I must thank David Mendosa for getting me back to this topic. His blog at Health Central on December 6, 2010 about the downfall of the Mediterranean diet was excellent and reminded me of what I had started back in October, but was not sure I was ready to finish it.
This is a good time to remind everyone that in general if someone says the word diet, chances are you will probably want to avoid it. Most diets are not set up for being adhered to for the long-term. They are generally maximized for the short-term to give the greatest benefit and most people will not adhere to one for the long-term.
If you want or need to lose weight, the key is to stop being sedentary and develop an exercise routine that fits you and your desires. Remember that the trips to and from the refrigerator don't count. To lose weight and maintain the weight loss, a lifestyle change is necessary. This change has to be flexible and something that can be acceptable in the months and years ahead.
WebMD has an excellent discussion about diets and while I agree with most of what is said, I must warn you that I grew up on a dairy farm and will probably never remove all dairy products from my menu. I have removed much of it because of the growth hormones added to feeds and the genetically modified grains used as feed. The discussion in WebMD is good because it does urge moderation of carbohydrates, fats, and protein and does not push one over the other. Their emphasis is on balanced nutrition which is as it should be.
I would also have problems with the Paleo (Paleolithic) diet which many are learning to follow. It is one of the better diets. I admit that I do not like diets for the reason that they are not sustainable, not always the most healthy, and many times are less nutritious. I have tried the South Beach diet, but after four months, found it unsustainable.
I am attempting to put together a combination of eating habits that are nutritious and may incorporate parts of the Paleo and South Beach diets that are realistic for me. This is one reason that I advise everyone to consult with a nutritionist and dietitian to arrive at something that is sustainable for you. It will include what works for you and is a sound and sustainable lifestyle change. I urge you to be careful of letting mantras influence you. The current mantra about whole wheat/grains is not healthy in the long run and needs to be modified to minimize these.
I also do not advise going to extremes on nutrition either. I have seen too many of these people on the internet and what they advise is not sustainable in the long-term and often not as nutritious in the long-term either. Until we learn moderation, most of us may never eat as healthy as we should.
Read David's blog here, and the WebMd article here. Another interesting WebMD article is here and two of my previous related blogs are here and here.
22 January 2011
21 January 2011
Supreme Court Rules on Medical Residents
The medical profession has been dealt another blow to their ego's. In addition to OSHA proposing limits on doctors' hours of work, especially interns, the Supreme Court has now ruled that interns are workers and not students. This means that federal withholding for FICA and Medicare must be filed and matched by the hospitals and other medical training facilities.
The Mayo Clinic in Rochester, Minnesota, and the University of Minnesota in Minneapolis, similar to other institutions with residency programs, began paying their share of the tax in 2005, but then separately sued the federal government to recover the money. This decision makes them eligible for the benefits of the Social Security Administration.
This now makes OSHA's intervention easier and will limit the hours interns and doctors will be able to work. At least this still allows for salaries instead of hourly wages for which overtime would play a part. There are other side issues at the heart of this decision which interns will not be subjected to and protects interns. This decision will create greater expenses to be covered by patients or taxpayers.
I repeat myself, but I believe the hazing part of intern learning has been blunted and the real world finally available for the interns. They will be able to learn in a more conducive environment and hopefully the OSHA regulation will ease the hours of work and make them hopefully better interns.
Is this the end? I doubt it as the Medical community still wants their hazing due and will be looking for other ways make interns pay their dues. Read the medscape article here and the New England Journal of Medicine article here.
The Mayo Clinic in Rochester, Minnesota, and the University of Minnesota in Minneapolis, similar to other institutions with residency programs, began paying their share of the tax in 2005, but then separately sued the federal government to recover the money. This decision makes them eligible for the benefits of the Social Security Administration.
This now makes OSHA's intervention easier and will limit the hours interns and doctors will be able to work. At least this still allows for salaries instead of hourly wages for which overtime would play a part. There are other side issues at the heart of this decision which interns will not be subjected to and protects interns. This decision will create greater expenses to be covered by patients or taxpayers.
I repeat myself, but I believe the hazing part of intern learning has been blunted and the real world finally available for the interns. They will be able to learn in a more conducive environment and hopefully the OSHA regulation will ease the hours of work and make them hopefully better interns.
Is this the end? I doubt it as the Medical community still wants their hazing due and will be looking for other ways make interns pay their dues. Read the medscape article here and the New England Journal of Medicine article here.
20 January 2011
Sleep Regulations Objected to By Doctors
Surgeons and related medical professionals are crying foul over proposed regulations that would limit the number of surgeries performed by some by requiring them to disclose the number of hours they have been working to patients. This would allow patients the right to decide to reschedule or ask for another surgeon.
Physicians are protesting as if they were back in college and doing hazing as part of initiation for residents joining a fraternity. They don't want this to end and feel everyone should go through this. Residents are considered potential fraternity members in the medical profession, but this hazing should have no place in determining their eligibility to the profession.
Even most physicians do not deny that lack of sleep can create problems, but turn right around and declare that the disclosure requirement would be oppressive and insidious. And this from people that are supposed to be professionals. When other occupations – airline pilots, truckers, and train operators are regulated and fined for hours of service violations – all in the name of public safety, the medical profession should also fall under regulations for public safety – ours.
When physicians are seeing only dollar signs for working long hours and putting patients in jeopardy, then they should be sued. Regulations would go a long way in deterring physicians from putting patients in danger and should limit lawsuits for doctor negligence and carelessness. Maybe doctors fearing lawsuits should not be doing surgery beyond 10 hours.
At least David Michaels, PhD, MPH, assistant secretary of labor for OSHA has indicated he is standing firm on this issue. He cites the dangers of working extremely long hours and the evidence of patient safety suffering. In a written statement Dr. Michaels issued last fall he said “It is clear that long work hours can lead to tragic mistakes, endangering workers, patients, and the public.” “Hospitals and medical training programs are not exempt for ensuring that their employees' health and safety are protected.”
Read the article here and draw your own conclusions. I am writing (emailing) my thoughts to my congressional delegation. Tomorrow what the Supreme Court says about interns.
Physicians are protesting as if they were back in college and doing hazing as part of initiation for residents joining a fraternity. They don't want this to end and feel everyone should go through this. Residents are considered potential fraternity members in the medical profession, but this hazing should have no place in determining their eligibility to the profession.
Even most physicians do not deny that lack of sleep can create problems, but turn right around and declare that the disclosure requirement would be oppressive and insidious. And this from people that are supposed to be professionals. When other occupations – airline pilots, truckers, and train operators are regulated and fined for hours of service violations – all in the name of public safety, the medical profession should also fall under regulations for public safety – ours.
When physicians are seeing only dollar signs for working long hours and putting patients in jeopardy, then they should be sued. Regulations would go a long way in deterring physicians from putting patients in danger and should limit lawsuits for doctor negligence and carelessness. Maybe doctors fearing lawsuits should not be doing surgery beyond 10 hours.
At least David Michaels, PhD, MPH, assistant secretary of labor for OSHA has indicated he is standing firm on this issue. He cites the dangers of working extremely long hours and the evidence of patient safety suffering. In a written statement Dr. Michaels issued last fall he said “It is clear that long work hours can lead to tragic mistakes, endangering workers, patients, and the public.” “Hospitals and medical training programs are not exempt for ensuring that their employees' health and safety are protected.”
Read the article here and draw your own conclusions. I am writing (emailing) my thoughts to my congressional delegation. Tomorrow what the Supreme Court says about interns.
19 January 2011
Are States Abandoning Medicaid?
This is a problem facing many states. And not a good one at that. Most are having financial problems and a difficult time paying for services for Medicaid patients. The description by the Texas state health agency of this being a “no-win situation” is very true.
States could lose billions of federal dollars (our tax dollars), if they drop out of the jointly funded federal and state program. In addition this would cause millions of people to go uninsured. Yet what are states to do when they are facing bankruptcy.
In the article, the state of Texas did the analysis and found that dropping Medicaid was not an option, but keeping it could well bankrupt the state. They are working on several more options. Texas is stating that the Federal government should allow the states have more freedom to design and manage their Medicaid programs. Other states are echoing this.
It seems that necessity has always been the mother of inventions and I think the financial stress may yield some workable and sustainable solutions. Texas also would like to see the formula for distribution of Medicare funds among the 50 states modified. Texas thinks that they are being short changed, which they may well be as are several other states.
Please read the article here. And no I don't think the states will abandon Medicaid, but there are serious problems in many states.
States could lose billions of federal dollars (our tax dollars), if they drop out of the jointly funded federal and state program. In addition this would cause millions of people to go uninsured. Yet what are states to do when they are facing bankruptcy.
In the article, the state of Texas did the analysis and found that dropping Medicaid was not an option, but keeping it could well bankrupt the state. They are working on several more options. Texas is stating that the Federal government should allow the states have more freedom to design and manage their Medicaid programs. Other states are echoing this.
It seems that necessity has always been the mother of inventions and I think the financial stress may yield some workable and sustainable solutions. Texas also would like to see the formula for distribution of Medicare funds among the 50 states modified. Texas thinks that they are being short changed, which they may well be as are several other states.
Please read the article here. And no I don't think the states will abandon Medicaid, but there are serious problems in many states.
18 January 2011
The Topic of Legal Euthanasia Again
I have been over the top on this topic, but I do feel that way since I am a person with diabetes. I feel that even though the counseling or “end of life” talks that medicare has had on the books is presently directed for those in hospice presently.
I am also of the belief that if we don't speak up, there will be no one to speak for us later if they decide to go after those of us with chronic diseases. This is the reason for my following this topic so closely.
Now I need to direct you attention to someone that I have respected in the patient empowerment field, Trisha Torrey. She speaks to the topic of death panels from a different perspective. Is she right, from her point of view, yes. Do I agree with her, in a word, no.
She is not a person with a chronic disease and at present has no reason to be concerned about “end of life” sessions with her doctor. She is correct that the original fear was started by those opposing Obama care. She is against these tactics and rightfully so. They were wrong to a point in doing this and for that I also agree as they hit below the belt so to speak. These opponents were the medical insurance companies and the pharmaceutical companies.
She does use the screen of living wills and end of life counseling to say this is a good thing. She also states that “advance care planning improves end of life care”. She is right in this and should have stopped there as a patient empowerment leader. I do agree that doctors often keep people alive when there is no longer any quality of life left and any hope of being active in their own care. This is where there is a purpose in living wills and medical powers of attorney including limited medical power of attorney.
I do not agree that doctors should be encouraged to discuss end-of-life issues and be reimbursed for this. I have been asked by several of my doctors to do a living will and specify what should be done medically. I have refused to discuss this with them for my own reasons and if the Medicare reinstates this in the future, I will oppose it again. And yes, I expect it will be reinstated quietly.
And, yes, I believe that once this is done, all doctors will have their sessions if for no other than the reimbursements. In the short term, there will be little effect, but in the long term, Medicare may decide that many life saving procedures will no longer be reimbursed. This is the time that legal euthanasia or “death panels” will become a reality.
I say that patient empowerment should include watching for this to happen and opposing it at every turn. Trisha Torrey says “it is time to appreciate and embrace this new regulation”. It may improve communications with our doctors, but I am not happy about some aspects of this.
Please read Trisha Torrey's blog here. If you need to read my previous blogs on legal euthanasia, read them here and here.
I am also of the belief that if we don't speak up, there will be no one to speak for us later if they decide to go after those of us with chronic diseases. This is the reason for my following this topic so closely.
Now I need to direct you attention to someone that I have respected in the patient empowerment field, Trisha Torrey. She speaks to the topic of death panels from a different perspective. Is she right, from her point of view, yes. Do I agree with her, in a word, no.
She is not a person with a chronic disease and at present has no reason to be concerned about “end of life” sessions with her doctor. She is correct that the original fear was started by those opposing Obama care. She is against these tactics and rightfully so. They were wrong to a point in doing this and for that I also agree as they hit below the belt so to speak. These opponents were the medical insurance companies and the pharmaceutical companies.
She does use the screen of living wills and end of life counseling to say this is a good thing. She also states that “advance care planning improves end of life care”. She is right in this and should have stopped there as a patient empowerment leader. I do agree that doctors often keep people alive when there is no longer any quality of life left and any hope of being active in their own care. This is where there is a purpose in living wills and medical powers of attorney including limited medical power of attorney.
I do not agree that doctors should be encouraged to discuss end-of-life issues and be reimbursed for this. I have been asked by several of my doctors to do a living will and specify what should be done medically. I have refused to discuss this with them for my own reasons and if the Medicare reinstates this in the future, I will oppose it again. And yes, I expect it will be reinstated quietly.
And, yes, I believe that once this is done, all doctors will have their sessions if for no other than the reimbursements. In the short term, there will be little effect, but in the long term, Medicare may decide that many life saving procedures will no longer be reimbursed. This is the time that legal euthanasia or “death panels” will become a reality.
I say that patient empowerment should include watching for this to happen and opposing it at every turn. Trisha Torrey says “it is time to appreciate and embrace this new regulation”. It may improve communications with our doctors, but I am not happy about some aspects of this.
Please read Trisha Torrey's blog here. If you need to read my previous blogs on legal euthanasia, read them here and here.
17 January 2011
Names for Empowered Patients
If you are a person with any chronic disease, chances are you have learned a lot about your disease. You may not know it all, but when it comes to your body, you know how you feel and what works for you. In this case I am talking about those of us with diabetes since that is what I am familiar and somewhat knowledgeable about.
Now Trisha Torrey opens another topic. She wants to know what we – those that are advocating for ourselves and are empowered patients – want to be called. Quite frankly it does not matter to me. Most of my doctors talk with me as a person and that is what I ask. I admit that I do not like doctors that talk at me, around me, or like I am not there when talking to another person. I do have one of these, but there are not any others with his specialty that is available without a longer drive than I am willing to make.
A few call me by my name and when out in public acknowledge me even if we don't stop and talk. This means that I am a person to them and when in the office I am a person with diabetes, heart disease, sleep apnea, and a few other medical problems. They ask questions of me and yes, some are yes and no questions, but many are discussion questions.
I have not had a doctor say “you will” do anything. I have had one doctor say that I should, but after discussion, this did not happen. One doctor asked if I would take a medication. In turn I asked him if it would not set off my allergy, and after a quick review of his medical book, say, “you are right, that is one I will not prescribe”, and made a note to put that on the do not prescribe list.
As such, I am generally very happy with my doctors. If the doctor wants to refer to me as a patient, I don't mind. It seems that many people are hung up with semantics and want to be referred to by another name. I think that is going to be almost impossible without a lot of education and by that I mean the both the medical community and the people being served by them as well as insurers and others.
Please read the blog by Trisha Torrey and decide for yourself. Also read the comments section as some of them are very interesting.
Now Trisha Torrey opens another topic. She wants to know what we – those that are advocating for ourselves and are empowered patients – want to be called. Quite frankly it does not matter to me. Most of my doctors talk with me as a person and that is what I ask. I admit that I do not like doctors that talk at me, around me, or like I am not there when talking to another person. I do have one of these, but there are not any others with his specialty that is available without a longer drive than I am willing to make.
A few call me by my name and when out in public acknowledge me even if we don't stop and talk. This means that I am a person to them and when in the office I am a person with diabetes, heart disease, sleep apnea, and a few other medical problems. They ask questions of me and yes, some are yes and no questions, but many are discussion questions.
I have not had a doctor say “you will” do anything. I have had one doctor say that I should, but after discussion, this did not happen. One doctor asked if I would take a medication. In turn I asked him if it would not set off my allergy, and after a quick review of his medical book, say, “you are right, that is one I will not prescribe”, and made a note to put that on the do not prescribe list.
As such, I am generally very happy with my doctors. If the doctor wants to refer to me as a patient, I don't mind. It seems that many people are hung up with semantics and want to be referred to by another name. I think that is going to be almost impossible without a lot of education and by that I mean the both the medical community and the people being served by them as well as insurers and others.
Please read the blog by Trisha Torrey and decide for yourself. Also read the comments section as some of them are very interesting.
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