Health care Blog

Public health knowledge

Nutrition Tips For Living Life With A Healthy Nutritious Diet

It sounds daunting but choosing to become a healthy eater is one of the wisest decisions you could make with your life! Being a healthy eater is not so much about studying labels, although that’s important. Nor is it about counting calories, although again that can be important depending on what your lifestyle goals are. It isn’t really even about knowing how to figure out how much fat is in the food you’re about to eat, even though that too is important. No, healthy eating is about being smart and making educated decisions about what you’re going to eat and knowing why you’re going to eat it. It’s about making balanced choices and eating in moderation. And about eating a variety of foods instead of restricting yourself to one or two food groups, or food types.

In other words, it’s about making sure you’re eating a healthy nutritious diet. Eating healthy is also a lifestyle commitment. A commitment to a better, healthier you and in return your body will reward you for it. You’ll be more alert, feel better, be able to do more, think better, learn better, have more energy…. The list of health benefits to be had by living life with a healthy nutritious diet are endless!

Healthy Nutritious Diet.

Healthy Nutritious Diet.

Start Your Healthy Eating Lifestyle With Some Education

Here are a few nutrition tips on how to start your healthy eating lifestyle. First up, ensure you know how to make healthy food choices. If you don’t already know why fresh fruit, vegetables, nuts and grains are good for you, learn! There’s nothing like knowing what something is going to do to, or for, your body for encouraging you to eat it, or stay away from it. If you suffer from any health conditions, learn whether you need to remove certain types of foods from your diet, and what food groups are better for you. Eating whole grains when you have belly fat is a case in point! Studies have shown that a diet rich in whole grains is an effective way to lose belly fat – if you’re trying to lose belly fat you should know something important like that. YOUR healthy nutritious diet therefore should include plenty of whole grain foods. Likewise, be aware of what the recommended daily consumption of various food groups is and try to follow those guidelines as much as possible.

Another Honey Of A Nutrition Tip

Take the time to learn about fruits and vegetables from a seasonal perspective, including some of the more unusual ones. Knowing what else is available over and above the standard winter fare for instance will add variety and additional food types to your diet. There is a great article on 4 overlooked but valuable winter veggies that you may not have thought about on the Planet Supplement website! And if you have a sweet tooth, honey is a great and healthy alternative to refined sugar – check the extensive honey compendium on their site while you’re there.

July 2nd, 2017 Posted by | happy life, health, health care, new | 6 Comments

Walking to Lose Weight

Looking to jump start your exercise plan? Walking to lose weight is a great way to kick your metabolism into gear while introducing your body gradually to exercise if you have not worked out in a while. Even if you work out already, walking adds more momentum and keeps your body in motion to keep your metabolism operating at its peak.

The actual number of calories you can burn by walking is dependent upon a variety of factors, including your weight, how fast you walk and how far you go. On average, if you walk about 2 miles at an average speed of 3 mph and weigh 150 pounds you will burn approximately 150 calories. To burn more, you can either walk further or walk faster.

By walking one more mile at the same speed you can burn another 80 calories or so. By walking the same distance, 2 miles, but increasing your speed to 4 mph (one mile in 15 minutes) you will burn another 20 or so calories.  That’s 170 calories every 15 min

walking-to-lose-weight

walking-to-lose-weight

utes at a brisk walking pace. This might sound like walking to lose weight is going to very hard or very time consuming. It really isn’t. If you can commit to a 20 minute walk every day or even every other day and do absolutely nothing else different, you will be burning enough calories to start losing pounds slowly, at the rate of about one a week. If you combine walking with a sound diet plan, you can be much more effective.

If you don’t think you are eating that much but you are having trouble losing weight, just get started on a twenty minute a day walking program and you will see an improvement.

Walking has more benefits than just losing weight. You might start out walking to lose weight but you will soon discover that you are walking to enjoy the flowers, walking to decrease your stress level and walking to get some special quiet time.

Walking is a very good way to relieve stress. It gives you time to think, and it is a great way to get peace and quiet. Leave your cell phone at home and enjoy some moments of solitude. Even as the seasons change, don’t be afraid to dress up in warm boots and a warm coat and take an umbrella with you. There is nothing quite so invigorating as walking outdoors in all weathers. The Queen of England is 91 years old, and still going strong as the monarch of Great Britain. What’s her secret? She loves to hike over her grounds in Windsor Castle in England and Balmoral Castle in Scotland. The rain doesn’t stop her and nor does the snow. I don’t think the Queen of England has ever lifted a dumbbell or tried a tango cha cha to a rap beat down at the local gym, but she walks regularly and she has remained very active. Which brings me to my next point.

There is more to walking than just walking to lose weight. Walking is recommended by chiropractors and doctors to keep your body in good health all around. Walking works your back, gluteals and abdominal muscles as well as your legs. It works your lungs and your heart. If you swing your arms when you walk you are using a good many of the muscles in your body. Walking undoes much of the tension and pain that is caused by sitting too long in front of the computer at work, or the T.V. at home. It keeps your body alive and active.

It is unfortunate that in today’s world it is easy to hop in your car, drive to work, sit in front of the computer, drive home, microwave something quick for dinner and then sit in front of the T.V. or your child’s soccer game, or an evening class, and then go to bed.

Your body was not made to do so much sitting still. It was made to move. Walking to lose weight might be the motivation to get started, but you will do so much more for yourself than that, if you start a walking regimen.

June 30th, 2017 Posted by | health, new | 6 Comments

Why vaccines are important for our country’s financial health, too

Imagine there was a simple treatment that could be given to babies and toddlers that was not only remarkably effective in preventing illness, but also inexpensive. And imagine that this treatment was not only inexpensive, but also lowered overall health care costs.

There’s no need to imagine; the treatment exists. It’s called immunization.

It’s National Infant Immunization Week, a time to recognize and celebrate immunization. It’s during infancy that we give the most vaccines, but the benefits extend far beyond infancy and beyond those babies. The protection lasts for years, keeping babies safe from vaccine-preventable illnesses as they grow — and, by decreasing the number of sick children who might make others sick, vaccines protect entire communities.

But one aspect of immunization that doesn’t get as much attention is the impact they can have on health care costs. Given that national health expenditures were 17.8% of the Gross Domestic Product in 2015 (nearly $10,000 per person) and are expected to rise more than 5% a year through 2025, we need to pay attention to anything that cuts costs — especially when it cuts costs by preventing illness.

The current recommended immunization schedule calls for babies to get the following vaccines by about 18 months of age (some of these are given as combination vaccines):

  • Four doses of vaccines against diphtheria, tetanus, pertussis, Haemophilus influenzae, and pneumococcus
  • Three doses of vaccine against polio and hepatitis B
  • Two doses of influenza vaccine (possibly three depending on when the child is born)
  • One dose of vaccine against measles, mumps, rubella, chicken pox, and hepatitis A

Prevention costs less than treatment

According to data from the Centers for Disease Control and Prevention (CDC), the cost of all of these vaccines is approximately $1,200 if obtained through CDC contracts, and about $1,600 if obtained through private insurance. While this sounds like a chunk of change, it’s nothing compared to the costs of doctor visits or hospitalizations.

The cost of an average doctor’s visit varies, but a sick visit can be $100-$200, more if any tests are needed. Emergency room visits can be several hundred dollars or more. Hospitalizations run in the thousands, sometimes tens of thousands. The average cost of a hospitalization to care for a baby with dehydration from rotavirus (a relatively simple problem) is $3,000-$5,000.

And if a child ends up with any disability from the illness —paralysis from polio, or neurologic problems from encephalitis caused by measles or varicella, or meningitis caused by Haemophilus or pneumococcus — the ongoing costs of treatments and special school services could be quite high.

Why immunization makes financial sense

There are also the costs that occur when parents must stay home to care for a sick child. According to the Bureau of Labor Statistics, the average hourly wage in the US is about $26 an hour. That means that every day off to care for a sick child is a lost $208 in wages, not to mention lost productivity.

It’s true that because vaccines are so effective, there are many fewer cases of vaccine-preventable diseases. This creates a “herd immunity,” meaning that the vaccinated people are protecting the unvaccinated ones; there are fewer of the germs around to catch. But there are still cases — and all it takes is a couple of $20,000 admissions for pertussis, $30,000 admissions for Haemophilus meningitis, or $37,000 heart surgeries for babies with congenital rubella syndrome, to show how vaccination makes good financial sense. And if fewer people vaccinate and the herd immunity breaks down, the costs will grow.

Prevention makes sense, not just for the physical health of our children and all our citizens, but for the financial health of our country, too.

May 23rd, 2017 Posted by | health, health care, vaccines | No Comments

Treadmills: Tips for using this versatile piece of exercise equipment

I used to think of treadmills as the walk (or run) of shame. They were only used on rainy or cold days when I was desperate to get in my workout.

But I have since wised up. Approached the right way, they can offer in-depth, all-around workouts beyond the usual push-the-button-and-go.

“The machines can target all the key muscle groups needed to improve lower body strength and endurance, such as quadriceps, calves, glutes, and hamstrings,” says Dr. Adam Tenforde with the Department of Physical Medicine and Rehabilitation at Harvard-affiliated Spaulding Rehabilitation Hospital. “Plus they offer various programmed workouts that vary the speed and incline, so you can focus on specific goals and needs, like cardiovascular health.”

Treadmills are also ideal for people returning to exercise after an injury or surgery, since you can control the pace and intensity, and they are equipped with handrails for added support.

Using treadmills safely and effectively

Most treadmills monitor intensity with hand sensors that measure your heart rate, but that’s not always the most accurate approach, says Dr. Tenforde. A better way to gauge your effort is with the rate of perceived exertion. This involves ranking your sense of how hard you’re working on a 1-to-10 scale, with 1 being low and 10 being high. For example, 5 to 7 is a moderate-intensity level where you work hard, but can maintain a conversation and not overexert yourself.

Finally, always do a five- to 10-minute warm-up and cool-down by walking at a slow pace. This helps reduce your risk of injury and improves post-workout recovery. (As always, talk to your doctor first before beginning any exercise program.)

Speed, endurance, and muscle building

Here are three treadmill routines from Dr. Tenforde you can add to your exercise program that address three areas of fitness: speed, endurance, and muscle building. Begin with a 10-minute workout and then gradually build up to 20 to 30 minutes as you progress.

Routine 1: Incline (endurance and muscle building). An incline setting generates more muscle activity than walking or running on a flat surface, since you work against gravity. A small 2014 study in the journal Gait & Posture found that incline treadmill walking also could benefit people with knee osteoarthritis and knee replacements.

The workout: Begin walking or running at a zero-grade incline at an exertion rate of 3 or 4 for up to two minutes, then increase to level 1 incline for another minute or two. Repeat the routine until you reach an incline level where you work at 5 to 7 exertion and try to maintain it for a minute or longer. Then reverse the routine until you reach the zero-grade incline again. It is fine to stay at an incline longer, or to exercise at a lower exertion rate, until you are more comfortable.

Routine 2: High-intensity interval training (speed, endurance, and muscle building). HIIT involves alternating between set periods of high-intensity work and rest. The high intensity is at an exertion rate of around 5 to 7, while you rest at a rate of 2 or 3. “HIIT is based on your individual exertion, so adjust the treadmill to match this desired effort,” says Dr. Tenforde. “The point with HIIT is to mix up the intensity to make yourself work harder for shorter periods. It can be fun and breaks up the monotony of exercise.” HIIT is also ideal for people who have trouble finding time to exercise. A study published online by PLOS One found that HIIT produces health benefits similar to longer, traditional endurance training.

The workout: Begin with a moderately high intensity-to-rest ratio of 1:3, in which you power walk or run for one minute and rest for three minutes. As you improve, you can vary the ratio to 1:2 or 1:1 or even work for longer high-intensity periods with shorter rest breaks.

Routine 3: Speed variations (speed, endurance). Most treadmills have pre-programmed workouts that vary the speed and incline with labels, such as “fat burning” or “hill climbing.” “These can help increase your cardiovascular health by varying the effort and can be another way to add variety,” says Dr. Tenforde.

The workout: Choose one of the pre-programmed workouts and adjust the speed and resistance as needed to ensure you stay within an exertion range of 5 to 7.

May 23rd, 2017 Posted by | happy life, health, health care | 11 Comments

Disposing of your expired or unused medications gets a whole lot easier (and safer) this weekend

Saturday, April 29th is National Drug Take Back Day, which means you can drop off any unused or expired medication no questions asked. It’s easy to lose track of medications, especially if you’re caring for someone else. But if those medications fall into the wrong hands — say, a child or a pet — one dose could be fatal. So, it’s better to dispose of your excess medication in a way that is safe to both those around you and to the environment.

Why does it matter how you dispose of your prescriptions?

Prescription drug abuse is a big problem right now, and even something as small as correctly disposing of your medications can help keep that under control. According to the Health and Human Services Department, almost 2,000 people in Massachusetts died from opioid overdoses in 2016.

Use this link to find the drop-off location nearest you. Collections will begin Saturday morning at 10 am and end at 2 pm.

What if there is no collection site near you?

Most medication can be thrown in the trash, but there are some things you can do to make sure no one finds them once they’ve been discarded.

  1. Mix the medications with something that tastes terrible, like cat litter or coffee grounds.
  2. Place this unsavory concoction in a sealed bag or an empty can so that it doesn’t leak.
  3. Throw the whole container in the trash.

Also, make sure you mark out any personal information on your prescription bottles with a permanent marker to ensure the privacy of yourself and your health records.

These tips don’t apply to strong painkillers or sedatives, so the FDA recommends you flush those medications down the toilet. While that is not the best solution for the environment, it’s better than any accidental fatalities. You may have received instructions for disposal when you picked up your prescription, so check that before flushing. If you would like to know if your medication should be dropped off at a collection site on National Drug Take Back Day or flushed down the toilet, check this list.


The Opioid Crisis in America

Register for this free, self-paced course here

Every day in the United States more than 1,000 people are treated in emergency departments for not using prescription opioids as directed. In 2015 more than 30,000 people died from overdoses involving prescription opioids. This course challenges preconceptions about who can become addicted to opioids, attempts to reduce the stigma that exists around addiction in general, and to help people learn about the multiple pathways to treatment.

May 23rd, 2017 Posted by | health | No Comments

Keep your seasonal allergies in check

Seasonal allergies can be frustrating. When spring crawls in, many people begin to experience all-too-familiar itchy and watery eyes, runny nose, and congestion. Symptoms of seasonal allergies are the result of an immune system in overdrive in response to pollen and other allergens. Those bothersome symptoms are intended to protect you from unwanted foreign particles, but in this situation they end up causing misery. There are quite a few options when it comes to controlling allergy symptoms, but we want to watch out for a few that can be quite dangerous when used incorrectly.

Nasal steroids

The first-line treatment for seasonal allergies is an intranasal corticosteroid such as fluticasone propionate (Flonase). These sprays are available without a prescription and you can use them as-needed. Nasal steroid sprays have been shown to help with both nasal symptoms of runny nose and congestion, as well as eye symptoms. When using these sprays, it is important to direct the spray away from the nasal septum, as there have been some cases of nosebleeds from using these sprays. If this happens, stop using the medication and let your doctor know.

To date, most studies looking at the effect of intermittent use of nasal steroids on growth in children have been inconclusive. However, a large study reported a slight reduction in the rate of growth when nasal steroids were used daily over 52 weeks by children before puberty. Therefore, it’s a good idea to discuss steroid nasal sprays with your doctor if you find your child needs it on a more regular basis.

Oral antihistamines

Antihistamines such as diphenhydramine (Benadryl), loratidine (Claritin), cetirizine (Zyrtec), and fexofenadine (Allegra) can also be quite helpful. The key is to take the medicine before symptoms develop, such as early in the morning. Another important thing to remember is that some of these medications can cause drowsiness and should be used cautiously during the day, especially if you are driving.

Decongestants

Nasal decongestant sprays such as phenylephrine and oxymetazoline (Afrin) should be used cautiously. Although they may work well in the short term when used occasionally, if used regularly for more than a few days (approximately five days), you may find your nose more congested than usual. This is called rebound congestion or rhinitis medicamentosa. I usually recommend patients not use these products for more than three days. Using these sprays too often causes a biochemical change in certain receptors on your cells, resulting in a vicious cycle of dependence — the more you use it, the worse your symptoms, and the more you need to use it. If this happens, stop using the medication, and talk to your doctor about switching to another type of nasal spray (intranasal glucocorticoid spray) which has been shown to help with this condition.

Oral decongestants such as pseudoephedrine or phenylephrine may help reduce symptoms as well. You should also use these medications cautiously. They mainly work by constricting blood vessels, and may cause side effects such as increased blood pressure, palpitations, headaches, nervousness, and irritability. These medications should not be used by patients with a history of uncontrolled high blood pressure, heart rhythm problems, strokes, glaucoma, or other conditions.

Alternative therapies

Other therapies that have been shown to be beneficial include nasal saline irrigation. Irrigating the nasal passages with prepared solutions, such as with neti pots, has been shown to improve symptoms of runny nose, congestion, and itchy throat, and to improve quality of sleep in children with acute sinusitis and allergic rhinitis. When using these products, however, make sure you are using distilled, sterilized, purified, or previously boiled water, as there have been rare cases of fatal infections by amoeba when using tap water that was contaminated. Although the evidence for menthol rubs such as Vicks is limited, some patients find that rubbing a little menthol ointment under the nose can sometimes also offer congestion relief.

Sources

Growth Velocity Reduced with Once-Daily Fluticasone Furoate Nasal Spray in Prepubescent Children with Perennial Allergic Rhinitis. The Journal of Allergy and Clinical Immunology, July 2014.

Fluticasone Reverses Oxymetazoline-Induced Tachyphylaxis of Response and Rebound Congestion. American Journal of Respiratory and Critical Care Medicine, 2010.

Efficacy of Nasal Irrigation in the Treatment of Acute Sinusitis in Children. International Journal of Pediatric Otorhinolaryngology, 2009.

Naegleria fowleri — Primary Amebic Meningoencephalitis (PAM). Centers for Disease Control and Prevention. Accessed March 2017.

March 28th, 2017 Posted by | allergies, health | No Comments

Chronic pain: The “invisible” disability

Sometime back in 2010, a good friend of mine from college who had since become a pediatrician posted a complaint on Facebook about “made up” health conditions. “Fibromyalgia, I’m looking at you,” she wrote. At this time, pain was more of an occasional visitor in my body rather than the permanent tenant it has since become. Still, I was offended on behalf of those patients with the disease.

Fast forward to today and my life is all about pacing. This is because everything I do — cook, sleep, work, walk — takes time. This gradual approach to every aspect of my life is not about enlightenment or mindfulness. It is about pain. Or more specifically, trying to evade or minimize it. To minimize is key because I’ve learned it can’t be avoided, at least not entirely, no matter my effort. For me, fibromyalgia became a default diagnosis — a catch-all phrase the doctors slapped on me to encompass all the aches and health complaints that had begun to persistently plague me. I received this diagnosis even as imaging showed degenerative changes and other damage in my spine and hips, even as endometriosis was confirmed to be spreading like strands of spider web inside my abdomen, wrapping its tendrils around my organs with the insidiousness of an invasive plant. When the pain reached the point of making it impossible to work more than on a very part-time basis most weeks, I began to inquire about disability. But my doctors — the same ones who diagnosed me, treated me, and viewed my MRI results — all shook their heads and refused to sign off on any paperwork.

“You don’t seem sick,” they said

This was the same line I was offered in college after extreme intestinal distress caused me to lose more than 20 pounds in a single semester. But the school nutritionist thought I just wasn’t eating enough bananas. “You have such shiny, healthy-looking hair,” she explained, pinching a lock of it between her fingers as though I were a doll on display. “People who are really sick don’t have hair like yours.” A colonoscopy showed nothing visibly wrong, so the doctor diagnosed me with irritable bowel syndrome and treated me as though I was a hopeless neurotic. “Stop being so stressed and eat your greens,” he scolded. Two years later, a laparoscopic surgery would show widespread endometriosis, a large portion of it choking my colon. Its removal eased my GI complications considerably. But by then I learned the hard lesson that doctors often erred on the side of disbelief when they couldn’t see something plainly… or even when they could.

I have heard an extensive list of reasons why I can’t be in as much pain as I say despite my test results… and besides my shiny hair, like: I am too young; I have good teeth; I’m too thin to have back problems. Yet, these haven’t granted me immunity from illness, and they have not prevented pain.

Only recently has medical research started to catch on to what patients suffering from chronic pain have long known. As reported in a New York Times Well column written by Tara Parker-Pope in 2011, a study by the Institute of Medicine discovered that pain can endure long after the illness or injury that caused its initial onset has been treated or healed, until it eventually evolves, or devolves, into its own disease. That is, pain is no longer indicative of another prognosis — it is the prognosis, and a disabling one at that.

Specifically, under the strain of prolonged pain, nerves not only become super-sensitized to pain signals, but begin amplifying them. Once these changes occur, they can be extremely difficult to undo. Meanwhile, most medical students are woefully lacking in training in chronic pain, usually receiving only a few hours’ worth in their entire education. In fact, veterinarians receive more training on how to treat animals in pain than medical doctors do for their human patients. Unfortunately, without an adequate understanding of pain and its mechanisms, many medical practitioners are quick to downplay the experience of their patients as faking or exaggerating. What this translates into is denying a disability because it is invisible to the naked eye.

Wiser doctors needed

What would help me at this point would be to have practitioners who are not only more well-versed in chronic pain, but are willing to acknowledge its disabling impacts on their patients. In other words, doctors should start believing their patients when they say they are hurting. Validation is the first step toward a solution, or at the least, toward offering alternative adjustments and treatments that can accommodate a pain patient and bring them a better quality of life in the absence of a long-term cure.

March 15th, 2017 Posted by | chronic, health, health care | No Comments

5 things to tell your child about 13 Reasons Why

Teens are affected by what their peers do and say — and by what they see in the media. We all know this. Most of the time, it isn’t a serious problem. But when it comes to suicide, it can be a serious problem.

That’s why many parents and professionals are worried about the Netflix series 13 Reasons Why. Based on the book by Jay Asher, it tells the story of Hannah, who kills herself and leaves behind 13 tapes for the people who played a role in her decision. The worry is that the series could make some vulnerable teens consider or try suicide.

How worrisome is this?

It’s a reasonable concern. Suicide is the second leading cause of death in youth ages 15 to 19, just behind accidents — some of which might actually be suicides. According to the 2015 Youth Risk Behavior Survey (YRBS), 17.7% of high school students said they considered suicide in the previous year, 14.6% made a plan, and 8.6% tried to kill themselves.

That’s a lot of kids. And given that there are studies that show that teens are more likely to commit suicide when they hear or read about another suicide, or when a schoolmate commits suicide, it’s understandable why the Netflix series has raised alarm. Trying to stop teens from watching it is a natural response. But besides the fact that it’s hard to do that for a show mostly watched online, the better response may be to use the show to start conversations, and get educated, about suicide.

Some teens are definitely at higher risk of suicide, such as those with mental health problems, a history of abuse, a history of a previous suicide attempt, or a family history of suicide. Teens who are LGBTQ (lesbian, gay, bisexual, transgender, or questioning) are also at higher risk. But given that the YRBS data shows that nearly one in five high school students thinks about suicide, there’s more that comes into play. Bullying, social isolation, and stressful life events, all of which happen to Hannah in the show, can make a teen think about dying — and, as also happens in the show, parents, friends, teachers, and others can be completely unaware of how sad and desperate a teen is feeling.

It’s certainly true that adolescence is almost by definition full of angst. But it’s important to be alert to anything that increases a teen’s risk of feeling suicidal, and to any signs that a teen is very sad, angry, or isolated. Too often, we are reluctant to even to talk about suicide, when talking is exactly what we need to do.

5 points to discuss with your child

Ideally, parents should watch 13 Reasons Why with their teens, and talk about it. But if that’s not possible (or if their teens have already watched it), here are some points worth discussing:

  1. The struggles and feelings Hannah has are common. So very many teens have trouble fitting in, or experience bullying, or have relationship problems, for example. Sometimes teens can feel like they are the only ones for whom life isn’t working out. Talking about this can put it in perspective, and allow you to point out that…
  2. There are other and better solutions than suicide. As horrible as a situation might feel in the moment, there is always something that can be done, and there is always someone who can help. Things can get better — unless you are dead, in which case they can’t. However, in order to get help, you have to let someone know you need it. So…
  3. If you ever start thinking about suicide, at all, tell someone. The best “someone” is someone who can help, or help you get help, like a parent, a teacher, or your doctor. But the most important thing is to tell someone. If you don’t feel comfortable telling someone you know, there are hotlines you can call, like the National Suicide Prevention Hotline: 800-273-8255. And, of course…
  4. If someone ever says that they are thinking about suicide, take it seriously. Don’t brush it off as a joke, don’t act like it’s no big deal or just a bad day. Act like they mean it, and get them help. You should also react and get help when someone is acting sadder than usual, is isolating herself or himself more, or is otherwise acting different in a way that is worrisome. If it turns out to be nothing, they will at least know how much you care about them. Which leads to another important message…
  5. We all have the power to help — or hurt — people every day. The people around Hannah didn’t realize how much they were hurting her, or how they could have helped her. Comments and actions that seem small can be devastating; kindnesses that seem small can make all the difference. If we use this Netflix series to talk about how we are responsible for each other, and how we need to take better care of each other, it could not only help us be better people, it could save lives.

March 12th, 2017 Posted by | health | No Comments

Acupuncture: A point in the right direction, or a stab in the dark?

Acupuncture is a treatment that dates back to around 100 BC in China. It is based on traditional Chinese concepts such as qi (pronounced “chee” and considered life force energy) and meridians (paths through which qi flows). Multiple studies have failed to demonstrate any scientific evidence supporting such principles. Acupuncture involves the insertion of thin needles into the skin at multiple, varying locations based on the patient’s symptoms. Once inserted, some acupuncturists hand turn the needles for added therapeutic benefit. Although there are many uses for acupuncture in traditional Chinese medicine, in Western medicine it is primarily used for the treatment of pain.

Acupuncture (im)pales in comparison to Western medicine

At a time when people are increasingly concerned about drug side effects, some consider acupuncture an attractive non-medication option. Unfortunately, many studies show that the potential benefits of acupuncture are short-lived. In my experience, I put acupuncture, massage, and chiropractic interventions in the same bucket. You may feel better for a day or two, but there is limited lasting improvement.

In one study, 249 people with migraines occurring two to eight times per month received either acupuncture, sham (fake/placebo) acupuncture, or were put on an acupuncture waiting list. The two treatment groups received treatment five days per week for four weeks. Twelve weeks after treatment, the acupuncture group had on average 3.2 fewer attacks per month, the sham acupuncture group had 2.1 fewer attacks per month, and the wait-list group had 1.4 fewer attacks per month. These results are modest at best, and carry an approximate treatment cost of $2,000 per month (estimating $100/session x 20 sessions). This figure does not include lost income from time away from work to attend appointments, travel costs, pain from the procedure, and recovery time.

In general, the effectiveness of standard treatment (medication and injectable therapies) is supported by much stronger scientific evidence than acupuncture, including large clinical trials with thousands of subjects. For those averse to medications, physical therapy is a great alternative — one based on actual human anatomy and scientific principles. My patients often complain that they do not feel significantly better after the five to 10 sessions of physical therapy that insurance companies typically approve. I advise them that the true benefit of physical therapy comes when the stretching and strengthening routines taught by the therapist are continued at home on a long-term basis. Expecting an instant and permanent cure from physical therapy is like going to the gym for a week, and expecting to lose 20 pounds — without any chance of regaining the weight. (If any readers find a gym like that, please let me know….)

Stuck with needles, then stuck with a bill

At a cost of around $100 per treatment, and with sessions that can last over an hour, acupuncture treatments can be limited by both time and cost. Some patients may confidently argue that they do not mind the cost, because their insurance plan covers acupuncture. I would caution those same patients that money does not grow on trees, especially in the health insurance forest. If money is spent on one expense, it cannot be spent on something else. A plan that covers acupuncture may include fine print about excessive co-pays or limited coverage for basic medications. In some cases, covering acupuncture or massage may affect other patients in the same pool. Imagine if everybody received free massages, but in turn a cancer patient’s lifesaving chemotherapy becomes unaffordable. Although this is an exaggerated example, it does demonstrate the economics of health insurance.

Skewer side effects?

Side effects are not just limited to medications; procedures can also have negative effects. Acupuncture is relatively safe when the practitioner uses single-use, sterile needles with a clean technique. Side effects can include skin infections, bleeding, and pneumothorax (collapsed lung) if the needles are inserted too deep in the chest. Physicians sometimes perform acupuncture, but medical training is not required, and the qualifications to secure a license to practice acupuncture vary by state. It is probably worth the added expense to have a more experienced and/or highly credentialed acupuncturist.

Needle-less to say, the procedure went well

I fondly recall meeting an elderly lady who had a good experience with acupuncture for the treatment of her migraines, but the benefit only lasted one to two days after each session. After failing multiple treatments, she tried Botox injections with physicians not named Dr. Mathew, which she found effective. Due to scheduling issues, she ended up seeing me for injections. After I explained the risks and benefits of the procedure, she asked, “Dr. Mathew, are you experienced?” I replied, “Well, I trained the other two doctors who performed your previous injections.” She replied, “Well, I guess that makes you experienced. Are you gentle?” I paused and then replied in a stern tone, “Well, I am known as the Butcher of New England.” The woman was mortified, and she actually turned a little pale. I then advised her that I was just kidding, and that I am one of the gentler injectors in the practice. We then proceeded with her treatment. After we were done, she said, “That was the gentlest set of injections I ever received, and my pain is actually better.” I then said, “Please don’t say that… you will ruin my horrible reputation as the Butcher of New England.”

March 10th, 2017 Posted by | Acupuncture, health | No Comments

Opioid addiction: Long-term treatment for a chronic condition

In 2015, motor vehicle accidents claimed the lives of more than 35,000 Americans. Sadly, the toll exacted by motor vehicle accidents has now been eclipsed. Data from the American Society of Addiction Medicine show that more than 52,000 of we Americans lost our lives to opioid overdose in 2015. Here in the Commonwealth, the story is even more grim; even accounting for differences in average age from community to community — younger people are still more likely to be affected than older people — the opioid overdose death rate has climbed to 23 per 100,000 residents as compared to 9 per 100,000 for the nation as a whole. The causes are numerous and a subject for another day. Similarly, approaches to solve the crisis are numerous and no one solution works for everyone who decides he or she has developed an opioid problem.

Medication Assisted Treatment (MAT)

One approach to treat people who are addicted to opioids is Medication Assisted Treatment (MAT) that combines medications to treat addiction with more traditional counseling approaches. One medication often used in MAT programs is buprenorphine-naloxone (trade name Suboxone, among others). This preparation — hereafter BN — combines buprenorphine, an opioid medication with partial activity that blunts cravings, and naloxone, an opioid overdose reversal medication that discourages abuse of the medication. When we compare groups of people addicted to opioids who are treated with and without BN, we see that those who receive the medication have a significantly higher rate of remaining free of other opioids. But how long should one continue the medication? A month? A year? A lifetime? And is it safe to continue the medication? We do not have the full answers yet, but early signals from the research indicate that not only is it safe but that longer treatment is better than shorter treatment.

Long-term treatment for a chronic condition

Many in the medical community have come to view addiction as a chronic disease. And, like many chronic diseases, it is one that can be managed but not yet cured. The thinking goes that just as those of us with high blood pressure take high blood pressure fighting medication each day for years, those of us with addiction would take addiction-fighting medication every day over years. The evidence shows that long-term proper treatment for high blood pressure lowers the risk for heart attack; evidence is now beginning to grow that long-term MAT can similarly decrease risk for relapse in those with addiction. As reported in a 2008 study in the American Journal on Addictions, patients who were successfully stabilized with a short course of BN could then be switched to long-term treatment with the medication. Forty percent of patients remained in treatment at two years and 20% at five years. When we remember that nearly half of people prescribed medication for blood pressure do not take their pills, we see that people on BN are not more likely to skip their medication than are people with better-studied chronic diseases. More importantly, though, greater than 90% of urine samples from those in the study remained free of opioids other than BN.

Long-term treatment with BN works.

How do people do without longer-term buprenorphine-naloxone treatment?

It is one thing to say that someone on a medication has a good outcome, but it is something else to prove that without the medication the person would not do well. Many advocate short-term treatment with BN. Help a person become stable and then taper off the medication. We now have evidence that this approach, however well intentioned, may be misguided. A 2014 study reported in the Journal of the American Medical Association demonstrates that over half of people who continued on BN maintenance remained free of opioids compared to just a third of those who were stabilized on BN and then tapered off. Further, far more of those treated with maintenance BN remained in the study compared to those who were tapered, suggesting that people remain committed to treatment while receiving BN.

Is long-term MAT safe?

Even if many people can be helped by extended BN treatment, it is important to consider possible side effects. Though we do not know the effects of being on BN for many decades, the 2008 American Journal on Addictions study looked for but did not find any serious adverse effects on the people treated. Earlier concerns that BN could cause liver damage also appeared to be unfounded as blood tests did not show signs of liver problems in any of the patients in the study.

More research is needed, of course, but the early evidence suggests that BN can safely help people remain off unwanted opioids over the long term just as blood pressure medication can protect people from the effects of high blood pressure. That is good news because each day off unwanted opioids is a day a person can focus on improving his or her life. Of course, buprenorphine-naloxone maintenance is not for everyone, but when it works it can work well and can give people room to breathe and rebuild their lives.

References

Abegaz et al. Nonadherence to antihypertensive drugs: A systematic review and meta-analysis. Medicine, 2017.

Fiellin, DA, et al. Long-Term Treatment with Buprenorphine/Naloxone in Primary Care: Results at 2–5 Years. The American Journal on Addictions, 2008.

Fiellin, DA, et al. Primary Care–Based Buprenorphine Taper vs Maintenance Therapy for Prescription Opioid Dependence: A Randomized Clinical Trial. JAMA Internal Medicine, 2014.

Opioid Addiction 2016 Facts & Figures. American Society of Addiction Medicine.

Woody, GE, et al. Extended vs Short-term Buprenorphine-Naloxone for Treatment of Opioid-Addicted Youth: A Randomized Trial. JAMA. 2008.

March 4th, 2017 Posted by | chronic, health care | No Comments