http://community.myhealthvillage.com/service/getFeed.kickAction?quantity=25 New blogs from Jan_Swaney_MD on myhealthvillage Thu, 11 Jun 2009 19:07:02 GMT Thu, 11 Jun 2009 19:07:02 GMT info@longitudehealth.com (webmasterMHV) info@longitudehealth.com (webmasterMHV) KickApps Feed Builder 2009-06-11T19:07:02Z 15 http://community.myhealthvillage.com/service/searchEverything.kickAction?as=43145&sortType=recent 0 http://community.myhealthvillage.com/_Is-your-diet-soda-safe/BLOG/344759/43145.html I’m getting a fizzy discomfort in my stomach about the potential negative health effects of diet soft drinks.  That’s right – those seemingly harmless, artifically sweetened knock-offs that become the drinks of choice for many people fighting the battle of the bulge.  Afterall, aren’t diet drinks a healthier alternative than regular sodas that are loaded with calories from high fructose corn syrup?  The answer to this is a resounding “probably."  But it turns-out that they may not be risk free.Enter the epidemiologists, whose elegant analyses can tease-out relationships that help launch new lines of investigation about cause and effect, and for whom we have much to thank in contemporary medicine.  They are the sleuths who first showed us that cigarette smoking causes lung cancer, high cholesterol poses a risk for heart disease, and maternal folate deficiency leads to birth defects.Three independent epidemiologic studies have recently found an association between the consumption of diet drinks and heightened risk for the development of obesity and the metabolic syndrome, conditions that are often a precursor to cardiovascular diseases such as heart attack and stroke.Each of these studies was a longitudinal study of a population cohort – meaning that the investigators collected a lot of information about participants at the outset and over a period of years, while oberving the relationships that emerged between certain  exposures (like to nutritional components including diet sodas) and subsequent health outcomes (like obesity and/or the metabolic syndrome.)  Collectively, these three studies include analysis of about 17,000 participants including those in the Framingham Study of residents from Framingham, Massachusettes; the Multi-Ethnic Study of Atherosclerosis (MESA) following adults from 6 major cities across the US; and the San Antonio Heart Study, which followed adults in San Antonio for over 10 years.In the Framingham study, both regular and diet soft drinks appeared to pose similar metabolic hazards for the development of metabolic syndrome, which flies in the face of conventional wisdom implicating high fructose corn syrup and insulin resistance as the sole mechanism leading to weight gain, high blood pressure, high triglycerides, and low HDL.  But wait, you say.  What about other variables that haven’t been taken into consideration?  Perhaps people who drink diet sodas are doing so to compensate for poorer dietary choices.  Not according to their food diaries – in fact, they tended to make better choices (eat more whole grains, vegetables and consume less fat) than those who drink sweetened soft drinks.  Well, what if they had more baseline obesity and that’s why they were drinking diet sodas?  Not so – researchers controlled for levels of obesity and the occurrence of metabolic syndrome at the outset.  And the team in San Antonio found the equivalent of an epidemiologist’s “smoking gun” when they uncovered a classic dose-response relationship between diet drinks and obesity, meaning that a linear relationship was seen and those with higher exposure to diet drinks had a greater likelihood for obesity.What could possibly serve as a biologic explanation for these findings?  Does the caramel content of both regular and diet drinks result in more advanced glycation end products, leading to insulin resistance and inflammation? Do artificial sweeteners, which are several hundreds or thousands times sweeter than sugar, lead to taste distortion and increased appetite for intensely sweet, high caloric foods?  Aspartame in rodents damages a portion of the brain involved in leptin signaling that reduces food intake.  A recent study by neurobiologists at Purdue showed tha rats, who guage a food’s caloric content by relying on its sweetness and viscosity, lost the ability to self-regulate consumption and overate when chronically exposed to artificially sweetened drinks.Years of watching medical debates evolve while research findings ebb and flow tells me that it’ll be a decade or more before this gets settled.  Meanwhile, we have lives to live and decisions to make.  I gave-up diet sodas about a year ago and drink more water, unsweetened tea, and skim milk.  I don’t miss the fizzy drinks or my contribution to our enormous pile of plastic and alumnium packaging, to boot! Jan   Dhingra R, Sullivan L, et al.  Soft drink consumption and risk of developing cardiometabolic risk  factors and the metaboic syndrome in middle-aged adults in the community.  Circulation 116:480-488,2007.Fowler SP, Williams K, et al.  Fueling the obesity epidemic?  Artificially sweetened beverage use and long-term weight gain.  Obesity 16:1894-1900, 2008. Nettleton JA, Lutsey PL, et al. Diet soda intake and risk of incident metabolic syndrome and type 2 diabetes in the multi-ethnic study of atherosclerosis.  Diabetes Care 32:688-694, 2009.Swithers Susan E, Davidson Terry L.  A role for sweet taste: calorie predictive relations in energy regulation in rats.  Behavioral Neuroscience 122:161-173, 2008.  I’m getting a fizzy discomfort in my stomach about the potential negative health effects of diet soft drinks.  That’s right – those seemingly harmless, artifically sweetened knock-offs that become the drinks of choice for many people fighting the battle of the bulge.  Afterall, aren’t diet drinks a healthier alternative than regular sodas that are loaded with calories from high fructose corn syrup?  The answer to this is a resounding “probably."  But it turns-out that they may not be risk free.Enter the epidemiologists, whose elegant analyses can tease-out relationships that help launch new lines of investigation about cause and effect, and for whom we have much to thank in contemporary medicine.  They are the sleuths who first showed us that cigarette smoking causes lung cancer, high cholesterol poses a risk for heart disease, and maternal folate deficiency leads to birth defects.Three independent epidemiologic studies have recently found an association between the consumption of diet drinks and heightened risk for the development of obesity and the metabolic syndrome, conditions that are often a precursor to cardiovascular diseases such as heart attack and stroke.Each of these studies was a longitudinal study of a population cohort – meaning that the investigators collected a lot of information about participants at the outset and over a period of years, while oberving the relationships that emerged between certain  exposures (like to nutritional components including diet sodas) and subsequent health outcomes (like obesity and/or the metabolic syndrome.)  Collectively, these three studies include analysis of about 17,000 participants including those in the Framingham Study of residents from Framingham, Massachusettes; the Multi-Ethnic Study of Atherosclerosis (MESA) following adults from 6 major cities across the US; and the San Antonio Heart Study, which followed adults in San Antonio for over 10 years.In the Framingham study, both regular and diet soft drinks appeared to pose similar metabolic hazards for the development of metabolic syndrome, which flies in the face of conventional wisdom implicating high fructose corn syrup and insulin resistance as the sole mechanism leading to weight gain, high blood pressure, high triglycerides, and low HDL.  But wait, you say.  What about other variables that haven’t been taken into consideration?  Perhaps people who drink diet sodas are doing so to compensate for poorer dietary choices.  Not according to their food diaries – in fact, they tended to make better choices (eat more whole grains, vegetables and consume less fat) than those who drink sweetened soft drinks.  Well, what if they had more baseline obesity and that’s why they were drinking diet sodas?  Not so – researchers controlled for levels of obesity and the occurrence of metabolic syndrome at the outset.  And the team in San Antonio found the equivalent of an epidemiologist’s “smoking gun” when they uncovered a classic dose-response relationship between diet drinks and obesity, meaning that a linear relationship was seen and those with higher exposure to diet drinks had a greater likelihood for obesity.What could possibly serve as a biologic explanation for these findings?  Does the caramel content of both regular and diet drinks result in more advanced glycation end products, leading to insulin resistance and inflammation? Do artificial sweeteners, which are several hundreds or thousands times sweeter than sugar, lead to taste distortion and increased appetite for intensely sweet, high caloric foods?  Aspartame in rodents damages a portion of the brain involved in leptin signaling that reduces food intake.  A recent study by neurobiologists at Purdue showed tha rats, who guage a food’s caloric content by relying on its sweetness and viscosity, lost the ability to self-regulate consumption and overate when chronically exposed to artificially sweetened drinks.Years of watching medical debates evolve while research findings ebb and flow tells me that it’ll be a decade or more before this gets settled.  Meanwhile, we have lives to live and decisions to make.  I gave-up diet sodas about a year ago and drink more water, unsweetened tea, and skim milk.  I don’t miss the fizzy drinks or my contribution to our enormous pile of plastic and alumnium packaging, to boot! Jan   Dhingra R, Sullivan L, et al.  Soft drink consumption and risk of developing cardiometabolic risk  factors and the metaboic syndrome in middle-aged adults in the community.  Circulation 116:480-488,2007.Fowler SP, Williams K, et al.  Fueling the obesity epidemic?  Artificially sweetened beverage use and long-term weight gain.  Obesity 16:1894-1900, 2008. Nettleton JA, Lutsey PL, et al. Diet soda intake and risk of incident metabolic syndrome and type 2 diabetes in the multi-ethnic study of atherosclerosis.  Diabetes Care 32:688-694, 2009.Swithers Susan E, Davidson Terry L.  A role for sweet taste: calorie predictive relations in energy regulation in rats.  Behavioral Neuroscience 122:161-173, 2008.  Thu, 11 Jun 2009 19:07:02 GMT http://community.myhealthvillage.com/_Is-your-diet-soda-safe/BLOG/344759/43145.html Jan_Swaney_MD 2009-06-11T19:07:02Z myhealthvillage I’m getting a fizzy discomfort in my stomach about the potential negative health effects of diet soft drinks.  That’s right – those seemingly harmless, artifically sweetened knock-offs that become the drinks of choice for many people fighting the battle of the bulge.  Afterall, aren’t diet drinks a healthier alternative than regular sodas that are loaded with calories from high fructose corn syrup?  The answer to this is a resounding “probably."  But it turns-out that they may not be risk free.Enter the epidemiologists, whose elegant analyses can tease-out relationships that help launch new lines of investigation about cause and effect, and for whom we have much to thank in contemporary medicine.  They are the sleuths who first showed us that cigarette smoking causes lung cancer, high cholesterol poses a risk for heart disease, and maternal folate deficiency leads to birth defects.Three independent epidemiologic studies have recently found an association between the consumption of diet drinks and heightened risk for the development of obesity and the metabolic syndrome, conditions that are often a precursor to cardiovascular diseases such as heart attack and stroke.Each of these studies was a longitudinal study of a population cohort – meaning that the investigators collected a lot of information about participants at the outset and over a period of years, while oberving the relationships that emerged between certain  exposures (like to nutritional components including diet sodas) and subsequent health outcomes (like obesity and/or the metabolic syndrome.)  Collectively, these three studies include analysis of about 17,000 participants including those in the Framingham Study of residents from Framingham, Massachusettes; the Multi-Ethnic Study of Atherosclerosis (MESA) following adults from 6 major cities across the US; and the San Antonio Heart Study, which followed adults in San Antonio for over 10 years.In the Framingham study, both regular and diet soft drinks appeared to pose similar metabolic hazards for the development of metabolic syndrome, which flies in the face of conventional wisdom implicating high fructose corn syrup and insulin resistance as the sole mechanism leading to weight gain, high blood pressure, high triglycerides, and low HDL.  But wait, you say.  What about other variables that haven’t been taken into consideration?  Perhaps people who drink diet sodas are doing so to compensate for poorer dietary choices.  Not according to their food diaries – in fact, they tended to make better choices (eat more whole grains, vegetables and consume less fat) than those who drink sweetened soft drinks.  Well, what if they had more baseline obesity and that’s why they were drinking diet sodas?  Not so – researchers controlled for levels of obesity and the occurrence of metabolic syndrome at the outset.  And the team in San Antonio found the equivalent of an epidemiologist’s “smoking gun” when they uncovered a classic dose-response relationship between diet drinks and obesity, meaning that a linear relationship was seen and those with higher exposure to diet drinks had a greater likelihood for obesity.What could possibly serve as a biologic explanation for these findings?  Does the caramel content of both regular and diet drinks result in more advanced glycation end products, leading to insulin resistance and inflammation? Do artificial sweeteners, which are several hundreds or thousands times sweeter than sugar, lead to taste distortion and increased appetite for intensely sweet, high caloric foods?  Aspartame in rodents damages a portion of the brain involved in leptin signaling that reduces food intake.  A recent study by neurobiologists at Purdue showed tha rats, who guage a food’s caloric content by relying on its sweetness and viscosity, lost the ability to self-regulate consumption and overate when chronically exposed to artificially sweetened drinks.Years of watching medical debates evolve while research findings ebb and flow tells me that it’ll be a decade or more before this gets settled.  Meanwhile, we have lives to live and decisions to make.  I gave-up diet sodas about a year ago and drink more water, unsweetened tea, and skim milk.  I don’t miss the fizzy drinks or my contribution to our enormous pile of plastic and alumnium packaging, to boot! Jan   Dhingra R, Sullivan L, et al.  Soft drink consumption and risk of developing cardiometabolic risk  factors and the metaboic syndrome in middle-aged adults in the community.  Circulation 116:480-488,2007.Fowler SP, Williams K, et al.  Fueling the obesity epidemic?  Artificially sweetened beverage use and long-term weight gain.  Obesity 16:1894-1900, 2008. Nettleton JA, Lutsey PL, et al. Diet soda intake and risk of incident metabolic syndrome and type 2 diabetes in the multi-ethnic study of atherosclerosis.  Diabetes Care 32:688-694, 2009.Swithers Susan E, Davidson Terry L.  A role for sweet taste: calorie predictive relations in energy regulation in rats.  Behavioral Neuroscience 122:161-173, 2008.  nonadult false Is your diet soda safe? text blog 319 11 5.0 http://community.myhealthvillage.com/service/displayKickPlace.kickAction?u=3398032&as=43145 http://media.kickstatic.com/kickapps/images/43145/photos/PHOTO_1656418_43145_3398032_ap_160X120.jpg false United States MO Columbia 65203 2 0 344759 3398032 Member 0 http://community.myhealthvillage.com/_Eat-Differently-Not-Less/BLOG/282636/43145.html Last week I was asked to distill information about how to eat a healthy diet into a few simple strategies.  I like Michael Pollan's succinct advice, "Eat food, not too much, mostly plants."  But in an attempt to be a little more explicit, here is my premise and advice.Though we are amid an obesity epidemic we can't (and won't) be successful trying to starve our way back to good health.  Americans need to learn to eat differently, not necessarily less.  I advocate that people first pay attention to the following EAT MORE list, and once they've learned to eat with abundance, begin to tackle label reading for the EAT LESS list.STAGE 1:·     No label-reading necessary for this EAT MORE list:o  more fruits and vegetables (8 to 10, 1/2 cup servings per day)o  more legumes (beans, lentils, dried peas) and whole grainso  breakfast every day. but make sure it includes something from the "eat more" category such as whole grains, dairy, and fruit.o  drink tap or filtered water to stay hydrated and keep your stomach full in order to cut cravingso  get 3-5 servings of low-fat dairy per day (skim milk, yogurt, low-fat cheese)STAGE 2:·     Become a label reader and EAT LESS of these:o  Avoid saturated fat -- for most people this means consuming no more than 10 to 15 grams of saturated fat per day.o  Avoid all trans fat (usually listed as a "partially hydrogenated oil" in the list of ingredients)o  Lower sodium in your diet to about 2300 mg/day.  Do this gradually (to retrain your taste buds) by avoiding processed foods - the ABCs - anything boxed, canned or cured - and choose fresh cuts of meats, vegetables or fruits.  Add flavor with the use of herbs, spices, garlic, vinegars, and salt substitutes.o  Don't drink empty calories.  Avoid drinks containing high fructose corn syrup like sodas and commercial "fruit" juices; women should have no more than 1 and men 2 alcoholic beverages per day.o  Be aware that even "diet" drinks may have harmful effects on your metabolism and aren't as healthy as they may seem.   Is this too simple?  Too complicated?  Too ambitious?  Let me know what you think! Jan Last week I was asked to distill information about how to eat a healthy diet into a few simple strategies.  I like Michael Pollan's succinct advice, "Eat food, not too much, mostly plants."  But in an attempt to be a little more explicit, here is my premise and advice.Though we are amid an obesity epidemic we can't (and won't) be successful trying to starve our way back to good health.  Americans need to learn to eat differently, not necessarily less.  I advocate that people first pay attention to the following EAT MORE list, and once they've learned to eat with abundance, begin to tackle label reading for the EAT LESS list.STAGE 1:·     No label-reading necessary for this EAT MORE list:o  more fruits and vegetables (8 to 10, 1/2 cup servings per day)o  more legumes (beans, lentils, dried peas) and whole grainso  breakfast every day. but make sure it includes something from the "eat more" category such as whole grains, dairy, and fruit.o  drink tap or filtered water to stay hydrated and keep your stomach full in order to cut cravingso  get 3-5 servings of low-fat dairy per day (skim milk, yogurt, low-fat cheese)STAGE 2:·     Become a label reader and EAT LESS of these:o  Avoid saturated fat -- for most people this means consuming no more than 10 to 15 grams of saturated fat per day.o  Avoid all trans fat (usually listed as a "partially hydrogenated oil" in the list of ingredients)o  Lower sodium in your diet to about 2300 mg/day.  Do this gradually (to retrain your taste buds) by avoiding processed foods - the ABCs - anything boxed, canned or cured - and choose fresh cuts of meats, vegetables or fruits.  Add flavor with the use of herbs, spices, garlic, vinegars, and salt substitutes.o  Don't drink empty calories.  Avoid drinks containing high fructose corn syrup like sodas and commercial "fruit" juices; women should have no more than 1 and men 2 alcoholic beverages per day.o  Be aware that even "diet" drinks may have harmful effects on your metabolism and aren't as healthy as they may seem.   Is this too simple?  Too complicated?  Too ambitious?  Let me know what you think! Jan Tue, 19 May 2009 18:40:49 GMT http://community.myhealthvillage.com/_Eat-Differently-Not-Less/BLOG/282636/43145.html Jan_Swaney_MD 2009-05-19T18:40:49Z myhealthvillage Last week I was asked to distill information about how to eat a healthy diet into a few simple strategies.  I like Michael Pollan's succinct advice, "Eat food, not too much, mostly plants."  But in an attempt to be a little more explicit, here is my premise and advice.Though we are amid an obesity epidemic we can't (and won't) be successful trying to starve our way back to good health.  Americans need to learn to eat differently, not necessarily less.  I advocate that people first pay attention to the following EAT MORE list, and once they've learned to eat with abundance, begin to tackle label reading for the EAT LESS list.STAGE 1:·     No label-reading necessary for this EAT MORE list:o  more fruits and vegetables (8 to 10, 1/2 cup servings per day)o  more legumes (beans, lentils, dried peas) and whole grainso  breakfast every day. but make sure it includes something from the "eat more" category such as whole grains, dairy, and fruit.o  drink tap or filtered water to stay hydrated and keep your stomach full in order to cut cravingso  get 3-5 servings of low-fat dairy per day (skim milk, yogurt, low-fat cheese)STAGE 2:·     Become a label reader and EAT LESS of these:o  Avoid saturated fat -- for most people this means consuming no more than 10 to 15 grams of saturated fat per day.o  Avoid all trans fat (usually listed as a "partially hydrogenated oil" in the list of ingredients)o  Lower sodium in your diet to about 2300 mg/day.  Do this gradually (to retrain your taste buds) by avoiding processed foods - the ABCs - anything boxed, canned or cured - and choose fresh cuts of meats, vegetables or fruits.  Add flavor with the use of herbs, spices, garlic, vinegars, and salt substitutes.o  Don't drink empty calories.  Avoid drinks containing high fructose corn syrup like sodas and commercial "fruit" juices; women should have no more than 1 and men 2 alcoholic beverages per day.o  Be aware that even "diet" drinks may have harmful effects on your metabolism and aren't as healthy as they may seem.   Is this too simple?  Too complicated?  Too ambitious?  Let me know what you think! Jan nonadult false Eat Differently, Not Less text blog 295 11 5.0 http://community.myhealthvillage.com/service/displayKickPlace.kickAction?u=3398032&as=43145 http://media.kickstatic.com/kickapps/images/43145/photos/PHOTO_1656418_43145_3398032_ap_160X120.jpg false United States MO Columbia 65201 2 0 282636 3398032 Member 0 http://community.myhealthvillage.com/_Adding-STYLE-to-Lifestyle/BLOG/262914/43145.html  In common parleance, we all have a lifestyle.  What I mean by this is that we all have a certain pattern to how we work, eat, sleep, exercise, use substances, and spend our free time.  Even people who say, “Not me, every day is different and I don’t have a pattern” are expressing a pattern of inconsistency that differentiates them from others who go about their lives in a highly routinized way.When we think about use of the word “style” in other contexts – like in art, architecture, and design – it conveys an element of structure, planning, and choice.   It can be described by a recognizable set of features that allow categorization for purposes of discussion, and it’s in this context that I think we might each look within ourselves and examine our individual “lifestyles.”  What’s your style?  What’s your plan?  Consider this analogy:  if your life is likened to a decades-long construction project, what kind of structure are you building?  What do your blueprints look like?  If you don’t have a set of blueprints, then it’s time to get some!A recent report from the medical literature1 shows the benefit of having blueprints, i.e. having a plan - and I’d like to share it with you briefly.  Adults with pre- or stage 1 hypertension (average BP 135/83 mm Hg) were randomized to 3 groups:  1) general advice only, 2) specifics about planned lifestyle change for BP control (lowering sodium, weight loss, and increased physical activity), and 3) these specifics combined with instruction on the DASH-diet (Dietary Approaches to Stop Hypertension - which I’ve written about before.)Researchers found that people in group 1 didn’t do as well as those in groups 2 and 3 with regard to lowering their BP and overall cardiovascular risk, and groups 2 and 3 successfully lowered their risk for future stroke and heart attack.  In other words, they got a plan - a blueprint!Here is what I think a blueprint should look like for most of us:Exercise a minimum of 150 minutes per week – and the more the better while avoiding injury.  This should include 2 sessions of strength training with the use of weights, exercise bands, or the equivalent resistance work)Eat 8-10 ½ cup servings of a variety of fruits & vegetables per dayKeep saturated fat to no more than about 6% of daily caloric requirements.   This will take a 1-time calculation and some daily mindfulness by reading food labels and determining sat fat grams.  To find YOUR target amount of saturated fat go to calculatesatfat.) Avoid all trans fatsSupplement with Vitamin D3 (~1000 mg/day) and calcium (more details on this in an upcoming blog)Take Aspirin 81 mg/day if you are over 45 (male) or 55 (female) unless you have an allergy or underlying bleeding disorder  Don’t smoke Drink no more than 1 alcoholic drink per day  (for women) and no more than 2 per day (for men)Get at least 7 hours of good sleep at night (see Jennifer’s recent blog on how to do this without the use of sleep aids)Build a social network that helps fill your life with meaningful, supportive relationshipsFind work or volunteer work that helps you feel fulfilledBe happy. This is a choice you make.  When life gives you lemons, make lemonaide. Buy a pair of rose colored glasses.  Find the silver lining in that cloud.  Feel (and spread) the love. JAN  1.       Maruther NM, Wang NY, Appel LJ.  Lifestyle interventions reduce coronary heart disease risk: results form the PREMIER Trial.  Circulation 2009; 119*15):2026-31.     In common parleance, we all have a lifestyle.  What I mean by this is that we all have a certain pattern to how we work, eat, sleep, exercise, use substances, and spend our free time.  Even people who say, “Not me, every day is different and I don’t have a pattern” are expressing a pattern of inconsistency that differentiates them from others who go about their lives in a highly routinized way.When we think about use of the word “style” in other contexts – like in art, architecture, and design – it conveys an element of structure, planning, and choice.   It can be described by a recognizable set of features that allow categorization for purposes of discussion, and it’s in this context that I think we might each look within ourselves and examine our individual “lifestyles.”  What’s your style?  What’s your plan?  Consider this analogy:  if your life is likened to a decades-long construction project, what kind of structure are you building?  What do your blueprints look like?  If you don’t have a set of blueprints, then it’s time to get some!A recent report from the medical literature1 shows the benefit of having blueprints, i.e. having a plan - and I’d like to share it with you briefly.  Adults with pre- or stage 1 hypertension (average BP 135/83 mm Hg) were randomized to 3 groups:  1) general advice only, 2) specifics about planned lifestyle change for BP control (lowering sodium, weight loss, and increased physical activity), and 3) these specifics combined with instruction on the DASH-diet (Dietary Approaches to Stop Hypertension - which I’ve written about before.)Researchers found that people in group 1 didn’t do as well as those in groups 2 and 3 with regard to lowering their BP and overall cardiovascular risk, and groups 2 and 3 successfully lowered their risk for future stroke and heart attack.  In other words, they got a plan - a blueprint!Here is what I think a blueprint should look like for most of us:Exercise a minimum of 150 minutes per week – and the more the better while avoiding injury.  This should include 2 sessions of strength training with the use of weights, exercise bands, or the equivalent resistance work)Eat 8-10 ½ cup servings of a variety of fruits & vegetables per dayKeep saturated fat to no more than about 6% of daily caloric requirements.   This will take a 1-time calculation and some daily mindfulness by reading food labels and determining sat fat grams.  To find YOUR target amount of saturated fat go to calculatesatfat.) Avoid all trans fatsSupplement with Vitamin D3 (~1000 mg/day) and calcium (more details on this in an upcoming blog)Take Aspirin 81 mg/day if you are over 45 (male) or 55 (female) unless you have an allergy or underlying bleeding disorder  Don’t smoke Drink no more than 1 alcoholic drink per day  (for women) and no more than 2 per day (for men)Get at least 7 hours of good sleep at night (see Jennifer’s recent blog on how to do this without the use of sleep aids)Build a social network that helps fill your life with meaningful, supportive relationshipsFind work or volunteer work that helps you feel fulfilledBe happy. This is a choice you make.  When life gives you lemons, make lemonaide. Buy a pair of rose colored glasses.  Find the silver lining in that cloud.  Feel (and spread) the love. JAN  1.       Maruther NM, Wang NY, Appel LJ.  Lifestyle interventions reduce coronary heart disease risk: results form the PREMIER Trial.  Circulation 2009; 119*15):2026-31.    Thu, 30 Apr 2009 16:05:19 GMT http://community.myhealthvillage.com/_Adding-STYLE-to-Lifestyle/BLOG/262914/43145.html Jan_Swaney_MD 2009-04-30T16:05:19Z Proctored Groups myhealthvillage  In common parleance, we all have a lifestyle.  What I mean by this is that we all have a certain pattern to how we work, eat, sleep, exercise, use substances, and spend our free time.  Even people who say, “Not me, every day is different and I don’t have a pattern” are expressing a pattern of inconsistency that differentiates them from others who go about their lives in a highly routinized way.When we think about use of the word “style” in other contexts – like in art, architecture, and design – it conveys an element of structure, planning, and choice.   It can be described by a recognizable set of features that allow categorization for purposes of discussion, and it’s in this context that I think we might each look within ourselves and examine our individual “lifestyles.”  What’s your style?  What’s your plan?  Consider this analogy:  if your life is likened to a decades-long construction project, what kind of structure are you building?  What do your blueprints look like?  If you don’t have a set of blueprints, then it’s time to get some!A recent report from the medical literature1 shows the benefit of having blueprints, i.e. having a plan - and I’d like to share it with you briefly.  Adults with pre- or stage 1 hypertension (average BP 135/83 mm Hg) were randomized to 3 groups:  1) general advice only, 2) specifics about planned lifestyle change for BP control (lowering sodium, weight loss, and increased physical activity), and 3) these specifics combined with instruction on the DASH-diet (Dietary Approaches to Stop Hypertension - which I’ve written about before.)Researchers found that people in group 1 didn’t do as well as those in groups 2 and 3 with regard to lowering their BP and overall cardiovascular risk, and groups 2 and 3 successfully lowered their risk for future stroke and heart attack.  In other words, they got a plan - a blueprint!Here is what I think a blueprint should look like for most of us:Exercise a minimum of 150 minutes per week – and the more the better while avoiding injury.  This should include 2 sessions of strength training with the use of weights, exercise bands, or the equivalent resistance work)Eat 8-10 ½ cup servings of a variety of fruits & vegetables per dayKeep saturated fat to no more than about 6% of daily caloric requirements.   This will take a 1-time calculation and some daily mindfulness by reading food labels and determining sat fat grams.  To find YOUR target amount of saturated fat go to calculatesatfat.) Avoid all trans fatsSupplement with Vitamin D3 (~1000 mg/day) and calcium (more details on this in an upcoming blog)Take Aspirin 81 mg/day if you are over 45 (male) or 55 (female) unless you have an allergy or underlying bleeding disorder  Don’t smoke Drink no more than 1 alcoholic drink per day  (for women) and no more than 2 per day (for men)Get at least 7 hours of good sleep at night (see Jennifer’s recent blog on how to do this without the use of sleep aids)Build a social network that helps fill your life with meaningful, supportive relationshipsFind work or volunteer work that helps you feel fulfilledBe happy. This is a choice you make.  When life gives you lemons, make lemonaide. Buy a pair of rose colored glasses.  Find the silver lining in that cloud.  Feel (and spread) the love. JAN  1.       Maruther NM, Wang NY, Appel LJ.  Lifestyle interventions reduce coronary heart disease risk: results form the PREMIER Trial.  Circulation 2009; 119*15):2026-31.    proctored groups, unproctored groups nonadult false Adding STYLE to Lifestyle text blog proctored groups,unproctored groups 335 1 5.0 http://community.myhealthvillage.com/service/displayKickPlace.kickAction?u=3398032&as=43145 http://media.kickstatic.com/kickapps/images/43145/photos/PHOTO_1656418_43145_3398032_ap_160X120.jpg false United States MO Columbia 65203 0 Proctored Groups 0 262914 3398032 Member 0 http://community.myhealthvillage.com/_Swine-Flu-and-the-3Cs/BLOG/259667/43145.html  As we brace for the emerging Swine Flu epidemic I’m reminded that our response and preparation encompass what we at MyHealthVillage.com like to call the 3 C’s:  choice, competence and connection.·         Choice to get actively involved, take care of yourself and your loved ones, and become an active participant in your own health.·         Competence -  both individually and collectively.  Individual competence means knowing how to avoid exposure to the virus, recognize early symptoms, and seek appropriate care if symptoms develop.  Collectively, we as a nation rely on a competent (informed and coordinated) group of scientists and administrators within the CDC and Department of Homeland Security to understand the virus, its spread, and the appropriate measures to prevent its spread and limit its impact.·         Connection – coping with this epidemic to avoid a worldwide pandemic requires timely and effective communication and coordination between citizens, scientists, public health officials, governments and private entities.  As citizens, we need to watch the news and talk with people within our individual communities to understand our unique level of risk and availability of resources.What shall we do?  Whatever we can – and for most of us that means frequent hand washing, sneezing or coughing into a tissue, avoiding touching our face or eating with our fingers, tuning into news updates, and  seeing a physician if we become ill with fever, chills, cough,fatigue and muscle aches.  Hopefully, months from now we’ll look back on this public health emergency as a small “blip” on the screen of the nation’s health.  Doing so will mean that our response has been a public health success – a pandemic averted due to the 3C’s.I hope that you and those you care about are untouched by this epidemic.  And if you are, I’d encourage you to explore the 3C’s as they relate to other health issues you may be dealing with – What are the choices you make that affect your health?  Could they be better?  What competencies (knowledge or skills) might help you cope better?  And what do your human connections do to impact the way you cope?  We’re here for you for all 3C’s.  Use the Village as a way to live better, longer.Jan   As we brace for the emerging Swine Flu epidemic I’m reminded that our response and preparation encompass what we at MyHealthVillage.com like to call the 3 C’s:  choice, competence and connection.·         Choice to get actively involved, take care of yourself and your loved ones, and become an active participant in your own health.·         Competence -  both individually and collectively.  Individual competence means knowing how to avoid exposure to the virus, recognize early symptoms, and seek appropriate care if symptoms develop.  Collectively, we as a nation rely on a competent (informed and coordinated) group of scientists and administrators within the CDC and Department of Homeland Security to understand the virus, its spread, and the appropriate measures to prevent its spread and limit its impact.·         Connection – coping with this epidemic to avoid a worldwide pandemic requires timely and effective communication and coordination between citizens, scientists, public health officials, governments and private entities.  As citizens, we need to watch the news and talk with people within our individual communities to understand our unique level of risk and availability of resources.What shall we do?  Whatever we can – and for most of us that means frequent hand washing, sneezing or coughing into a tissue, avoiding touching our face or eating with our fingers, tuning into news updates, and  seeing a physician if we become ill with fever, chills, cough,fatigue and muscle aches.  Hopefully, months from now we’ll look back on this public health emergency as a small “blip” on the screen of the nation’s health.  Doing so will mean that our response has been a public health success – a pandemic averted due to the 3C’s.I hope that you and those you care about are untouched by this epidemic.  And if you are, I’d encourage you to explore the 3C’s as they relate to other health issues you may be dealing with – What are the choices you make that affect your health?  Could they be better?  What competencies (knowledge or skills) might help you cope better?  And what do your human connections do to impact the way you cope?  We’re here for you for all 3C’s.  Use the Village as a way to live better, longer.Jan  Tue, 28 Apr 2009 16:06:44 GMT http://community.myhealthvillage.com/_Swine-Flu-and-the-3Cs/BLOG/259667/43145.html Jan_Swaney_MD 2009-04-28T16:06:44Z Proctored Groups myhealthvillage  As we brace for the emerging Swine Flu epidemic I’m reminded that our response and preparation encompass what we at MyHealthVillage.com like to call the 3 C’s:  choice, competence and connection.·         Choice to get actively involved, take care of yourself and your loved ones, and become an active participant in your own health.·         Competence -  both individually and collectively.  Individual competence means knowing how to avoid exposure to the virus, recognize early symptoms, and seek appropriate care if symptoms develop.  Collectively, we as a nation rely on a competent (informed and coordinated) group of scientists and administrators within the CDC and Department of Homeland Security to understand the virus, its spread, and the appropriate measures to prevent its spread and limit its impact.·         Connection – coping with this epidemic to avoid a worldwide pandemic requires timely and effective communication and coordination between citizens, scientists, public health officials, governments and private entities.  As citizens, we need to watch the news and talk with people within our individual communities to understand our unique level of risk and availability of resources.What shall we do?  Whatever we can – and for most of us that means frequent hand washing, sneezing or coughing into a tissue, avoiding touching our face or eating with our fingers, tuning into news updates, and  seeing a physician if we become ill with fever, chills, cough,fatigue and muscle aches.  Hopefully, months from now we’ll look back on this public health emergency as a small “blip” on the screen of the nation’s health.  Doing so will mean that our response has been a public health success – a pandemic averted due to the 3C’s.I hope that you and those you care about are untouched by this epidemic.  And if you are, I’d encourage you to explore the 3C’s as they relate to other health issues you may be dealing with – What are the choices you make that affect your health?  Could they be better?  What competencies (knowledge or skills) might help you cope better?  And what do your human connections do to impact the way you cope?  We’re here for you for all 3C’s.  Use the Village as a way to live better, longer.Jan  proctored groups nonadult false Swine Flu and the 3C's text blog proctored groups 388 2 4.5 http://community.myhealthvillage.com/service/displayKickPlace.kickAction?u=3398032&as=43145 http://media.kickstatic.com/kickapps/images/43145/photos/PHOTO_1656418_43145_3398032_ap_160X120.jpg false United States MO Columbia 65203 3 Proctored Groups 0 259667 3398032 Member 0 http://community.myhealthvillage.com/_A-Dose-of-Walking/BLOG/253023/43145.html Walking as a medication?  Or even better than a medication?When it comes to keeping pounds off from as we age, walking is better than any pill out there.  We’ve known for a long time that runners keep their weight off as the years progress, but what about walkers?    Until recently, there really hadn’t been any research that demonstrated the effect of walking on weight gain age-related weight gain, but a recent study from the American Journal of Clinical Nutrition shows that a regular walking can have significant effects on preventing the weight gain associated with aging.Participants in the Coronary Artery Risk Development for Young Adults (CARDIA) Study were 18-30 years old when the study began and were re-examined after 2, 5, 7, 10 and 15 years.  After accounting for calorie intake and other factors, there was a strong association between walking and the prevention of weight gain; people who walked were less likely to gain weight, and there was predictable dose-response.  The more that people walked, the more likely they were to keep off the pounds; two hours of walking per week was better than none, and four hours of walking per week was even better.There isn’t a pill out there that can even come close to showing that kind of benefit.  Commercial weight loss pills are associated with a risk for significant, serious adverse events and their effect seems to plateau at around 3-5 lbs. of weight loss, even when taken over an extended period of time.  Walking is free, safe, and the more you do of it, the more benefit you derive.  Of course, you’ll want to make sure you walk in a safe place, wear a good pair of shoes that fit you well, and take appropriate precautions with sunscreen, a water bottle, and reflective clothing for nighttime conditions.Our bodies are literally made to walk and perhaps that’s the reason walking is the exercise of choice for 70% of people.  How does walking make you feel?  Let me hear from you.   And if you aren’t sure, then I’d like to have you strap on a comfortable pair of shoes and let me know.    Walking as a medication?  Or even better than a medication?When it comes to keeping pounds off from as we age, walking is better than any pill out there.  We’ve known for a long time that runners keep their weight off as the years progress, but what about walkers?    Until recently, there really hadn’t been any research that demonstrated the effect of walking on weight gain age-related weight gain, but a recent study from the American Journal of Clinical Nutrition shows that a regular walking can have significant effects on preventing the weight gain associated with aging.Participants in the Coronary Artery Risk Development for Young Adults (CARDIA) Study were 18-30 years old when the study began and were re-examined after 2, 5, 7, 10 and 15 years.  After accounting for calorie intake and other factors, there was a strong association between walking and the prevention of weight gain; people who walked were less likely to gain weight, and there was predictable dose-response.  The more that people walked, the more likely they were to keep off the pounds; two hours of walking per week was better than none, and four hours of walking per week was even better.There isn’t a pill out there that can even come close to showing that kind of benefit.  Commercial weight loss pills are associated with a risk for significant, serious adverse events and their effect seems to plateau at around 3-5 lbs. of weight loss, even when taken over an extended period of time.  Walking is free, safe, and the more you do of it, the more benefit you derive.  Of course, you’ll want to make sure you walk in a safe place, wear a good pair of shoes that fit you well, and take appropriate precautions with sunscreen, a water bottle, and reflective clothing for nighttime conditions.Our bodies are literally made to walk and perhaps that’s the reason walking is the exercise of choice for 70% of people.  How does walking make you feel?  Let me hear from you.   And if you aren’t sure, then I’d like to have you strap on a comfortable pair of shoes and let me know.    Wed, 22 Apr 2009 17:03:10 GMT http://community.myhealthvillage.com/_A-Dose-of-Walking/BLOG/253023/43145.html Jan_Swaney_MD 2009-04-22T17:03:10Z Proctored Groups myhealthvillage Walking as a medication?  Or even better than a medication?When it comes to keeping pounds off from as we age, walking is better than any pill out there.  We’ve known for a long time that runners keep their weight off as the years progress, but what about walkers?    Until recently, there really hadn’t been any research that demonstrated the effect of walking on weight gain age-related weight gain, but a recent study from the American Journal of Clinical Nutrition shows that a regular walking can have significant effects on preventing the weight gain associated with aging.Participants in the Coronary Artery Risk Development for Young Adults (CARDIA) Study were 18-30 years old when the study began and were re-examined after 2, 5, 7, 10 and 15 years.  After accounting for calorie intake and other factors, there was a strong association between walking and the prevention of weight gain; people who walked were less likely to gain weight, and there was predictable dose-response.  The more that people walked, the more likely they were to keep off the pounds; two hours of walking per week was better than none, and four hours of walking per week was even better.There isn’t a pill out there that can even come close to showing that kind of benefit.  Commercial weight loss pills are associated with a risk for significant, serious adverse events and their effect seems to plateau at around 3-5 lbs. of weight loss, even when taken over an extended period of time.  Walking is free, safe, and the more you do of it, the more benefit you derive.  Of course, you’ll want to make sure you walk in a safe place, wear a good pair of shoes that fit you well, and take appropriate precautions with sunscreen, a water bottle, and reflective clothing for nighttime conditions.Our bodies are literally made to walk and perhaps that’s the reason walking is the exercise of choice for 70% of people.  How does walking make you feel?  Let me hear from you.   And if you aren’t sure, then I’d like to have you strap on a comfortable pair of shoes and let me know.    coronary artery risk, heart disease, proctored groups, unproctored groups, walking, weight loss nonadult false A Dose of Walking? text blog coronary artery risk,heart disease,proctored groups,unproctored groups,walking,weight loss 426 21 5.0 http://community.myhealthvillage.com/service/displayKickPlace.kickAction?u=3398032&as=43145 http://media.kickstatic.com/kickapps/images/43145/photos/PHOTO_1656418_43145_3398032_ap_160X120.jpg false United States MO Columbia 65203 1 Proctored Groups 0 253023 3398032 Member 0 http://community.myhealthvillage.com/_Death-from-the-Other-Side/BLOG/218501/43145.html In my years of practicing medicine I’ve always dressed for death in white coat, clutching a stethoscope - but this time was different.  I wore jeans, jotted notes in a spiral notebook, and painstakingly fed the patient when the hospital tray arrived.   This was death from the other side of the stethoscope, and it was different.   It was Dad. My father died several weeks ago after a devastating, one-month illness.  It is still so fresh in my mind that I am trying to figure it all out, even though I’ve spent my life in medicine and have seen death many times before.  It was like I was cast in a stage play that I knew well, but was thrust into a role for which I was unprepared and didn’t know the lines. Dad’s condition deteriorated quickly and we were powerless to restore his health to something he would have considered an acceptable quality of life.  Along the way he lost the ability to speak for himself, but thankfully, he had made a Living Will that helped us know how to navigate the rocky terraine of dying in the 21st century.  The final act opened when Dad began to having trouble swallowing, choking on his food.  I knew it was an ominous sign because it put him at risk for aspiration pneumonia.  Yet, his Living Will indicated that he wouldn’t want a feeding tube in the event of any of the following: 1) mental incapacity, 2) an inability to feed himself if not likely to regain it, or 3) a prognosis likely to result in death in a relatively short period of time.  At the point we were pondering feeding tube, he actually fulilled all three of these criteria – simultaneously. The kicker is that the young doctors who were caring for him, interns and residents in a teaching hospital, were very hesitant to discuss prognosis, let alone futility, and never inquired about the presence of a Living Will.  Yet, because he'd gone to the effort to make a Living Will and we had the conviction to follow it, Dad’s suffering was shortened by weeks and perhaps months because the fact he wasn’t tube fed.   I’m wondering how often doctors fail to ask about the presence of a Living Will in seeking to determine the patient’s expressed wishes around end-of-life decisions.  Was ours an unusual experience?  If not, then there is much to be done to help doctors, patients, and their loved ones write a better script for care at the end of life.   In my years of practicing medicine I’ve always dressed for death in white coat, clutching a stethoscope - but this time was different.  I wore jeans, jotted notes in a spiral notebook, and painstakingly fed the patient when the hospital tray arrived.   This was death from the other side of the stethoscope, and it was different.   It was Dad. My father died several weeks ago after a devastating, one-month illness.  It is still so fresh in my mind that I am trying to figure it all out, even though I’ve spent my life in medicine and have seen death many times before.  It was like I was cast in a stage play that I knew well, but was thrust into a role for which I was unprepared and didn’t know the lines. Dad’s condition deteriorated quickly and we were powerless to restore his health to something he would have considered an acceptable quality of life.  Along the way he lost the ability to speak for himself, but thankfully, he had made a Living Will that helped us know how to navigate the rocky terraine of dying in the 21st century.  The final act opened when Dad began to having trouble swallowing, choking on his food.  I knew it was an ominous sign because it put him at risk for aspiration pneumonia.  Yet, his Living Will indicated that he wouldn’t want a feeding tube in the event of any of the following: 1) mental incapacity, 2) an inability to feed himself if not likely to regain it, or 3) a prognosis likely to result in death in a relatively short period of time.  At the point we were pondering feeding tube, he actually fulilled all three of these criteria – simultaneously. The kicker is that the young doctors who were caring for him, interns and residents in a teaching hospital, were very hesitant to discuss prognosis, let alone futility, and never inquired about the presence of a Living Will.  Yet, because he'd gone to the effort to make a Living Will and we had the conviction to follow it, Dad’s suffering was shortened by weeks and perhaps months because the fact he wasn’t tube fed.   I’m wondering how often doctors fail to ask about the presence of a Living Will in seeking to determine the patient’s expressed wishes around end-of-life decisions.  Was ours an unusual experience?  If not, then there is much to be done to help doctors, patients, and their loved ones write a better script for care at the end of life.   Sun, 22 Mar 2009 23:00:27 GMT http://community.myhealthvillage.com/_Death-from-the-Other-Side/BLOG/218501/43145.html Jan_Swaney_MD 2009-03-22T23:00:27Z Unproctored Groups myhealthvillage In my years of practicing medicine I’ve always dressed for death in white coat, clutching a stethoscope - but this time was different.  I wore jeans, jotted notes in a spiral notebook, and painstakingly fed the patient when the hospital tray arrived.   This was death from the other side of the stethoscope, and it was different.   It was Dad. My father died several weeks ago after a devastating, one-month illness.  It is still so fresh in my mind that I am trying to figure it all out, even though I’ve spent my life in medicine and have seen death many times before.  It was like I was cast in a stage play that I knew well, but was thrust into a role for which I was unprepared and didn’t know the lines. Dad’s condition deteriorated quickly and we were powerless to restore his health to something he would have considered an acceptable quality of life.  Along the way he lost the ability to speak for himself, but thankfully, he had made a Living Will that helped us know how to navigate the rocky terraine of dying in the 21st century.  The final act opened when Dad began to having trouble swallowing, choking on his food.  I knew it was an ominous sign because it put him at risk for aspiration pneumonia.  Yet, his Living Will indicated that he wouldn’t want a feeding tube in the event of any of the following: 1) mental incapacity, 2) an inability to feed himself if not likely to regain it, or 3) a prognosis likely to result in death in a relatively short period of time.  At the point we were pondering feeding tube, he actually fulilled all three of these criteria – simultaneously. The kicker is that the young doctors who were caring for him, interns and residents in a teaching hospital, were very hesitant to discuss prognosis, let alone futility, and never inquired about the presence of a Living Will.  Yet, because he'd gone to the effort to make a Living Will and we had the conviction to follow it, Dad’s suffering was shortened by weeks and perhaps months because the fact he wasn’t tube fed.   I’m wondering how often doctors fail to ask about the presence of a Living Will in seeking to determine the patient’s expressed wishes around end-of-life decisions.  Was ours an unusual experience?  If not, then there is much to be done to help doctors, patients, and their loved ones write a better script for care at the end of life.   unproctored groups nonadult false Death from the Other Side text blog unproctored groups 375 21 5.0 http://community.myhealthvillage.com/service/displayKickPlace.kickAction?u=3398032&as=43145 http://media.kickstatic.com/kickapps/images/43145/photos/PHOTO_1656418_43145_3398032_ap_160X120.jpg false United States MO Columbia 65203 2 Unproctored Groups 0 218501 3398032 Member 0 http://community.myhealthvillage.com/_Resilience/BLOG/153272/43145.html Resilience Have you seen our new video on overcoming Breast Cancer?  If not, then check it out.  You’ll meet Jackie, an amazing and inspirational woman whose story is one of resilience in the face of this scary, chronic condition.  She makes the point of saying she’s not a survivor, she’s an overcomer; a word that conveys more hope and power in dealing with her illness than does surviving.  She even says that having cancer has done her some good.  Ponder that a while.        I admire the resilience it takes to say that, and am reminded of a recent news blurb I read in “The Week” about Michael J. Fox, star of “Family Ties” and the “Back to the Future” movies, who has severe Parkinson’s Disease.  Nowadays, at some point virtually every day, his limbs go entirely slack, his speech slurs, and he suffers from spastic tremors.  Yet despite this, he manages to remain active and credits his disease with bringing him closer to his wife and children.  “I really love my life.  For everything that’s worse, there’s something that’s better.  Yes, it’s a horrible condition.  But it’s part of an amazing life.  And not an ‘otherwise amazing life.’  It’s part of what makes my life amazing.”   It sounds a bit like Jimmy Stewart in "It's a Wonderful Life."  Resilience in the face of hardship.  We know it when we see it.  Watch Jackie’s video and you’ll spot it.  How does it develop?  Can it be learned?  If so, can it taught or shared?  I want to hear your thoughts on this.    Jan   Resilience Have you seen our new video on overcoming Breast Cancer?  If not, then check it out.  You’ll meet Jackie, an amazing and inspirational woman whose story is one of resilience in the face of this scary, chronic condition.  She makes the point of saying she’s not a survivor, she’s an overcomer; a word that conveys more hope and power in dealing with her illness than does surviving.  She even says that having cancer has done her some good.  Ponder that a while.        I admire the resilience it takes to say that, and am reminded of a recent news blurb I read in “The Week” about Michael J. Fox, star of “Family Ties” and the “Back to the Future” movies, who has severe Parkinson’s Disease.  Nowadays, at some point virtually every day, his limbs go entirely slack, his speech slurs, and he suffers from spastic tremors.  Yet despite this, he manages to remain active and credits his disease with bringing him closer to his wife and children.  “I really love my life.  For everything that’s worse, there’s something that’s better.  Yes, it’s a horrible condition.  But it’s part of an amazing life.  And not an ‘otherwise amazing life.’  It’s part of what makes my life amazing.”   It sounds a bit like Jimmy Stewart in "It's a Wonderful Life."  Resilience in the face of hardship.  We know it when we see it.  Watch Jackie’s video and you’ll spot it.  How does it develop?  Can it be learned?  If so, can it taught or shared?  I want to hear your thoughts on this.    Jan   Fri, 19 Dec 2008 15:07:01 GMT http://community.myhealthvillage.com/_Resilience/BLOG/153272/43145.html Jan_Swaney_MD 2008-12-19T15:07:01Z Proctored Groups myhealthvillage Resilience Have you seen our new video on overcoming Breast Cancer?  If not, then check it out.  You’ll meet Jackie, an amazing and inspirational woman whose story is one of resilience in the face of this scary, chronic condition.  She makes the point of saying she’s not a survivor, she’s an overcomer; a word that conveys more hope and power in dealing with her illness than does surviving.  She even says that having cancer has done her some good.  Ponder that a while.        I admire the resilience it takes to say that, and am reminded of a recent news blurb I read in “The Week” about Michael J. Fox, star of “Family Ties” and the “Back to the Future” movies, who has severe Parkinson’s Disease.  Nowadays, at some point virtually every day, his limbs go entirely slack, his speech slurs, and he suffers from spastic tremors.  Yet despite this, he manages to remain active and credits his disease with bringing him closer to his wife and children.  “I really love my life.  For everything that’s worse, there’s something that’s better.  Yes, it’s a horrible condition.  But it’s part of an amazing life.  And not an ‘otherwise amazing life.’  It’s part of what makes my life amazing.”   It sounds a bit like Jimmy Stewart in "It's a Wonderful Life."  Resilience in the face of hardship.  We know it when we see it.  Watch Jackie’s video and you’ll spot it.  How does it develop?  Can it be learned?  If so, can it taught or shared?  I want to hear your thoughts on this.    Jan   proctored groups nonadult false Resilience text blog proctored groups 409 20 5.0 http://community.myhealthvillage.com/service/displayKickPlace.kickAction?u=3398032&as=43145 http://media.kickstatic.com/kickapps/images/43145/photos/PHOTO_1656418_43145_3398032_ap_160X120.jpg false United States MO Columbia 65203 1 Proctored Groups 0 153272 3398032 Member 0 http://community.myhealthvillage.com/_Cold-Turkey-is-So-So-Good/BLOG/140152/43145.html Cold Turkey is So, So Good!Just around the corner is the America Cancer Society’s “Great American Smoke-Out,” a day that Americans are encouraged to go “cold turkey” in an effort to quit smoking.  A timely new piece of research from UCLA details the hazards of smoking to nurses who participated in the Nurses’ Health Study, an important epidemiologic research study that has been ongoing for several decades.  The results convey both the good news and bad news about smoking: First, the good news.  Smoking rates declined from 33.2% in 1976 to 8.4% in 2003.On the other hand, when compared with non-smokers, death rates among women in their 70's were 2.3 times higher for current smokers and 1.5 times higher for former smokers.Do you or someone you care about smoke?  Have you given any thought to quitting?  What would be important enough to for you to consider quitting?  Consider these positive changes that take place following the last cigarette.  According to the Surgeon General, in20 minutes – the heart rate and blood pressure drop12 hours – the carbon monoxide level in the bloodstream drops to normal2 weeks to 3 months – circulation improves and lung function increases1 to 9 months – coughing and shortness of breath decrease and lungs regain normal or near normal ability to handle mucus and fight infection1 year – excess risk of coronary artery disease drops to half that of a continuing smoker10 years – lung cancer death rate is half that of a continuing smoker, and the risk of cancer of the mouth, throat, esophagus, bladder, cervix, and pancreas are reduced, too If you have quit before or know someone who has been successful, what do you think was the key to success?  And what advice would you have for others?Jan   Cold Turkey is So, So Good!Just around the corner is the America Cancer Society’s “Great American Smoke-Out,” a day that Americans are encouraged to go “cold turkey” in an effort to quit smoking.  A timely new piece of research from UCLA details the hazards of smoking to nurses who participated in the Nurses’ Health Study, an important epidemiologic research study that has been ongoing for several decades.  The results convey both the good news and bad news about smoking: First, the good news.  Smoking rates declined from 33.2% in 1976 to 8.4% in 2003.On the other hand, when compared with non-smokers, death rates among women in their 70's were 2.3 times higher for current smokers and 1.5 times higher for former smokers.Do you or someone you care about smoke?  Have you given any thought to quitting?  What would be important enough to for you to consider quitting?  Consider these positive changes that take place following the last cigarette.  According to the Surgeon General, in20 minutes – the heart rate and blood pressure drop12 hours – the carbon monoxide level in the bloodstream drops to normal2 weeks to 3 months – circulation improves and lung function increases1 to 9 months – coughing and shortness of breath decrease and lungs regain normal or near normal ability to handle mucus and fight infection1 year – excess risk of coronary artery disease drops to half that of a continuing smoker10 years – lung cancer death rate is half that of a continuing smoker, and the risk of cancer of the mouth, throat, esophagus, bladder, cervix, and pancreas are reduced, too If you have quit before or know someone who has been successful, what do you think was the key to success?  And what advice would you have for others?Jan   Mon, 17 Nov 2008 18:52:46 GMT http://community.myhealthvillage.com/_Cold-Turkey-is-So-So-Good/BLOG/140152/43145.html Jan_Swaney_MD 2008-11-17T18:52:46Z myhealthvillage Cold Turkey is So, So Good!Just around the corner is the America Cancer Society’s “Great American Smoke-Out,” a day that Americans are encouraged to go “cold turkey” in an effort to quit smoking.  A timely new piece of research from UCLA details the hazards of smoking to nurses who participated in the Nurses’ Health Study, an important epidemiologic research study that has been ongoing for several decades.  The results convey both the good news and bad news about smoking: First, the good news.  Smoking rates declined from 33.2% in 1976 to 8.4% in 2003.On the other hand, when compared with non-smokers, death rates among women in their 70's were 2.3 times higher for current smokers and 1.5 times higher for former smokers.Do you or someone you care about smoke?  Have you given any thought to quitting?  What would be important enough to for you to consider quitting?  Consider these positive changes that take place following the last cigarette.  According to the Surgeon General, in20 minutes – the heart rate and blood pressure drop12 hours – the carbon monoxide level in the bloodstream drops to normal2 weeks to 3 months – circulation improves and lung function increases1 to 9 months – coughing and shortness of breath decrease and lungs regain normal or near normal ability to handle mucus and fight infection1 year – excess risk of coronary artery disease drops to half that of a continuing smoker10 years – lung cancer death rate is half that of a continuing smoker, and the risk of cancer of the mouth, throat, esophagus, bladder, cervix, and pancreas are reduced, too If you have quit before or know someone who has been successful, what do you think was the key to success?  And what advice would you have for others?Jan   nonadult false Cold Turkey is So, So Good! text blog 305 0 0.0 http://community.myhealthvillage.com/service/displayKickPlace.kickAction?u=3398032&as=43145 http://media.kickstatic.com/kickapps/images/43145/photos/PHOTO_1656418_43145_3398032_ap_160X120.jpg false United States MO Columbia 65203 0 0 140152 3398032 Member 0 http://community.myhealthvillage.com/_The-Politics-of-Health/BLOG/123796/43145.html The Politics of Health Last week’s final presidential debate focused on domestic and economic policy, yet I doubt that many listeners found clarity in the candidate’s positions on health care reform. What do they agree on?  Rising health care costs are swallowing-up ever larger portions of GDP, hurting American businesses’ ability to compete in the global marketplace, and yet, an unacceptable number of Americans, including many working families, are without timely and appropriate access to primary and specialty care due to lack of insurance.  Unpaid medical costs are the number one cause of bankruptcy in America. What do they disagree on?  They disagree on how to rob Peter to pay Paul.  Obama will cover children who are currently uninsured through something akin to a parental mandate to purchase health insurance, and he’ll make available the health insurance plan options provided to US government workers and senators so that small businesses and others disadvantaged by adverse risk-pooling can find insurance more affordably than when searching for individual coverage.  McCain will tax employee health benefits while providing a $2500-$5000 tax credit to individuals and families to encourage them to purchase health insurance in the marketplace, while allowing insurance companies to market regionally or nationally rather than being bound by state-to-state regulations. What neither said.  None of these plans will do much to lower health care costs.  At the risk of oversimplifying, I see 3 ways to lower health care costs: fund public health and primary care initiatives that focus on prevention (“an ounce of prevention is worth a pound of cure” - or perhaps nowadays we say a few hundred dollars worth of prevention is worth several thousands of dollars worth of cure,) reduce duplication and waste while driving improved quality and patient safety (the mantra of the health IT community and other proponents of electronic medical records,)  launch a thoughtful public discussion of what sort of care is optimal for patient and family comfort near the end of life.  Palliative care, more humane and patient-centered than routine care, aims to provide comfort rather than life extension when there is no cure, nor reasonable expectation for prolongation of life.    Obama and McCain are partially, incompletely, addressing #1 and #2.  Regardless of who wins the election, there is much work to be done to address the inequities and spiraling costs of health care.  Meanwhile, seventy five percent of US health care costs are driven by our toxic lifestyle: smoking, overeating, lack of exercise, stress, and alcohol/substance abuse.   In this election season as we ponder what we want in our politicians its incumbent on each of us to do our patriotic best to eat well, exercise, and be a change agent for our communities including those whom we love.  After all, our very way of life depends on it! Jan              The Politics of Health Last week’s final presidential debate focused on domestic and economic policy, yet I doubt that many listeners found clarity in the candidate’s positions on health care reform. What do they agree on?  Rising health care costs are swallowing-up ever larger portions of GDP, hurting American businesses’ ability to compete in the global marketplace, and yet, an unacceptable number of Americans, including many working families, are without timely and appropriate access to primary and specialty care due to lack of insurance.  Unpaid medical costs are the number one cause of bankruptcy in America. What do they disagree on?  They disagree on how to rob Peter to pay Paul.  Obama will cover children who are currently uninsured through something akin to a parental mandate to purchase health insurance, and he’ll make available the health insurance plan options provided to US government workers and senators so that small businesses and others disadvantaged by adverse risk-pooling can find insurance more affordably than when searching for individual coverage.  McCain will tax employee health benefits while providing a $2500-$5000 tax credit to individuals and families to encourage them to purchase health insurance in the marketplace, while allowing insurance companies to market regionally or nationally rather than being bound by state-to-state regulations. What neither said.  None of these plans will do much to lower health care costs.  At the risk of oversimplifying, I see 3 ways to lower health care costs: fund public health and primary care initiatives that focus on prevention (“an ounce of prevention is worth a pound of cure” - or perhaps nowadays we say a few hundred dollars worth of prevention is worth several thousands of dollars worth of cure,) reduce duplication and waste while driving improved quality and patient safety (the mantra of the health IT community and other proponents of electronic medical records,)  launch a thoughtful public discussion of what sort of care is optimal for patient and family comfort near the end of life.  Palliative care, more humane and patient-centered than routine care, aims to provide comfort rather than life extension when there is no cure, nor reasonable expectation for prolongation of life.    Obama and McCain are partially, incompletely, addressing #1 and #2.  Regardless of who wins the election, there is much work to be done to address the inequities and spiraling costs of health care.  Meanwhile, seventy five percent of US health care costs are driven by our toxic lifestyle: smoking, overeating, lack of exercise, stress, and alcohol/substance abuse.   In this election season as we ponder what we want in our politicians its incumbent on each of us to do our patriotic best to eat well, exercise, and be a change agent for our communities including those whom we love.  After all, our very way of life depends on it! Jan              Mon, 20 Oct 2008 15:42:28 GMT http://community.myhealthvillage.com/_The-Politics-of-Health/BLOG/123796/43145.html Jan_Swaney_MD 2008-10-20T15:42:28Z myhealthvillage The Politics of Health Last week’s final presidential debate focused on domestic and economic policy, yet I doubt that many listeners found clarity in the candidate’s positions on health care reform. What do they agree on?  Rising health care costs are swallowing-up ever larger portions of GDP, hurting American businesses’ ability to compete in the global marketplace, and yet, an unacceptable number of Americans, including many working families, are without timely and appropriate access to primary and specialty care due to lack of insurance.  Unpaid medical costs are the number one cause of bankruptcy in America. What do they disagree on?  They disagree on how to rob Peter to pay Paul.  Obama will cover children who are currently uninsured through something akin to a parental mandate to purchase health insurance, and he’ll make available the health insurance plan options provided to US government workers and senators so that small businesses and others disadvantaged by adverse risk-pooling can find insurance more affordably than when searching for individual coverage.  McCain will tax employee health benefits while providing a $2500-$5000 tax credit to individuals and families to encourage them to purchase health insurance in the marketplace, while allowing insurance companies to market regionally or nationally rather than being bound by state-to-state regulations. What neither said.  None of these plans will do much to lower health care costs.  At the risk of oversimplifying, I see 3 ways to lower health care costs: fund public health and primary care initiatives that focus on prevention (“an ounce of prevention is worth a pound of cure” - or perhaps nowadays we say a few hundred dollars worth of prevention is worth several thousands of dollars worth of cure,) reduce duplication and waste while driving improved quality and patient safety (the mantra of the health IT community and other proponents of electronic medical records,)  launch a thoughtful public discussion of what sort of care is optimal for patient and family comfort near the end of life.  Palliative care, more humane and patient-centered than routine care, aims to provide comfort rather than life extension when there is no cure, nor reasonable expectation for prolongation of life.    Obama and McCain are partially, incompletely, addressing #1 and #2.  Regardless of who wins the election, there is much work to be done to address the inequities and spiraling costs of health care.  Meanwhile, seventy five percent of US health care costs are driven by our toxic lifestyle: smoking, overeating, lack of exercise, stress, and alcohol/substance abuse.   In this election season as we ponder what we want in our politicians its incumbent on each of us to do our patriotic best to eat well, exercise, and be a change agent for our communities including those whom we love.  After all, our very way of life depends on it! Jan              nonadult false The Politics of Health text blog 316 0 0.0 http://community.myhealthvillage.com/service/displayKickPlace.kickAction?u=3398032&as=43145 http://media.kickstatic.com/kickapps/images/43145/photos/PHOTO_1656418_43145_3398032_ap_160X120.jpg false United States MO Columbia 65203 1 0 123796 3398032 Member 0 http://community.myhealthvillage.com/_Theres-Something-About-Mary/BLOG/112695/43145.html There’s Something About Mary Mary won’t be coming to spend the weekend with me, after-all.  We won’t be climbing the bleachers to find our seats and gaze out on the spectacle of a Big 12 college football game.  Instead, she’ll be in round 3 of chemotherapy for a tumor that has no business being there. I am angry, chagrinned and amazed.   Angry because Mary couldn’t have lived a life more devoted to promoting health.  She is a cracker-jack Physician’s Assistant and has spent her entire career helping people function better in the face of what are often devastating illnesses.  She has always taken extremely good care of herself, eaten well, and maintained a very high level of fitness.  Her cancer is unjust -- doesn’t it realize that she is not deserving of this assault?Chagrinned because her vulnerability makes me confront my own.  Mary and her husband have been friends of ours since we were in our 20’s, and though our paths have led us to alternate geographies, we’ve traveled in parallel universes and our reunions quickly strip away differences in our communities and life circumstances.  If this could happen to her, it certainly could happen to me.Amazed because Mary is strong, in general and in the particular.  Here’s what I mean.  When I called her last weekend during the final few days of her first 3-week cycle of chemotherapy, she had just run a 5K a few hours earlier.  In characteristic style, she deflected my gushes of amazement and praise with a self-effacing, “Well I didn’t really run…I just jogged.”   In point of fact, her time bested mine for the only 5K race I ever “ran” when I turned 40.  Listen carefully to her wisdom, a woman who has spent her life helping people cope with illness, “Well you know why I do it.  I do it as much for my mental health as my physical.”  So, what is the evidence that physical exercise improves mental health in cancer and in non-cancer states?  Has it been scientifically shown?  A recent review article discusses the preponderance of evidence for the benefits of exercise.1 If exercise were a drug that could be marketed by a pharmaceutical company - let’s just call it Excervia, for fun - here is what the television ad would say: "If you have cancer, ask your doctor about Excervia.  It improves physical fitness, cardiovascular fitness, sleep, quality of life, psychological and social well-being, and self-esteem while decreasing symptoms of fatigue, anxiety and depression.  There are no known side-effects when taken in moderate doses." "If you don’t have cancer, Exercervia has been shown to improve physical fitness, cardiovascular fitness, social function, self-esteem, body image, sleep, chronic pain, mood, and stress response while decreasing the risk of heart disease, diabetes, cancer, depression, and anxiety.  There are no known side-effects when taken in moderate doses." Quick, write me a prescription!  But wait, what does it cost?  The bad news is that your insurance carrier won’t pay for it.  The good news is that it is free.  Walking is a great form of exercise and other than a good pair of shoes, it won’t cost you anything.   It is available right outside your front door, at your place of work, in a city park, or along one of your favorite by-ways.  Find a buddy, a book on tape, or your favorite music and strap on your shoes. I’m no runner, but I’m going to find an upcoming 5K and walk it briskly for Mary.  Every step along the way I'm going to celebrate Mary and the other friends who have enriched my life and made it whole.  I'm going to cherish my health and not take it for granted.  I'm going to do what I can to be here tomorrow, for friends and family, aging parents who need me, and grandkids not yet born.  How about you?Jan    Krobp MT, Musanti K, Dorwood J.  Exercise and Quality of Life Outcomes in Patients with Cancer.  Seminars in Oncologic Nursing, 2007; 23(4):285-296.   There’s Something About Mary Mary won’t be coming to spend the weekend with me, after-all.  We won’t be climbing the bleachers to find our seats and gaze out on the spectacle of a Big 12 college football game.  Instead, she’ll be in round 3 of chemotherapy for a tumor that has no business being there. I am angry, chagrinned and amazed.   Angry because Mary couldn’t have lived a life more devoted to promoting health.  She is a cracker-jack Physician’s Assistant and has spent her entire career helping people function better in the face of what are often devastating illnesses.  She has always taken extremely good care of herself, eaten well, and maintained a very high level of fitness.  Her cancer is unjust -- doesn’t it realize that she is not deserving of this assault?Chagrinned because her vulnerability makes me confront my own.  Mary and her husband have been friends of ours since we were in our 20’s, and though our paths have led us to alternate geographies, we’ve traveled in parallel universes and our reunions quickly strip away differences in our communities and life circumstances.  If this could happen to her, it certainly could happen to me.Amazed because Mary is strong, in general and in the particular.  Here’s what I mean.  When I called her last weekend during the final few days of her first 3-week cycle of chemotherapy, she had just run a 5K a few hours earlier.  In characteristic style, she deflected my gushes of amazement and praise with a self-effacing, “Well I didn’t really run…I just jogged.”   In point of fact, her time bested mine for the only 5K race I ever “ran” when I turned 40.  Listen carefully to her wisdom, a woman who has spent her life helping people cope with illness, “Well you know why I do it.  I do it as much for my mental health as my physical.”  So, what is the evidence that physical exercise improves mental health in cancer and in non-cancer states?  Has it been scientifically shown?  A recent review article discusses the preponderance of evidence for the benefits of exercise.1 If exercise were a drug that could be marketed by a pharmaceutical company - let’s just call it Excervia, for fun - here is what the television ad would say: "If you have cancer, ask your doctor about Excervia.  It improves physical fitness, cardiovascular fitness, sleep, quality of life, psychological and social well-being, and self-esteem while decreasing symptoms of fatigue, anxiety and depression.  There are no known side-effects when taken in moderate doses." "If you don’t have cancer, Exercervia has been shown to improve physical fitness, cardiovascular fitness, social function, self-esteem, body image, sleep, chronic pain, mood, and stress response while decreasing the risk of heart disease, diabetes, cancer, depression, and anxiety.  There are no known side-effects when taken in moderate doses." Quick, write me a prescription!  But wait, what does it cost?  The bad news is that your insurance carrier won’t pay for it.  The good news is that it is free.  Walking is a great form of exercise and other than a good pair of shoes, it won’t cost you anything.   It is available right outside your front door, at your place of work, in a city park, or along one of your favorite by-ways.  Find a buddy, a book on tape, or your favorite music and strap on your shoes. I’m no runner, but I’m going to find an upcoming 5K and walk it briskly for Mary.  Every step along the way I'm going to celebrate Mary and the other friends who have enriched my life and made it whole.  I'm going to cherish my health and not take it for granted.  I'm going to do what I can to be here tomorrow, for friends and family, aging parents who need me, and grandkids not yet born.  How about you?Jan    Krobp MT, Musanti K, Dorwood J.  Exercise and Quality of Life Outcomes in Patients with Cancer.  Seminars in Oncologic Nursing, 2007; 23(4):285-296.   Fri, 03 Oct 2008 14:53:22 GMT http://community.myhealthvillage.com/_Theres-Something-About-Mary/BLOG/112695/43145.html Jan_Swaney_MD 2008-10-03T14:53:22Z myhealthvillage There’s Something About Mary Mary won’t be coming to spend the weekend with me, after-all.  We won’t be climbing the bleachers to find our seats and gaze out on the spectacle of a Big 12 college football game.  Instead, she’ll be in round 3 of chemotherapy for a tumor that has no business being there. I am angry, chagrinned and amazed.   Angry because Mary couldn’t have lived a life more devoted to promoting health.  She is a cracker-jack Physician’s Assistant and has spent her entire career helping people function better in the face of what are often devastating illnesses.  She has always taken extremely good care of herself, eaten well, and maintained a very high level of fitness.  Her cancer is unjust -- doesn’t it realize that she is not deserving of this assault?Chagrinned because her vulnerability makes me confront my own.  Mary and her husband have been friends of ours since we were in our 20’s, and though our paths have led us to alternate geographies, we’ve traveled in parallel universes and our reunions quickly strip away differences in our communities and life circumstances.  If this could happen to her, it certainly could happen to me.Amazed because Mary is strong, in general and in the particular.  Here’s what I mean.  When I called her last weekend during the final few days of her first 3-week cycle of chemotherapy, she had just run a 5K a few hours earlier.  In characteristic style, she deflected my gushes of amazement and praise with a self-effacing, “Well I didn’t really run…I just jogged.”   In point of fact, her time bested mine for the only 5K race I ever “ran” when I turned 40.  Listen carefully to her wisdom, a woman who has spent her life helping people cope with illness, “Well you know why I do it.  I do it as much for my mental health as my physical.”  So, what is the evidence that physical exercise improves mental health in cancer and in non-cancer states?  Has it been scientifically shown?  A recent review article discusses the preponderance of evidence for the benefits of exercise.1 If exercise were a drug that could be marketed by a pharmaceutical company - let’s just call it Excervia, for fun - here is what the television ad would say: "If you have cancer, ask your doctor about Excervia.  It improves physical fitness, cardiovascular fitness, sleep, quality of life, psychological and social well-being, and self-esteem while decreasing symptoms of fatigue, anxiety and depression.  There are no known side-effects when taken in moderate doses." "If you don’t have cancer, Exercervia has been shown to improve physical fitness, cardiovascular fitness, social function, self-esteem, body image, sleep, chronic pain, mood, and stress response while decreasing the risk of heart disease, diabetes, cancer, depression, and anxiety.  There are no known side-effects when taken in moderate doses." Quick, write me a prescription!  But wait, what does it cost?  The bad news is that your insurance carrier won’t pay for it.  The good news is that it is free.  Walking is a great form of exercise and other than a good pair of shoes, it won’t cost you anything.   It is available right outside your front door, at your place of work, in a city park, or along one of your favorite by-ways.  Find a buddy, a book on tape, or your favorite music and strap on your shoes. I’m no runner, but I’m going to find an upcoming 5K and walk it briskly for Mary.  Every step along the way I'm going to celebrate Mary and the other friends who have enriched my life and made it whole.  I'm going to cherish my health and not take it for granted.  I'm going to do what I can to be here tomorrow, for friends and family, aging parents who need me, and grandkids not yet born.  How about you?Jan    Krobp MT, Musanti K, Dorwood J.  Exercise and Quality of Life Outcomes in Patients with Cancer.  Seminars in Oncologic Nursing, 2007; 23(4):285-296.   nonadult false There's Something About Mary text blog 591 11 5.0 http://community.myhealthvillage.com/service/displayKickPlace.kickAction?u=3398032&as=43145 http://media.kickstatic.com/kickapps/images/43145/photos/PHOTO_1656418_43145_3398032_ap_160X120.jpg false United States MO Columbia 65203 2 0 112695 3398032 Member 0 http://community.myhealthvillage.com/_Zen-and-the-Art-of-Personal-Health-Maintenance/BLOG/106755/43145.html Zen and the Art of Personal Health Maintenance  Breast cancer survivor:  "The information that you get at your doctor’s office is focused, it is objective, it is unattached emotionally, it is not at all comforting… and none of those things are going to get you through it.  The things that are going to get you through it…are to be encouraged by others and maybe be shown how, like how the hell am I going to get this wig on and not look like I’ve got a mop on my head?” Several years ago I did a series of long interviews with women who had breast cancer, exploring where they found the information that had been useful to them in deciding upon treatment and coping with the condition.  Conducting this research gave me a chance to slow down, sit in an unhurried fashion and listen to women tell their stories as they talked about such a major transformative event in their lives.  This leisurely conversation was far from the 15-30 minute office visit I had grown used to, one loaded with questions I directed to the patient about new symptoms, medication side effects, and evidence-based guidelines on screening and prevention.   Looking back on it, I suppose these long interviews were the beginning of something that has proved transformative for me.  The transcripts from those conversations say much about the challenges people face as they sift and sort through information they need to cope well in the face of chronic illness.  Clearly, the role of the doctor is secure and often decisive in helping individuals select what they feel is the best course of therapy.   Making this judgment requires a comprehensive understanding of how to categorize and stage the disease as well as working knowledge of an extensive literature on clinical response to various treatments.  For many, especially older adults, they trust their doctor to know best and will do what s/he recommends.    But when it comes to the day-to-day coping with the enormity of a life forevermore changed by a diagnosis - waking up with the anxiety that this could be the day a recurrence rears its ugly head, or the frustration of wanting one’s original body back, thank you very much - the doctor’s office is not a place to find answers or much comfort.  I wish it were otherwise.  For this, women found helpful their connections with others – women (and men) who had themselves experienced cancer, friends, family, ministers and other practitioners. I am reminded Robert Pirsig’s, “Zen and the Art of Motorcycle Maintenance,” which explored of the tug between rational thought based on the Greek tradition vs. the eastern way of knowing through being, and who asserted that humans need both types of wisdom to make the most of their experience.     Discussions of the art and science of medicine are not new, but in the brave new (and improved) world of patient empowerment, let’s think anew of the art and science of patient-hood.  Individuals are gaining access to the quantitative and rational information needed to make their own decisions while also finding a ready source of common wisdom through social health networks like myhealthvillage.com.  The two opportunities are complementary and not in competition with one another.  Let’s use the village to help use them both to their maximal good! Jan   Zen and the Art of Personal Health Maintenance  Breast cancer survivor:  "The information that you get at your doctor’s office is focused, it is objective, it is unattached emotionally, it is not at all comforting… and none of those things are going to get you through it.  The things that are going to get you through it…are to be encouraged by others and maybe be shown how, like how the hell am I going to get this wig on and not look like I’ve got a mop on my head?” Several years ago I did a series of long interviews with women who had breast cancer, exploring where they found the information that had been useful to them in deciding upon treatment and coping with the condition.  Conducting this research gave me a chance to slow down, sit in an unhurried fashion and listen to women tell their stories as they talked about such a major transformative event in their lives.  This leisurely conversation was far from the 15-30 minute office visit I had grown used to, one loaded with questions I directed to the patient about new symptoms, medication side effects, and evidence-based guidelines on screening and prevention.   Looking back on it, I suppose these long interviews were the beginning of something that has proved transformative for me.  The transcripts from those conversations say much about the challenges people face as they sift and sort through information they need to cope well in the face of chronic illness.  Clearly, the role of the doctor is secure and often decisive in helping individuals select what they feel is the best course of therapy.   Making this judgment requires a comprehensive understanding of how to categorize and stage the disease as well as working knowledge of an extensive literature on clinical response to various treatments.  For many, especially older adults, they trust their doctor to know best and will do what s/he recommends.    But when it comes to the day-to-day coping with the enormity of a life forevermore changed by a diagnosis - waking up with the anxiety that this could be the day a recurrence rears its ugly head, or the frustration of wanting one’s original body back, thank you very much - the doctor’s office is not a place to find answers or much comfort.  I wish it were otherwise.  For this, women found helpful their connections with others – women (and men) who had themselves experienced cancer, friends, family, ministers and other practitioners. I am reminded Robert Pirsig’s, “Zen and the Art of Motorcycle Maintenance,” which explored of the tug between rational thought based on the Greek tradition vs. the eastern way of knowing through being, and who asserted that humans need both types of wisdom to make the most of their experience.     Discussions of the art and science of medicine are not new, but in the brave new (and improved) world of patient empowerment, let’s think anew of the art and science of patient-hood.  Individuals are gaining access to the quantitative and rational information needed to make their own decisions while also finding a ready source of common wisdom through social health networks like myhealthvillage.com.  The two opportunities are complementary and not in competition with one another.  Let’s use the village to help use them both to their maximal good! Jan   Wed, 24 Sep 2008 15:24:42 GMT http://community.myhealthvillage.com/_Zen-and-the-Art-of-Personal-Health-Maintenance/BLOG/106755/43145.html Jan_Swaney_MD 2008-09-24T15:24:42Z myhealthvillage Zen and the Art of Personal Health Maintenance  Breast cancer survivor:  "The information that you get at your doctor’s office is focused, it is objective, it is unattached emotionally, it is not at all comforting… and none of those things are going to get you through it.  The things that are going to get you through it…are to be encouraged by others and maybe be shown how, like how the hell am I going to get this wig on and not look like I’ve got a mop on my head?” Several years ago I did a series of long interviews with women who had breast cancer, exploring where they found the information that had been useful to them in deciding upon treatment and coping with the condition.  Conducting this research gave me a chance to slow down, sit in an unhurried fashion and listen to women tell their stories as they talked about such a major transformative event in their lives.  This leisurely conversation was far from the 15-30 minute office visit I had grown used to, one loaded with questions I directed to the patient about new symptoms, medication side effects, and evidence-based guidelines on screening and prevention.   Looking back on it, I suppose these long interviews were the beginning of something that has proved transformative for me.  The transcripts from those conversations say much about the challenges people face as they sift and sort through information they need to cope well in the face of chronic illness.  Clearly, the role of the doctor is secure and often decisive in helping individuals select what they feel is the best course of therapy.   Making this judgment requires a comprehensive understanding of how to categorize and stage the disease as well as working knowledge of an extensive literature on clinical response to various treatments.  For many, especially older adults, they trust their doctor to know best and will do what s/he recommends.    But when it comes to the day-to-day coping with the enormity of a life forevermore changed by a diagnosis - waking up with the anxiety that this could be the day a recurrence rears its ugly head, or the frustration of wanting one’s original body back, thank you very much - the doctor’s office is not a place to find answers or much comfort.  I wish it were otherwise.  For this, women found helpful their connections with others – women (and men) who had themselves experienced cancer, friends, family, ministers and other practitioners. I am reminded Robert Pirsig’s, “Zen and the Art of Motorcycle Maintenance,” which explored of the tug between rational thought based on the Greek tradition vs. the eastern way of knowing through being, and who asserted that humans need both types of wisdom to make the most of their experience.     Discussions of the art and science of medicine are not new, but in the brave new (and improved) world of patient empowerment, let’s think anew of the art and science of patient-hood.  Individuals are gaining access to the quantitative and rational information needed to make their own decisions while also finding a ready source of common wisdom through social health networks like myhealthvillage.com.  The two opportunities are complementary and not in competition with one another.  Let’s use the village to help use them both to their maximal good! Jan   nonadult false Zen and the Art of Personal Health Maintenance text blog 474 11 5.0 http://community.myhealthvillage.com/service/displayKickPlace.kickAction?u=3398032&as=43145 http://media.kickstatic.com/kickapps/images/43145/photos/PHOTO_1656418_43145_3398032_ap_160X120.jpg false United States MO Columbia 65203 1 0 106755 3398032 Member 0 http://community.myhealthvillage.com/_Nesting/BLOG/105303/43145.html Nesting  This weekend we packed-up the Prius and headed across country to the campus our son, a college sophomore, now calls home. The empty nest is far from new, but somehow I feel it more acutely when I’m on his turf, climbing 3 flights of stairs to reach the small dorm room where he nests and sleeps, suspended a few feet from the ceiling on a lofted twin bed that hovers over an institutional desk of similar size, and where every foot of floor space is committed to laundry baskets, backpacks, book shelves, trash cans, and yes, a modest beer can pyramid which conveys a respectful, “Hey Mom, we cleaned-up for you!”  We had a great day filled with sporting events, a cook-out, and irresistible walk across the beautiful campus. Last year at this time I took a batch of his favorite cookies, but this time he waived it off and asked me to bring a few recipes including a copy of my mother’s “Fresh Apple Cake” and some of the Johnny Red apples I’d picked on a recent excursion to a friend’s orchard. It turns out, he’s going to prepare a meal and bake one of his favorite cakes for friends. As I drove away, absent the transfer of cookies, I realized that he this is one of many ways in which he is growing-up. He’s baking and cooking on his own now, and for the same reason my husband and I do - to be purposeful about what we eat and show that we care. Granted, its not easy to find the time to cook from scratch, but when I think of it as a way to give a gift of health and caring, then it seems like time well spent. Its even better to cook WITH the one(s) you care about – the time goes even more quickly and your collaboration in the kitchen is another way to build memories and strengthen your bond. Here’s the recipe for our family’s favorite “Fresh Apple Cake.” It’s a great fall treat and healthier than most because it uses cooking oil rather than saturated fats like butter and shortening. I don’t peel the apples because the peel is a good source of micronutrients and fiber...and not peeling also speeds up preparation! I use whole wheat pastry flour in all of my baking rather than all-purpose flour to get more fiber and nutrients into the finished product without sacrificing texture or flavor. 1 1/2 C canola oil (may use 1 C oil and 1/2 C applesauce)2 C sugar3 C flour 3 eggs 1 t soda 1 t salt2 t vanilla1/2 t nutmeg1/2 t cinnamon3 C chopped fresh apples (my favorite are Jonathans, but any tart apple will do)1 C chopped pecans or walnuts1 C golden raisinsCombine oil and sugar. Add beaten eggs and vanilla. Sift together the dry ingredients and add dry to the first mixture. Stir in chopped fresh apples, nuts and raisins. Pour into a greased and floured Bundt or oblong 13” x 9” pan and bake at 325 for 1 hour and 15 minutes, or until a toothpick inserted into the center comes out clean. Jan Nesting  This weekend we packed-up the Prius and headed across country to the campus our son, a college sophomore, now calls home. The empty nest is far from new, but somehow I feel it more acutely when I’m on his turf, climbing 3 flights of stairs to reach the small dorm room where he nests and sleeps, suspended a few feet from the ceiling on a lofted twin bed that hovers over an institutional desk of similar size, and where every foot of floor space is committed to laundry baskets, backpacks, book shelves, trash cans, and yes, a modest beer can pyramid which conveys a respectful, “Hey Mom, we cleaned-up for you!”  We had a great day filled with sporting events, a cook-out, and irresistible walk across the beautiful campus. Last year at this time I took a batch of his favorite cookies, but this time he waived it off and asked me to bring a few recipes including a copy of my mother’s “Fresh Apple Cake” and some of the Johnny Red apples I’d picked on a recent excursion to a friend’s orchard. It turns out, he’s going to prepare a meal and bake one of his favorite cakes for friends. As I drove away, absent the transfer of cookies, I realized that he this is one of many ways in which he is growing-up. He’s baking and cooking on his own now, and for the same reason my husband and I do - to be purposeful about what we eat and show that we care. Granted, its not easy to find the time to cook from scratch, but when I think of it as a way to give a gift of health and caring, then it seems like time well spent. Its even better to cook WITH the one(s) you care about – the time goes even more quickly and your collaboration in the kitchen is another way to build memories and strengthen your bond. Here’s the recipe for our family’s favorite “Fresh Apple Cake.” It’s a great fall treat and healthier than most because it uses cooking oil rather than saturated fats like butter and shortening. I don’t peel the apples because the peel is a good source of micronutrients and fiber...and not peeling also speeds up preparation! I use whole wheat pastry flour in all of my baking rather than all-purpose flour to get more fiber and nutrients into the finished product without sacrificing texture or flavor. 1 1/2 C canola oil (may use 1 C oil and 1/2 C applesauce)2 C sugar3 C flour 3 eggs 1 t soda 1 t salt2 t vanilla1/2 t nutmeg1/2 t cinnamon3 C chopped fresh apples (my favorite are Jonathans, but any tart apple will do)1 C chopped pecans or walnuts1 C golden raisinsCombine oil and sugar. Add beaten eggs and vanilla. Sift together the dry ingredients and add dry to the first mixture. Stir in chopped fresh apples, nuts and raisins. Pour into a greased and floured Bundt or oblong 13” x 9” pan and bake at 325 for 1 hour and 15 minutes, or until a toothpick inserted into the center comes out clean. Jan Mon, 22 Sep 2008 14:03:19 GMT http://community.myhealthvillage.com/_Nesting/BLOG/105303/43145.html Jan_Swaney_MD 2008-09-22T14:03:19Z myhealthvillage Nesting  This weekend we packed-up the Prius and headed across country to the campus our son, a college sophomore, now calls home. The empty nest is far from new, but somehow I feel it more acutely when I’m on his turf, climbing 3 flights of stairs to reach the small dorm room where he nests and sleeps, suspended a few feet from the ceiling on a lofted twin bed that hovers over an institutional desk of similar size, and where every foot of floor space is committed to laundry baskets, backpacks, book shelves, trash cans, and yes, a modest beer can pyramid which conveys a respectful, “Hey Mom, we cleaned-up for you!”  We had a great day filled with sporting events, a cook-out, and irresistible walk across the beautiful campus. Last year at this time I took a batch of his favorite cookies, but this time he waived it off and asked me to bring a few recipes including a copy of my mother’s “Fresh Apple Cake” and some of the Johnny Red apples I’d picked on a recent excursion to a friend’s orchard. It turns out, he’s going to prepare a meal and bake one of his favorite cakes for friends. As I drove away, absent the transfer of cookies, I realized that he this is one of many ways in which he is growing-up. He’s baking and cooking on his own now, and for the same reason my husband and I do - to be purposeful about what we eat and show that we care. Granted, its not easy to find the time to cook from scratch, but when I think of it as a way to give a gift of health and caring, then it seems like time well spent. Its even better to cook WITH the one(s) you care about – the time goes even more quickly and your collaboration in the kitchen is another way to build memories and strengthen your bond. Here’s the recipe for our family’s favorite “Fresh Apple Cake.” It’s a great fall treat and healthier than most because it uses cooking oil rather than saturated fats like butter and shortening. I don’t peel the apples because the peel is a good source of micronutrients and fiber...and not peeling also speeds up preparation! I use whole wheat pastry flour in all of my baking rather than all-purpose flour to get more fiber and nutrients into the finished product without sacrificing texture or flavor. 1 1/2 C canola oil (may use 1 C oil and 1/2 C applesauce)2 C sugar3 C flour 3 eggs 1 t soda 1 t salt2 t vanilla1/2 t nutmeg1/2 t cinnamon3 C chopped fresh apples (my favorite are Jonathans, but any tart apple will do)1 C chopped pecans or walnuts1 C golden raisinsCombine oil and sugar. Add beaten eggs and vanilla. Sift together the dry ingredients and add dry to the first mixture. Stir in chopped fresh apples, nuts and raisins. Pour into a greased and floured Bundt or oblong 13” x 9” pan and bake at 325 for 1 hour and 15 minutes, or until a toothpick inserted into the center comes out clean. Jan nonadult false Nesting text blog 546 20 5.0 http://community.myhealthvillage.com/service/displayKickPlace.kickAction?u=3398032&as=43145 http://media.kickstatic.com/kickapps/images/43145/photos/PHOTO_1656418_43145_3398032_ap_160X120.jpg false United States MO Columbia 65203 3 0 105303 3398032 Member 0 http://community.myhealthvillage.com/_List-less-No-More/BLOG/103894/43145.html List-less No More! Several years ago an article appeared in the New England Journal of Medicine reporting on a term used by French physicians, “La Maladie du Petit Papier”, that describes the situation that arises when patients bring a little piece of paper filled with a list of symptoms. Note that the full term starts with “Maladie,” which translates to malady, which means illness. The point made by its originators was that patients carrying such a list, if it were long, were likely to be experiencing physical symptoms as a manifestation of mental illness. In my experience, when the list is long and the symptoms are vague, physicians are challenged to figure-out whether items on the list represent a yet undiagnosed complex illness, rare syndrome, or the astute observations of the signals a patient’s body may be sending in the absence of a known disease. But enough about maladies and diagnostic dilemmas. Let's go back to the the idea of bringing a little piece of paper to the office visit. I am ALL for the list -- and many doctors would agree with me even though their offices are swimming in paper. Why? Because the list is a great way to communicate your concerns efficiently,“at a glance,” and reflect your proposed agenda for the vanishingly shortened visit that has been whittled to a mere 15 minutes (or less) in many offices. If your list is longer than what can be achieve in the time allotted, together you and your doctor will decide what should be covered on that visit and what might be deferred until the next meeting. Importantly, creating the list and finding out as much as you can about your concerns ahead of time will improve your communication with your doctor and be an important step in taking charge of your health. These days, your health and healthcare are complex and you can’t afford to be passive or list-less! Grab that little piece of paper and take it with you. Jan List-less No More! Several years ago an article appeared in the New England Journal of Medicine reporting on a term used by French physicians, “La Maladie du Petit Papier”, that describes the situation that arises when patients bring a little piece of paper filled with a list of symptoms. Note that the full term starts with “Maladie,” which translates to malady, which means illness. The point made by its originators was that patients carrying such a list, if it were long, were likely to be experiencing physical symptoms as a manifestation of mental illness. In my experience, when the list is long and the symptoms are vague, physicians are challenged to figure-out whether items on the list represent a yet undiagnosed complex illness, rare syndrome, or the astute observations of the signals a patient’s body may be sending in the absence of a known disease. But enough about maladies and diagnostic dilemmas. Let's go back to the the idea of bringing a little piece of paper to the office visit. I am ALL for the list -- and many doctors would agree with me even though their offices are swimming in paper. Why? Because the list is a great way to communicate your concerns efficiently,“at a glance,” and reflect your proposed agenda for the vanishingly shortened visit that has been whittled to a mere 15 minutes (or less) in many offices. If your list is longer than what can be achieve in the time allotted, together you and your doctor will decide what should be covered on that visit and what might be deferred until the next meeting. Importantly, creating the list and finding out as much as you can about your concerns ahead of time will improve your communication with your doctor and be an important step in taking charge of your health. These days, your health and healthcare are complex and you can’t afford to be passive or list-less! Grab that little piece of paper and take it with you. Jan Thu, 18 Sep 2008 20:07:04 GMT http://community.myhealthvillage.com/_List-less-No-More/BLOG/103894/43145.html Jan_Swaney_MD 2008-09-18T20:07:04Z myhealthvillage List-less No More! Several years ago an article appeared in the New England Journal of Medicine reporting on a term used by French physicians, “La Maladie du Petit Papier”, that describes the situation that arises when patients bring a little piece of paper filled with a list of symptoms. Note that the full term starts with “Maladie,” which translates to malady, which means illness. The point made by its originators was that patients carrying such a list, if it were long, were likely to be experiencing physical symptoms as a manifestation of mental illness. In my experience, when the list is long and the symptoms are vague, physicians are challenged to figure-out whether items on the list represent a yet undiagnosed complex illness, rare syndrome, or the astute observations of the signals a patient’s body may be sending in the absence of a known disease. But enough about maladies and diagnostic dilemmas. Let's go back to the the idea of bringing a little piece of paper to the office visit. I am ALL for the list -- and many doctors would agree with me even though their offices are swimming in paper. Why? Because the list is a great way to communicate your concerns efficiently,“at a glance,” and reflect your proposed agenda for the vanishingly shortened visit that has been whittled to a mere 15 minutes (or less) in many offices. If your list is longer than what can be achieve in the time allotted, together you and your doctor will decide what should be covered on that visit and what might be deferred until the next meeting. Importantly, creating the list and finding out as much as you can about your concerns ahead of time will improve your communication with your doctor and be an important step in taking charge of your health. These days, your health and healthcare are complex and you can’t afford to be passive or list-less! Grab that little piece of paper and take it with you. Jan nonadult false List-less No More! text blog 320 10 5.0 http://community.myhealthvillage.com/service/displayKickPlace.kickAction?u=3398032&as=43145 http://media.kickstatic.com/kickapps/images/43145/photos/PHOTO_1656418_43145_3398032_ap_160X120.jpg false United States MO Columbia 65203 2 0 103894 3398032 Member 0 http://community.myhealthvillage.com/_Bedside-Manner-isms/BLOG/97413/43145.html Bedside Manner-isms I promised to get back some thoughts on the fact that most people rate bedside manner as the most important aspect of choosing a doctor. Intuitively, people seem know that bedside manner translates to better healthcare. So what is the evidence that a choosing a doctor with a good bedside manner ensures better healthcare? And if so, what exactly are these manner-isms? Is it a smile? Making good eye contact? Yes to both…but it goes beyond a smile and a handshake. For a start, let’s look at a couple of recent studies that show remarkably similar results with regard to physician communication style and health-related outcomes. In the first study, researchers at the University of Michigan found that when doctors provide more complete information and actively involve patients in diabetes treatment decisions, patients are more likely to follow-through with their self-care and achieve better control of their diabetes. 1 In the second study, researchers in Houston found that a more collaborative communication style between doctors and patients led to better control of hypertension. 2 A close reading of these studies allows us to get a clearer picture of the bedside manner-isms found to be associated with better outcomes in these two chronic conditions. Both capture two key bedside manner-isms that make a difference: better communication skills , specifically: giving more information, letting you know test results when promised, explaining treatment alternatives, letting you know what to expect from treatment and a collaborative decision-making style , specifically: asking for your ideas in making treatment plan, giving choices about treatment, asking to talk about your goals for your care, thinking about your values/traditions when recommending treatments, helping to make a treatment plan that you can do in your daily life So the next time you see your doctor, make a list of questions ahead of time and don’t nod an agreeable “ok” until you get answers in language you can understand – news you can use. Before your doctor writes a new prescription or orders a new test, make sure you understand your choices and agree that this one suits you best. Afterall, it's a long-term investment in a relationship that can help you attain better health, and manner-isms really do matter. __________ 1. Heisler M, Cole I, Weir D, et al. Does physician communication influence older patients’ diabetes self-management and glycemic control? Results from the health and retirement study. J Geront 2007; 62:1435-1442. 2. Naik A, Kallen M, Walker A, Street R. Improving hypertension control in diabetes mellitus: the effects of collaborative and proactive health communication. Circulation 2008;117:1361-1368. Bedside Manner-isms I promised to get back some thoughts on the fact that most people rate bedside manner as the most important aspect of choosing a doctor. Intuitively, people seem know that bedside manner translates to better healthcare. So what is the evidence that a choosing a doctor with a good bedside manner ensures better healthcare? And if so, what exactly are these manner-isms? Is it a smile? Making good eye contact? Yes to both…but it goes beyond a smile and a handshake. For a start, let’s look at a couple of recent studies that show remarkably similar results with regard to physician communication style and health-related outcomes. In the first study, researchers at the University of Michigan found that when doctors provide more complete information and actively involve patients in diabetes treatment decisions, patients are more likely to follow-through with their self-care and achieve better control of their diabetes. 1 In the second study, researchers in Houston found that a more collaborative communication style between doctors and patients led to better control of hypertension. 2 A close reading of these studies allows us to get a clearer picture of the bedside manner-isms found to be associated with better outcomes in these two chronic conditions. Both capture two key bedside manner-isms that make a difference: better communication skills , specifically: giving more information, letting you know test results when promised, explaining treatment alternatives, letting you know what to expect from treatment and a collaborative decision-making style , specifically: asking for your ideas in making treatment plan, giving choices about treatment, asking to talk about your goals for your care, thinking about your values/traditions when recommending treatments, helping to make a treatment plan that you can do in your daily life So the next time you see your doctor, make a list of questions ahead of time and don’t nod an agreeable “ok” until you get answers in language you can understand – news you can use. Before your doctor writes a new prescription or orders a new test, make sure you understand your choices and agree that this one suits you best. Afterall, it's a long-term investment in a relationship that can help you attain better health, and manner-isms really do matter. __________ 1. Heisler M, Cole I, Weir D, et al. Does physician communication influence older patients’ diabetes self-management and glycemic control? Results from the health and retirement study. J Geront 2007; 62:1435-1442. 2. Naik A, Kallen M, Walker A, Street R. Improving hypertension control in diabetes mellitus: the effects of collaborative and proactive health communication. Circulation 2008;117:1361-1368. Fri, 05 Sep 2008 12:35:50 GMT http://community.myhealthvillage.com/_Bedside-Manner-isms/BLOG/97413/43145.html Jan_Swaney_MD 2008-09-05T12:35:50Z myhealthvillage Bedside Manner-isms I promised to get back some thoughts on the fact that most people rate bedside manner as the most important aspect of choosing a doctor. Intuitively, people seem know that bedside manner translates to better healthcare. So what is the evidence that a choosing a doctor with a good bedside manner ensures better healthcare? And if so, what exactly are these manner-isms? Is it a smile? Making good eye contact? Yes to both…but it goes beyond a smile and a handshake. For a start, let’s look at a couple of recent studies that show remarkably similar results with regard to physician communication style and health-related outcomes. In the first study, researchers at the University of Michigan found that when doctors provide more complete information and actively involve patients in diabetes treatment decisions, patients are more likely to follow-through with their self-care and achieve better control of their diabetes. 1 In the second study, researchers in Houston found that a more collaborative communication style between doctors and patients led to better control of hypertension. 2 A close reading of these studies allows us to get a clearer picture of the bedside manner-isms found to be associated with better outcomes in these two chronic conditions. Both capture two key bedside manner-isms that make a difference: better communication skills , specifically: giving more information, letting you know test results when promised, explaining treatment alternatives, letting you know what to expect from treatment and a collaborative decision-making style , specifically: asking for your ideas in making treatment plan, giving choices about treatment, asking to talk about your goals for your care, thinking about your values/traditions when recommending treatments, helping to make a treatment plan that you can do in your daily life So the next time you see your doctor, make a list of questions ahead of time and don’t nod an agreeable “ok” until you get answers in language you can understand – news you can use. Before your doctor writes a new prescription or orders a new test, make sure you understand your choices and agree that this one suits you best. Afterall, it's a long-term investment in a relationship that can help you attain better health, and manner-isms really do matter. __________ 1. Heisler M, Cole I, Weir D, et al. Does physician communication influence older patients’ diabetes self-management and glycemic control? Results from the health and retirement study. J Geront 2007; 62:1435-1442. 2. Naik A, Kallen M, Walker A, Street R. Improving hypertension control in diabetes mellitus: the effects of collaborative and proactive health communication. Circulation 2008;117:1361-1368. nonadult false Bedside Manner-isms text blog 523 20 5.0 http://community.myhealthvillage.com/service/displayKickPlace.kickAction?u=3398032&as=43145 http://media.kickstatic.com/kickapps/images/43145/photos/PHOTO_1656418_43145_3398032_ap_160X120.jpg false United States MO Columbia 65203 3 0 97413 3398032 Member 0 http://community.myhealthvillage.com/_How-Doctors-Choose-Their-Doctors-And-You-Should-Too/BLOG/93385/43145.html How Doctors Choose Their Doctors - And You Should Too!     I often get asked advice from non-physician friends about what doctor I'd recommend they choose as a primary care physician or specialist. This is a common theme at backyard picnics, receptions, fundraisers, and chance encounters at the grocery store.     It goes something like this, " Hi Jan, gosh I haven't seen you since a couple of years ago when our kids graduated from high school. Wasn't that a great ceremony? Wow, those peaches look good! Hey, I've been meaning to ask you...see, my insurance has changed and I have to pick a new primary care doctor and so I'm wondering who you'd recommend?"     I figure the "Golden Rule" is a good place to start with most things in life and I always end-up recommending docs I'd be willing to see myself, as if I were the one needing care. So I'm going to shed some light on just how it is that I (and most other doctors) choose other doctors.     But to start, what do we value? I don't think doctors are different from anyone else, we want doctors we can talk to and whose judgment we trust. A recent survey from the American Board of Medical Specialties reports that Americans rate communication skills and bedside manner as the most important aspect of choosing a doctor. Second in importance comes board certification – but it turns out that for the most part, John and Jane Q. Public don’t know what that means, and often confuse it with a license to practice medicine.     So here's the big difference; a license to practice medicine doesn't require board certification. I'm not kidding about this. Licensure requires passing all 3 steps of the United States Medical Licensure Exam (USMLE), one year of training beyond medical school in an accredited training program (sometimes called an internship), and being deemed a member in good standing of the profession by that state's medical licensing board. Board certification (and I can see why this gets confusing) requires all of that AND completion of an entire residency in an accredited training program (an additional 2-6 years beyond internship) devoted to a medical specialty, plus passage of the certifying exam administered by that medical specialty board.     Licensure is required of all physicians who wish to practice medicine and deliver care to patients, but board certification is not; it's voluntary and yet is one very important standard by which physicians judge one another. Not to be board certified is an exception rather than the rule, and you should make sure your physician is board certified. If you're not sure, you can find-out (free of charge) by going to http://www.abms.org .     I want to revisit the catch-all phrase "bedside manner" and talk about other aspects of how I choose (or recommend) a doctor, but I'll save those musings for another day. My peaches are getting soft.     Jan   How Doctors Choose Their Doctors - And You Should Too!     I often get asked advice from non-physician friends about what doctor I'd recommend they choose as a primary care physician or specialist. This is a common theme at backyard picnics, receptions, fundraisers, and chance encounters at the grocery store.     It goes something like this, " Hi Jan, gosh I haven't seen you since a couple of years ago when our kids graduated from high school. Wasn't that a great ceremony? Wow, those peaches look good! Hey, I've been meaning to ask you...see, my insurance has changed and I have to pick a new primary care doctor and so I'm wondering who you'd recommend?"     I figure the "Golden Rule" is a good place to start with most things in life and I always end-up recommending docs I'd be willing to see myself, as if I were the one needing care. So I'm going to shed some light on just how it is that I (and most other doctors) choose other doctors.     But to start, what do we value? I don't think doctors are different from anyone else, we want doctors we can talk to and whose judgment we trust. A recent survey from the American Board of Medical Specialties reports that Americans rate communication skills and bedside manner as the most important aspect of choosing a doctor. Second in importance comes board certification – but it turns out that for the most part, John and Jane Q. Public don’t know what that means, and often confuse it with a license to practice medicine.     So here's the big difference; a license to practice medicine doesn't require board certification. I'm not kidding about this. Licensure requires passing all 3 steps of the United States Medical Licensure Exam (USMLE), one year of training beyond medical school in an accredited training program (sometimes called an internship), and being deemed a member in good standing of the profession by that state's medical licensing board. Board certification (and I can see why this gets confusing) requires all of that AND completion of an entire residency in an accredited training program (an additional 2-6 years beyond internship) devoted to a medical specialty, plus passage of the certifying exam administered by that medical specialty board.     Licensure is required of all physicians who wish to practice medicine and deliver care to patients, but board certification is not; it's voluntary and yet is one very important standard by which physicians judge one another. Not to be board certified is an exception rather than the rule, and you should make sure your physician is board certified. If you're not sure, you can find-out (free of charge) by going to http://www.abms.org .     I want to revisit the catch-all phrase "bedside manner" and talk about other aspects of how I choose (or recommend) a doctor, but I'll save those musings for another day. My peaches are getting soft.     Jan   Mon, 25 Aug 2008 22:38:35 GMT http://community.myhealthvillage.com/_How-Doctors-Choose-Their-Doctors-And-You-Should-Too/BLOG/93385/43145.html Jan_Swaney_MD 2008-08-25T22:38:35Z Proctored Groups myhealthvillage How Doctors Choose Their Doctors - And You Should Too!     I often get asked advice from non-physician friends about what doctor I'd recommend they choose as a primary care physician or specialist. This is a common theme at backyard picnics, receptions, fundraisers, and chance encounters at the grocery store.     It goes something like this, " Hi Jan, gosh I haven't seen you since a couple of years ago when our kids graduated from high school. Wasn't that a great ceremony? Wow, those peaches look good! Hey, I've been meaning to ask you...see, my insurance has changed and I have to pick a new primary care doctor and so I'm wondering who you'd recommend?"     I figure the "Golden Rule" is a good place to start with most things in life and I always end-up recommending docs I'd be willing to see myself, as if I were the one needing care. So I'm going to shed some light on just how it is that I (and most other doctors) choose other doctors.     But to start, what do we value? I don't think doctors are different from anyone else, we want doctors we can talk to and whose judgment we trust. A recent survey from the American Board of Medical Specialties reports that Americans rate communication skills and bedside manner as the most important aspect of choosing a doctor. Second in importance comes board certification – but it turns out that for the most part, John and Jane Q. Public don’t know what that means, and often confuse it with a license to practice medicine.     So here's the big difference; a license to practice medicine doesn't require board certification. I'm not kidding about this. Licensure requires passing all 3 steps of the United States Medical Licensure Exam (USMLE), one year of training beyond medical school in an accredited training program (sometimes called an internship), and being deemed a member in good standing of the profession by that state's medical licensing board. Board certification (and I can see why this gets confusing) requires all of that AND completion of an entire residency in an accredited training program (an additional 2-6 years beyond internship) devoted to a medical specialty, plus passage of the certifying exam administered by that medical specialty board.     Licensure is required of all physicians who wish to practice medicine and deliver care to patients, but board certification is not; it's voluntary and yet is one very important standard by which physicians judge one another. Not to be board certified is an exception rather than the rule, and you should make sure your physician is board certified. If you're not sure, you can find-out (free of charge) by going to http://www.abms.org .     I want to revisit the catch-all phrase "bedside manner" and talk about other aspects of how I choose (or recommend) a doctor, but I'll save those musings for another day. My peaches are getting soft.     Jan   proctored groups nonadult false How Doctors Choose Their Doctors - And You Should, Too! text blog proctored groups 515 10 5.0 http://community.myhealthvillage.com/service/displayKickPlace.kickAction?u=3398032&as=43145 http://media.kickstatic.com/kickapps/images/43145/photos/PHOTO_1656418_43145_3398032_ap_160X120.jpg false United States MO Columbia 65203 1 Proctored Groups 0 93385 3398032 Member 0