Mel Walsh

Up The Medical Creek---But With a Paddle

  When it comes to navigating the health care system, do you feel up the creek without a paddle? Or In middle of the Pacific without a paddle and there are fins following the canoe?

Well, if you’re in a hospital on your own without a human angel watching over you, you may feel as though you are at sea alone. So assemble a care posse to help out if you are going to a hospital. Don’t go in without family or friends to watch over your care and speak up if you are in la-la-land or just too sick to speak up yourself.

Take a simple, common problem: Suppose the controller device that rings for help is beyond the reach of the hospitalized person.  A buddy can make sure the controller is always within reach.  A buddy can also go out to the nurse’s station to ask for help that has not been forthcoming when the controller buttons have been pressed. And pressed.

A buddy can also make sure the tray table hasn’t been shoved out of the way and inaccessible. I have seen many people unable to reach their bedside water supply.

Can you say post-op dehydration?

 

Medical Patientry 101

                    Whether it’s you that's entangled in a complex health care system or a loved one, it’s important that you learn how to navigate the bumps. But few are taught medical system literacy. So here are a few of the issues where we need expert coaching: Asking for a second opinion without offending the doctor; asking the right questions about diagnosis and treatment; requesting infection-control procedures before anyone works on you or inserts an IV; double-checking the dosage and name of meds, understanding consent forms and much more.

There’s Help: Books

            Patient advocacy is just coming into its own as a life skill. If you want to read up---here are some options:

            The Empowered Patient: Hundreds of Life-Saving Facts, Action Steps and Strategies You Need to Know, by Dr. Julia Hallisy.

            YOU: The Smart Patient…Insider’s Handbook for Getting the Best Treatment, by Michael Roizen and Mehmet Oz.

More Help: The Web

            Mouse on over to www.everypatientsadvocate.com. That’s the site for Trisha Torrey, who is also About.com’s expert on patient empowerment. She offers down-to-earth advice and usable facts---the only kind of fact my mind will glom onto. (No, I don’t even know when the Battle of 1066 was.) Look at Trish’s site and check out her article about how to evaluate medical “news”.

In-Person Help: A Conference

            Big doings in San Francisco on the patient empowerment front: a May 16^th conference called Empowered Health Care, keynoted by Dean Ornish, MD.  More info at www.empoweredhealthcon.com.           

            In sum---all us medically involved mice quivering before the system should cheer up. It is possible to be assertive while sporting a bare-bottomed hospital gown.

Take Your Driving Self-Test Here!

  Every parent says it: I don’t want to be a burden on my kids.

            That sentiment shows parents are beyond wonderful. Their kids have been a burden to them for decades and yet the parents don’t want to get back at the buggers.

            However, if you really don’t want to burden your kids, think outside the usual box of horrors---the one that involves nursing homes and you with the mental capacity of a daffodil. Imagine instead what a burden it will be for your kids to have a parent on the road who should not be driving. Think of the worries your children will have---images of geezer you mashed up in a car crash. 

            Further, collisions are not the path to geezer health and independence. If you get into trouble, your kids are the ones that will have the burden of visiting the ER, neglecting their jobs and children to look after you.        .

How To Know If You Should Hang Up the Car Keys

            The AARP puts forth these warning signs---their list, my words:

·      Your parking is way off. Not within the lines.

·      Scrapes and dings, not only on the car, but on the garage, mailboxes or fences.

·      Fender benders.

·      Stopping in traffic for no reason.

·      Getting lost a lot.

·      Not using signals or using them wrong---driving a hundred miles on a freeway with your left clicker on.

·      Hard for you to move into the correct lane of traffic.

·      Hitting curbs.

·      Driving too fast or too slow.

·      Slow response to surprise situations.

·      Getting all worked up when driving.

·      More close calls.

·      Claiming that “cars come out of nowhere” at you.

·      Trouble getting your foot from the gas to the brake.

·      Clueless about dangerous situations.

 

            I’d add a few more things: If your children tell you that it’s time to stop driving, they are probably right. If you have trouble seeing at night and can’t tell a black-coated person on the roadside from a penguin out for a stroll, it’s time to stop driving after dark.

            Other things to watch:  you‘ve gotten so short with age, you can’t see over the dash. Or you can’t turn your neck to check out the blind spot and everything looks like a blind spot.

 

            The truth is, some day, if we live long enough, we all will have to stop driving and it’s a good idea to begin thinking now how get to the store, the doc or your favorite watering hole. This is easier said than done, but public transport, friends, neighbors and moving into a town center in the later years are all possibilities.

            So is taking a younger lover with a clean driving record. Your choice.

           

Staying Alive: Low-Salt Living Is Part of the Plan

Somebody out there cares about you.

The American Medical Association is going to bat for your heart and circulatory system, meaning the docs want to keep you from congestive heart failure or a stroke induced by high blood pressure.

The AMA says one very effective way to avoid these health disasters is to cut back on salt. Salt keeps water in the body and makes blood pressure go up. Why? The system has more fluid in it, but it’s the same old circulatory pipes that have to handle the extra pressure. (You don’t have to be a plumber to get the concept.)

The Coming Salt Wars

 Right now, most of us eat twice as much salt as is good for us. So the AMA, which has never before requested the regulation of a food ingredient, has asked the FDA to classify salt as a food additive. That would mean the packaged food companies would have to limit how much salt they can add to your frozen dinners, chip snacks, popcorn, canned goods and ready-to-cook pizzas.

Of course, industry interests will fight the AMA and so it will go. But we don’t have to sit on the sidelines watching the coming salt wars. We can control our salt intake here and now.

Easier Said Than Done

Since supermarkets are hidden salt traps, you have to be alert when shopping. Start reading those labels with this in mind: The Center for Disease Control says 1500 mgs a day is the upper limit of what most of us should have. Some frozen dinners have more than that for just one meal. But there are low-salt foods out there. Also, look for places where you can order groceries online such as www.healthyheartmarket.com.

In the dairy department, pick low salt cheeses. Swiss, ricotta and fresh mozzarella tend to be less salty. The deli case may have low-salt turkey for sandwiches. The freezer may offer little cubes of frozen herbs---garlic, basil, parsley---to punch up meals

Mitigating the Salt Disaster

There are ways to cut the salt of prepared products. I use canned chicken broth, cut it with water and add a splash of sesame oil to jump up the flavor. I cut mayo with yogurt or no-fat sour cream. (FAGE no-fat yogurt is a winner.) Or use less of a salty product---just a small swipe of mustard rather than a slather.

Instead of high salt crackers, try no-salt matzos. They are excellent carriers of dips and peanut butter.

The good news is that this salt reduction program is likely to work to lower blood pressure. The other news it that it may push you into more from-scratch cooking with fresh ingredients. If so, here’s some help: The No-Salt, Lowest Sodium Cookbook by Donald Gazzaniga. And don’t miss this fabulous blog full of tips and recipes: http://dontsalt.blogspot.com.  

Mel Walsh is a gerontologist, author and columnist. Her latest book, Hot Granny, is available at www.Amazon.com.

 

On the Road Still: Staying in Charge of Your Driving

Question: Would you like to extend your safe driving lifetime by many years? Or do you want to hang up your car keys too early, either because of an accident or because you haven’t reviewed the rules of the road since you last made out in a Nash?

            Well, if you want to keep safe and happy on the road, consider the AARP Driver Safety Program, the nation’s first and largest classroom refresher course for motorists 50 and over. Also, any age driver can take the online version of the course at www.aarp.org.

            So Why Go?

            Partly to update your knowledge of driving technique. Example: It used to be that people were taught to hold on to the steering wheel at clock positions 10 and 2. Now the recommendations are 8 and 4 o’clock, so when and if an airbag pops out at 600 miles an hour, that airbag won’t throw your arms into your face.

            And then, do you know how far your chest should be from the steering wheel so you won’t get injured by the airbag in an accident? Ten to 12 inches . That’s easy for people with long arms, but manageable for the rest of us. (Further airbag hint: if, like me, you like to put your legs up on the dash during a long trip as a passenger, don’t. The force of the airbag can turn us into human pretzels.)

            Another example of changing rules: older people were taught to pump their brakes, but today, you don’t do that when cars have ABS, an anti-lock braking system. Instead, you just stay steady down on that brake. (To check for ABS, look for an ABS symbol on the dash when you turn the car on.)

            So What Else Is There To Know?

            Lots. Driving is like love-making. Just because you’ve been doing it for years doesn’t mean you know all there is to know on the subject. For instance, do you know how older adults get in trouble on the road? Are you thinking highway driving? Nope. It’s intersections. At least 40% of fatal crashes for drivers 75 and older take place at intersections.

            Why? The vision changes that come with age have a lot to do with it. Your peripheral vision (side vision) and depth perception (judging the speed and distance of oncoming traffic) both diminish with age. You may think “that car came out of nowhere” to crash into your side at an intersection, but it could have been that older eyes were playing depth perception tricks.

            How Do I Find an AARP Course Near Me?

            Go to AARP.org and put Driver Safety Search into the search box. More info at 1-888-227-7669. 

 Watch out for the intersections on the way to class.

Halt The Salt

 

We’re a nation of salt junkies, but to sober us up, the experts at the Center for Disease Control are finally getting the message out about salt’s connection to high blood pressure. In a recent report, the CDC says we eat far too much salt, especially in processed and prepared food. A single frozen meal may have as much as a teaspoon of salt--about 2500 mgs. Same for those cans of soup in your pantry. Sea ‘o salt.

And going out to eat will not save us. Fast food meals are also loaded with salt. So are chips, nuts, hot dogs and many of the foods that are not fresh and not prepared by your own darling hands.

So Who Cares?

            Probably you should. As the Center For Disease Control says: Too much salt is bad for your health: “It can increase your blood pressure and your risk for a heart attack or stroke”. Since these conditions are among the leading causes of death in the US, salt is not just a matter of taste, it can be a matter of life or death. Personally, since I have cut my salt consumption, my blood pressure has fallen from one-hundred-and-awful over mumble-eight to something that doesn’t make the nurse turn pale.

Currently, the recommended limit is 2,300 mgs of salt a day---about a teaspoon---but the CDC says most people would be better off at 1,500 mgs a day, hard to do if your food groups are the three currently popular choices: canned, frozen and fast.

But, once you make the salt breakaway, you can taste the food underneath the disguise of sodium. And you certainly do build up a shelf of herbs and spices. Pepper is a help here as is Chinese Five Spice Powder for sauces and soups plus Garam Masala which I add to almost anything just to wake up the people at the table.

Grow your Own Taste

Now is great to start a mini herb garden. I grabbed some clay pots and just put in chives, oregano, peppermint, spearmint, chocolate mint, dill, basil, lemon verbena, lemon balm and bay. I also keep a water glass filled with a bunch of parsley next to the stovetop. You could do the same with any green herbs you love. Snip them over what’s in the frying pan.

Additionally, a lemon in the fridge is always good to add zing and I pour orange juice, the taste of sunshine, over everything but Cranky Pants. It’s especially good on fruit compotes and baking chicken parts.

Next week there’ll be more about a low-salt lifestyle that won’t bore your taste buds, but meanwhile, one excellent paperback is Cooking Without a Grain of Salt, by Elma Bagg, Susan Bagg Todd and Robert Ely Bagg.

They show how to get high taste without getting high blood pressure.

Good on them.

Hunting for Docs

 

            Tell me I’m not hallucinating. I remember when people could call a doctor’s office and get in that day. The wait was hours, not weeks or months.

It would take a book, not a column, to say how and why the medical delivery system has changed over time, so I’ll stick to a smaller point: I have a friend who was peeing blood and the urologist in her medical system couldn’t see her for a month. Anyone with a bladder infection knows how uncomfortable it is. An appointment the next hour seems too far away. (She found care elsewhere.)

            My conclusion from that and the many other reports I’ve heard is that there are not enough doctors in CA. Sure, you can get into the debate about whether we have a shortage or not. Some think it’s just that we practice medicine inefficiently. (See the various reports at the Kaiser Family Foundation, www.kff.org. )

Well, maybe that’s it, but I cannot discount the stories I hear from people all over CA. Here are some of their experiences and they certainly seem related to short staffing:

* Appointments for an office visit not available for months even though the condition seems urgent, painful or medically pressing.

* Urgent care centers so crowded one can wait for 3 or 4 hours.

* Emergency rooms so overwhelmed that unless you are bleeding profusely or have fallen on the floor in a spectacular fit, you will grow roots in your fanny sitting in the waiting room.

Urgent care centers and ER’s are often overwhelmed because people are using them for un-urgent care like colds. And they are doing this partly because they don’t have a primary care/family doctor.

Trying to Find A Family Doc

To their credit, the urgent care center I visited last week on the California coast was trying to solve the problem of people cluttering urgent care with their sniffles. At the end of the visit, the staff gave out a helpful list to clients without a family doctor. It was titled: Primary Care Physicians Accepting New Patients.

Study the list. Find a doc. That was the good idea. But I noticed that several of the docs listed said their practices were closed to new patients, but maybe they would accept patients on a case-by-case basis. Other docs refused to treat people who were covered by Medicare, Blue Cross, Aetna or Tricare. Another put a geographical cutoff on his practice He only accepted patients who lived in certain nearby towns. Some wanted yearly retainers of up to $3000.

It sure seemed like looking for a doc in a haystack.

Don’t Blame the Docs

They are the victims too. When’s the last time you saw a happy relaxed doc who had an active practice? They are overworked and caught in the same inefficient system you are. And even those who give up a private practice to work in something like an urgent care clinic are still overworked--- sometimes 12 hours a day.

And then they have insurance matters strangling their practices and student loans weighing on their earnings. Further, some in rural areas are poorly reimbursed for their services by Medicare and other organizations. What’s more, the doctors who are doing basic family practice and primary care, earn way less than the specialists.

We’ll see if the stimulus money is intelligently applied to improve some of these issues. People like Senator Charles Grassley are on the case to improve access to primary care. And we’ll see what President Obama does, but I say that there is something you and I can do without being elected to Congress or the White House. Here’s the plan:

Do everything possible to stay healthy and out of the broken system. And you know the drill: Eat fresh veggies and fruits, fish, whole grains. Exercise a half-hour most days. Stop smoking. Stop over-drinking. Stop OD-ing on a toxic mix of legal drugs. Some people I know take 12 drugs.

And how did they get them from doctors they can’t get in to see?

Canada? Mexico? Borrowing from a friend? Stealing from Mom’s medicine cabinet? I don’t know,

What I know for sure is we have some control here and we are foolish not to use our power to surf this mess.

So---and I really mean it—take care of yourself.