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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Studies show vaccination can help prevent more than just cervical cancer
Earlier in the week a federal advisory committee recommended that boys and young men should be vaccinated against human papillomavirus, or HPV, to protect against anal and throat cancers that can result from sexual activity.
And while there are some who feel that such a decision is controversial, there are others who say such a recommendation is timely, as America’s youth become more and more exposed to the horrors of sexually transmitted diseases.
“The HPV vaccine is a major advancement in the fight against cancer,” said Giang T. Nguyen, MD, medical director of Penn Family Care and Assistant Professor of Family Medicine & Community Health for the Perelman School of Medicine at the University of Pennsylvania. “This is important because HPV is the likely cause of nearly all cases of cervical cancer in the world. The current vaccines are able to prevent infection with the types of HPV that cause most cervical cancers.”
Nguyen contends that awareness and understanding of HPV is still rather low, especially in urban cities such as Philadelphia, although he is quick to say that things are slowly improving. He believes that as more people learn about HPV and how to prevent it, vaccine rates will likely increase.
Meanwhile, people who have less wealth or less education, who don’t speak English and particularly persons of color, may be at a greater disadvantage because the public health information may not reach them as effectively.
These are perhaps the communities that are most at risk, because they also may not be getting sufficient cervical cancer screening.
In addition to cervical cancer, HPV can result in other cancers, such as penile, throat and anal cancer. These cancers are less common than cervical cancer but among gay and bisexual men, or men who have HIV, these cancers are more of a risk.
“Some people (including some doctors) feel that HPV vaccination in boys and men is not a cost-effective use of limited health system resources,” Nguyen said. “However, if these males ultimately have sex with unvaccinated females, there could be great benefit (to the female partners). Or, if the boys are gay or bisexual, the vaccination could be very helpful in reducing the other cancer risks as well. However, more thorough cost analysis is still needed.”
Many feel that the recommendation by the panel, the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention, is likely to transform the use of the HPV vaccine, since most private insurers pay for vaccines once the committee recommends them for routine use.
The HPV vaccine is unusually expensive. Vaccination against HPV is pricey, its three doses cost pediatricians more than $300, and pediatricians often charge patients hundreds more, with the three-shot series for the Gardasil vaccine typically costing about $390.
“As a doctor who serves a diverse population in West Philadelphia, I see women with abnormal Pap test results all the time (Pap tests are used to look for early signs of cervical cancer),” Nguyen said in an email to The Tribune. “If a higher portion of young women (and the men they have sex with) are HPV-free due to prior vaccination, then we can hope to see rates of abnormal Paps (and cervical cancer) drop a lot in this community.”
The committee recommended that boys ages 11 and 12 should be vaccinated. It also recommended vaccination of males ages 13 through 21 who had not already had all three shots. Vaccinations may be given to boys as young as 9 and to men between the ages of 22 and 26.
The committee recommended in 2006 that girls and young women ages 11 to 26 should be vaccinated, but vaccination rates in the United States have so far been disappointing.
The vaccine has been controversial because the disease it prevents results from sexual activity, and that controversy is likely to intensify with the committee’s latest recommendation since many of the cancers in men result from homosexual sex. The HPV vaccine became a source of contention among Republican presidential candidates after some candidates criticized Gov. Rick Perry of Texas for trying to require that girls in his state be vaccinated. Representative Michele Bachmann falsely suggested that the vaccine causes mental retardation.
“The vaccination could begin as young as age 9, and boys and young men 13 to 21 years of age who hadn’t received the vaccine should also be vaccinated,” said Dr. Anne Schuchat, Interim Deputy Director for Science and Public Health Program at the Centers for Disease Control and Prevention (CDC).
The current level of use of the HPV vaccine among girls is “disappointing,” Schuchat noted, and since the virus is passed via sexual conduct, “there is the potential that vaccinating boys will reduce the spread of HPV from males to females and reduce some of the HPV burden women suffer from.”
An HPV vaccine has been available since 2006, but until now the CDC had only recommended inoculation for females between the ages of 9 and 26 to limit their risk of cervical cancer.
According to Schuchat, the new recommendations were based on the effectiveness of the vaccine in males. She noted that while the numbers of cervical cancers has been decreasing, head and neck cancer and anal cancers — which affect both genders — have been on the rise.
One expert agreed with the CDC panel that vaccinating boys should help prevent cancers in both genders.
“In a perfect world, immunization of all girls might be the most cost-effective way of preventing HPV disease in women,” said Dr. Kenneth Bromberg, chairman of pediatrics and director of the Vaccine Research Center at The Brooklyn Hospital Center, New York City. “However, since we do not live in a perfect world, a very strong argument can be made for immunizing boys in order to prevent genital warts in males and the prevalence of HPV-related cancers in both boys and girls. The increasing awareness of the role HPV plays in other diseases, such as head and neck cancers and, possibly, heart disease, would be yet another reason to consider universal immunization.”
The vaccine has been controversial with some parents who contend it could encourage young women and men to engage in sexual relations at an early age.
HPV is widespread among men. An international study published in March in The Lancet found that half of all adult males in the United States may be infected with the virus.
More than 40 strains of HPV exist, and all are passed along by skin-to-skin contact, usually during sexual relations, according to the CDC.
The most well-known strain of HPV causes genital warts. But other strains show no obvious symptoms and clear up on their own with no medical treatment, Dr. Jean Bonhomme, an assistant professor at the Morehouse School of Medicine in Atlanta, told HealthDay.
“Because it normally causes no symptoms, men and women can get it and pass it on without even knowing they have it,” Bonhomme said.
Since the virus spreads through skin contact, normal protections that prevent the spread of disease through body fluids won’t work, Bonhomme said.
“Diseases like herpes and HPV cannot be completely prevented by condoms because they are both spread by contact with skin,” Bonhomme said. “If the virus comes into contact with the scrotum or thighs, you can still be infected.”
Men don’t have the screening tools for HPV-related cancers that are available to women. A Pap test can detect cervical cancer in women, Bonhomme said, but there’s no comparable test for penile or anal cancer in men. As a result, many men don’t realize they have these cancers until they begin showing late-stage symptoms.
“The precedent regarding use of a vaccine to prevent a sexually transmissible illness was set years ago with the Hepatitis B vaccine, which prevents another infection that is largely transmitted through sex (although babies born to infected mothers may also be infected during delivery),” Nguyen said. The difference now is that more people are talking about the STD angle for HPV than they did for Hep B when that vaccine was introduced.”
The New York Times Contributed to this report.
Zack Burgess is the enterprise writer for The Tribune. He is a freelance writer and editor who covers culture, politics and sports. He can be contacted at zackburgess.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.
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.
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.
An initiative is underway to increase well-baby pediatric visits during an infant’s first year of life.
The Maternity Care Coalition has partnered with the National Healthy Mothers, Healthy Babies Coalition, Merck and the National Medical Association to launch Healthy Beginnings for Babies.
Healthy Beginnings for Babies launched in three urban areas, Philadelphia, Baltimore and Chicago.
“The program really hopes to increase the number of moms who are taking their babies for well-baby care and ensuring that all babies get the vaccinations they need during the first year,” said Karen Pollack, MCC’s director of programs.
“What we find in working with families is that there are a lot of things that make it difficult for moms to get kids to the doctor.”
MCC staff is working to educate parents about the importance of well-baby visits by distributing educational materials and conducting outreach through health fairs and other activities.
MCC is distributing a booklet for parents titled “Guide For Baby’s 1st Year” that offers information on child development issues, what parents can expect for pediatric visits during their babies first year, questions to ask their health professionals and a scheduling chart for well-baby visits and immunizations.
Well-baby appointments enable medical providers to ensure that a baby is healthy and developmentally on track. During the appointments, a baby’s growth is charted and the baby is given a physical examination. The healthcare provider will also check the baby’s general development, provide nutritional information and administer vaccinations.
“When babies aren’t getting all their immunizations, and when they’re not regularly going to a healthcare provider, there is a concern about potential developmental delays or it makes them at greater risk for exposure to different illnesses,” says Pollack.
Founded in 1980, MCC focuses on improving maternal and child health and well-being.
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.
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.
Fish are an excellent source of protein, monounsaturated fatty acids and a lot of minerals. They contain the highest sources of iodine and potassium. Most fish is also low in saturated fat.
Fish can be categorized as freshwater, saltwater and shellfish. Each category differs slightly in nutritional value. Freshwater fish provide magnesium, phosphorus, iron, zinc and copper. Saltwater fish and shellfish are rich in iodine, fluorine, phosphorous, copper, iron, calcium and cobalt. The fat content of fish varies not only with the size and type of fish, but with the time of year. Fatty fish, which include halibut, mackerel and salmon, are higher in fat but contain more vitamins A and D. Shellfish are low in fat but are higher in cholesterol than most other fish.
According to the American Heart Association, you can have at least two servings of low mercury content seafood each week. Fish that is high in methylmercury can be very unhealthy. Women who are planning to become pregnant or are pregnant, nursing or feeding a young child should modify the type and the amount of fish they eat.
Guidelines recommended by Tthe American Heart Association include:
1. Don’t eat shark, swordfish, king mackerel or tilefish. They all contain high levels of mercury.
2. Choose light tuna over albacore (white) tuna because it has more mercury. Don’t eat more than 6 ounces per week of albacore tuna.
3. If you eat fish from local lakes, streams or rivers, make sure you know what is in the water. If you don’t, eat only six ounces of any fish for the week.
When buying fish, you should know your store. It should have good refrigeration. When it’s on display, the ice should cover enough of the fish to keep it cold. Fresh fish should smell fresh. It should have a mild sea breeze odor. It should never have a strong fishy odor. A whole fresh fish should have bright, clear and shiny eyes. The scales should be shiny and cling tightly to the skin. The gills should be bright red or pink. Steaks and fillets should be moist and free from drying or browning around the edges.
Never buy fish at a store when cooked seafood is stored next to raw seafood. When buying canned fish, never buy swollen or dented cans.
Fish is also bought frozen. When buying frozen fish, make sure the packages are not damaged and the fish are frozen solid. Never buy frozen fish that is covered with ice crystals or appears to have freezer burn. Always buy frozen fish that is below the frost line in the display case. Frozen shellfish should be packaged in closefitting, moisture-proof containers. Frozen shellfish that is prepared, such as crab cakes or breaded shrimp, should be frozen solid and should not show any discoloration or drying or have an unpleasant odor.
When you want to buy the freshest shellfish, they should be alive. Live mussels, clams or oysters will close tightly when you tap them. Live crabs and lobsters will show leg movement. Fresh oysters and scallops should have a fresh odor. Fresh oysters should be surrounded by a clear, slightly milky or light gray liquid. When in doubt about freshness, you can ask the store owner to show you the certified shipper’s tag that should accompany all types of fish.
Storing your fish is just as important as buying good fish. You should refrigerate your seafood purchase as soon as possible. You should keep your refrigerator’s temperature between 340 and 400F and your freezer should be at 00F or colder. You should keep fish in the original wrapper and in the coldest part of the refrigerator, which is under the freezer, or in special meat keepers. When storing fish in the refrigerator, always cover it tightly. Freezer bags make good containers. You should never leave fish in a hot car for extended periods of time. If your frozen fish should thaw, you cannot refreeze it. Fish can be stored frozen for three to six months. The longer these foods are stored frozen, the more likely they will lose flavor, texture and moisture. Products such as crab meat can be stored up to six months in the refrigerator before being opened. Once opened, you should use the fish within three to five days. Canned fish can be stored in a cool, dry place for a year. You should refrigerate or freeze leftovers immediately in a moisture-proof package or container.
You should defrost seafood in the refrigerator. If you don’t have the time, you can put it in a resealable plastic storage bag and immerse the bag in cold water. If you defrost your fish in the microwave, you should cook it immediately after defrosting.
To avoid problems when handling or preparing your fish for cooking, you should take some precautions. You should always wash your hands with hot soapy water before and after handling raw seafood. Don’t leave cooked or raw seafood unrefrigerated for more than two hours. This includes preparation time. When marinating fish, do it in the refrigerator and always throw away the marinade you used. Bacteria will linger on all the surfaces that the raw fish touches. Don’t reuse a dishcloth or a sponge used to clean up counters or other surfaces that you’ve used during your food preparation. You should replace sponges on a regular basis. You should always wash your counters, utensils, plates, cutting boards and other surfaces that have been touched by raw seafood. Always use hot soapy water to clean up after handling seafood. This should include the inside of your refrigerator.
When cooking fish, the 10-minute rule is a good guide. This rule also applies to baking, broiling, grilling, steaming and poaching. Measure the fish at the thickest part. Figure 10 minutes of cooking time for each inch of thickness. If the fish measures less than one inch, try 3 to 5 minutes. Add five minutes if the fish is cooked in a sauce. Double the cooking time if the fish is frozen.
Fish is done when the flesh is opaque and begins to flake easily when tested with a fork at the thickest part. Fish is usually ready when the internal temperature reaches 1450F. You should cook shrimp until it turns pink and is firm. Depending on the size, it takes three to five minutes to boil or steam one pound of medium sized shrimp in their shell. Shellfish, such as clams, mussels and oysters will become plump and opaque when cooked completely. The edges of oysters will turn up when completely cooked. Scallops turn milky white or opaque and firm when completely cooked. They take three to four minutes to cook thoroughly depending on the size. Lobster turns bright red when completely cooked. You should allow five to six minutes per pound. Don’t put the lobster in the pot until the water begins to boil. The cooking time doesn’t start until the water starts to boil again after putting the lobster in the pot.
If you enjoy raw or lightly marinated seafood, you should make sure it comes from certified waters. You can ask to see the certificate. You should keep this type of seafood dish refrigerated until you get ready to eat it.
Seafood can be a safe nutritious protein source if we handle it carefully.
Before starting your fitness program, consult your physician.
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