Holiday spirits

Here’s an alcohol-free toast to the holidays.

The Kandiyohi County Drug-Free Communities Coalition recently posted several recipes for non-alcoholic drinks on their blog, and they sound delicious.

Here’s the ingredient list for Frosty Mocha: chocolate ice cream, half and half, coffee, cinnamon, semisweet chocolate and almond extract. Chocolate ice cream? Pour me a double helping, please.

Some of the other recipes call for sparkling combinations such as cranberry juice, lime juice and ginger ale,  or cranberry-grape juice, orange sherbet and ginger ale.

Alcohol tends to hold a central place in many Christmas festivities. Not everyone wants to or is able to join in, though – women who are pregnant, for instance, or people who are on prescription medication that doesn’t mix well with alcohol. And what about those who are recovering alcoholics?

The Drug-Free Communities Coalition has posted several holiday hosting tips for families with children that are worth sharing:

  • Let your child know what you expect.  Tell your child that adults may be drinking during the holidays but under no circumstances are they allowed to consume alcohol.
  • Plan a nonalcoholic holiday party with your child so children learn that they can have fun without alcohol. Send out invitations with alcohol and drug free messages on them, and make sure the guests know that yours will be a substance-free event
  • For your holiday meal, let your child help you prepare and serve traditional drinks without alcohol. You can make nonalcoholic cider, eggnog, or punch
  • Make sure your holiday festivities involve lots of delicious-and nonalcoholic-food, which your child can help you make.
  • If your older child is going to a holiday event, call ahead to make sure that the event will be alcohol and drug free. Check in with the party planner to see what measures are in place to keep alcohol out.
  • Good examples for kids also tend to result in good examples for grownups.

    How much work does it take to mix up a cranberry cooler? Here’s a video, courtesy of Lakeland Broadcasting and Q102, that shows you how.

    More videos featuring other mocktail recipes can be found on the Q102 website. Here’s to your health!

    Living longer, living sicker

    Does the fact that Americans are living longer mean they’re also healthier? Not necessarily, according to a new study that appears in the upcoming issue of the Journal of Gerontology.

    In fact the researchers identified a rather depressing trend: Average morbidity, or the years of life spent with serious disease or declining functional mobility, has actually gone up. In other words, we may have gained quantity but we’re coming up short when it comes to quality.

    The study more or less turns upside down the belief that life expectancy and better health go hand in hand. Among some of its findings:

    - From 1998 to 2008, the average number of healthy years has decreased.

    - A 20-year-old man in 1998 could expect to live another 45 years without encountering cardiovascular disease, cancer or diabetes. By 2006 this had dropped to 43.8 years. For women, the expectancy of remaining disease-free dropped during this same period from 49.2 years to 48 years.

    - The number of people reporting a lack of functional mobility has grown. Functional mobility was defined in the study as the ability to walk up 10 steps, walk a quarter-mile, stand or sit for two hours, and stand, bend or kneel without needing special equipment. The study found that a 20-year-old man today can expect to spend 5.8 years of the rest of his life without functional mobility, compared to 3.8 years a decade. The average 20-year-old woman will likely spend 9.8 years without mobility vs. 7.3 years a decade ago.

    - The disease burden appears to be rising. The researchers found an increase in cardiovascular disease among older men, a significant increase in the incidence of diabetes among all adult age groups over 30, and a rising proportion of Americans with multiple diseases.

    Some of this may reflect the fact that health care in the U.S. has evolved toward more aggressive identification and labeling of chronic disease. But in an accompanying news release, one of the study’s authors, Eileen Crimmins, said what it “most clearly reflects is increasing survival of people with disease.”

    Crimmins, who holds the AARP Chair in Gerontology at the University of Southern California, said the evidence indicates we haven’t been anywhere near as successful in preventing or delaying the onset of disease as we have in preventing death from disease.

    “The growing problem of lifelong obesity and increases in hypertension and high cholesterol are a sign that health may not be improving with each generation,” she said. “We do not appear to be moving toward a world where we die without experiencing significant periods of disease, functioning loss and disability.”

    For many years, saving lives and extending life expectancy have been the markers of success for everything from heart attacks to cancer. There has been less focus on the hidden cost of longer life spans burdened by disease and what this means in the actual experience of the patient.

    In an ideal world, we’d be able to prevent everything. Everyone would live long, healthy lives and die quickly at the end. The more realistic view is that we try to prevent or delay disease as much as possible, and look for ways to help people live as well as possible. On some level, disease and decline are inevitable. This doesn’t have to mean they’re inevitably a burden.

    ‘Tis the season to be icy

    Blog readers don’t need me to tell them the obvious: It’s icy and slippery outdoors, and if you aren’t careful, you could fall and break a bone or get a concussion.

    Heartland Orthopedic Specialists of Alexandria has issued some timely advice on how to avoid the slips, slides and falls that frequently contribute to injuries at this time of year.

    For starters, stay tuned to the weather forecast so you know what to expect and can prepare for it.

    Slow down and take your time. Watch for icy spots on streets, sidewalks, steps and parking lots. If there are hand railings, use them.

    Wear boots or shoes that provide traction and support your ankles.

    If you need someone else to lend a steadying arm while you negotiate an icy sidewalk, ask for help.

    Types of injuries that are most common from slipping or falling on the ice are broken bones, concussions, sprains and strains. The results are often painful and inconvenient. One of my siblings wore a cast for several weeks after falling on the ice and breaking a wrist some years ago. I know someone else who sustained a concussion after falling backward on the ice. Sometimes a fall can be life-threatening if the victim ends up with a severe head injury.

    I did some research and came up with some additional tidbits of information. Here’s some advice from the University of Iowa about how to prevent and deal with back injuries caused by falls or near-falls on the ice. It reiterates the point about footwear and suggests adopting the winter shuffle method of walking: short steps and gently planting the whole foot with each step.

    This news release from our northern neighbors in Canada offers some further refinements on the winter shuffle: Walk consciously and cautiously. Since your arms help provide balance, keep them out of your pockets and avoid carrying heavy loads that can interfere with your balance.

    There might be no way to fall gracefully on ice, but falling the right way can help minimize the likelihood of injury. Two words: tuck and roll. Experts say it can help prevent your head, wrists and elbows from hitting the ground. Although most people’s temptation is to put out a hand to try to break their fall, this can result in a broken wrist or arm.

    This video I found on You Tube gives you some idea of how easy it can be, even for the young and able-bodied, to slip and fall:

    About one minute into the video, you can see a young woman fall flat on her back. Although she gets up fairly quickly, I wouldn’t be surprised if she ended up with some bruises – and it looks like she may also have hit her head on the frozen ground. Other unfortunate pedestrians land hard on their knees, tailbones and other parts of their anatomy.

    It looks like it hurts. So be careful out there.

    The handbook of hard-luck tales

    Ever since Costs of Care announced a national essay contest for people’s personal stories about their health care bills, I’ve been eagerly checking the website to see how the contest is faring.

    The wait is almost over: Winners will be announced next week. In the meantime, six finalists – three clinicians and three patients – have been chosen. Entries are being judged by a distinguished panel whose members include author and essayist Dr. Atul Gawande; Jeffrey Flier, dean of Harvard Medical School; Michael Leavitt, former U.S. Secretary of Health and Human Services; and Michael Dukakis, former Democratic nominee for president of the United States.

    It would be hard to think of an organization better suited to something like this. Costs of Care is a nonprofit organization focused on creating greater awareness, especially among doctors, of how everyday clinical decisions can have an enormous financial impact on patients.

    Of the stories that have been posted on the website so far, what mostly comes through is frustration, mixed with no small amount of sadness for everyone who’s caught up in a system that ought to be cost-conscious but seldom is.

    There’s the story of a 41-year-old pregnant woman, an immigrant with a low-paying job who no longer has enough money to buy food. What tipped her over the edge? Three ultrasound bills, only one of which was covered by her insurance. Tarcia Edmunds-Jehu, a nurse midwife from Boston who submitted her story to the contest, writes that two of those ultrasounds probably weren’t even necessary and wouldn’t have made any difference on the outcome of the pregnancy – but because of the mother’s age, they were ordered as a routine precaution.

    Edmunds-Jehu sums it up:

    We almost never think about what a test costs or whether it is paid for. Trying to find out the cost of a test is sometimes almost impossible. We almost never stop to think if a test is really indicated, or if the results will change the course of their treatment.

    As providers we order tests because they are there, or because it’s easy, or because everyone gets them, or because we are scared if we don’t we’ll be sued, or because of arbitrary protocols. Sometimes we order tests because it’s the best thing for a patient.

    No one orders tests thinking we might be taking food out of the mouths of our patients and their families, but sometimes that is exactly what we are doing.

    Another finalist entry comes from Brad Wright, a graduate student with a $3,000 deductible. When he developed a sinus infection, he was sent for a CT scan and a blood panel. What he didn’t know, until the bill arrived a month later, was that the laboratory was out of network – even though it was in the same building as the doctor’s office. The cost: $478. He writes that the experience “taught me a lot about our fragmented health care system, how little patients or providers know about the real cost of health care, and how hard it is for patients to make price-based decisions when the system isn’t designed with that in mind.”

    To my mind, one of the most disturbing tales is this one, which comes from Dr. Steve Sanders, a primary care doctor in Tulsa, Okla. It’s the story of “Mike,” a 29-year-old unemployed, uninsured truck driver who wound up with a bill for $11,000 after going to the emergency room with chest pain. I’d urge you to follow the link and read the whole story to get all the details.

    Many of these stories, especially Mike’s, have sparked some heated online discussion here, here and here.

    How do clinicians balance between what’s necessary and what isn’t? When does reasonable care turn into defensive-medicine overkill? Should clinicians know the price for each service and recommend what the patient can afford, or should they recommend what’s best for the patient regardless of cost? Do patients need to be more assertive? Or should they just suck it up and pay the bill without complaining?

    Clearly patients have to take some responsibility. Consider the case of Mike, who “forgot” to get on his wife’s health insurance plan after losing his job and ended up being uninsured, then told his doctor he would have to file for bankruptcy because he couldn’t pay his $11,000 ER and hospital bill. For one thing, forgetting to sign up for health insurance – especially if it’s available and affordable – is a pretty huge lapse of judgment. For another, why not first try to work out a payment plan with the hospital before filing for bankruptcy?

    But the other side to this is that patients are often held hostage by a system that lacks transparency and gives them little control. The pregnant immigrant probably had no way of knowing whether additional ultrasounds were beneficial, one commenter wrote at The Health Care Blog: “She probably was too intimidated to even ask or question the doctor. A consumer-friendly health care system would have provided her the right information (in a manner she could understand) to help her make the right decision.”

    Some commenters bashed Mike for going to the emergency room via ambulance for what turned out to be indigestion. Sure, it was expensive, but “the system delivered what was asked of it,” one online commenter wrote. “Health illiteracy at its finest” was the assessment of one of the commenters on the Costs of Care blog.

    Others pointed out that the patient couldn’t have known the diagnosis ahead of time – and that when he wanted to leave the hospital, he was warned it would be against medical advice. “In most developed countries an ER doc would take responsibility for telling the guy to go home, but to come back if certain symptoms appeared/became worse,” wrote a commenter at Kevin MD. ”This has little to do with tort reform and everything to do with being a physician.”

    What’s the answer? I wish I knew. Unfortunately stories like this are common. I’m only surprised the Costs of Care essay contest received 115 entries rather than 1,150. Stay tuned for the announcement next Wednesday of the winner.

    The hospital amenity wars

    Do private rooms, luxe bedding, massage therapy and WiFi mean you’re getting better hospital care?

    Not necessarily. But for a growing number of consumers, hospital amenities (or lack thereof) seem to be an increasingly important factor in their choice of hospital.

    An article last week in the New England Journal of Medicine describes this emerging trend, comparing it to the medical technology arms race that predominated in the 1970s and 1980s:

    Now, yet another style of competition appears to be emerging, in which hospitals compete for patients directly, on the basis of amenities. Though amenities have long been relevant to hospitals’ competition, they seem to have increased in importance — perhaps because patients now have more say in selecting hospitals. And the hospital market is booming. National spending on hospitals exceeded $700 billion in 2008 and is growing rapidly.

    The authors cite an example: the new $829 million Ronald Reagan UCLA Medical Center in Los Angeles, which opened in 2008 and boasts “private and family-friendly rooms, magnificant views, hotel-style room service for meals, massage therapy.” Patients obviously like it, because UCLA Medical Center has seen a 20 percent increase in the number of patients who say they would definitely recommend the facility to their family and friends.

    This isn’t necessarily a bad trend. For too long, hospitals paid little attention to the extras that might help make a stay in the hospital more comfortable. If patients disliked sharing their room with a stranger or had a window with a view overlooking a brick wall, well, too bad. They were patients in a hospital, not guests at a luxury hotel. These days the thinking has changed, boosted by a fair amount of research showing that patients and families tend to feel less stressed and are better able to start the healing process when they’re in an environment that’s quieter, soothing and more home-like.

    Here’s the question, though: Is the emphasis on amenities going too far, possibly at the expense of clinical quality?

    When the authors of the NEJM article examined survey data, they found many patients valued nonclinical extras far more than the actual clinical care. In one survey, patients said they were willing to travel farther to a hospital that offered more amenities, even if the care was no better than at a hospital closer to home.

    Hospital amenities seemed to be a factor in physician referrals as well, the study’s authors wrote:

    Physicians said that when deciding where to refer patients, they placed considerable weight on the patient experience, in addition to considering the hospital’s technology, clinical facilities, and staff. Almost one third of general practitioners even said they would honor a patient’s request to be treated at a hospital that provided a superior nonclinical experience but care that was clinically inferior to that of other nearby hospitals.

    It’s easy to criticize hospitals for investing in fancy amenities that don’t contribute directly to patient care. The fact is, however, that consumers want and even expect amenities. Hospitals that don’t offer these extras can place themselves at a serious competitive disadvantage. On some level, then, amenities and their role in the patient experience do matter.

    As the NEJM article’s authors point out, hospital amenities also have implications for how hospitals are paid and how quality of care is measured. If payment becomes more value-based, we need to figure out what amenities are worth and how they should be weighed against cost and clinical excellence.

    If the cost is higher and the quality of care is average, is it really a bargain for patients to choose a hospital on the basis of its hotel-style rooms? Or is the consumer better off selecting a hospital that’s perhaps a little less glitzy but consistently scores high on quality measures? Is it possible for hospitals to do well in all three areas – cost, quality and amenities – without being forced to make some tradeoffs?

    What do readers think? Would you travel to receive care at a hospital that’s “nicer” even if your hometown hospital offers the same quality of clinical care? Would you choose a hospital with more amenities if you knew it would cost more? Leave your responses in the comment section below.

    Image: lobby of the Four Seasons Hotel, downtown Miami. Courtesy of Wikimedia Commons.

    The weekly rundown, Dec. 8

    Blog highlights from the past week:

    Most-read posts: A rant about safety; Noteworthy 1.1; Happy 2nd blogiversary.

    Most-read posts from the archive: Bald ain’t beautiful, from May 25; Fudging the record, from May 21.

    Most blog traffic:  Friday, Dec. 3.

    Top referring links: wctrib.com; West Central Tribune on Facebook.

    Search term of the week: “nagging about diabetes.”

    Towards a healthier U.S.

    The Healthy People 2020 priority list was announced last week, and guess what? It’s a thoughtful and comprehensive list that encompasses a wide range of issues that help contribute to – or detract from – overall health.

    The priorities include many of the usual suspects, such as weight, physical activity, diabetes and heart disease. But it’s interesting to note some of the new areas that will be focused on over the next decade. Many of them, such as genomics or health care-associated infections, reflect emerging and important issues.

    The priority list indicates a new emphasis on health care needs at various stages of life, such as early and middle childhood, the teen years and the geriatric years.

    I was a little surprised to see sleep health is now a goal of Healthy People 2020. I’d assumed this was either already one of the priorities or wasn’t deemed important enough to make the list. I say it’s about time we started paying more attention to how we’ve become a nation of the chronically sleep-deprived and what this is doing to our well-being.

    I also like the fact that health-related quality of life and the social determinants of health have been added to the list of goals.

    All told, Healthy People 2020 has nearly 600 objectives to accomplish over the next decade. This initiative by the federal government was launched in 1979 to help set the framework for health promotion and prevention activities in communities across the U.S., decade by decade. For Healthy People 2020, multiple federal agencies spent months developing the priorities and obtaining public input to come up with the final plan – a hefty document it describes as “ambitious, yet achievable.” Preliminary data suggest that about 71 percent of the goals for Healthy People 2010 have been met.

    I don’t expect to hear people avidly discussing Healthy People 2020 while they wait in line at Starbucks for the barista to take their order. Perhaps they should, though. Too often, health is reduced to “stop eating junk food and get off the couch.” While nutrition and physical activity do make a difference, they’re by no means the only factor that contributes to health. Income levels, the social and physical environment, food safety, occupational safety, immunizations and access to health care services are among the many other things that matter as well.

    Healthy People 2020 might be huge and rather daunting, but it’s only by dealing with the big picture that improvements can take place so more Americans have a shot at living longer and healthier lives.

    Noteworthy 1.1

    I know I’ve said this before but I’ll say it again: So much to blog about, so little time. Here are some highlights from the many tidbits that have crossed my desk recently:

    - Yahoo! recently issued its year-end list of the top searches for 2010, and pregnancy was at the top of list for health searches, followed by diabetes. The rest of the top 10, in order: herpes; shingles; lupus; depression; breast cancer; gall bladder; HIV; fibromyalgia.

    Among the top searched questions on Yahoo! in 2010 was how to lose weight. A top obsession? Bedbugs, which came in at No. 7.

    - Here’s an interesting report from LeaseTrader.com: In a rush by professionals to escape leases for high-priced cars, male doctors are at the head of the pack. LeaseTrader.com’s analysis looked at cars valued at $40,000 or more that were being dumped on the marketplace by customers who were downsizing their finances. Male doctors were ahead of lawyers and even financial executives in ridding themselves of expensive leases for Maseratis, Mercedes and BMWs. The report suggests that declining reimbursement and uncertainty surrounding the future of health care are prompting some physicians to cut back on their personal spending.

    - Will Santa Claus be delivering the latest electronic gadget to the children in your household? Don’t let them strain their eyes by peering too long at digital devices, warn eye experts.

    There’s actually a name for it: “computer vision syndrome,” or CVS, which includes back and neck pain, dry eyes and headaches. Some nuggets of advice: Use proper lighting, remind your kids to blink often and to give their eyes a rest every 20 minutes or so, and make sure they wear their prescription glasses if they have them.

    - For all the national clamor about obesity, there’s one age group that seems to be overlooked - the 18- to 35-year-olds. The University of Minnesota is launching a new clinical trial to look at ways of using technology and social media to engage young adults. The CHOICES trial (Choosing Healthy Options in College Environments and Settings) will test a for-credit course model that uses web-based social networking to prevent unhealthy weight gain among 44o student participants.

    It’s being offered at Anoka-Ramsey Community College, Inver Hills Community College and St. Paul College. Trial participants will be given cooking demonstrations, exercises for stress management, and other information and activities to help their improve their sleep, eating and physical activity patterns. Half the participants will be randomized into a control group with fewer interventions and no social networking. At the end of the two-year trial, results will be compared to see which group fared better.

    The study is part of a five-year national initiative to test innovative, technology-based strategies for helping young adults avoid unhealthy weight gain. Six other studies, besides the one in Minnesota, are under way.

    - There’s nothing like a mystery shopper to shed painful light on how organizations sometimes fall short in their customer service. A news release from the Baird Group, which is a member of the Mystery Shoppers Provider Association, offers an inside look at some of the discoveries that mystery shoppers make in health care: A receptionist yakking with a coworker while a patient stands waiting at the counter. Employees taking a smoking break under a sign that says “no smoking.” Staff members ignoring a patient or visitor who is obviously lost.

    Although “patient-centered” is the concept du jour, Kristin Baird, whose group works exclusively with health care organizations, says many organizations are “anything but.”

    What qualities have she and her mystery shoppers seen in the best organizations? “What I see in these is a concerted focus on making service expectations real through communication, inspection, accountability and action,” she said.

    - Finally, the American Pharmacists Association sent out some practical advice for people to manage their medication regimens during the excitement of the holidays:

    If you’re going to travel, bring more medications than you expect to use and store them in their original labeled containers. Be aware that some medications, such as insulin, need to be kept cool. If you plan to be in your car for a long period of time, bring a cooler so you can store your insulin inside (but not directly next to ice). Some medications also might require special equipment such as needles or pumps, so be sure to remember all the prescribed parts of your routine.

    If you’re flying, keep your medications in a carry-on bag. Check your airline’s regulations, because liquids in some quantities are prohibited on planes. A pharmacist can provide you with smaller bottles if this is an issue.

    Have a plan for adjusting your medication regimen. And don’t forget to bring an up-to-date list of all your current medications and vaccinations. Although no one wants to end up in an emergency room or doctor’s office while they’re traveling for the holidays, having a complete and accurate medication list can help make it a little less stressful, both for you and for the providers who need to know about your current treatments.

    HealthBeat photo by Anne Polta

    Happy 2nd blogiversary

    Where does the time go? Today is HealthBeat’s second blogiversary. The first entry was published Dec. 1, 2008. This post is the 444th.

    To mark the occasion, here’s a newly released movie trailer produced and edited by newsroom colleague Jannet Walsh:

    Check it out! Jannet, who joined the West Central Tribune in October, blogs at Minnesota Native Daughter. You can see the movie trailer for her blog here.

    To read more about how this blog was started, here’s An interview with the blogger.

    Many thanks to everyone who takes the time to read and comment. If there are topics you’d like to see addressed in future blogs, leave your ideas and comments below. And have some birthday cake. It’s on me.