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Although I made it through another Black Friday without spending a penny (due more to an aversion to shopping than any principled stand against the degradation of holidays with naked consumerism) I have not been immune to the relentless marketing of “goodies” via email and social media.  Electronics are always pushed especially hard and have great appeal. Cell phones, tablets, computers and game consoles can be functional (tools for communication, resources for information) and fun (games, social media, movies, on demand TV). But it comes at a price that goes beyond their substantial dollar costs.

Our overuse of “devices” is impacting our health.  Studies have shown that with increasing screen time comes higher rates of depression, obesity, poor sleep quality, decreased physical activity and decreased socialization.  And our children mimic our behaviors.  Children do not have a natural ability to manipulate digital devices or any inherent interest in them, but they do have a powerful drive to emulate the behavior of the adults in their lives, and when they see parents and others spending much of their time staring at one screen or another they are quick to pick up on the behavior.  Children who spend more time with TV, electronic games, smart phones and other screens are less physically active and have a higher risk of obesity, behavior problems, ADHD, poor sleep, and poor school performance.  And the average child spends 7 hours a day focused on one screen or another.

It is alarming to note that studies have shown that heavy use of the internet is associated with:

  • shrinkage (called atrophy) of the gray matter of the brain in the areas involved with organizing, planning and impulse control
  • degradation of white matter, which allows for communication between different parts of our brain and helps us to balance emotional responses with reason
  • thinning of the cortex of the brain and decreased ability to perform cognitive tasks and a heightened sensitivity to rewards and an insensitivity to losses
  • changes in dopamine systems that mimic addiction so that heavy users may crave access to  screen time when they cannot have it

For adults these dynamics can be annoying to others but also substantial impairments to personal, social and work success.  Their impact on children can be profound as the changes in a developing brain (and brain development continues into our early 20s) may be permanent.

So here are a few straightforward strategies to balance the value and fun of screen time with the need for real human engagement and physical activity:

  • Put your own devices away and spend quality time with the children in your life.  This time should include physical activity, conversation, shared experiences and lots and lots of eye contact (one study has shown that the more time parents spend on devices the more risky their child’s behavior came – an attention gaining strategy!).  You’ll feel better too.
  • Limit your screen time and your children’s screen time.  1 hour a day for all screens, including TV, is the recommendation for children.
  • Remove TVs from the bedroom.  TV at bedtime impairs sleep and leads to behavioral problems in children.
  • Ban electronics from the dinner table and have a conversation!
  • Set aside time dedicated to physical activity, for you and for your children.

It feels good to unplug and it is unlikely that you’ll regret foregoing screen time in favor of time spent with family, friends, your children or even a good book.

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With all of the justifiable attention to the challenge of opioid (heroin and prescription narcotic) addiction in our state it is easy to lose sight of the harm that results from the unsafe use of alcohol. Here are some facts about alcohol use in our society:

  • 1 in 4 high school students in Maine reports drinking alcohol in the last month and 1 in 6 reports binge drinking.
  • 4 in 10 people aged 18 to 25 report binge drinking in the prior month.
  • In 2013 there were 1203 alcohol related car crashes in Maine.
  • 41% of EMS responses for overdose are related to alcohol.
  • 50% of Americans age 12 and over report being current drinkers (that’s 135,000,000 people using alcohol).
  • There are 60,000,000 Americans who are binge drinkers and there are 17,000,000 heavy drinkers.
  • Only 1 in 6 people with problem drinking talk to their doctor or health care provider about it.

Most people are familiar with many of the complications of heavy alcohol use – intoxication, impaired judgment and accidents from binge drinking. Most of us are aware of the harm to work, family, and social ties that can arise from the chronic regular use of alcohol. Fewer people understand all of the potential health consequences of problem drinking. These include damage to the liver and liver failure (cirrhosis), pancreatitis, gall stones, osteoporosis, high blood pressure, vitamin deficiency, anemia, atrial fibrillation, birth defects, and an increased risk of heart disease, stroke, dementia, kidney disease, depression, suicide and diabetes. Few people realize that alcohol is a carcinogen. Women who drink even modest amounts of alcohol have a higher risk of breast cancer than those who do not drink, and regular use of alcohol increases the risk of cancer of the mouth, esophagus, stomach and colon, cancer of the liver, pancreatic cancer and lung cancer.

Alcoholism (also called Alcohol Use Disorder ) is diagnosed by meeting 2 or more of a list of symptoms or behaviors, which can be found here: http://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/alcohol-use-disorders The more of these a person has, the more severe the alcohol use disorder, and about 7% of our adult citizens (17 million people) have Alcohol Use Disorder. Alcohol Use Disorder runs in families and there are people who are genetically more at risk. It is also more common in people with other mental health problems.

A much larger number of people (as many as 30% of adults) have what is called “At Risk” use of alcohol – that is they may not have yet experienced social or medical complications of their alcohol use but are at risk for developing those complications. More importantly, with education and support they have a chance to reduce their alcohol use to safer levels. Thus, it becomes important that we find ways of identifying people with “at risk” or problem drinking and offer them the information and resources they need to be safer and healthier. Fortunately there are tools we can use to help in that work. It is likely that primary care providers will be doing more routine screening for “at risk” use of alcohol as part of normal history taking with patients, and each of us can also do our own test, for ourselves, our friends and our family. In adults a very helpful screen is the Alcohol Use Disorders Identification Test (AUDIT). An easy to use version which calculates and helps you to interpret your score can be found here: http://www.markjayalcoholdetox.co.uk/audit.php. This questionnaire asks about your frequency of drinking, the amounts you drink, binge drinking and potential serious consequences of your drinking. It’s quick and easy and if you score greater than 8, your drinking is putting you at risk and by reducing the amount you drink you can reduce those risks. If you score over 20 you are likely already suffering harm from alcohol and should do all that you can to cut back, including talking to your primary care provider. Education, counseling and peer support can help and there are medications which can improve your chances of reducing your alcohol use.

For more information and to learn what is being done here in Maine I suggest the following links:

http://www.lunderdineen.org/alcohol-use-time-ask

http://www.niaaa.nih.gov/alcohol-health

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Earlier this year I suffered a fairly significant episode of low back pain due to a herniated disc.  Yes, I overdid it and I did not lift that air conditioner as carefully as I might have, so I accept full blame.  That didn’t make it any better when the spasms set in in the middle of the night! This was my most severe episode of back pain, but like almost all adults, I’ve had other episodes during my life, so this is a subject on which I write with true empathy.

So some important things you should know about low back pain:

  • It is very common. In fact it is the second most common reason people seek care with a doctor or other healthcare provider.
  • It is almost never serious, although serious conditions, like significant illness or cancer, can cause back pain. The vast majority of cases are straightforward and are related to muscle strain or spasm, or as in my recent case, a herniated disc.
  • Acute low back pain usually gets better on its own. Although the pain can be severe and debilitating, it is usually temporary and more than 90% of cases resolve by 6 weeks. When back pain becomes chronic (lasting more than 12 weeks) it can be more complicated to treat and can interfere with important functions of daily living. It is critical to understand that narcotic pain medicines have no role in treating chronic back pain, and if you have been started on them for acute low back pain, after a few weeks it is time to look at other therapies (a topic for another blog).
  • Treatment for acute low back pain is pretty straightforward. Stretching, physical therapy, chiropractic therapy, cold and heat therapy, massage and acupuncture can all help. Improving your posture, strengthening your core (especially your abdominal muscles), a healthy diet, weight loss, stress management, smoking cessation and good sleep habits can all contribute to a more speedy recovery.
  • Most of the time X Rays are not necessary. It’s even less frequent to need a CT scan or MRI. These tests are typically reserved for pain that lasts more than 6 weeks or in instances when symptoms or physical findings indicate a more serious cause of the pain.
  • There are warning signs of more serious disease. Fever, weight loss, other persistent symptoms, worsening pain after a few days, weakness in your legs or a loss of sensation should be evaluated by your primary care provider. If you have other serious medical conditions like diabetes or osteoporosis, or if you take prednisone or other medicines that suppress your immune system you should seek attention early on.
  • Surgery is seldom the answer. I wish I had a dollar for every patient I have seen who has had back surgery and continues to have pain. This isn’t because of poor surgeons or poor techniques. Rather, abnormal findings on a test like an MRI are very common as we age and may or not be the cause of a person’s back pain. Even most herniated discs will get better without surgery (mine did).
  • Most importantly, staying active, maintaining a healthy weight and a healthy lifestyle, using good back mechanics and exercising good judgment can help prevent back problems in the first place.

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Summer is here and after the winter of 2015 we rightly expect to take advantage of as many opportunities as possible to enjoy the warm weather and the beauty of our lakes, rivers, seashore and woods.  Most of the time in summertime in Maine, we are blessed with comfortably warm days and comfortably cool nights.  But there are days when the heat can become a risk and that risk can be elevated for susceptible people.

Children can get a heat rash (called Miliaria) which can cause itching or a burning sensation.  It usually resolves once the skin is cooled, either by moving to a cooler room or applying cool compresses or taking a cool bath.  Young children are especially susceptible to the very high temperatures that occur very quickly in a car left in the sun.  This is a very unsafe environment for children and they simply should never be left in a car in the heat.

Older people can develop edema, or swelling, in their hands and feet as a result of heat exposure, and exposure to heat can also cause fainting in susceptible people (called heat syncope).  The elderly, those with chronic illness, or people on certain fluid medicines or blood pressure medicines can be more prone to this problem.  This can occur while the body temperature remains normal, and treatment consists of moving to a cooler area, lying down and elevating the legs.

Heat cramps can occur in the legs, arms and abdomen and can be very painful.  Again some people are more susceptible than others, and stretching and moving to a cooler environment can help.  I experienced this phenomenon one time on a long bike rife in high heat and humidity and it is very unpleasant!  Less commonly a syndrome called heat tetany can occur.  It results from hyperventilation due to heat, a change in acid/base balance in the body and resulting symptoms like spasms of the hands and feet and tingling around the mouth.  A quiet, calm and cool environment can help, but the temperature should be checked and if it is elevated medical attention should be sought immediately.

Heat exhaustion occurs in people with heat exposure and an elevated temperature (up to 104 F) and includes symptoms like a rapid heart rate, sweating, nausea, vomiting, headache, weakness, fainting, profound thirst and confusion.  This is a potential emergency and medical evaluation should be an immediate priority.  Often the body’s electrolytes (sodium, potassium, etc.) are normal but they can be abnormally low.  Treatment can consist of cooling and drinking fluids like sports drinks, or IV fluids may be necessary.  Children, the elderly and people with chronic diseases are particularly susceptible.

Heat stroke occurs with heat exposure when the body core temperature exceeds 104 F and there is confusion or altered mental status.  In some instances the person affected by heat stroke will stop sweating  When heat stroke does not involve exertion it is most common in children who are either unable to exit  a very hot environment (for example, the parked car) or who have illnesses or are on medications (some meds for ADHD) which make them susceptible.  When heat stroke is related to exertion it tends to occur in young adults involved in heavy exertion (work or athletic events or military training) in conditions of high heat and humidity.  When relative humidity exceeds 75% our body’s self-regulation fails to adapt fully in most circumstances (because our perspiration won’t evaporate rapidly enough).  Heat stroke is a life threatening medical emergency and aggressive treatment with cooling, fluids, some medications and other interventions require hospitalization.

All of these problems are best approached by a a carefully planned approach to prevent the problems in the first place.

  • If you are not used to hot temperatures allow yourself to gradually adjust to them through limited exposure and exertion at first.
  • Restrict your activity in high heat or in high heat and humidity to that which you can comfortably accomplish.
  • Sporting events should be curtailed in high risk situations.
  • Hydration breaks during active times are important.  Rest and fluids can be very effective.  Interestingly, sport drinks are more likely to lead to adequate hydration than water, simply because people are more likely to drink more of them.
  • Light, loose fitting, lightly colored, absorbent clothing is very helpful.

Here’s wishing you all a safe, enjoyable and comfortably warm summer!

 

 

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Summer is here and in addition to all that we enjoy about this time of year, it is also the season when insects reappear. Some are nuisances (black flies!), some help control nuisances (dragon flies!) and still others carry disease which can profoundly impact our wellbeing. The common deer tick (ixodes scapularis) carries the bacterium (borrelia burgdorferi) which causes Lyme Disease in humans. Here is a link to images of the Lyme tick and some other common ticks (which do not transmit Lyme Disease): http://www.cdc.gov/ticks/life_cycle_and_hosts.html

There are some simple steps you can take to reduce your risk of contracting Lyme Disease.

  1. Know when you are at risk. These ticks reside in wooded areas, leaf piles and tall grass. When you are in these areas wear long pants, long sleeves, and socks. It’s even better if you tuck your pants into your socks.
  2. Reduce the risk in your own back yard. Create a barrier to the ticks by keeping your lawn mowed, remove leaf piles and build a border of gravel or mulch between your yard and woods or long grass.
  3. Use insect repellent. The chemical diethylytoulamide, or DEET, is an effective tick repellent and is found in many commercial insect repellents. It does not have to be 100% DEET, and can be sprayed on clothing and skin. Permethrin powder can also be applied to clothing to ward off ticks.
  4. Better check yourself. When you have been in an area where ticks may live, check yourself and your children carefully for ticks. Have someone else look at your scalp and back to make sure that you haven’t missed any. Bathing after spending time in tick prone areas can also help to reduce risk.       Ticks need to stay on your skin for at least 24 hours to transmit Lyme Disease so early detection and removal can be crucial. Most disease is transmitted when ticks have been on your skin for more than 48 hours.
  5. Properly remove any ticks that you find. This is best accomplished by using tweezers to grasp the tick as close to your skin surface as possible and gently but steadily pull straight up. If bits of the tick remain do not try to “dig them out”. Your immune system will extrude them with time. Once the tick is removed wash the bite area thoroughly with soap and water.
  6. If you have had a tick on you talk to your primary care provider. If the tick was on you for more than 36 hours you may choose to take antibiotics to prevent Lyme Disease, but you can also choose watchful waiting, and treatment if a rash or other symptoms appear. Both options are reasonable and relatively safe. The use of antibiotics to prevent disease does not have to be a long course (in fact , a single dose is recommended). If the classic “bulls eye” rash or other early symptoms appear, treatment may last for 10 days to 3 weeks. Here is a link to view the classic rash of Lyme Disease, called erythema migrans, but it does not occur in every case: http://en.wikipedia.org/wiki/Erythema_chronicum_migrans
  7. If it is possible save the tick in a zip lock bag for your primary care provider to see. It is uncommon now to have to send a tick for identification since most providers are adept at distinguishing between Lyme ticks and the common wood tick. However, it may be necessary in some instances.

There is a great deal of controversy about Lyme Disease and much of the discussion has led to unnecessary fear. The simple steps I’ve outlined are not controversial and can help us all enjoy a happy and safe summer.

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For better or worse I normally I like to fill this blog with my own thoughts on health care related topics.  However, once in a while I see something that is so well done that I think it is important to share it here – this month is one of those instances.  What follows is largely summarized from a Cleveland Clinic patient information page, which I highly recommend.  You can most easily access it by “liking” the Cleveland Clinic on Facebook, or go to health.clevelandclinic.org. First, let’s remember that over 100 million people in the US suffer with chronic pain.  Second, you should know that the National Institute of Health (NIH) estimates that over 70% of people with chronic pain receive improper treatment.  And finally, it’s critical that we all understand that there is no evidence that narcotic pain medications are effective in treating chronic pain and there is very significant evidence of the harm these medicines inflict on individuals, on their families and on our communities.

Here are some home based treatments which actually do work in helping people cope better with chronic pain and achieve a higher level of functioning:

  • Deep breathing – slowing your breathing intentionally while taking deep cleansing breaths can help you relax and allow you to lessen your discomfort.
  • Get some sleep – restful sleep is critical to our body’s restorative process and allows us to cope with all kinds of stress, including pain, during the day.  Sleep medicines cause sedation but do not induce restful sleep, so they are not the answer.  A concept called sleep hygiene (ordering your exercise, nutrition, evening habits and sleep environment to maximize sleep) is effective, free and not that difficult, yet few people commit to it.
  • Exercise – Even though you have pain there is almost always a way to make regular exercise part of your life.  Stretching, strengthening and aerobics all help and the better your muscle tone the better your body can protect itself from painful movement.  Exercise also releases natural chemicals which reduce pain and increase our sense of wellness.
  • Work on your smoking habit – tobacco products increase sensitivity to pain and reduce circulation, along with the myriad other deleterious health effects you already know about.
  • Practice “mindfulness” – rather than ignoring or cursing your pain, acknowledging it, observing it and being conscious of how it effects your movement, your breathing, and your attitude and emotions actually helps you to tolerate it better.  There are many mindfulness coaches who can help with this, and there also on line resources.
  • Eat a whole-food, plant based diet – whole grains, vegetables, legumes and fruits have anti-inflammatory effects and can reduce pain in joints and muscles (including your back!), while processed meat, red meat, sugar, white bread and pasta have the opposite impact.
  • Yoga – it works.  Period.  Really.  And beginner poses are easily found online.  Try it!
  • Enjoy your hobbies – make a point of doing the things that bring you pleasure.  It reduces stress and improves health.  For me it’s visiting with my granddaughter and biking, and I can’t wait to combine the two!
  • Engage in social activities – people with chronic pain can lean toward isolation, and many of the medications commonly used to treat pain also cause social withdrawal.  Regular activity with other people helps to reduce anxiety and pain.

I hope you’ll consider these simple, safe and effective strategies for yourself or a loved one suffering with chronic pain.  It can be better!

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The beginning of April always brings to mind the usual jokes and the relentless, unsuccessful attempts my family always made to pull off successful pranks in recognition of this unofficial holiday. I guess we were just not that imaginative. In healthcare there has always been great creativity applied in attempts to prevent disease and to cure common ailments, some of which require great imagining. So in our own celebration of April Fool’s Day here are some updated medical myths from the University of Arkansas for Medical Sciences, a place which has committed great energy to lampooning unsubstantiated claims in healthcare.

  • “Base tans” protect you from sunburns – FALSE. This commonly practice preventive measure only offers the equivalent of SPF 1 to 4, essentially no protection at all. Add to that the fact that the base tanning is also damaging your skin and increasing the risk of skin cancer and it is totally impractical.
  • “The five second rule” protects you from contamination when you drop food – FALSE. If the surface which the food contacts is contaminated even rinsing the food may not help. Discarding it is the safest approach.
  • You can sweat toxins out of your body – FALSE. Although sweat lodges are sometimes parts of purification ceremonies in Native American culture, sweating actually removes no toxins. Toxins are removed by your kidneys, liver and GI system.
  • Flip Flops are bad for your feet – PARTIALLY TRUE. If you have normal feet with no deformities then wearing flip-flops is equivalent to walking barefoot. But if you have flat feet, poor balance, loss of sensation their lack of protection and the change in gait that they engender (shorter more shuffling steps) and their tendency to skid on wet surfaces can cause pain and injury.
  • Honey is helpful in treating allergies – FALSE. Because honey is natural many people feel that it has added benefit over other sweeteners. That is not true, and the pollen in honey is not the same as that which can cause allergies in adults. It tastes great but has no known therapeutic benefit. By the way, one of my favorite pieces of trivia is that honey is the only kosher food that comes from a non-kosher animal.
  • It is dangerous to wake a sleepwalker – FALSE. Waking a sleep walker will not put them in any danger or cause any harm. The best approach is simply to guide a sleepwalker back to their bed (adults rarely sleepwalk – it is mainly experienced by children).
  • Taking fish oil is good for your heart – FALSE. This is a big one and there is actually no evidence of benefit.
  • Wearing a copper bracelet can cure arthritis – FALSE. The whole premise of a copper deficiency (which is exceedingly rare) causing joint problems is problematic, very little copper is absorbed through the skin, and no studies have ever shown benefit.
  • And finally, cold, wet weather causes colds – FALSE. It is staying indoors more that causes colds to be spread. It is possibly that the drier air in winter allows viruses to survive longer on surfaces and this may contribute as well.

If you’re interested in medical myth busting much more is available at www.uamshealth.com/medicalmyths. Happy Springtime!

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Memory loss and dementia are among the healthcare problems that people fear the most. They are also among those that create the most significant challenges for families and caregivers, and often without the supports or resources to respond as fully as we would like. But knowledge is power and the more we understand the problem, the better prepared we will be to deal with it. So here are some basics.

What is dementia?

Most simply, it describes difficulty with reason, judgment, and memory. There are normal, age related changes that are not dementia (for example, occasionally forgetting a name or an appointment, requiring assistance with new technology, misplacing things) but it’s important to recognize when the problem may be more significant. There are 10 warning signs that can help you to know whether a memory problem or other intellectual decline should cause concern:

  1. Memory loss that disrupts daily life.
  2. Challenges in planning, or in solving problems.
  3. Difficulty completing familiar tasks.
  4. Confusion with time or place.
  5. Trouble understanding visual images.
  6. New problems with words in speaking or writing.
  7. Misplacing things and being unable to retrace steps.
  8. Poor judgment.
  9. Social withdrawal.
  10. Changes in mood or personality.

What causes dementia?

Alzheimer disease accounts for 60 to 80% of dementia. We know that this involves deposits of a substance called beta amyloids (known as plaques) in brain cells, and that there are also disordered protein fibers called neurofibrillary tangles. We do not know what causes these changes and we do not yet have effective treatment. There are medicines which can lead to minor and temporary improvements but they have significant potential side effects as well.

Other causes of dementia include poor circulation to the brain, Lewy Body Dementia, caused by another abnormal protein structure and often associated with symptoms of Parkinson’s Disease and with vivid hallucinations, Parkinson disease itself, and Pick’s Disease, usually occurring at an earlier age and often with speech and language impairment. Alcohol and repeated brain injuries can also lead to dementia. And it is always important to consider whether any medications a person is taking could be causing side effects which contribute to these symptoms.

Who is at risk for dementia?

The risk increases with aging. Dementia is rare before age 50 and common after age 80. Alzheimer disease tends to run in families, and a person with a parent or sibling with Alzheimers may have a 10 to 30% risk of developing it themselves. The family risk is higher if it developed at an earlier age. High blood pressure, smoking, and diabetes may play a role, particularly in the damage they cause to blood vessels.

What can I do?

It appears that staying physically active, socially connected and mentally engaged reduces the risk of dementia. Also, being alert to the symptoms and seeking evaluation early may be important.

www.alz.org has some very important resources, including a checklist for preparing for a visit with your doctor or primary care provider. It includes writing down details about changes in memory, prompts to identify important changes in memory and intellectual function, medication lists and questions to ask your doctor. It can be found here: http://www.alz.org/documents/national/ed_doc_checklist.pdf

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“Open Enrollment” for 2015, which is the time when you can sign up for health insurance and, if you qualify, get subsidy for the premiums, ends on February 15. With that deadline fast approaching you may want to consider the reasons you should consider getting coverage.

  1. You won’t have an opportunity to enroll after February 15. Many people believe that they can enroll once they may have a need for insurance, and while that may sometimes be the case, there is almost always a delay during which you remain uncovered and responsible for all costs incurred.
  2. You can protect yourself from financial devastation. Like car insurance, health insurance covers costs most of us could not possibly afford, and gambling on continued good health can result in huge financial losses. An unexpected illness or accident can lead to hundreds of thousands if dollars in expenses. This is one of the most common reasons that people have to file for bankruptcy.
  3. You can gain access to primary care and preventive care. Under the Affordable Care Act annual physical exams and important preventive care, such as age appropriate cancer screenings, are free, even if you have not yet met your deductible. And as primary care transforms to a more comprehensive approach, which often includes mental health services, oral health and care management, you can gain access to these important resources. This also assures access to appropriate follow up care if you do have an unexpected healthcare need.
  4. You may qualify for a subsidy! People who are not offered affordable health insurance through their employer qualify for subsidy if they earn between 100% and 250% of federal poverty level (FPL). For example, for a family of 4 this is an income range of $23,850 to $59,625. So if you are a family of 3 with one child and two adults, each 30 years old and neither of whom smokes, with a household income of $35,000, you could get a silver plan (very good coverage) for $154 per month (normal cost would be $776 per month). The FPL numbers can be found here: http://obamacarefacts.com/federal-poverty-level/ and this is a very helpful premium calculator from the Kaiser Family Foundation: http://kff.org/interactive/subsidy-calculator/
  5. There are options. If you are young and healthy and don’t qualify for subsidy, you may choose a catastrophic plan, to protect against devastating unexpected costs. There are also bronze plans, with higher deductibles in exchange for lower premiums.
  6. There is help! At PCHC we have Outreach and Enrollment specialists, whose sole job is to help you work through your options and choose the coverage that is right for you. You don’t have to be a PCHC patient – you can call 404-8080 to get more information. Additional help can be found at www.enroll207.com and at www.healthcare.gov .

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Well, it’s that time of year, isn’t it? An opportunity for a fresh start with a fresh year and many of us make resolutions aimed at our health and wellbeing. Our good intentions don’t always translate into sustained action, but perhaps prioritizing our health goals would help. What follows is based on a Facebook post from the Cleveland Clinic – I have listed the suggestions for healthy living in what I consider to be their order of importance and added comments on evidence behind the recommendations.

  1. If you smoke bend all of your will to quitting. There is no more impactful change you can make. On average smokers lose 10 years of life expectancy, largely due to heart and lung disease, a variety of cancers, stroke and inactivity. It often helps to think about or even list the reasons why you would like to quit smoking and to list the things that are preventing you from succeeding. It also helps to think about how ready you are to quit. If you have tried without success previously, keep at it! Most people who quit for good have tried multiple times before they kick the habit. And the day you quit your health can start to improve and the damage from smoking begins to reverse itself.
  2. Get moving. I have been impressed throughout my career that the seniors who are the happiest are those who have stayed physically active. I am not talking about running marathons or power lifting. Regular exercise (as in daily) for relatively short periods of time (as little as 30 minutes and it can be split up) has benefit for your heart, lungs, muscles and bones, and for your sense of wellbeing. Remember that it is good to push yourself – the harder the exercise the more benefit. But this should be done within reason and relative to the point from which you’re starting. Walking, exercise equipment, strength exercises, Yoga, Tai Chi, biking, whatever you enjoy is great. And remember that flexibility matters too!
  3. Eat well. A proper diet is critical to health and the majority of Americans tend to eat in very unhealthy ways. Avoid saturated fats, refined carbohydrates and sugars, trans fats, fast food and highly processed foods. In addition to contributing to high cholesterol, heart disease and vascular disease these foods cause inflammation in your body, which has all kinds of negative effects. On the other hand fruits, vegetables, grains, nuts, legumes and fish oils all reduce inflammation. Herbs and natural spices do as well, and they taste better!
  4. Get some sleep. Poor sleep contributes to inflammation and to a variety of chronic diseases. Good sleep is critical to natural restorative processes and to maintaining good physical and mental health. The chronic use of prescription medication is NOT the answer for sleep problems. These medicines do not increase restorative sleep and they cause all kinds of issues including falls, daytime drowsiness, depression, dependence and addiction. Diet plays a key role; more complex carbohydrates, lean protein, and unsaturated fats can help, as can exercise, yoga and good “sleep hygiene” (Google it!).
  5. Know your blood pressure and check it a few times a year, more often if you are being treated for high blood pressure. Home BP kits work pretty well and you may be able to use a friend or relative’s equipment. Or stop by your doctor’s office and ask for a BP check. Normal BP is below 140/90. High blood pressure contributes to heart disease, stroke, vascular disease and kidney disease and can usually be treated easily and effectively.
  6. Know your risk of heart disease. I think this is far more important than just knowing your cholesterol levels. Indeed, it helps you to make informed decisions about whether medicines for high cholesterol are likely to help you (“possibly” if you have a personal history of heart disease, “possibly” if you are at high risk for heart disease, “unlikely” if your risk is low). Here is a heart disease risk calculator: http://cvdrisk.nhlbi.nih.gov/
  7. Get to and maintain a healthy weight. Note that this is 7th on my list. I don’t want to minimize the importance of a healthy weight and if you are significantly overweight this goal should move up the list. But exercise, good sleep and a healthy diet all contribute to weight loss and for people who are mildly or modestly overweight but not obese these other six priorities are more important.

Best of luck in meeting your goals for the new year and happy 2015 to all!