volunteers work together to accomplish the patients desires. This team effort helps address the patient’s complete needs; physical comfort, emotional and spiritual support. Treating the entire patient is very important. Then, after the patient passes the family has a great support system and grief counseling, and support groups available anytime there is a need. I have had many heart-to-heart talks with patients in addition to fun and silly times together. After every assignment I take time to reflect on the experience. I have always learned something from each patient. The patients and families have always thanked me and said how much my service and the Hospice services in general made a positive difference.

I encourage anyone interested in Hospice or in volunteering to call your local Hospice organization. If you have questions please contact me at christinalufkin1@yahoo.com. Christina is also available for interviews or guest speaking engagements. Christina Lufkin, Author “Live with Purpose:Die with Dignity” www.christinalufkin.weebly.com

Comments by Dr. Pullen: Over the years I have had nothing but positive experiences with hospice. When my Mom passed last spring Hospice was involved and they definitely made for a better experience all around. See my post, Saying Goodbye. Hospice has several major advantages from a flexibility and financial standpoint also for terminal patients. The Medicare reimbursement for Hospice is on a per-diem basis, and the Hospice team has a great deal of flexibility in choosing services to provide to patients, many of which would not be eligible for regular Medicare coverage.

You may also enjoy How We Fail and End of Life Care.

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The Unexpected Health Benefits of Running

September 12, 2011 Dr. Pullen

The Unexpected Health Benefits of Running

by Charles Boren

The ancient Greeks used running as a form of training and competition. It was a way to test personal fortitude and improve physical health. Many of the health benefits of running were known even in those ancient times. In modern times, many start running for the same reasons. They run to improve their physical endurance, lose weight and build muscle. While these common health benefits of running influence many to start running, runners are surprised to learn just how extensive the health benefits are. Running improves the quality of sleep, fights off depression and anxiety, and improves joint health and stability.

Sleep disorders affect a surprising percent of the population today. There is good news to those who suffer from them. Running can actually improve the decrease the symptoms of sleep disorders and improve the quality of sleep. It also appears to help people sleep more efficiently. That is, the amount of time spent actually sleeping while in bed increases. Running helps people fall asleep more quickly, toss-and-turn less through the night, and wake up more rested than those who do not run.

The runner’s high is a well-documented phenomenon, and major benefit, of running. This is a unique feeling often reported during long, strenuous amounts of exercise. The feeling can range from relaxed and peaceful to intensely euphoric. It is produced when endorphins flood the brain as part of a stress response to running. These endorphins are the natural drugs of the body. They reduce pain and are responsible for the happy and content feelings similar to many those produced by narcotics. While many runners experience this phenomenon, many do not realize the long-term positive effect that is has. Over time, the regular doses of endorphins to the brain can combat both anxiety and depression. In fact, many studies have shown that following a regular running program markedly reduces the symptoms of these disorders.

A common misconception is that the high-impact nature of running negatively affects the joints in the body. The truth is that running may actually improve joint health and stability. (1) This is done in a number of ways. First, running helps keep excess weight off. Just a ten-pound increase in body weight can cause a 45-pound increase in stress on the knees (2). Second, running causes cartilage to expand and contract with the natural movements created while running. This forces nutrients and oxygen into the cartilage cells. Without this, the cells will slowly die from oxygen depletion and starvation. Third, running strengthens the tendons and ligaments that support and stabilize joints. This prevents injury in the long-term. Overall, running greatly improves joints and prevents the onset of arthritis.

Building muscle, losing weight, and strengthening the heart are the health benefits that motivate people to start running. However, it is the unspoken benefits that keep them running. As a whole, runners have better sleep, improved mental states, and healthier joints. Many runners feel that they are taking responsibility for their health by running. They physically feel better, less stressed and they have peace of mind. This is a reward all in itself.

Bio: Charles spends much of his free time running. On the side he also runs an automotive company, where he purchases vehicles.

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USPSTF: Losing its Independence?

August 22, 2011 Dr. Pullen

Mammograms and death panels: why the Preventive Services Task Force keeps pulling its punches

Originally posted at Common Sense Family Doctor by Kenny Lin MD

Health reform was supposed to have been good news for the U.S. Preventive Services Task Force. Until 2009, this independent panel of federally-appointed experts in primary care and preventive health was not particularly well known, and its evaluations of the effectiveness of clinical preventive services had no binding authority on public or private insurance plans. Within the small circle of physicians and policymakers who were aware of the their work, however, the USPSTF won accolades and respect for “calling it as they saw it,” sticking strictly to the evidence and writing screening recommendations that frequently conflicted with more expansive guidelines promulgated by other professional organizations.

For example, the USPSTF differed from the Centers for Disease Control and Prevention in finding insufficient evidence to screen for hepatitis C, and only recommending HIV screening in high-risk patients (rather than universal screening between the ages of 13 and 64). Unlike the American Diabetes Association, which endorses testing for diabetes in all patients age 45 or older, the USPSTF found that the evidence supported screening only patients with high blood pressure. The Task Force clashed with the American Academy of Opthalmology in finding insufficient evidence to support routinely screening adults for glaucoma. And it checked the pharmaceutical company-supported enthusiasm for COPD screening by concluding that there was no benefit to routine spirometry in adults without respiratory symptoms.

A more politically-minded group (as federally-supported guideline committees tend to be) would probably have been unable to make such a series of controversial statements without stirring up a public backlash. But here, the USPSTF’s low profile served to protect it from the advocacy groups that dominate conversations about federal coverage for health care services. But in 2009, that all changed, as the Task Force was prominently featured in health reform legislation proposed in the U.S. House and the Senate. Ultimately, the Affordable Care Act mandated that USPSTF-endorsed (“A” and “B”) preventive services receive first-dollar coverage from Medicare and private health insurance plans.

Scrutiny of the USPSTF quickly intensified, especially after it issued a politically-radioactive new statement that stepped back from recommending routine mammography for women in their 40s. It was tagged as a “death panel” that, in the words of one spectacularly misinformed newspaper columnist, had “gone rogue”and ought to be immediately dissolved. (Not coincidentally, there is a Roger Maris-sized asterisk in the ACA’s list of USPSTF “A” and “B” services that basically directs insurers to disregard the USPSTF’s 2009 breast cancer recommendations and instead rely on the 2002 version.) With the Task Force literally fighting for its very survival, it was perhaps inevitable that politics would begin trumping science - which goes a long way toward explaining why members were willing to meekly go along with the absurd cover story that their November 2010 meeting was cancelled due to “scheduling conflicts.”

In the 17 months since the passage of health reform, the USPSTF has been only a shadow of its independent self. After publishing an average of one new statement per month for most of my tenure on their staff (2006-2010), a public comment process imposed by the Agency for Healthcare Research and Quality turned into a bottleneck for releasing timely, evidence-based recommendations. None of the 4 new statements that have successfully traversed the public comment process has been particularly noteworthy.Osteoporosis: a modest expansion of screening to more high-risk women under the age of 65. Testicular cancer: a reaffirmation of the near-universal consensus that screening is not necessary.Prevention of newborn gonorrhea eye infections: affirming the standard of care. And earlier this week, the USPSTF retreated from its previous recommendation against screening for bladder cancer was not warranted, instead finding insufficient evidence to make a statement one way or the other.

Of course, a Task Force that makes few waves is exactly what the current Administration wants. Never mind that clinicians and patients must continue to wait for long-overdue updates on screening for prostate cancer, screening for oral cancer, breast cancer chemoprevention, and vitamin D and calcium supplements. (All of these topics had already been voted by the Task Force and were within months of publication in March 2010 but have been subsequently delayed, postponed, or suppressed from entering the public comment queue.) How long can this state of affairs reasonably continue? As the 2012 elections draw nearer, how likely is it that the USPSTF will be permitted to advance any science with even remotely political implications? And – though it pains me to ask – is a Task Force that is forced to pull its punches due to politics really that much better than no Task Force at all? I think possibly not. Leave a comment to let me know your thoughts on this topic please.

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