March 29, 2013

AMA: $20M in Grants for Med Schools to Create Education Innovation

The American Medical Association (AMA) will offer medical schools $20 million in grants to develop innovation in education. The schools must submit proposals by May 15, 2013. By July 1, the AMA will announce the winners of the grant program, which begins on September 1, just in time for the new academic year.

On January 17, AMA Executive Vice President and CEO James L. Madara, MD, described the program with these comments:
Today, a gap exists between physician training and the day-to-day realities of the evolving and emerging health care system. The AMA wants to change that and lower barriers for engagement. We want to bring schools together to foster and accelerate the kind of bold changes that will help you not only succeed, but thrive in the evolving health care environment. 
In recent posts, I’ve discussed the the shifting roles of medical professionals as the healthcare environment evolves (i.e., “gets more complicated”):
Those are all big questions, and it seems absolutely right that the AMA is pro-actively urging med schools to create new ideas for a new time… and then funding the “winning” efforts, presumably to create blueprints other schools can follow.

March 28, 2013

After 35 years, I Still Don't Know Why AA Works for Me, But Not Others

In my early years of sobriety, I made a big deal of each anniversary. One day sober! One month! Six months! One Year! Five Years! One day at a time, I was building a new, different, and very much better life.

With the passage of  years, I've paid less and less attention to my sobriety anniversaries. But today is a special one. It is 35 years since I walked into an AA meeting in a church basement near Washington's Shoreham Hotel, hoping find a way to stay sober. This anniversary, I've decided, is an especially significant and symbolic marker.

I started drinking alcohol at 15 and continued until March 28, 1978 when I was nearing my 50th birthday --  35 years of drinking (more and more with each passing year). It's impossible to determine the exact date, but I'm celebrating today as the point at which I've logged  in more sober days than boozing days. 

But Why?
In the many AA meetings I've attended and the hundreds of talks I've had with AA buddies, this is one of the most frequent topics: why is AA working for me, but not for others who are as smart, determined, and deserving?

March 27, 2013

Retail Clinics and Nurse Practitioners Instead of Doctors

I wrote favorably yesterday (below) about my first visit to a CVS Minute Clinic. After researching these clinics... and the function of nurse practitioners, I realize this CVS model offers a solution to the looming shortage of primary care doctors.

There is plenty of evidence that well-trained nurse practitioners can provide routine services every bit as good as -- sometimes even better than -- what patients receive from their doctors. That was certainly my experience.

Popularity of Retail Health Clinics 
CVS has its Minute Clinics; Walgreens has "Take Care Clinics." Similar walk-in clinics are springing up in other pharmacies, superstores and workplaces.

March 26, 2013

CVS Minute Clinic: Why Didn't I Go There Sooner?

In last week's post about statins and cholesterol, I mentioned getting a cholesterol checkup at my local CVS "Minute Clinic." It was my first experience with one of these increasingly prevalent clinics, and I gave it 9-out-of-10 points in the satisfaction survey.

Six months ago, I wanted to get a cholesterol check and did what I usually do: schedule it at my internist's office. Here's a comparison of the two experiences.

CVS  Minute  Clinic Visit
While shopping at my local CVS -- just five minutes from my house -- I noticed their Minute Clinic and asked if I could get my cholesterol checked. The nurse practitioner on duty said "yes, easily." It was closing time, so I decided to come back the next day. She advised fasting for at least eight hours before the test.

When I returned, there was no waiting line. It took just a few minutes to enter my information on a kiosk screen, much less paperwork time than is required for a first visit with a new doctor. Moments later, the nurse called me into her office.

She asked a few questions about my health history: Flu shot? Smoking? Taking blood pressure meds? Family history of heart disease? Physical activity? She asked about the purpose of my visit and took my blood pressure and temperature.

She took a small blood sample for the cholesterol test. A few minutes later, she had the results.  

She shared my info for total cholesterol, LDL, HDL, triglycerides, and the total cholesterol/HDL ratio. Then she explained how my numbers compared with the recommended norms. Of particular interest for me, she shared my Framingham Coronary Heart Disease Risk Score, which indicated a ten percent risk of dying of a heart attack in the next ten years.

Finally, she gave me a three-page printout. The first page had all the information from our interview, vital signs, test results, instructions, and follow-up. The second page provided an interpretation of the test results showing desirable, borderline, and abnormal cholesterol numbers. It included recommended lifestyle changes for achieving better results. The third page provided clear information about cholesterol and its components, the factors that might increase cholesterol, and the risk factors for heart disease. 

The visit took about 30 minutes. I was charged $93, but some of that will be reimbursed by Medicare and my supplemental insurance. I was very favorably impressed!

My Doctor's Office Visit
After going on a Lipitor holiday for a few weeks last fall, I decided to get a cholesterol checkup. I called my internist's office and got an appointment for a few days later. 

His office is ten minutes away -- not bad, but still twice as far as my CVS -- and parking there is more difficult. Since I'm a long-time patient, I didn't have any paperwork. I had told the receptionist I only wanted the test and didn't need to see the doctor. I received the authorization papers to go down the hall to the laboratory for the test.

I waited about 15 minutes before they took the blood sample. My internist called a day or two later with the  results... and a lecture about getting back on Lipitor. 

I was billed later for $52. Medicare and my secondary insurance picked up most of this charge.

Bottom Line
The CVS visit took 30 minutes. I got the results immediately. I came home with a full written report on everything covered in the visit and helpful background information. 

Getting results from the office visit -- from my phone call to make an appointment to the doctor's call with the numbers -- required about four days. I didn't get a written report but had to make notes during the phone call. I didn't get any background information, only a lecture on sticking with Lipitor. In fairness, I'm sure my internist would have taken time with a new patient to explain the numbers and their significance. We've talked about cholesterol many times. 

The CVS visit may end up costing a bit more after the insurance reimbursements come in. 

I was so impressed with the CVS experience that I did some research on these clinics. I'll share those findings tomorrow. 

March 25, 2013

Ten Tips for Communicating with Someone with Alzheimer's

The March 13, 2013 edition of Dementia Today: Daily News and Views on Alzheimer’s Disease and Other Dementias featured the following “Ten Tips for Communicating with an Alzheimer’s Patient.”

The tips are good to keep in mind, since about half of all people over 85 have Alzheimer’s. (Better make sure my kids see this post, since I'll be 84 in a couple of months.) Every 69 seconds, another American develops AD.

[Note:  After this was posted, my housemate Nimesh commented, appropriately, that these are tips worth remembering when communicating with anyone.]

Here are those tips:

March 22, 2013

Redefining and Treating High Blood Pressure in Seniors

The last few posts (below) reviewed recent research about seniors using statins to treat cholesterol. I mentioned my decision to take a holiday from my decades-long practice of taking 20mg of Lipitor (a popular statin) every night.

I've also wondered: do I really still need to take my blood pressure med? For over a year -- since experiencing stomach upset on the full dosage, and with my doctor's approval -- I'd been taking only half of my bp medication. As I've discovered with other meds, a half dose often produces the desired results, and with fewer side effects. 

After I developed a chronic cough from another bp medicine, my doctor prescribed Tribenzor, which I'm taking now. It's a combination of olmesartan, amlodipine, and hydrochlorothiazide. For the past year, I'd been taking half of the recommended dose and getting good results. But I was still experiencing some stomach queasiness.

So, again employing my "less is more" mantra, I decided to take this half dose only every other day. I monitored my bp several times a day and saw I was getting readings even more erratic than usual. So I checked in today with the blood pressure specialist who had OK'd the half dose.

March 21, 2013

Statins and Acute Kidney Injury

Yesterday, I posted the piece (directly below) about using statins to lower cholesterol.

Today, I noticed lots of online commentary about a story published in the March 19 edition of the British Medical Journal. Based on a giant Canadian study that followed two million people aged 40 and over who used statins between 1997 and 2008, researchers discovered that those taking “high potency” dosages were 34% more likely to require hospitalization from acute kidney injury (AKI) than those taking lower doses.

Because that percentage includes only participants who were hospitalized, the study likely underestimates kidney injury from statin use, according to lead author Colin Dormuth, an epidemiologist and assistant professor at the University of British Columbia. “Our estimates are probably quite conservative,” he said.

The large study focused on statins we’re all familiar with – Crestor, Lipitor, and Zocor. Their ability to reduce cholesterol levels is well known, as are the risks. But the AKI link is apparently new; even today, the Mayo Clinic’s website listed only these four “potential serious side effects” from statin use:
  • Liver damage 
  • Muscle problems 
  • Increased blood sugar or type 2 diabetes 
  • Neurological side effects 

March 20, 2013

Cholesterol and Statins and Me: an Update

The benefit of statins for the elderly has been especially controversial of late. For years, I've been taking 20mg of Lipitor -- the most popular statin -- every day (night, actually). Fortunately, a generic is finally available, but it's still a pricey drug.

When I'd receive the letter from my internist with results from my annual physical, he'd report on my "very good" or "excellent" cholesterol numbers. He'd then urge me to continue the Lipitor routine, and I'd keep it going. But recently, I've seen reports questioning the use of statins generally, especially for seniors with no evidence of heart disease.

Last July, I reported on a book Are Your Prescriptions Killing You? by geriatric pharmacist Armon B. Neal, who warned "if you are over age 60, stay away from statins at all costs." I began researching the issue and have amassed a thick file of reports.

Based on that research, I decided to discontinue Lipitor and see what happened. I'll share the results of a cholesterol test I took last week. But first . . .

March 19, 2013

Vegan Diet: Pros and Cons

Yesterday I posted two videos produced by Dr. Michael Greger, an internationally recognized expert on nutrition and food safety, that made a case for the vegan diet for both treating and forestalling Parkinson's. After doing some additional research, I've decided to give the vegan diet a try for the next month.

Here's a synopsis on my research on vegan diet pros and cons:

The Academy of Nutrition and Dietetics concludes that "well-planned" vegetarian and even vegan diets are "healthful, nutritionally adequate, and may provide health benefits in the prevention and treatment of diseases like type 2 diabetics, obesity, heart disease, and cancer.

March 18, 2013

Can Vegan Diets Prevent and Treat Parkinson's?

While searching for information about coffee's effects on health, I came across a video I liked. Digging deeper, I discovered a motherlode of diet and health information packaged in short, often humorous videos based on scientific studies.  A quick search led to two of his videos on vegan diets and Parkinson's.

Coffee Is Good For You

March 16, 2013

Good (?) News Finding #2: Slow Walks May Be Better than Intense Workouts

I wrote yesterday about a new finding that overweight people -- especially seniors --live longer. But closer examination showed that the study has some caveats.

That's also true of the seemingly good news from another recent study. It suggests you'll be happier taking long, slow walks instead of busting your buns on the treadmill. It also recommends standing -- not sitting -- whenever possible.

The obesity study involved nearly 3 million people from many countries. This new exercise study involved 18 college students at Maastricht University in Norway.

Since I'm not a fan of working up a sweat at the gym, I liked the headline. Unfortunately, the researchers focused on the importance of getting off your duff. Less sitting, more standing. I know this is an issue for me.

When volunteers spent two hours standing and four hours walking each day, they had healthier insulin levels and lower triglycerides than when they spent an hour a day at the gym cycling for all they were worth. And that was true even though the volunteers in both groups burned nearly the same amount of calories. The main difference was in the number of hours sitting. 

Triglycerides, for example, barely improved with vigorous exercise, but were 22 percent better when volunteers spent only 8 hours a day sitting. /this is just the latest in a spate of studies finding  that sitting is bad for us.

#  #  #
So, based on these two studies, I am now going to stop sitting at my desk chair, stand up, and take a slow walk to the kitchen for a piece of cake.

March 15, 2013

Good (?) News Finding #1: Fat Seniors Live Longer

Following the latest health news can be depressing and discouraging. If a new study says "You should do X," I'm not doing it. If the study warns "Don't do Z," you can bet I AM doing it.

It was a nice change of pace to find these two recent headlines:

  1. The mildly overweight live longer, and 
  2. Long slow walks may be better than high-intensity workouts on the treadmill or exercise bike. 

We'll look at the first today, and the second tomorrow.

The Mildly Overweight Live Longer!
How about that? Researchers from the CDC and elsewhere pooled data from 97 studies from over a dozen countries, tracking nearly 3 million people ( )

Here are some of the findings:
  • Overweight people had a 6 percent  lower overall death rate than those of normal weight. (Data were adjusted for age, gender and smoking.)
  • For people over 65, the mortality benefit of carrying a few extra pounds was even better. 

March 14, 2013

Ditching the Sleeping Pills: Not Easy But Worth It

As I reported yesterday, using sleeping pills -- prescribed or OTC -- for more than a week or two is a bad idea, and a hard habit to stop.

I know from my own experience. But overcoming this addiction has enhanced my well-being almost as much as my getting rid of  nicotine and alcohol.

Eliminating Sleep Aids
I recounted my history with insomnia and sleeping pills yesterday. I'll just add a few details today, the final chapter in the story.

March 13, 2013

Sleep and Seniors and Pills

An estimated 22% of Americans struggle with insomnia every night. Those of us age 65 and older are one-and-a-half times more likely to battle the condition.

A prime suspect just so happens to be something that's supposed to help: prescription sleep aids. "You get benefits early on, but if you continue to use them long-term you can adapt to them, they're less effective and can interfere with sleep," according to Dr. Lawrence Epstein, an instructor at Harvard Medical School. He adds:
Some people feel it's easier to take a pill than to try other methods to treat insomnia, and many physicians continue giving them prescriptions because they aren't trained in sleep medicine or they feel pressured to help their patients get sleep immediately. 
Sleep complaints result in millions of over-the-counter sleep aids sales, and 25 million prescriptions for stronger drugs every year. But every drug marketed to help with sleep has significant downsides, especially if used for more than several weeks. I'm living proof. See my post yesterday about my battles with insomnia.

March 12, 2013

From Chronic Insomnia to Two Good Sleeps a Night

Today, I pick up on yesterday's post about our obsession to get "seven solid hours" of sleep. In fact, two separate sleeps each night just might be the more normal pattern.

My Battles with Insomnia
Until several years ago, I struggled with insomnia all my life. In my wild early years, I overcame the problem by making sure I was at least half-drunk when I went to bed. If I woke up in the middle of the night, the glass of vermouth under my side of the bed would send me right back to sleep.

After I got sober in 1978, my sleep was generally OK for a few years. Then for several years I couldn't fall asleep in my bedroom, but found I could get a solid night's sleep on the living room couch. I'm embarrassed to admit it took me years to figure out that the street light beyond my window was the culprit. The problem disappeared when I installed blackout blinds.

March 11, 2013

Two Sleeps a Night May Be Better than One

The axiom -- seven solid hours of sleep to maintain good health -- is now being questioned by medical researchers and historians.

Until a century and a half ago, people typically slept in two distinct phases bridged by an hour or more of wakefulness. This break was often a period of quiet early morning wakefulness. With the afternoon nap (siesta), this sleeping pattern was normal before the Industrial Age.

I've stumbled into this very sleep cycle, which I feel has greatly enhanced the quality of my life. Two recent media reports make me think what I'm doing isn't so odd. Unfortunately, many others like me assume something is wrong, and they rush to the doctor for unneeded sleeping pills.

March 8, 2013

"Solving the 'Cocktail Party Problem': How We Can Focus on One Speaker in Noisy Crowds"

I have Parkinson's and fear Alzheimer's. So, I'm intrigued by all the  new findings that show how our brains work... or how they don't. One of my best sources of information is Science Daily.

I've signed up for daily emails from their section "mind & brain" section. I regularly see interesting headlines, then click to read the full stories.

The exact title of today's blog post appeared among this morning's Science Daily headlines. I thought, "That's always been a problem for me, too."

March 7, 2013

Parkinson's Research Update: Kudos for Obama's Proposed Brain Mapping

I've been closely following research on both Parkinson's and Alzheimer's. It seems that researchers have just about given up (at least for now) on finding a cure for either disease. Instead, they're focusing on improved treatments and searching for biomarkers which might help them diagnose -- then treat -- the diseases sooner. I'm not holding my breath for a cure.

Both diseases take tolls -- emotional and financial -- that will increase dramatically as our population ages. In President Obama's State of the Union address, he called for a 10-year project to map the human brain. Excellent news! Obama's administration hopes to announce soon its intention to assemble the pieces -- including funding, the trickiest element these days -- for the decade-long project.

March 6, 2013

In Battling Parkinson's, I'm the Commander in Chief

My neurologist and physical therapist have both told me the same thing: My interest in my PD -- and my wish to play an active role in managing it -- are unusually strong . . . and unusually helpful.

I like learning about my disease and my therapies. Being involved with my doctors somehow empowers me, and makes me feel like I'm more in control of my health. That feeling of being in charge -- or at least of being a truly active partner in my own healthcare -- might just be as important a part of my own wellbeing these days as the drugs I take, the food I eat, the exercise regimens I follow.

I don't know if other "actively involved" patients feel the same profound benefit I do. If there's one thing I've learned these past few years as a PWP, it's this: everyone's situation is different.

Nevertheless, here's what I've been doing:

My Medications 
I take less medication now than I did when first diagnosed over three ago. From the start, I was prescribed the two standard PD meds:

March 5, 2013

Yes, I Still Have Parkinson's Disease

That's right. Still have it. I haven't talked about it for awhile on the blog so I decided to give an update on where I am with my Parkinson's disease and then later on the current status of PD research. Today it's - -

Parkinson's and My Life Today
I got my diagnosis almost four years ago. At the time, I thought my life was about to change… radically. I made plans for a very different kind of future. I came THIS close to selling my house and moving into a senior residence where the help I thought I’d surely soon need was available around the clock. Worried about living a compromised life and burdening my children with anxiety -- and their inheritance with a massive resource drain – I read up on “self-deliverance,” setting the time and circumstances to bring one’s own life to an end.

March 4, 2013

War, Love, and the Richest Life: My Friends Marione and Daniel Ingram

My treasured friend Marione Ingram will give an author talk at 3pm this Saturday afternoon, March 9, at DC's most desirable venue for book promotion, Politics & Prose. Her just-published memoir, The Hands of War: A Tale of Endurance and Hope, from a Survivor of the Holocaust, has already earned a Kirkus starred review, a prized accolade in the publishing industry.

Here's the synopsis from the Politics & Prose events calendar:
Ingram was born in Hamburg in 1935; Jewish, she experienced the violence of anti-Semitism at an early age. Surviving the Gestapo, the Allied bombing of her homeland, and the chaotic post-war years, she emigrated to the U.S. and became involved in the civil rights struggle in Mississippi. Ingram is also an artist of international stature and a gifted writer (see Granta 96); her memoir is a powerful and intimate account of some of the last century’s most devastating events.
Marione’s childhood in Germany is certainly a story of extraordinary fortitude and survival. But her years since coming to America have been remarkable, too.

I first met Marione in 1960, when her husband Daniel and I worked together at the Bureau of National Affairs (BNA). We lost track of each other for a few decades, but my friendship with the Ingrams deepened since they returned to DC in 2007.

Since 1956, Marione's story involves her life with Daniel; they are the most “coupled” couple I know. So, for the new author of The Hands of War, we’ll call this part of their saga:

The Hands of Love

March 1, 2013

Medicare, Brill's Hero, Has A Major Flaw

Like many others, we've been talking a lot this week about Steven Brill's Time magazine cover story, "Why Our Medical Bills Are Killing Us." His report details the "unholy alliance" of hospitals, Big Pharma and insurance companies. Medicare, however, emerges as the "hero" in his villian-packed account.

But Medicare has a basic flaw, a key reason our medical costs are higher than those of the next ten most developed countries combined. In the final years of life, a major mismatch exists between what Medicare covers and what people really need.

An All-Too-Typical Story: Joe's Father's Last Two Years
This example is based on a true story from a friend we'll call Joe.