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Archive for July, 2011

Today, the national health care proposal is politicized instead of evaluating it on its merits. Almost everyone agrees that health care needs reforming because the government programs, Medicare and Medicaid, are inefficient and face bankruptcy in the near future. There is concern that an estimated 47 million people in this country have no health insurance. Approximately, 20 million illegal aliens are included in that number.

Why should we have confidence in federal national health insurance when the government can’t run the Medicare and Medicaid programs successfully? Why is the administration so vague about the details of this health plan? A mandatory health program is a further erosion of our individual rights. Why is Why consider a health program like those in Canada and England that are inferior to our system? How much will national health insurance add to our huge national debt? Proposing an even larger federal health plan as a solution to the present two failing governmental programs is analogous to assigning a pilot to operate a 1,000 passenger multi-engine jet plane, who failed to fly two different type single engine airplanes.

The major objection to this new national health care proposal is the expense. The accuracy of the cost estimates is in question. “The head of the CBO testified that the House health care bill could cost $200 to $300 billion more than Congressional estimates: “We do not see the sort of fundamental changes that would reduce the trajectory of federal health spending by a significant amount…The legislation significantly expands the federal responsibility for health care costs”. This figure is probably extremely conservative.

A key expense of health care today, liability suits and their threat, is not addressed in the new health plan because self-serving legislators protected trial lawyers, their generous campaign contributors. These overly aggressive attorneys cause unnecessary costly medical tests by doctors fearing malpractice suits. These barristers are the reason physicians’ liability insurance premiums are so high.

National insurance premiums will be more expensive in order to pay for the burden of the uninsured. The young will bear most of the cost, which is especially unfair considering the likelihood of their need for medical care. Elderly health care will be rationed, too, to reduce costs.

There aren’t enough doctors to care for the additional 47 million individuals covered in this new national health care plan. People seeking medical care will have long waits for all medical appointments. Medical records of every American will be stored electronically in Washington, D.C. Treatments, as well as who is eligible for them, will be determined on the basis of a statistical format established by bureaucrats in a Medical Records Agency.

Why are we obligated to provide health insurance for approximately 20 million illegal aliens? Why not fix Medicaid and Medicare by correcting their weaknesses? Why not have safety nets for those who can’t afford health insurance? Why force people to enroll, who don’t want health insurance?

Americans have themselves to blame for this health insurance fiasco. We passively accepted the role reversal in our relationship with Congress.

Members of Congress are now our masters instead of the servants of the people. We have made Congress the royalty of this nation. Voters consistently re-elect the same incumbents of Congress, who create all of these popular, fiscally unsound programs to preserve their careers. Vote out these self-serving rascals in the next election, the country will be so much better off without them.

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Perhaps the most popular among Iris beauty products is the Irish seaweed extract, a unique combination of the rejuvenating and therapeutic effects of Irish seaweed, various marine extracts, and other excellent quality ingredients. This exfoliating scrub is designed for men and women alike.

Nadur Organics Company is perhaps the largest retailer of a wide selection of Irish products. Aside from distributing Iris beauty products, Nadur Organics manufacture them as well.

Their products are primarily made of organic and natural ingredients that are proven safe and effective on human skin. If you are particular about what ingredients are used in your cosmetics, then Iris products are for you. They are the perfect botanical and natural alternative to chemical-laden commercial products that can easily be bought in any store today. You can check the labels of any Iris product to know that they use only the finest natural and organic ingredients to nurture your hair, face, and skin, and to make sure that they do not contain substances that you are allergic to. Their products are specially designed to take good care of men and women with different hair and skin types.

Thousands of Iris beauty and skin care product companies, as well as their most experienced distributor, Nadur Organics Company, are scattered all over the United States and Canada. Just go to your nearest local retailer of Iris beauty products for the best beauty and skin care experience.

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Being physically fit provides a foundation for overall health and well being (Health and Fitness Principles). We can define physical fitness as, the physical attributes and skills that one has that allows them to perform the tasks of daily living effectively and alertly, while leaving an adequate amount of energy in reserve for recreational and/or emergency activities (Health and Fitness Principles). When we hear the term, physical fitness, we typically think of activities such as running, jumping, or lifting weights. But, fitness involves much more than how much you can “lift”, how fast you can run, or how high you can jump (Physical Activity and Health).

Practically speaking, it has more to do with your ability to easily and effectively carry out common activities like shoveling snow, back packing, mowing grass, or playing with your children.

What can exercise do for me?

Regular physical activity has been associated with decreased risk for many illnesses. According to the American Heart Association, regular, moderate exercise has been shown to provide the following benefits:

o Decreased risk of heart disease

o Decreased risk of heart attack

o Lower total cholesterol

o Lower blood pressure

o Decreased risk of being overweight or obese

o Decreased risk of stroke

o Lower stress levels

o Improved sleep

o Improved physical appearance

o Increased energy and strength

o Stronger heart, lungs, bones, and muscles

(Why Should I be Physically Active, AHA)

As with other components of wellness, the transition to becoming more physically fit requires lifestyle changes. In order to reap the benefits of regular physical activity you must be able to make a lifelong commitment to your program (Fitness Fundamentals). It isn’t necessary to have any special equipment, or to join a health club or gym. It only requires that you participate consistently in some type of moderate – vigorous physical activity. Again, this does not need to be limited to traditional health club style exercises. Use your imagination, and select activities that you can enjoy. For example, rock climbing, hiking, rowing, or dancing would be excellent alternatives to the typical exercise program.

Physical Assessment

Regardless of your current health or physical condition, it is always a good idea to have a physical examination before undertaking any exercise or nutrition program. This is especially true if you are over the age of 35 and have been inactive for several years (Fitness Fundamentals). There are several other indications that would also suggest the need to consult with your physician before starting:

o High blood pressure

o History of heart disease

o Dizzy spells

o Difficulty breathing after mild exertion

o Arthritis or other bone ailment

o Muscle, ligament, or tendon problems

o Known or suspected disease

o If you smoke

(Fitness Fundamentals)

Although there are some small risks that go along with exercise, it has been well documented that the risks associated with inactivity, and/or being overweight are much, much greater (Fitness Fundamentals).

A properly designed fitness program should always focus on balance. In other words, a program should address each component of fitness. According to The Aerobics Fitness Association of America, there are five components of fitness (Yoke, et al).

1. Muscular Strength

2. Muscular Endurance

3. Cardio-respiratory endurance

4. Flexibility

5. Body Composition

In addition to including balance in your routine, you should always begin the program development process by establishing a set of realistic goals. It is unfortunate that the majority of information about cardio and strength training that people hold as true are nothing more than “urban legend”. I have listed below several of my favorite fitness and exercise myths:

Popular Exercise Myths

1. “If you stop weight training the muscle that you have built will turn to fat.” As bodybuilding legend, Franco Colombu once said, “That would be like saying that an apple can turn to an orange.” Muscle and fat are two completely unique types of tissue. Therefore, it is impossible for fat to “turn into” muscle. Likewise, it is not possible for muscle to “turn into” fat.

2. “Weight training makes women have a masculine appearance.” Proper weight training will help almost anyone to look healthier by improving body composition and making the body look more tight and firm. The huge muscles that are seen in the professional women’s bodybuilding ranks are produced by very large quantities of anabolic/androgenic steroids, not simply by strength training alone.

3. “You need to spend a great deal of money on dietary supplements to be successful.” The foundation of any exercise program is built upon the combination of a balanced diet, plenty of rest, and a well designed exercise regimen. Supplements are definitely not necessary for strength trainers or endurance trainers regardless of their fitness level.

4. “It takes expensive machines and workout equipment to build a quality physique.” Although it is desirable to have a few basic pieces of equipment at your disposal, it is very possible to design an effective workout routine with no equipment at all. There is a great deal of research that has demonstrated a number of advantages to “low tech” functional strength training programs. This doesn’t mean that you should avoid the fancy weight machines. But, you should keep in mind that some of the greatest physiques in history were developed with little or no exercise equipment at all.

5. “Weight training will make you muscle bound and stiff.” Actually, research has demonstrated that when resistance exercises are performed through their full range of motion, flexibility increases. Weight training stretches opposing muscle groups.

Designing Your Program

As you begin putting together your program, it is helpful to use what is known as the FITT formula.

F.I.T.T. =

F = Frequency (how often you exercise)

I = Intensity (how hard you are working when exercising)

T = Type (what type of exercise is being done?)

T = Time (how much time is spent exercising)

The American College of Sports Medicine has established specific guidelines concerning the FITT formulas for both cardio-respiratory training and strength training. The guidelines for Cardio training are as follows:

Cardio Guidelines:

o Frequency = three – five times per week

o Intensity = 55 – 90% of max heart rate

o Time (or duration) = from 20 – 60 minutes

o Type = Common forms of cardio training: walking, cycling, jogging, swimming, stair climbing, and dancing

o Beginners = Start by working at approximately 55 – 70% of max heart rate

o Hydration = be certain that your body is adequately hydrated before and after exercise Approximately

A recent study at the University of Chicago, included a combined total of 15,440 men and women from 31 hospitals between the years 1990 and 2000. These subjects underwent CABG (coronary artery bypass graft). The average age of the men was 63 and the average age of the women was 66. One enigmatic result of that study is that 22% of women are more likely to die after CABG than men!

This article is based on my observations about how women while they are treated undergoing open heart surgery. At times women, because of their body fat, are deemed difficult cases because it may be harder and more labor intensive to harvest arterial conduits (internal thoracic mammary arteries, radial arteries) for bypass grafts. The difficulty is due to smaller vessel size (women are smaller than men!), the time and effort involved in the dissection procedure, and other factors. As a result of my observations and research I was able to write the following not as an alarmist but to provide information. The following actions may save your life.

Do your research to find the best cardiologist and surgeon for your specific heart problem. Specialization in heart surgery means that some heart surgeons do certain procedures better than others, because THEY DO MORE!

Just because your surgeon or doctor is nice to you in the office, does not mean that he or she is qualified to do your procedure. Do your research to find the best practitioner for your insurance dollars or your personal dollars if you are paying cash.

Some surgeons simply are not proficient in cases that they do not routinely do on a weekly or monthly basis. Examples of some of these cases are: reoperations, combination reoperations and concomitant valve surgery, myectomy for IHSS, and primary CABG.

Reasons a surgeon may not be surgically proficient in more difficult procedures are because of the lack of volume of cases and type of cases that a surgeon does in a year’s time, as well the auxiliary resources (skilled and experienced nursing, a dedicated cardiac unit, intensivists, anesthesia, and perfusionists, etc.) Smaller hospitals tend to do very healthy (relatively speaking) first time surgeries with practically no other serious disease factors and/or processes in play. The surgeon and hospital may do these types of primary cases to keep their mortality rate down. An increase in the hospital’s or surgeon’s mortality rate affects both entities adversely; financially as well as their reputations. Furthermore, if things do go bad in one of these institutions and the patient winds up with a prolonged stay in the OR the intensive care postoperatively, the patients insurance may not pay beyond a ‘reasonable’ cost. The hospital may have to take the ‘hit’ for costs beyond reasonable or go after the patient for what may be an incredible amount of money. Sometimes, the patient unfortunately dies.

Even in a heart center like The Cleveland Clinic, there are heart surgeons who perform some surgeries slightly better than the others because it becomes their specialty! A particular surgery may be one that he or she performs exceptionally well. That is the surgeon you want. For instance, a surgeon may be well known for mitral valve surgery, or renowned for doing reoperative CABG’s; that is the person you want.

As stated above, and repeated here because of its overarching importance, a particular hospital may not have the required highly trained nurses, cardiologists, diagnostic technology and equipment, surgeons, and auxiliary personnel for the preoperative, intra-operative, and postoperative course a patient will require.

View your doctor and surgeon as independent contractors. You, the patient, are paying them! It is their privilege to serve you. Doctors need patients in order to practice medicine and make a living.
Go to the largest, best teaching heart center or hospital in your area. If necessary go outside the state, or the country. Why? A larger facility will have the exposure and experience in treating a large number of patients with varying degrees of heart disease problems.

Also, patients now present acutely (particularly women) to the hospital with a number of disease processes in play as well as the prime offender of heart disease. Concurrent diseases such as diabetes, renal disease and failure, patients on IABP (intra-aortic balloon pumps), LVAD (left ventricular assist device), carotid disease, previous heart operations, and other forthcoming surgeries to name a few, are medical situations a larger heart center may be equipped with professional staff and technology to handle.

Because of a facility’s experience and success in diagnosing, treating, and surgical intervention, your presentation for your specific heart malady will be handled more proficiently (a thorough and quick diagnosis alone can save your life!).

Go to the largest heart disease center that routinely operates on patients from around the world. Why? Because these institutions will have the diagnostic and operative experience with differences in vasculature (typically peoples from Asia and the Middle East have smaller arteries and veins) and other rare and odd heart disease processes.

Also, foreign patients for the most part pay CASH. They come to a certain institution by referral generally because it’s the best place to treat their problem. Think about it, someone who pays cash can afford to go anywhere in the world, yet they have chosen a particular institution based on its successes and the expertise of its staff.

Invest in and develop a professional and emotional bond with your REGISTERED NURSE before and during your hospital stay. This includes the floor nurse, the OR nurse, and the intensive care nurse. Your RN is your partner in helping you achieve your most optimal course of care and recovery. He or she is your most vocal, profound, and proximal patient advocate, and your first line of defense against untoward events on the floor, in the OR, and in the postoperative intensive care unit.

Registered nurses are highly trained, educated, and technologically advanced practitioners. Nurses routinely and unobtrusively perform over 100 assessments on a patient. Some of the assessments occur while the nurse is having a casual conversation with the patient. These assessments, coupled with patient advocacy and articulating a course of action between the patient and nurse and at times the patient’s family, could mean the difference between recovery and tragedy.

Women need to ask their doctor, their surgeon, and their cardiologist what their quality of life will be after a heart procedure. Also ask about the emotional and social resources that are available to help you combat the anxiety (before and after), depression, and feelings of helplessness that many women experience after heart surgery?
Women, particularly older women, generally experience more anxiety and depression after surgery! As women we tend to be nurturers, but many women do not put into place a system for their own nurturance before and after major life altering surgery! Network, make friends, do everything you can to ensure your best quality of life after such a major procedure!

Find out how your surgeon, your doctor and cardiologist plan to decrease the possibility of you having a stroke before, during, and after your heart surgery-particularly after. Women have a higher stroke risk after heart surgery than men!

BE FEISTY! Not arrogant, not mean, or nasty.
Be knowledgeable about your procedure.
Expect and then demand that healthcare persons interacting with you identify themselves to you, talk to you and not around you in the third person.
Make sure that anyone you talk with (surgeon, nurse, cardiologist, housekeeping) answers your questions and concerns with respect and in understandable terms.

Come into the hospital fighting for your life…because you are!

Exactly five years ago today, I was implanted with the VNS Therapy™ System (the vagus nerve stimulator) in the double-blind, placebo-controlled investigational trial of vagus nerve stimulation for the treatment of chronic depression. I had never even heard of the vagus nerve, but I had absolutely nothing to lose and everything to gain. There are no words which can adequately describe my gratitude for how this therapy changed my life. Fortunately, this medical breakthrough treatment has been FDA approved and patients are benefiting from this remarkable therapy.

Centers for Disease Control and Prevention

The April 2006 Issue of the Centers for Disease Control and Prevention publication Preventing Chronic Diseases published some very interesting information about the importance of integrating care for medical and mental illness. Here is a summary of the conclusions of the study:

Two review articles present overwhelming evidence that mental disorders and medical illnesses are strongly linked. Medical illnesses such as cardiovascular disease, diabetes, asthma, and cancer are associated with mental illnesses, and the more serious the medical condition; the more likely it is that the patient will experience a mental illness. Individuals with depressive disorders are about twice as likely to develop coronary artery disease, twice as likely to have a stroke, more than four times as likely to have a myocardial infarction (MI), and four times as likely to die within 6 months of an MI as people without depressive disorders.

Depression is a common poststroke condition, and effective treatment of depression can improve cognitive functioning and survival. People with diabetes are two times as likely to have depression as the general population, and the presence of depression as a comorbidity to diabetes is associated with poor adherence to medication regimens, greater complications of diabetes, increased numbers of emergency room visits, and poorer physical and mental functioning.

Health care expenditures are more than four times greater for people with diabetes who have depression than for people with diabetes who do not have depression. Symptoms of depression and anxiety are common (up to 50%) in people with asthma. The presence of depressive symptoms increases as the frequency of attacks increases. Individuals with cancer commonly have mental disorders, especially depression; effective treatment of depression is associated with decreases in pain and symptoms as well as improved immune functioning. Interestingly, improved hemoglobin levels in people with cancer have been reported to improve depressive symptoms, reminding us again about the link between medical and mental disorders.

The link between medical and mental illnesses thus extends to treatments, not just the diseases. Chronic pain, Alzheimer’s disease and Parkinson’s disease, epilepsy, and obesity are other conditions in which mental and medical disorders routinely coexist and in which the presence of a mental disorder impairs functioning and effective disease management.
Finally, people with mental disorders also have impairments in everyday functioning and have greater difficulty following medical regimens, leading to poorer response. Moreover, people with mental disorders are more likely to smoke and abuse alcohol and drugs, leading to greater risk for medical illness and poor adherence to medical treatments.

The World Health Organization has defined health as a “state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. Physical and mental diseases are inextricably bound, and improving one improves the other. Improved mental and physical health will improve quality of life and social well-being. The evidence tells us what we already know; the work ahead is to turn evidence into everyday practice.

The only FDA approved long-term treatment option for chronic depression is now available and being introduced to the psychiatric community: vagus nerve stimulation. You can learn more about this remarkable treatment at [http://www.VagusNerveStimulation.com]

A prescription from an M.D. is required for this ninety minute out-patient procedure.