Independence Blue Cross has launched a $10 million foundation geared toward transforming health care in the Philadelphia region.
The IBC Foundation targets three areas: caring for the community’s most vulnerable; leading innovative approaches to health care and developing the health-care workforce of the future with an intense focus on nursing education.
“It is with great pride and enthusiasm that we announce the launch of the IBC Foundation,” said IBC president and CEO Daniel J. Hilferty.
“Building upon our deep commitment to our community, the foundation is poised to build healthier communities and spur innovation. By caring for the most vulnerable people in our community, enhancing the quality of health care for all and supporting groundbreaking innovations in health care, the foundation will help drive change in health care in our region for generations to come.”
The foundation’s creation was announced Thursday afternoon during the launch of IBC’s Nursing For Tomorrow Forum held at WHYY headquarters on Independence Mall.
Lorina Marshall Blake, IBC vice president of community affairs, will head the foundation.
The new foundation will focus on caring for the most vulnerable in the Philadelphia region by helping the uninsured get quality health care and supporting seniors and their caregivers. The newly created Blue Safety Net will provide $2 million in grants in 2011 to private nonprofit clinics that care for the uninsured and underinsured.
IBC announced foundation grants totaling $1 million to 15 clinics serving 70,000 patients in all five counties in the region.
The foundation’s second area of impact is directed at enhancing health-care delivery and will focus on developing the health-care workforce needed for the future. This work will concentrate on strengthening the region’s nursing workforce through a new $1.5 million initiative called Nurses For Tomorrow.
Nurses for Tomorrow will improve the quality of care in the region by increasing the supply of nurses and nurse educators through $1 million in scholarships awarded through 27 undergraduate nursing programs and 12 graduate nursing programs in the Philadelphia region. The Nurses for Tomorrow initiative will support the creation of three fellowships over the next two years to drive innovation in nursing education. The initiative will also establish continued education for nursing deans, nurse educators and administrators and support the development of a web-based resource for all area nursing schools.
“We are very excited about this new foundation and expanding our partnership with IBC ever further,” said Beverly Malone, CEO of the National League for Nursing, who joined IBC officials for the foundation’s launch.
“What can’t be overlooked is that IBC is not only continuing to support nursing education through scholarships, but again is leading the way in a manner no one else has thought to do.”
The foundation is launching a new Innovation Grant program that will provide $1 million to support projects and research that significantly advance the practice and delivery of health care. The foundation’s first Innovation Grant was awarded to the National Nursing Centers Consortium to enable area nonprofit clinics to use electronic medical records to provide more efficient and safer patient care.
The foundation’s website is now accepting applications for Innovation Grants at www.ibxfoundation.org.
Hilferty was joined at the foundation launch by Mayor Michael Nutter and Drexel University President John Fry, who highlighted IBC’s long partnership with Drexel.
Pennsylvania’s preterm birth rate is improving but there is still work to be done.
The state earned a “C” on the 2011 March of Dimes Premature Birth Report Card, an assessment that compares the state and the nation’s 2009 preliminary preterm birth rates with the organization’s goal of 9.6 percent of all live births by 2020.
Since 2006, the state’s preterm birth rate has dropped from 11.8 percent to 11.5 percent, according to the March of Dimes.
“It points out that even though we’re made some improvements in reducing preterm births we still have a way to go, which is why the March of Dimes is so important both in educating about prematurity and being able to support research into the causes of premature births,” says Dr. Larry Kaiser, president and CEO of Temple University Health System.
Kaiser noted that Philadelphia sees higher numbers of premature births because of its large proportion of uninsured women.
“We know that uninsured women have a higher incidence of premature birth and sometimes that is because of health-related problems and sometimes it’s a result as a lack of prenatal care,” he said.
“We’ve done a pretty good job with smoking during pregnancy and reducing the number of late preterm births but there’s still a higher incidence in the uninsured.”
Premature birth is the leading cause of newborn death and babies who survive an early birth often face breathing problems, cerebral palsy and intellectual disabilities. The problem costs the United States more than $26 billion annually, according to the Institute of Medicine.
Dr. Jay S. Greenspan, a neonatologist and chair, March of Dimes program services committee says tackling prematurity takes a multi-prong approach.
“The problem is very complex, so unlike some other problems that the March of Dimes has tackled such as polio or spina bifida, this has many aspects to it that even go beyond a medical issue to a social issue and a disparity issue.”
Greenspan noted that the rates of prematurity are directly linked to the health of the nation’s women of childbearing age.
“The healthier the young women are in the country, generally, the lower the prematurity rate,” Greenspan says.
“Combating prematurity includes living a healthy lifestyle, combating stress and thinking ahead about becoming pregnant.”
To help address the issue in Pennsylvania, the March of Dimes is investing $4.2 million for a range of new programs.
Dolores T. Smith, March of Dimes, state director of program services, gave an overview of some of pilot projects that will impact Philadelphia.
Under one project, postpartum education is being offered to mothers of preterm newborns in an effort to reduce repeat preterm birth. This program is underway at the neonatal intensive care units of Abington Memorial, Thomas Jefferson and Pennsylvania Hospitals.
“We recognize that the woman at highest risk for pre-term birth is a woman who has already had a pre-term birth,” said Smith.
After women are educated about their risk factors, they are encouraged to visit a maternal fetal medicine specialist who can assess their medical records and closely monitor them before and during their next pregnancy.
Through other programs, the March of Dimes will fund efforts to provide interconceptional education during well-child pediatric visits; participating medical providers in Philadelphia will be trained on providing group prenatal care as well.
In addition, March of Dimes is funding research projects at Children’s Hospital of Philadelphia, Temple University, St. Christopher’s Hospital for Children, Lankenau Institute for Medical Research and the Hospital of the University of Pennsylvania.
The March of Dimes says its 2020 preterm birth goal can be achieved by giving all women of childbearing age access to health care coverage, implementing proven interventions to reduce the risk of an early birth, such as not smoking during pregnancy, getting preconception and early prenatal care, progesterone treatments for women who are medically eligible, avoiding multiples from fertility treatments, avoiding elective Caesarian sections and inductions before 39 weeks of pregnancy and by funding new research on prevention of preterm birth.
As a part of Prematurity Awareness Month, the March of Dimes Pennsylvania Chapter will hold Day of Gratitude events at hospitals and neonatal intensive care units across the state.
The March of Dimes and organizations from Australia, Africa and Europe will observe World Prematurity Awareness Day on November 17.
An estimated 13 million babies are born preterm, and of those, one million die as a result of their early birth, according to an October 2009 March of Dimes report.
Throughout November, the following buildings and bridges in Philadelphia will be lit purple as a symbol of hope to the babies and families fighting premature birth: One Liberty Place, Strawberry Mansion Bridge, The Ben Franklin Bridge, The CIRA Centre, PECO Energy Building, Two Liberty Place and Philadelphia College of Osteopathic Medicine.
If you stretch after you work out, will it stop muscle soreness from working out?
Sally, researchers at the University of Texas at Tyler found that stretching did not prevent muscle soreness after a workout. They asked non-athletic people to exercise 20 minutes. Two thirds were asked to stretch. Each person was then asked to rate how sore his or her muscles were over the next three days. The amount of soreness was the same for both groups. The researchers also took a blood sample from each person to see if the level of serum creatinine kinase, which is an indicator of muscle damage, had risen. Stretching had no affect on the levels.
While stretching will not stop soreness, it is important for flexibility. Doing a warm-up before you stretch ensures that the muscles have dilated and have increased circulation, which makes it easier to stretch the muscles and lowers your chances of injury while doing so?
When you exercise, the rise in body temperature and blood flow causes your muscle size to increase between 10 and 20 percent. If you stretch your muscles before you warm up you risk pulling or tearing a muscle. Research in the area of exercise science and physiology has proven that you should warm up before you stretch. This will also release hormones, which help increase the elasticity of your muscles. To warm up before you stretch, you can do a slow jog, brisk walk, jump rope or do jumping jacks for about five minutes. To stretch your muscles, hold the stretch for 30 to 60 seconds. If you can only do five seconds fine, start there and increase your time. Never bounce or jerk when you stretch, it should be slow and sustained.
Ex-Smokers and Caffeine
I just stopped smoking and I feel great. My problem is caffeine; I’m drinking more coffee. Will this new habit be as bad as smoking?
Cigarette smokers metabolize caffeine more rapidly than nonsmokers. This means that smokers have to drink more coffee to get the same level of caffeine in their blood. It’s this difference that can cause problems for people who have just quit smoking.
Researchers in San Francisco found that when ex-smokers drank their usual amount of coffee, the levels of caffeine in their blood rose 250 percent over previous levels because they were metabolizing it more slowly. These high levels could cause some ex-smokers to start smoking again. The higher levels of caffeine can make a person jittery, causing an ex-smoker to use a cigarette to calm the nerves.
Here are some tips that will help to quit smoking and stay off the caffeine.
1. Keep a positive attitude. Believe that you can quit.
2. Get rid of all cigarettes and matches and have your teeth cleaned.
3. Change your habits. After a meal, go for a walk. When you want to go out, go to places that prohibit smoking.
4. When the urge hits do something else. Plan several activities that you can do every time you get the urge.
5. Tell others that you’ve quit. They’ll be glad to remind you that you want to stop smoking.
6. Get more information about the hazards of smoking. The more you know, the better prepared you’ll be to deal with not smoking.
Caffeine is a psychoactive stimulant. It will increase alertness, decrease fatigue, give euphoria, and elevate your mood. The bad effects of caffeine can include sleeplessness, irritability, anxiety and depression. A person can suffer the bad affects from one or two cups of coffee a day.
If you drink more than 250 mg of caffeine a day, which is about two and a half cups, you can suffer from caffeine intoxication. The symptoms include restlessness, nervousness, excitement, excessive urination, insomnia, heartburn, muscle twitching and rambling thought and speech.
There are some withdrawal symptoms when you try to break the caffeine habit. They can include depression, constipation, runny nose, nausea, headaches and a craving for caffeine. To quit, it’s best to gradually reduce your caffeine intake. Try to reduce your daily intake of caffeine by 100mg each week. That is about one cup of coffee. Continue decreasing your consumption until you’re down to a safe level, which is about one cup a day. Your plan should also include relaxation, stress reduction, good nutrition and exercise.
I just noticed that I have started to develop stretch marks. Is there anything I can do to get rid of these unsightly marks.”
There are no proven ways to remove, cure or change stretch marks completely. Most begin as small tears in the skin. They are usually a result of a rapid weight gain, a big growth spurt, pregnancy or even muscle growth. Knowing this, it would be good to just not get too big too fast. One way to slow growth is to do aerobic exercise to control your body’s fat percentage and growth. The fastest growing tissue is the fat cell. Aerobic workouts will help you burn body fat, if you do 30 minutes or more of continuous movement. It takes your body 20 minutes to switch to the fat-burning stage during a workout. Try to get in at least 30 minutes of aerobic exercise three to four times a week. Try to keep your aerobic workout under 60 minutes. This way you won’t overdo it and you’ll decrease your risk of injury due to repetitive stress. Thirty to 45 minutes is ideal, but you may have to start below 10 minutes and increase your workout time gradually. Some examples of aerobic exercise include 30 minutes or more of brisk walking, jogging, bicycling, swimming, walking in a pool, aerobic dance and jumping rope. Workouts, which include a lot of, stop and go movements will burn calories but are not considered aerobic. Non-aerobic exercises include karate, volleyball, weight lifting, sprinting, tennis, ballet and gymnastics. If you’re trying to lose weight, aerobic workouts with a proper eating plan will help you see results within a few weeks.
Time for Breakfast
I don’t have time for breakfast. What can I eat in the morning that is quick?
Instead of coffee or skipping breakfast, make a pit stop at your blender before you leave home. Pour in a cup of orange juice and a half-cup of sliced pineapple and a few strawberries. Blend for a few seconds and pour it in a large container you can take with you for the ride. Carry a straw and you can easily sip and drive while you fuel your body with vitamins A and C, potassium and phosphorus. Fruits and fruit juices are an excellent way to wake up and energize your body.
After a small fruit meal, cereals are a great choice. Skip the cereals with fruit and nuts mixed in; they don’t break down well in the stomach when mixed. Also, use soy milk on your cereal instead of milk. You can drink milk, but it’s best to drink it alone. Choose cereals that have less than 200 milligrams of sodium per serving. Also, make sure that the first ingredient is a whole grain such as 100 percent whole wheat, brown rice or corn. If you find sugar listed, it should be the last ingredient. Companies listing sucrose, fructose or maltose should not fool you, they are all sugars. Whole-grain cereals are an excellent source of complex carbohydrates, fiber, vitamins and minerals. Make sure you’re getting the right stuff; read the label.
Fresh Fruit and Fruit Juice
What is the difference between eating fresh fruit and drinking fruit juice? Are dried fruits as nutritious as fresh fruit?
West Oak Lane
Fruit juice is a good alternative to alcohol, imitation fruit-flavored drinks and soda, but eating whole fruit is important too. Ounce for ounce, whole fruit is more filling, has more fiber and contains fewer calories. Studies show that the fiber present in whole fruit helps regulate the breakdown of carbohydrates (starchy foods, grains, rice, vegetables and fruit) better than fruit juice.
Whole fruit causes sugar to enter the bloodstream more slowly than juice, which in turn allows your body to release less insulin. A slower steady release of insulin is important to keep blood sugar levels stable. This will cause your energy level to remain fairly constant, rather than fluctuate wildly, which can cause tiredness, dizziness, emotional instability and a host of other symptoms.
Dried fruit has some advantages and disadvantages when compared to fresh fruit. Because drying reduces water, it concentrates nutrients. As a result, dried fruit is usually high in minerals like copper, iron, potassium, and sometimes beta-carotene. Dried fruit is high in fiber and fat free. On the down side, dried fruits lose most of their vitamin C, and the sugar content becomes more concentrated. Dried fruit may contain as much as 70 percent sugar by weight, which approaches the level of some candies. Sulfites are added to the drying process to preserve color and beta-carotene. Some people, especially asthmatics, are allergic to sulfites. There are sulfite-free dried fruits on the market, so shop around.
Fresh fruit should make up the bulk of your fruit intake. Drink juices and eat dried fruits in moderation.
Before starting your fitness program, consult your physician.
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More than a million people are affected by Type 2 diabetes and don’t even know it. And the risks they face are high: Left untreated, the condition can raise the risk of heart attacks, blindness and amputation.
Type 2 is the most common form of diabetes, accounting for 90 percent of cases.
Diabetes occurs when the pancreas does not produce enough insulin, the hormone that converts glucose into energy, or when the body stops responding to insulin, triggering high levels of glucose in the blood. This causes symptoms such as fatigue, thirst, frequent urination, recurrent thrush and wounds that are slow to heal.
Most people associate Type 2 diabetes with being overweight, eating junk food or a couch-potato existence. Yet research suggests that modest weight gain, or even relatively minor disruptions to normal sleep patterns, could be enough to cause it. If you regularly get less than five hours’ sleep, your risk of getting diabetes is double that of someone who gets seven to eight hours.
It’s thought the danger arises because lack of rest upsets the body’s circadian rhythm, the internal clock that regulates natural sleep and wake cycles.
Being awake when we should be asleep increases the release of the stress hormone cortisol, which promotes the generation of glucose (to provide energy to the body to keep it going).
Our fast-paced society takes its toll on sleep. The average American sleeps about 7–7 1/2 hours a night. A hundred years ago, the average was 9 hours.
Insomnia isn’t just an occasional rough night or sleeping less than you think you should. The key question to determine if you have insomnia is “How rested do I feel?” If you have all the energy and alertness you want, you don’t have insomnia, no matter how little sleep you get. On the other hand, if you’re tired and drowsy all day, you may have insomnia, even if you’re in bed 12 hours a night. The quality of sleep is as important as the quantity. For example, if you’re struggling for breath all night or your body can’t relax because of stress and tension, you may not feel rested, no matter how much you sleep.
There are at least three kinds of insomnia: problems getting to sleep, problems staying asleep and waking up too early and not being able to go back to sleep. Problems getting to sleep (sleep-onset insomnia) are often due to stress, too much activity or anxiety at bedtime, or bad sleep habits.
Problems staying asleep (sleep-maintenance insomnia) are often due to medical problems such as sleep apnea or an enlarged prostate. We all wake up 12–15 times a night, but we usually get right back to sleep without ever realizing or remembering we’ve been awake. It’s insomnia if you can’t get back to sleep easily. Problems with waking up too early are often a sign of depression, or they may be caused by noise and light in the bedroom.
Until recently, though, it was thought that lack of sleep had few long-term health effects. The main concern has been accidents and mistakes due to poor concentration and fatigue. But recent studies at institutions such as the University of Chicago and Pennsylvania State University have shown that sleep deprivation (getting at least two hours less than you want) leads to insulin resistance, increases in appetite and higher levels of stress hormones in the blood — conditions that can contribute to the development of diabetes. Some researchers believe there may also be a connection between sleep disorders and heart disease.
While sleeplessness can promote diabetes, symptoms associated with high blood glucose, low blood glucose (hypoglycemia) and some diabetes complications can also interfere with sleep. If your blood glucose level is high, you may be in the bathroom urinating every few hours during the night. Hypoglycemia can cause nightmares, night sweats, or headache; hunger that wakes you up to get food; or symptoms associated with daytime hypoglycemia such as rapid heartbeat, dizziness, or shaking.
It is important to realize that sleep (or the lack of it) is just one of the factors which influence diabetes Type 2, but it is an important factor, all right. We can safely conclude that someone with regular and quality sleep drastically reduces the probability of diabetes.
The benefits of a good night’s sleep and conversely, the consequences of quality sleep deprivation, generally are well documented. The durations of adequate and inadequate sleeping may vary, though, depending on age. Recent studies have increasingly been establishing a connection between quality sleep deprivation and diabetes Type 2.
In other words, quality sleep deprivation can cause diabetes Type 2.
Does this mean that all I need to do to combat diabetes is get a good night’s sleep?
Yes and no. Sleep deprivation has a direct correlation to blood sugar control.
In fact, according to a recent study for the University of Chicago, restoring a healthy amount of sleep may be as powerful an intervention as the drugs currently used to treat Type 2 diabetes. This suggests that improving sleep quality in diabetics would have a similar beneficial effect as the most commonly used anti-diabetes drugs.
Remember, I’m not a doctor. I just sound like one.
Take good care of yourself and live the best life possible!
The information included in this column is for educational purposes only. It is not intended or implied to be a substitute for professional medical advice. Readers should always consult their healthcare providers to determine the appropriateness of the information for their own situation, or if they have any questions regarding a medical condition or treatment plan.
Glenn Ellis is a health advocacy communications specialist. He is the author of “Which Doctor?” and is a health columnist and radio commentator who lectures, and an active media contributor nationally and internationally on health related topics.
His second book, “Information is the Best Medicine,” was released this month. For more good health information, visit: www.glennellis.com.
Medical breakthroughs have led to a near doubling of human lifespan over the last century, from 47 years old in 1900 to nearly 80 years old today. Infectious diseases and bacterial infections that used to kill millions of people each year have been tamed, though not eliminated. Some cancers can now be treated or eradicated by detecting them early with scanners and other technologies, and surgeons can repair or even replace hearts, livers, eyes and other organs with remarkable precision and success.
Every medical study ever conducted has concluded that 100 percent of all Americans will eventually die. This comes as no great surprise, but the amount of money being spent at the very end of people's lives probably will.
As we prepare for a decision from the Supreme Court, in all the discussion of health-care reform, there is one issue that has received almost no attention, but has the potential to save billions of dollars and untold suffering if it is effectively addressed. I’m talking about futile treatments at or near the end of life.
According to Dartmouth, Medicare pays about $50,000 during a patient’s last six months of care by U.C.L.A., where patients may be seen by dozens of different specialists and spend weeks in the hospital before they die.
Of the almost one-third of Medicare expenditures attributable to the 5 percent who die each year; about 1/3 of expenses in the last year are spent in the final month.
Modern medicine has become so good at keeping the terminally ill alive by treating the complications of underlying disease that the inevitable process of dying has become much harder and is often prolonged unnecessarily.
But when it comes to expensive, hi-tech treatments with some potential to extend life, there are few restrictions.
By law, Medicare cannot reject any treatment based upon cost. It will pay $55,000 for patients with advanced breast cancer to receive the chemotherapy drug Avastin, even though it extends life only an average of a month and a half; it will pay $40,000 for a 93-year-old man with terminal cancer to get a surgically implanted defibrillator if he happens to have heart problems too.
Every other major industrialized nation but the United States has a budget for how much of taxpayer funds are allocated to health care, because they've all recognized that you could bankrupt your country without it.
Multiple studies have concluded that most patients and their families are not even familiar with end-of-life options and things like living wills, home hospice and pain management.
The questions are critical, even if some people find them difficult to even think about.
Should a feeding tube be installed when the patient can no longer be nourished by mouth? Should a ventilator be attached when breathing independently becomes difficult? If the patient has severe dementia, should antibiotics be used if pneumonia develops? Should cardiopulmonary resuscitation be attempted if the heart stops beating?
Or should the patient receive just comfort care — treatment for pain, nausea, anxiety, depression and other debilitating symptoms — and be allowed to die a natural death?
Only about one-third of Americans have completed any kind of advance directive to guide their families and physicians when they cannot speak for themselves. Of the advance directives that have been executed, many, if not most, are too vague to be truly useful.
Some people choose not to receive certain types of treatment if they are near the end of life because they do not wish to prolong the dying process. Some of the life-sustaining procedures people choose to decline (which can be included in their advance directives) are:
• Cardiopulmonary resuscitation (CPR) – If a person’s heart stops or if that person stops breathing and the person has not indicated he or she does not want CPR, health-care professionals usually try to revive him or her using CPR. In most cases when people have a terminal illness this is not successful. (You do not need to have an advance directive to request a do-not-resuscitate order.)
• Artificial breathing – If your lungs stop working properly, your breathing can be continued using a machine called a ventilator. A ventilator is a device that pumps air into a person’s lungs through a tube in the person’s mouth or nose that goes down the throat. The machine breathes for a person when he or she cannot.
• Artificial feeding – There are various methods to feed people who can no longer eat, including inserting a tube into the stomach through a person’s nose or through the abdominal wall to bring food and fluids directly to the stomach or by giving liquid nutrients through a catheter in the vein.
The real problem is that many of the patients that are being treated aggressively, if you ask them, they would prefer less aggressive care.
Sometimes, in spite of treatment, a condition or illness will cause death. In those cases, patients can decide what they do and do not want done. They can decide whether they want aggressive treatment that might prolong life or whether they prefer to stop treatment, which could mean dying sooner but more comfortably. They may want to plan their own funerals. Advance directives can help make the patient's wishes clear to families and health-care providers.
Care at the end of life focuses on making patients comfortable. They still receive medicines and treatments to control pain and other symptoms. Some patients choose to die at home. Others enter a hospital or a hospice. Either way, services are available to help patients and their families deal with issues surrounding death.
Many decisions have to be made when a person reaches the end of life. Some of the most important decisions about the end of life concern the type of medical care and the extent of that care that you would like to receive.
Planning ahead and discussing your desires with your family is important, because you may be unable to make decisions yourself if you are incapacitated in some way, such as being unconscious. This guidance should be in the form of written instructions so that your wishes are clear and can be legally honored.
Because of advances in medicine, each of us, as well as our families and friends, may face many decisions about the dying process. As hard as it might be to face the idea of your own death, you might take time to consider how your individual values relate to your idea of a good death. By deciding what end-of-life care best suits your needs when you are healthy, you can help those close to you make the right choices when the time comes. This not only respects your values, but also allows those closest to you the comfort of feeling as though they can be helpful.
The simplest, but not always the easiest, way is to talk about end-of-life care before an illness. To help people make sound health-care decisions and get the care they would want for themselves or their family members as life draws to a close, the National Institute on Aging has produced a comprehensive 68-page booklet, “End-of-Life: Helping With Comfort and Care.” Individual free copies can be obtained through the institute’s website, www.nia.nih.gov, or by calling (800) 222-2225.
We have got to accept that, “No one gets out alive”…
Remember, I’m not a doctor. I just sound like one. Take good care of yourself and live the best life possible!
The information included in this column is for educational purposes only. It is not intended nor implied to be a substitute for professional medical advice. The reader should always consult his or her healthcare provider to determine the appropriateness of the information for their own situation or if they have any questions regarding a medical condition or treatment plan.
Glenn Ellis, is a health advocacy communications specialist, and the author of “Which Doctor?” He is a health columnist and radio commentator who lectures, and is an active media contributor nationally and internationally on health related topics. His second book, “Information is the Best Medicine,” is due out this month. For more good health information, visit: www.glennellis.com.
Like many of you, more and more we are hearing about family, friends and loved ones facing a sudden issue with the pancreas.
Most people don’t know much about this organ, but in fact, it is an important part of the human body. It often goes unnoticed — until a problem occurs.
The pancreas is a gland that lies crosswise deep in the abdomen between the stomach and the spine. The pancreas serves two purposes — endocrine and exocrine functions:
The endocrine function allows for the production of insulin, which is imperative for the metabolism and regulation of blood glucose (the thing that keeps you from being diabetic).
The exocrine component aids in the digestion of food. Pancreatic juices filled with important enzymes flow into the small intestine and break down the carbohydrates, proteins and fats to allow absorption into the body.
Problems with the pancreas usually come down to two things — pancreatitis and pancreatic cancer.
Pancreatitis is an inflammation of the pancreas where the enzymes that help digest fats, proteins and carbohydrates start digesting the pancreas. There are two types of pancreatitis: acute and chronic. Acute pancreatitis occurs suddenly lasts a short amount of time (usually no more than two days) and heals itself. Whereas chronic pancreatitis pain lasts for a long time and results in the inability to digest fat and damages insulin production. Symptoms for both may include: sever pain and swelling in upper abdomen, jaundice, fever, sweating, nausea and rapid pulse. Causes for acute pancreatitis may include gall stones and drinking too much alcohol. Usual causes for chronic pancreatitis are alcohol abuse and excess iron in the blood.
Quite simply, pancreatitis refers to inflammation of the pancreas; usually marked by abdominal pain. The primary causes are identified in the medical community as alcohol, gallstones (by virtue of the shared biliary tree), infection and certain medications such as diuretics.
There are strong indications that a major factor in chronic non-acute pancreatitis is the stress put on the pancreas through a diet high in cooked and processed foods — a diet deficient in natural or supplemented enzymes.
Research done on rats and chickens that were fed cooked foods revealed that the pancreas enlarged to handle the extra burden of the enzyme-deficient diet. In other words, the pancreas will enlarge over time when called upon to compensate for a diet high in enzyme-deficient foods. Animals such as cattle, goats, deer and sheep get along with a pancreas about a third as large as the human pancreas because of their raw food diet. However, when these animals are fed heat-processed, enzyme-free food, their pancreas enlarges up to three times the normal size than when fed on a raw plant diet. Make no mistake: Long-term, non-acute pancreatitis is a condition that affects virtually every person living on a modern diet — given enough time.
Just like pancreatitis, the incidence of pancreatic cancer is rising dramatically in the developed world. Pancreatic cancer is a very deadly form of cancer. Because it is generally diagnosed late this cancer is very tough to treat. Pancreatic cancer is one of the few cancers for which survival has not improved substantially over nearly 40 years.
Pancreatic cancer is a leading cause of cancer death largely because there are no detection tools to diagnose the disease in its early stages when surgical removal of the tumor is still possible. Early pancreatic cancers cause few symptoms, most of which are vague. Because signs and symptoms of most pancreatic cancer may be mistaken for less-serious digestive problems, the disease is rarely detected before it has spread to nearby tissues or distant organs through the bloodstream or lymphatic system.
According to WebMD, symptoms that may arise, in typical order of occurrence, include:
Significant weight loss accompanied by abdominal pain, the most likely warning signs.
Vague but gradually worsening abdominal pain that may decrease when leaning forward and increase when lying down. Pain is often severe at night and may radiate to the lower back.
Digestive or bowel complaints such as diarrhea, constipation, gas pains, bloating, or belching.
Nausea, vomiting, and loss of appetite.
Jaundice, which is usually painless and is indicated by yellowish discoloration of the skin and eye whites, very dark urine, and light-colored stools.
Sudden onset of glucose tolerance disorder, such as diabetes.
Black or bloody stool, indicating bleeding from the digestive tract.
Enlarged liver and gallbladder.
Clay- or light-colored stools.
Bronze urine color.
Blood clots in the legs.
Research from Johns Hopkins points to the fact that the incidence of pancreatic cancer is 50 percent to 90 percent higher in African Americans than in any other racial group in the United States. Not only is pancreatic cancer more common among African Americans, but African Americans also have the poorest prognosis of any racial group because they often are diagnosed with advanced, and therefore, inoperable cancer. African Americans also are less likely to receive surgery than any other racial group in the United States.
Many studies have been conducted to determine why there is an increased risk of pancreatic cancer among African Americans. These studies suggest that environmental and socioeconomic factors may be important. Cigarette smoking, which causes about 25 percent of pancreatic cancer, is more common among African Americans and therefore may partially explain why pancreatic cancer is more common in African Americans. Other risk factors for pancreatic cancer that are more common in African Americans include diabetes mellitus, pancreatitis and being overweight.
Treatment of pancreatic cancer is especially difficult because the location of the pancreas means that tumors tend to spread rapidly to highly innervated (rich in nerves) regions of the back and spine.
The steps for taking care of your pancreas are fairly simple.
Chronic pancreatitis: Long-term inflammation of the pancreas (pancreatitis) has been linked to cancer of the pancreas. In fact, long-term, non-acute inflammation of the pancreas may be the single leading cause of pancreatic cancer.
Diabetes: Diabetes is not only a symptom of pancreatic cancer, but long-standing Type 1 diabetes significantly increases the risk of pancreatic cancer.
Obesity: Obesity also significantly increases the risk of pancreatic cancer.
Alcohol: Consume alcohol only in moderation as even small quantities of alcohol inflame the pancreas, not to mention the liver.
Smoking: Statistically, smoking doubles the risk of pancreatic cancer. It has been estimated that as many as one in four cases of pancreatic cancer are the direct result of smoking cigarettes. The risk of pancreatic cancer drops close to normal in people who quit smoking.
Diets high in meats, cholesterol, fried foods, and nitrosamines increase the risk of both pancreatic cancer and pancreatitis, while diets high in raw fruits and vegetables reduce risk. A new study, from the World Cancer Research Fund, found eating processed meats like bacon and sausage could increase your risk for deadly pancreatic cancer. For every piece of sausage or two strips of bacon a person eats every day, there’s a 19 percent rise in risk for pancreatic cancer, the study found. The bottom line is that a Mediterranean diet is “pancreas friendly.”
Now that we have a basic understanding of the pancreas, there are a few things we can do to help a healthy pancreas stay that way: Keep your weight in the desirable range; don’t overload your body with sugar; get some exercise; and limit your alcohol consumption.
Remember, I’m not a doctor. I just sound like one. Take good care of yourself and live the best life possible!
The information included in this column is for educational purposes only. It is not intended nor implied to be a substitute for professional medical advice. Reader should always consult their healthcare providers to determine the appropriateness of the information for their own situation or if they have any questions regarding a medical condition or treatment plan.
Glenn Ellis is a health advocacy communications specialist. He is the author of Which Doctor? and “Information is the Best Medicine.” A health columnist and radio commentator who lectures on health related topics, Ellis is an active media contributor on health equity and medical ethics. For more good health information, visit: www.glennellis.com.
Here in America, our culture, tells us that we should fight hard against age, illness and death. And holding on to life, to our loved ones, is indeed a basic human instinct. However, as the end of life approaches, letting go may not feel like the right thing to do.
Americans are a people who plan. We plan everything: our schedules, our careers and work projects, our weddings and vacations, our retirements. Many of us plan for the disposition of our estates after we die. The one area that most of us avoid planning is the end of our life. Yet, if we don’t plan, if we don’t at least think about it and share our ideas with those we love, others take over at the very time when we are most vulnerable, most in need of understanding and comfort, and most longing for dignity.
Most people do not die traumatically. Instead, the last days of their lives are spent in a hospital, nursing home, or in their own homes. In your advance directive (see below), you can state your preferences about where you wish to be in the event of terminal illness or during the process of dying. If you choose to be at home, many home care options are available, including home health and custodial care.
Advance directives are written instructions that communicate your wishes about the care and treatment you want to receive if you reach the point where you can no longer speak for yourself. Medicare and Medicaid require that health care facilities that receive payments from them provide patients with written information concerning the right to accept or refuse treatment and to prepare advance directives. Every state now recognizes advance directives, but the laws governing directives vary from state to state.
Probably the most commonly used form of advance directive is the durable power of attorney for health care (or Health Care Proxy). This is a document in which you appoint someone else to make medical treatment decisions for you if you cannot make them for yourself. This is certainly a wise move to make, because if you do not name a proxy or agent, the likelihood of needing a court-appointed guardian (like the hospital itself) grows greater, especially if there is disagreement regarding your treatment among your family and doctors.
It is wise to have an advance directive so medical personnel and your loved ones will know what care and services you prefer and what treatment you would refuse, in the event that you are unable to communicate your wishes. You also can designate the person, or more than one person, whom you would like to make decisions on your behalf. In a surprising number of families, there is disagreement over what a very ill relative would prefer. The advance directive makes your wishes clear. An advance directive can express both what you want and don’t want. Even if you do not want treatment to cure you, you should always be kept reasonably pain free and comfortable.
It’s best to think of Advance Health Care Directives as works in progress. Circumstances can change, as can your values and opinions about how you would best like your future health-care needs to be met. Directives can be revoked or replaced at any time as long as you are capable of making your own decisions. It is recommended that you review your documents every few years or after important life changes and revise your directives to ensure that they continue to accurately reflect your situation and wishes.
Re-examine your health care wishes every few years or whenever any of the “Five Ds” occur:
• Decade – when you start each new decade of your life.
• Death – whenever you experience the death of a loved one.
• Divorce – when you experience a divorce or other major family change.
• Diagnosis – when you are diagnosed with a serious health condition.
• Decline – when you experience a significant decline or deterioration of an existing health condition, especially when it diminishes your ability to live independently.
Another form or method of instruction available to you is a Do Not Resuscitate or DNR order, which instructs medical personnel, including emergency medical personnel, not to use resuscitative measures. A do-not-resuscitate (DNR) order tells medical professionals not to perform CPR. This means that doctors, nurses and emergency medical personnel will not attempt emergency CPR if the patient’s breathing or heartbeat stops.
DNR orders may be written for patients in a hospital or nursing home, or for patients at home. Hospital DNR orders tell the medical staff not to revive the patient if cardiac arrest occurs. If the patient is in a nursing home or at home, a DNR order tells the staff and emergency medical personnel not to perform emergency resuscitation and not to transfer the patient to a hospital for CPR.
Ask your doctor for a time when you can go over your ideas and questions about end-of-life treatment and medical decisions. Tell him or her you want guidance in preparing advance directives. If you are already ill, ask your doctor what you might expect to happen when you begin to feel worse. Let him or her know how much information you wish to receive about your illness, prognosis, care options, and hospice programs.
Medical advances make it possible to keep a person alive who, in former times, would have died more quickly from the serious nature of their illness, injury or infection. This has set the stage for ethical and legal controversy about the patient’s rights, the family’s rights and the medical profession’s proper role.
Each American has the constitutional right, established by a Supreme Court decision, to request that medical treatment be withdrawn or withheld. The right remains valid even if you become incapacitated. Doctors can always refuse to comply with your wishes if they have an objection based on their own religious beliefs, for example, or consider your wishes medically inappropriate. However, they may have an obligation to transfer you to another healthcare provider who will comply with your wishes.
Questions you should ask your doctor if you are diagnosed with a terminal illness:
•Tell me straight: How long do I realistically have?
•Realistically, what can I expect in terms of symptoms and process?
•What can I expect if I go Route A or Route B?
•What do you think I should do and why?
All of these questions may sound very difficult to discuss now, when the time for decisions is still in the future. However, they are harder to discuss when someone is really sick, emotions are high and decisions must be made quickly.
It is true that more older people, rather than younger, use advance directives, but every adult should have one. Younger adults actually have more at stake, because, if stricken by serious disease or accident, medical technology may keep them alive but insentient for decades. Some of the most well-known “right to die” cases arose from the experiences of young people (e.g., Karen Ann Quinlan, Terri Schiavo) incapacitated by tragic illnesses or car accidents and maintained on life support.
Looking at all the information available and making the best decision you can, will give you peace of mind, the comforting awareness that you did what was right as you knew it.
Remember, I’m not a doctor. I just sound like one. Take good care of yourself and live the best life possible!
The information included in this column is for educational purposes only. It is neither intended nor implied to be a substitute for professional medical advice. Readers should always consult their healthcare providers to determine the appropriateness of the information for their own situation or if they have any questions regarding a medical condition or treatment plan.
Glenn Ellis is a health advocacy communications specialist. He is the author of “Which Doctor?,” and is lecturing a health columnist and radio commentator and an active media contributor nationally and internationally on health related topics.
His second book, “Information is the Best Medicine,” is due out in fall, 2011. For more good health information, visit: www.glennellis.com.
Almost one year after undergoing a life-saving heart transplant at Hahnemann University Hospital, Tryphosa Pressley returned to the facility for another reason — to become an employee.
The Southwest Philadelphia resident first came to Hahnemann in 2005 as a patient undergoing treatment for congestive heart failure.
During the 1990s, Pressley realized something was wrong when she began to experience shortness of breath while walking. She couldn’t walk up and down the hallway at her job without feeling short of breath. Her primary care physician thought she had bronchitis and started treating her with antibiotics. However, her symptoms did not improve.
After consulting another physician, she was diagnosed with congestive heart failure, a condition in which the heart can no longer pump enough blood to the rest of the body.
When she was referred to Dr. Howard J. Eisen at Temple University Hospital, he told her she needed a heart transplant, however, she wasn’t ready to undergo the surgery.
“At that time I was very naïve, and I didn’t know anything about heart transplants,” says Pressley.
Eisen said her congestive heart failure was possibly due to a combination of a virus that attacked her heart and hypertension. Pressley was placed on various medications to treat the heart failure.
When Eisen moved to Hahnemann in 2005, Pressley made the move with him. Eisen specializes in heart failure and heart transplant care.
Pressley went through periods of hospitalization because her body kept retaining water. Less blood was being pumped to her kidneys, resulting in fluid retention.
In 2006, Pressley had a defibrillator implanted near her heart. The device gave Pressley a necessary jolt several times over the next few years. She recalled an occasion when the device gave her such a powerful jolt that she was knocked down a flight of stairs.
“The doctors told me at that time that the defibrillator really saved my life,” Pressley recollected.
By 2009, her heart was worsening. In January of 2010, Pressley and her family discussed transplant options and she was placed on the waiting list for a new heart. She was told that she couldn’t continue to live without receiving a heart.
Due to the heart failure, Pressley’s kidneys started to fail. While awaiting a new organ, Pressley was hospitalized for months and given intravenous medications to help stabilize her condition.
“The vast majority of patients with heart failure do very well for years with medication. Unfortunately some people’s heart failure progresses despite the medicine that we have and that happened with her,” says Eisen, Chief, Division of Cardiology, Drexel University College of Medicine.
“When that happened, that’s when we had to do something that would prolong her life and improve her quality of life, and that was heart transplantation.”
One of the biggest issues facing people who have heart failure is the lengthy wait for a new heart.
“The problem is there is a tremendous shortage of organs so that’s why people have to wait such a long time. The shorter the wait, the more likely people are to survive after transplant,” said Eisen.
Pressley wouldn’t receive a new heart until December 17, 2010, almost 11 months after she was placed on the waiting list. For Pressley, the heart was like a Christmas present.
When she learned that she would finally receive a new heart, Pressley couldn’t contain her enthusiasm. At the time, she faced end-stage heart failure.
“I just started hollering and screaming and thanking the good Lord for the miracle,” says the native of Florence, S.C.
Prior to receiving her heart, she was placed on dialysis.
In November 2011 — almost a year after she underwent heart surgery — Pressley returned to Hahnemann to work as a lab assistant.
“I had God’s favor. He is a miracle-working God,” says Pressley.
Pressley is reaping the benefits of living with a new heart.
“She’s done great. The pressure in her lungs has come down. She’s done extremely well,” says Eisen.
“I’m living a lot better. I can get around better. I just feel 100 percent better than I would have felt 10 years ago,” she said.
“I can do what I want to do. I don’t have any limitations.”
In addition to working at Hahnemann, Pressley is active in various ministries at Prayer Chapel Church of God in Christ in Upper Darby, Pa.
Now Pressley is gearing up to write a book about coping with congestive heart failure.
“I believe that if I had known what I know now, my case wouldn’t have gotten so severe,” she said.
Three Rwandan medical students recently tapped into a unique study program at Thomas Jefferson University.
The students participated in an exchange program that enables Rwandan medical students to study at Jefferson, while Jefferson students and faculty visit Rawanda to provide assistance with the healthcare needs of the people in Rugerero, a genocide-survivor village in northwest Rwanda. The Rugerero Survivors Village was built as a safe haven for the thousands of Rwandans who fled to the Congo to escape genocide in the early 1990s.
“The program exposes Rwandan medical students to intensive training beyond what is offered in Rwanda; and helps our students interested in careers in family medicine gain exposure to the health issues in other parts of the world,” said Dr. James Plumb, professor in the Department of Family and Community Medicine, co-director of the Center for Urban Health at Jefferson and faculty liaison for the program.
Since 2005, a total of 45 medical, nursing, physical therapy, occupational therapy, and population health students from Jefferson have traveled to Rugerero and the rural community of Akarambi, north of the capital city of Kigali, to assist in aiding the health needs of the Rwandan people.
Approximately 15 students from the National University of Rwanda School of Medicine have come to Philadelphia to participate in two months of third and fourth year medical training at Jefferson Medical College and Thomas Jefferson University Hospital since 2006.
Jefferson students participate in clinical clerkships at the National University of Rwanda’s Medical School, working in the field with the people of Rugerego and Akarambi. The Rwandan students rotate through clinical instruction in family medicine and pediatrics. They also received classroom training through the "College within The College" (CwiC) track at JMC, allowing them access to population health courses as medical college students.
For Rawandan medical student Christophe Rusatira, participating in the program proved to be an interesting educational experience. One of the things that he found most interesting was the difference between Jefferson’s medical school system and Rawanda School of Medicine.
“I learned a lot in the hospital. I also got an opportunity to see more materials and equipment that I haven’t seen before. It was good to see at least how they were used,” says Rusatira, who aspires to become a cardiologist.
Rawanda faces major health concerns such water sanitation, hand hygiene, malnutrition and HIV/AIDS.
Over eight years of travel to Rugereo and three years in Akarambi, Jefferson students have developed programs including the Health and Hygiene Train-the-Trainer program, providing training on hand-washing and disease transmission; examined and provided nutritional assessments for the adults and children of Rugerero; taught HIV/AIDS education; and linked the village to medical students through the Rwanda Village Concept Project, an international student-run project, with a mission to improve the living standards in a Rwandan community by using simple and low-cost methods and to develop the capabilities of the students in participatory development work.
Participating students from Jefferson hail from Jefferson Medical College and the Schools of Nursing, Population Health and Health Professions.
Dave Casper, a second year medical student at Jefferson was amazed at how accommodating the people were when he visited Rawanda during the summer. The students traveled with a translator when they visited the homes in the villages or hosted classes.
“Most people had very open minds in regard to what it is that we’re trying to teach,” Casper said. “At the same time, they’re very intellectual in the sense that they grasp the concepts and ask thought provoking questions and just really as a whole, have a desire to learn more.”
The association with Rwanda arose out of a partnership with Barefoot Artists, an organization working with poor communities around the globe to help people heal and thrive through self-expression and action.
One of the greatest, and most undertreated, threats affecting Americans today is mental illness. Hundreds of millions of people worldwide are affected by mental, neurological or behavioral problems at any time.
The holiday season can be a time full of joy, cheer, parties and family gatherings. But for many people, it is a time of self-evaluation, loneliness, reflection on past failures and anxiety about an uncertain future.
The incidence of depression has jumped by between four- and five-fold as unemployment, cuts in hours and concern about job security have become common.
In any given year 26 percent of American adults suffer from mental disorders.
Think about it, when you walk down the street, at least one out of every four or five people you pass is suffering form some form of mental illness.
It is way past time for us to look at the state of mental health care in this country. Especially regarding emotional and mental illness, there are so many people who are unable to seek treatment because they may be unable to navigate the system in order to receive services or they just don’t have enough money to pay for treatment if they fall into middle class incomes because insurance rarely covers mental health issues effectively. It must be remembered, also, that in the 1970s the doors to the mental hospitals were closed to the indigent; those people flooded the streets with nowhere to live, and no place to recive help. Not to mention that we, as a society, turn a blind eye.
Mental health policies in America have changed radically over the past 60 years. A one-time emphasis on caring for patients in large institutions has shifted to treating them in outpatient settings in the community. The ways mental disorders are diagnosed and categorized have changed. And the use of psychotropic medications is more prevalent than it used to be.
Eleven percent of Americans ages 12 or older use antidepressants, according to analysis of data by the Centers for Disease Control. The study found that individuals usually take medication for at least two years, although about 14 percent have been taking antidepressants for 10 or more years. Almost one in four middle-aged women are using antidepressants, and women overall are 2.5 times more likely to take the medication. The researchers found that a third of the people who take antidepressant medication haven’t seen a medical health care professional in the past year. Yet, only a third of people with severe depressive symptoms take antidepressant medication, according to researchers. One in four patients visiting a health service has at least one mental, neurological or behavioral disorder, but most of these disorders are neither diagnosed nor treated.
Mental illnesses affect, and are affected by, chronic conditions such as cancer, heart and cardiovascular diseases, diabetes and HIV/AIDS. Untreated, they bring about unhealthy behavior, non-compliance with prescribed medical regimens, diminished immune functioning and poor prognosis.
When stress is at its peak, it’s difficult to stop and regroup. Try to prevent stress and depression in the first place, especially if the holidays have taken an emotional toll on you in the past.
As we go through this holiday season, here are some tips form the Mayo Clinic that may help make it posible for many of us not to succumb to the “blues”:
Seek professional help if you need it. Despite your best efforts, you may find yourself feeling persistently sad or anxious, plagued by physical complaints, unable to sleep, irritable and hopeless, and unable to face routine chores. If these feelings last for a while, talk to your doctor or a mental health professional.
Despite our good intentions, remember that the holidays rarely turn out as planned. Focus on making them a special time for you and your family, no matter what the circumstances. Celebrate this season of hope and expectation. Celebrate the many blessings in your life.
Remember, I’m not a doctor, I just sound like one. Take good care of yourself, and live the best life possible!
The information included in this column is for educational purposes only. It is neither intended nor implied to be a substitute for professional medical advice. Readers should always consult their healthcare providers to determine the appropriateness of the information for their own situation or if they have any questions regarding a medical condition or treatment plan.
Glenn Ellis is a health advocacy, communications specialist. He is the author of “Which Doctor?” and is a lecturing health columnist, radio commentator and active media contributor nationally and internationally on health related topics. His second book, “Information is the Best Medicine,” is due out in January. For more good health information, visit: www.glennellis.com.