The Most Interesting Man In the World Teaches the PHB about the Medical Home

The Population Health Blog isn't sure why its Twitter account was targeted by the Dos Equis ads about the exploits of "the world's most interesting man." Tweets on how "His grandmother uses his family recipes!" and "Fish fight for his bait!" tempted the PHB succumb to Twitter followership.

Which naturally prompted the debonair PHB to ponder the exploits of the Patient Centered Medical Home (PCMH).

To wit:

The White House wants to throw the bus under the PCMH.

Health insurers like it when the PCMH loses money.

The PCMH sues malpractice attorneys.

Ezekiel Emanuel wants be enrolled in a PCMH after he turns 75.

Biker pediatricians have tattoos that say "PCMH."

When they encounter a PCMH, actuaries stop counting.

PCMH jargon about smart device apps has led to the creation of a PMCH jargon app.

"PCMH" is how "ACO" is successfully spelled.

The most interesting man in the world is enrolled in a PCMH

The PHB invites other exploits.

Stay healthy, my friends.

One Week of Group Exercise Classes - RECAP

Last week, I challenged myself to five days in a row of group exercise classes.  I was feeling like I needed to push myself more with my workouts and thought that the group atmosphere would be a good motivator to keep me determined and giving my all to my workouts.  I was right.  These classes are no joke!  I ended up making it through four classes and took Friday off.  Last week was one of the busiest weeks of school so far with lots on the calendar, which meant for many early mornings and late nights.  I knew that I physically could not do one more class on Friday and was disappointed that I didn't complete all 5 classes.  But, now I know for the future that it's best to do three or four classes, take a day off, then do three or four classes again.  That's what I'm planning this week.  

Below is a detailed recap of each day and a review of the classes I took.  

MONDAY - YOGA

Mondays are always hard, and, as I lay sleeping in my warm, cozy bed, still super tired from a long weekend, and being up late working on Monday's posts, my alarm was nagging me to wake up.  I'd already hit snooze too many times and it was almost 7am (the alarm was set for 6).  For a second I thought, "What if I don't go today?  Who will know?" Well, I will know, and I don't want to let myself or you down.  So I got my tired ass up.  My son is usually awake before me, but Mondays are hard on him too.  "I'm still sleeping.  Leave me alone!" He growled at me, which is totally not like him.  I grabbed his school clothes, went downstairs and started making our protein pancake, pulling already-assembled school snack and lunch from the fridge and into the backpack.  My groggy son made his way downstairs, ate his pancake, I had to help get him dressed for school and we're out the door at 7:40.  I hope he naps at school today, I think.  

Hurrying to the gym, I'm stressed because I don't want to be late for my first class and I'm actually nervous because I've never done this class or yoga before.  I realize I have that high-school feeling of "what if everyone already knows each other and what to do and I'm left out?"  Also, I don't really know where the class is taught, so that's stressing me out a little.  But, I get there in plenty of time and there are already about 20 women standing outside the room waiting.  "Are you waiting for the yoga class?" I ask the woman closest to me.  "Yes, if you don't get here early, you won't get a spot."  

And they're all in flip-flops or bare feet.  I'm in athletic shoes.  oops.  Once the door opens and we enter the room, I see a mat already set up on the floor, so I go sit on it and take my shoes and socks off.  "I was saving that spot for my friend" a woman says.  oops, again.  So, I go get my own mat, two blocks and a towel and there's barely any spot to lay the mat out.  It's a huge room and it's full of people.  After I got situated, I counted at least 75 people there for the class (mostly women, but a few men).  

The instructor starts the class with a quote from Einstein- something about insanity and he talks about that for awhile.  He is a good instructor, even though I don't do yoga, I can tell.  (and also judging by how popular his class is).  His voice is calm and even and he instructs you very specifically on how to do the poses.  He's actually really eloquent in describing what your body should be doing.  A few times, he nonchalantly adjusted how I was holding a pose and did so for other people in the class too.  

Breathing is important in yoga- in and out through your nose and it should make sound.  Holding the poses was challenging, but I think I did okay.  My favorite part of yoga was the end- the two minutes of lying quietly on my back while soothing music played in the background was heavenly.  I realize I never just sit quietly at home.  I'm always go, go, go.  Even if I'm sitting on the couch, it's either while watching t.v., playing on my iPad, or reading.  So, just laying still quietly was awesome.

The instructor ended the class with a Dalhi Lama quote about giving your full attention to the task you are doing.  Great way to start a Monday.

Monday night, after dinner, we had a PTO officer meeting to prepare for the big school PTO meeting that Thursday.  The meeting lasted until 10:30 p.m., so it was a late night.

TUESDAY - CORE MOTION
I woke up on Tuesday morning really sore.  I didn't think I'd pushed myself that hard with yoga the day before, but my muscles thought differently.  I had an early text from my friend saying she was keeping her daughter home sick, so our running was canceled.  Wanting to continue the group exercise, I checked the schedule and found "Core Motion: a non-stop cardio workout using a medicine ball that emphasizes functional movement, fat-burning, and core strength."  This class was so hard, but also ended up being my favorite.  You could use a 2 or 4 pound medicine ball (the size of a basketball).  I chose the 4lb ball and was dying after 45 minutes of the hour-long class.  There's a lot of movements where you are pushing the ball above your head and you hold it the whole time.  This class reminded me most of the workouts I did with my trainer when I was training for my contest.  It incorporated the strength and cardio elements at the same time.  45 minutes in, I was looking for the door, but I stuck with it.  I was a sweaty mess at the end.

WEDNESDAY - CUTTING EDGE (strength) 
By Wednesday, I realized I was seeing some of the same people as in the first two classes.  I guess they do these classes pretty frequently.  This class was similar to Core Motion, except you use sets of free weights.  The step bench was mostly for when we lay on it to do chest exercises- like flys with the weights.  We did a lot of cardio too, like burps (yuck!) and abwork with planks and crunches.  Again, the class was super challenging.   The round discs are for lunges and my legs were on fire!!!

As the class started, the instructor asked if anyone was new to the class - I'm not sure if I was the only new one, but I was the only person who actually raised her hand.  The instructor was nice enough to come over to me a couple of times and make sure I was doing okay.  And, at the end, she came over again and asked what I thought.  I told her how hard the class was, and it made me feel out of shape- but I liked it."  She said, "I was keeping an eye on you and you did great!"

Doing three days in a row of hard exercise had me feeling really good.  It's easier to eat healthier when you are working hard too.

Wednesday after school, my son had swimming lessons, then I came home and made dinner for my husband and had plans to have dinner with my girlfriends at one's house with our friend visiting from out of town.  After leaving my girlfriends house, I made a late-night trip to Target for last-minute PTO items.  I think I made it to bed around midnight.

THURSDAY - CYCLE TECH 
By Thursday morning, I was so tired.  We had a classmate come over at 6:15am that we were bringing to school, so it was an extra early morning.  I drank a cup of coffee to get me going (I usually wait until after my workout because I sometimes get too jittery/hungry if I drink it before).  My husband agreed to do the cycling class with me since he didn't have any appointments that morning and we knew the instructor.  Thank God this class was only 45 minutes.  I really felt like my legs might not make it through this class, but once you get going and the music was so good, I'm proud to say I gave it my all.  It was 45 minutes, but that was all cycling.  We were told to "make sure to stretch" when the class ended.

The instructor for a spin class makes all the difference, along with the music they play.  This class rocked, and I remembered that the instructor is a Christian, because he threw in a Hillsong song. :) He was so good, encouraging us the whole time, saying, "leave the anger behind, the stress behind"  "own the moment, this is your exercise, don't sit on your butt. . . "  And he kept changing the lights for different moods.  He was good about telling us what RPM we should be at too.  I'd never done a class where they had that kind of monitor on the bike before.  My husband snapped this pic before class started- and it filled up (about 40 people?).

After class, I had to hurry and get to the school to do some work, then rush to my hair appointment, and back to the school with wet hair to finish up.  I got home around 4pm, then had to be back at the school at 6pm for our 6:30 meeting.  I ended up getting home around 8:30pm, got in bed with my son so I could hear all about his first day of karate and then stayed up late working on my Weekend Steals & Deals post for Honey We're Home.  I went to bed with it unfinished, and decided to skip Friday's workout so I could finish my post and because my body was so physically exhausted and sore. 

FRIDAY
Nada.  Definitely needed this rest day. I felt bad to disappoint y'all!  I had said that I was going to do five workouts and only did four, but I figured it's better to be honest and give you the truth than to push myself past what I know is good for me.  At lunch with some friends on Friday, my girlfriend gave me some "thank you" cookies and that was the first sweets I indulged in all week!  And I kept my water consumption up too.

WHAT I LEARNED:  These group classes are an awesome workout!  They are not the aerobics classes of the 80s, but instead, are intense cardio/weight training exercises. The workouts are similar to what I did with my trainer (the Core Motion and Cutting Edge) and the group class helps keep you going when you feel like quitting.  The other thing I liked about having an instructor was I didn't have to think about what exercise to do next.  They are there telling you what to do and the transitions from one exercise to the next happen quickly.  I really wanted to leave without doing the whole hour on Tuesdays and Wednesdays classes, but being in the group made me stick with it.  I felt slimmer and stronger after just four classes.  I know that if you stick to intense group classes like these, you will get in shape!

Also, I did feel intimidated at first because these were my first classes and I didn't know what I was doing or know anyone in the classes.  That's okay.  I overheard other people saying they hadn't done the classes before either.  Sure, having a friend go with you might make you feel more comfortable, but it's still YOUR workout.  Make it yours!

I still want to do the Friday class I missed "Muscles" and plan to do that one this week.  Also, tomorrow, my husband and I are doing "Cardio Kickbox".  I'm scared of this one because the class description is, "Moderate/fast paced. High energy workout of kickboxing drills and combinations incorporating heavy bags."  Um, never done anything like this before, but I bet it's a great workout!  It's okay to be scared, but I don't want to let fear paralyze me.  Be courageous and strong.  Conquer your fears.  You will be rewarded.

I'm so glad I gave these classes a chance.  I definitely felt a change in my body after just four classes (along with healthy eating)!

Are you convinced to try a group class now?

Help Advance Diabetes Research

A University of Virginia researcher named Hannah Menefee contacted me recently to ask for our help.  She and her colleagues are conducting a study on how people with type 2 diabetes use Facebook to manage their health, and how that technology can be leveraged to support effective health communication.

If you have type 2 diabetes, and you'd like to participate in the study, please join their Diabetes Management Study Facebook group.  There, you'll receive more information about the study, you'll receive a short survey, and you may be invited into one of the study phases.

Dr. Emanuel Hopes He Dies Before He Gets Old

Poor judgment.

The Population Health Blog can't discern another explanation for Ezekiel Emanuel's Why I Hope to Die at 75 article in The Atlantic.  Since leaving Washington DC, Dr. Emanuel has become safely ensconced at the University of Pennsylvania, where he can disclose what he was really thinking while he was helping to stand up the Affordable Care Act.

The Population Health Blog appreciates Dr. Emanuel's recycled nostrums on the quality vs. quantity of elder-years, Americans' unrealistic yearnings for immortality and medical over-testing. And, if the essay prompts patients and families talk to their doctors about end-of-life care, even better.

But those good points are far outweighed by four intellectual blunders:

1) The watershed age of "75" that is used by Dr. Emanuel is an average.  Many individual patients suffer declines in quality of living and life expectancy before as well as after that particular age. The PHB has been privileged to care for healthy persons aged 85 who have been correctly looking forward to additional years of rich and rewarding activity.

2) The "value" of a "poor quality" life is in the eye of the beholder. The PHB has also been privileged to care for very unhealthy persons over the age of 75 who remarkably treasure every day they are alive. Who is Dr. Emanuel to disagree with their decision-making?

3) While The Atlantic piece is about the writer's very personal views, they're not only arguably ageist, they're confirming the worst fears of the "death-panel" loonies.

4) Last but not least, real doctors know that healthcare preferences can change. That's especially true for end-of-life care, where yesterday's kitchen-table decisions routinely fail to account for today's emergency room realities. While Dr. Emanuel may hope he dies before he gets old, he should think on how the lyricists behind My Generation continue to rock decades later. He may live to regret his words.

THE LAST TEN POUNDS

The last ten pounds can be a struggle, especially when everything comes to a screeching halt.  The scale is no longer budging, frustration is happening and the stress of it all is putting the adrenal glands on overdrive.  A cortisol rush is the last thing our bodies need when we are trying to lose that last ten pounds as studies have shown that it hampers our ability to lose weight.  The important thing to understand is that plateaus are normal in our journey of health and weight loss.  Also, adjustments with our food intake and exercise program will need to be reviewed several times along the way. 

Keep up the positive and progressing with your program regardless of what the scale says.  Many factors are at play when the body begins to slow down and usually a simple review and change up of the program gets things moving again. Things to consider: are you eating enough? The body is a wonderful machine and knows exactly what to do with the food we consume and knows when it is not getting enough fuel.  If we withhold fuel from our body, it will refuse to give up any reserves.  Our body sees that as energy and we need energy to burn energy.  Are you being true to your program?  Sometimes we fall back into old patterns and re-introduce foods that are not on the healthy menu for weight loss and many can even be in denial about that.  Our body will remain in a maintenance or weight gain pattern if we are not honest with our healthy food intake.  Are you exercising less? With a reduction of exercise there will be a reduction in the amount of weight that is lost per week.  Simple math spells out with the expenditure of energy results in the reduction of weight.  Take some time to review your priorities and determine if exercise has taken a backseat.  Are you burned out?  This can happen to all of us and it is important to add plenty of variety to our workout programs and healthy foods to keep the interest high.

The last ten pounds can be a challenge, but they can also be another tool of learning along our weight loss journey.  We can choose to become frustrated and throw in the towel, or open up our minds to do what it will take to get back on track with the program.  It is also important to take one day and one pound at a time and celebrate everything done to create a healthy body.  The last ten pounds will respond to what you are willing to do to be rid of it, or keep it.  It still comes down to choices and changes, and it is always a good thing to get a refresh on the mental battery to provide the motivation we need to keep going.  

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Stay Healthy!

Darla

user of THE Herbal Face Food and proud to show my images without photo shop or airbrushing. I am 50 years young and celebrate Fit at 50!

The Antifragile VA: Lessons from the NFL

Unacceptable behavior. Tone deaf sanctions. Superficial investigations blaming a few bad apples. Contrite leadership promising change.

Population Health Blog readers might think that this is about the National Football League (NFL), but it's also about the Veterans Administration (VA) whitewash.

But, in reality, this is about something much bigger: the unpredictably predictable dysfunction that happens to large and complex organizations. Mix insular leadership (Commissioner or Secretary), an unaccountable bureaucracy (owners or appointees), huge budgets (as in very huge) with hidebound government oversight, and something very big and very bad is bound to happen. Sooner rather than later.

That something often remote (an elevator or a Phoenix clinic), is only obvious in retrospect (atrocious male violence or gaming outcomes), signals a deeper problem (player recruitment or leadership integrity) and results in a loss of reputation that lasts for years. 

Think baseball and steroids, NASA and shuttles, GM and starters, Presidents and red lines.

This is classic antifragility.  As we continue to concentrate economic and social power into large organizations, logarithmic jumps in complexity will lead to rare, contagious, catastrophic and unpredictable crack-ups. Naturally, our response will be to layer in more systems complexity.

Assuming large and complex ACOs prove they can really conjure money out of providing fewer health services, the PHB believes their next biggest threat is a black swan event. A huge patient data breach.  Withholding care.  Cutting corners.  Something else. You read it here first.

In the meantime, smart PHB readers will discern that there are some important differences between the NFL and the VA:

                                  VA                                            NFL
    
Problem:               Waiting lists.                      Switches and fists.

Involving:                   Docs                                     Jocks

Result:          Congressional indignation.       Sponsor consternation

Solution:             Budget Conference                    Press conference.

The Media:     Monday morning quarterbacking   Monday Night Football

So the chief gets:          Replaced                         Breathing space

The real problem:        A monopoly                         A monopoly

One Week of Group Classes - THE PLAN

Hi friends!  I'm trying something new this week to shake up the semi-funk I've been in lately with my workouts.  I only worked out once last week because I felt too busy with all the commitments going on.  Some weeks are like that, but they leave me feeling icky.  And, as y'all know, when we workout, our eating is typically better.  We don't workout so hard during the week, just to "blow it." So, this week, I'm doing a week (Monday - Friday) of group workouts.  I feel like I need the boost of energy and support you get when working out in a group.  There's a commitment because it starts and stops at a specific time and you do get a great workout.  Once the class gets started, it's rare that someone leaves without completing that class. 

I printed out the schedule and class descriptions of group exercise classes at my gym and found they typically have three options for the time of day I like to go (in the morning right after dropping my son off at school).  This works perfect for me, I just get up, get dressed/eat my protein pancake/get my son fed and ready for school and we're off.  No hair, makeup, or coffee (I prefer to linger with that after I get home and showered).  When I get home, I know my day is off to a great start because I got my workout out of the way! 

I chose a variety of classes so that I can experience different types of exercise and instructors.  If I really like one, I'll consider committing to that class for a longer period.  On Tuesdays, I'm sticking to our school running club, which is just a few women that run the 3-mile track at our local park right after drop off.  

Here's my schedule of GROUP CLASSES for this week with the class description below:

Monday- Yoga Body (8:30 - 9:30) YOGA
A well-rounded hatha yoga practice that will lightly warm you up and stretch you out while beginning to train your body for more advanced work.  Most appropriate for those who have prior yoga experience and are physically fit.  

I've never tried yoga (well, once, over ten years ago), so we'll see about this.  There was no other "beginner" yoga class offered at my timeframe.  I've have a couple of very close girlfriends who rave about yoga, and I'm eager to try it for the mind/body connection.  Any advice for this first-timer? 

Tuesday- Running Club (8:15 - 9:00) CARDIO
Run/walk intervals for 3 miles outside. 

We've increased our stamina lately, so we're running more, walking less. This is great because we are done quickly and I can get on with the rest of my day sooner. 

Wednesday- Cutting EDGE (8:30 - 9:30) STRENGTH
A more refined format including traditional weigh training combined with timed cardio intervals consisting of basic, athletic movements specifically designed to enhance the strength portion of the workout experience.

I definitely want to keep my strength up and my muscles toned, so I'm excited about this class.  I bet it will be hard- timed cardio intervals always are, especially if you push yourself. 

Thursday- Cycle Tech (8:30 - 9:15) CYCLE
An indoor cycling class designed to prepare you for race day; some of the techniques, specific ride profiles and drills are those used by competitive cyclists. 

I've met the instructor who teaches this class and I think he's a pretty hard-core cyclist.  I'm interested to see how his teaching technique is.  I hope the music is good!

Friday- Muscles (8:30 - 9:30) STRENGTH
A muscle conditioning class for all levels, using various resistance equipment to build strength resulting in a total body weight workout. 

My friends say the instructor who teaches this class is the best, and I can't wait to see for myself!

Hitting "publish" on this post and sharing this goal with you will keep me accountable to completing all these classes.   As far as my diet goes, my goal is simple- don't eat any sweets (ice cream, cookies, brownies, etc.) and drink lots of water- 55 ounces a day (about half my body weight in ounces).  

I will report back and let you know the classes went and whether I plan to stick with it.  

Will you commit to a joining a group class with me this week?

YOU HAVE TO CHANGE TO CHANGE

We can all get stuck in a rut, feel funky, or backslide on our health and fitness programs.  Burnout and frustration are top reasons for giving up and falling into old habits and it is at that point where we can dig our heels in complete rebellion turning our noses up at the changes that need to happen to live a healthy lifestyle. The truth within each of us paints a different picture and honestly, we all want to be healthy and look the part but to really be healthy and feel healthy, you have to change to experience a change.  That is the truth with all things in life: change requires change.  If we are unhappy with our health, our body, our jobs, where we are in life, people in our life, our spiritual life, our emotional self and the list does go on and on, a deliberate choice to change to change needs to happen.  

Sometimes it is a difficult process to implement the necessary changes and our rebel self can surface and try to sabotage our attempts to do something great, and for the general populous succeeds unfortunately.  Getting mad about it will not bring about what needs to be done, but taking a personal inventory, making a promise to ourselves to change, and following through with that change is what will make the difference in our lives.  I suppose if the anger was channeled into the positive and motivates the change, then getting mad could be an OK thing.  However, I have seen anger turn into bitterness, which can lead to frustration and giving up all together.  Change takes a choice, takes patience and not perfection.  As we strive to change our health and fitness, it is important to realize that it will be a journey and a challenge.  Remember, that challenges in life are what change us and that becomes the learning tool of becoming a healthy person physically and emotionally.

I like that saying that goes “Do what you have always done and you will get what you have always gotten” because it rings true to what life and being healthy is all about.  If we do not change what we do, we will remain the same in our states of unhappiness, unhealthiness, depression, stressed out situations, and emotional wreckage. It is time to get out that paper and pen and start dissecting our lives and owning the unhealthy parts so that we can figure out what needs to be done to change each area. Are you unhealthy, unhappy, stressed, depressed, anxious, or angry and whatever question you want to add? Why and what needs to be done to change that? The goal for each of us is to implement the changes that will create the healthy changes that will last a lifetime.  I find that once health is made a priority and the body starts feeling better, it is easier to move forward and make other changes as our bodies are better able to deal with stress and emotional situations.  Let’s make the change to change not only a “have to” but a “want to” for a happier you and a healthier life. 

Stay Healthy Fitness Happenings: Want to promote your business through low cost Ad Space or a fun Giveaway with Stay Healthy Fitness? Check out my pages for Ad Space or Host a Giveaway and I look forward to assisting you!

 

DON'T MISS MY FREE UPDATES

Thanks for stopping by my Blog, hope you enjoy the content, and if you have not become a follower yet, I would love to see your face on my friend's list, or if you want to receive my free updates, use the button at the right to select your feed preference. I look forward to responding to your comments and appreciate your shares!

Darla Leal, Fit at 50
 Orange Photography 2014

Food Reward Friday

Today's lucky "winner"... waffles!!!

Read more »

My AHS14 Talk on Leptin Resistance is Posted

The Ancestral Health Society just posted a video of my recent talk "What Causes Leptin Resistance?"  Follow the link below to access it.  Enjoy!

What Causes Leptin Resistance?

IT’S ONLY FIVE POUNDS…

How many times do we justify being unhealthy with the “it’s only” intro.  Whether it’s only five pounds, two cookies, a bag of chips, one alcoholic drink, or one missed workout, it is easy to get hooked into the trap of “it’s only”.  What happens more than not is “it’s only” turns into a daily use of trying to get away with something that leads us in the opposite direction of our goals.  The five pounds turns into ten, the two cookies turns into five, one missed workout turns into several and you get the picture that is painted with two innocent words.

The “it’s only” dilemma can hit at any time, but I find it creeps back into the picture once results from following a great nutrition and fitness program have been achieved.  Further, I have seen it completely snowball into a return back into old unhealthy eating patterns and sedentary lifestyle.  The two words are not as innocent as one might believe and especially if an inner strength to follow through on the one time “it’s only” behavior is not fully obtained.  For example, let’s look at the time it takes to break the cycle of sugar craving which is generally two weeks to twenty one days, and hypothetically use a person that is two days shy of that goal and of all days, the “it’s only” word comes to mind and tongue as a store bought processed cookie is consumed.  Now, I am all about moderation and do not get me wrong on this, however, when it comes to not fully adopting a healthy lifestyle, this time of weakness can derail all the effort put into those days of breaking a sugar craving cycle. 

Personally, why risk the goals for “it’s only” and especially if there is a struggle of inability to resist unhealthy processed food? There is no denying that two innocent words can take a person from success to digress in short order, and within a few weeks, that person stands in shock and asking “how did this happen?”.  It happened because “it’s only” became the tool that was used more consistently than the healthy choices.  Pay attention to that inner voice that is talking and especially as unhealthy food choices and bailing on workouts are happening.  Also, check your friends and family and listen to what they are saying as well…they can be the worst “it’s only” culprits as you strive to reach your health and fitness goals.  The more we are aware of the two words that draw us backward and how we use them to justify unhealthy choices, the better we will be able to stand up against the negative impact “it’s only” can have on our bodies and overall health.    

Want to promote your business through low cost Ad Space or a fun Giveaway with Stay Healthy Fitness? Check out my pages for Ad Space or Host a Giveaway and I look forward to assisting you!

 

I dedicate this Blog to my fabulous husband and celebrating our wedding anniversary over this past weekend.  I "Love You Forever and a Day"! 

Happy Anniversary to my forever friend and husband

DON'T MISS MY FREE UPDATES

Thanks for stopping by my Blog, hope you enjoy the content, and if you have not become a follower yet, I would love to see your face on my friend's list, or if you want to receive my free updates, use the button at the right to select your feed preference. I look forward to responding to your comments and appreciate your shares!

Stay Healthy!

Darla

Telehealth Helps!

... and have you taken your pills today?

Are you in the "telehealth" business? 

Do you sell, buy, broker or provide remote monitoring, telephonic follow-up, internet-based patient management, handheld health apps, video-support or home-based medical devices? 

Then you'll probably want to download this 32 page paper.

Bashur and colleagues set out to review every good (defined as any controlled study with a valid concurrent comparison group with at least 150 study subjects) research paper on the impact of telehealth on three conditions: heart failure, stroke and chronic obstructive pulmonary disease.

177 references later, their conclusion is that telehealth - over a broad range of patient types (age, illness severity and co-morbidities), level and intensity of patient participation, provider types (nurses vs. physicians with or without an explicit protocol) - increases quality of care and reduces unnecessary utilization. 

In other words, telehealth is substitutive.  It doesn't add to inefficient services, it replaces them with something cheaper.

The Population Health Blog already knew that, of course, but it's handy to have an authoritative text that catalogs every published study.

What the PHB didn't quite know:

The official definition:

Telehealth (e-health, mobile health, m-health), connected health) is the delivery of healthcare via information and communication technology.

Telehealth jargon: when you launch it, make sure you have:

1. Fidelity (use in an appropriate setting with optimal strength and integrity),

2. Maturation (the technology may not have fully integrated personnel, other technology and patients to achieve maximum efficiency) and

3. Bundling (where the technology is vulnerable to how other concomitant supporting services are configured.

Minimum Elements and Practice Standards for Health Impact Assessment Version 3

From the SOPHIA HIA Practice Standards Working Group:

The HIA Practice Standards Working Group is happy to report that Minimum Elements and Practice Standards for Health Impact Assessment, Version 3 has now been finalized and released. The group establish a structured process through which public comments on Version 2 of the standards could be submitted. We received extensive feedback – 137 individual comments by our count. The comments were thoughtful and insightful. Each comment was considered and, for each, we came to consensus on what changes to the standards to make, if any. Version 3 includes a more detailed description of the purpose and scope of the standards, a very significantly re-worked set of minimum elements, as well as significant changes to the practice standards.

The document can be downloaded here.

Is One DIet Program Better Than Another for Weight Loss?

As a doctor, the Population Health Blog was often asked by overnourished patients to help find a "best" diet.  Its advice to simply eat less and skip desert, however, was insufficient to overcome the commercial programs' allure of word-of-mouth, dubious advertising and fanciful on-line marketing . As a result, many desperate PHB patients fell into closed loops of pseudoscience, anecdotal testimonials and expertly crafted statements "not evaluated by the FDA."

As a population-health skeptic, the outcomes-focused PHB was never convinced that one commercial diet plan was "better" than any other.  Not only are excess calories very efficiently turned into corpulence by a very efficient human metabolism, it didn't make sense that that persons could eat their way to weight loss with more [insert one of the following: protein, fat, fiber, pre-packaged meals or vitamins].  Last but not least, if all these commercial weight loss outfits spent a tenth of their marketing budget on real science, the PHB may have had the evidence it needed to make a recommendation.

Well, a meta-analysis of "Named" (you'd recognize the brands) diet program outcomes has been published in JAMA and the results are decidedly unimpressive.  The good news is that all of the household-name programs result in modest weight loss compared to no diet.  The bad news is that the loss of two to six pounds for each program was no better or worse compared to the others.

The PHB's take?  It's up to the consumer to weigh their personal preferences for one type of diet plan vs. another.  In addition, out-of-pocket costs may also play a role in helping sustain the dieter's motivation in getting their money' worth. 

Beyond those two considerations, however, it's just a matter of eating less calories, not more of the latest nutritional fad.

Pumpkin Pie Oats

As September progresses, it's gradually getting colder, the trees are changing colour and different kinds of pumpkins are starting to pop up here and there in the grocery stores. My favourite winter squash is the butternut squash; sweet, creamy and incredibly versatile! I promise to share my best pumpkin soup recipe with you in the future, but for now these pumpkin pie oats will have to do. They're well worth a try!

Pumpkin Pie Oats

1/2 cup oats

1 cup almond milk

1 tsp pumpkin pie spice

3 tbsp puréed pumpkin or butternut squash

3-4 small dates, mashed or chopped or 1 tbsp liquid sweetener of choice

A pinch of salt

How to:
1. Add oats, almond milk and a dash of salt to a small saucepan and bring to the boil. 
2. Let simmer on a low heat for a few minutes until it has thickened up a bit. 
3. Add the pumpkin pie spice, pumpkin purée and dates and stir until they have been well incorporated. 
4. Cook for a few more minutes or until you've reached your desired consistency. pour the porridge into a bowl and top with yummy fruit, nuts or nut butter!

Of Risk Stratification, Health System Variation and "Stupid" Decision-Making

A fly in the ointment

Years ago, a middle-aged Population Health Blog patient came in for a routine follow-up appointment.  Since his last visit, he had developed iron deficiency anemia. Since slow blood loss can be a sign of an early and curable cancer in the gastrointestinal tract, the PHB recommended a series of unpleasant tests. After a rather routine explanation of the time, expense and inconvenience of those tests, the patient surprised the PHB with a one-word answer: "No."

He went on to live for decades.

Which brings the PHB to this JAMA article on individually-tailored screening for another type of cancer. While even screening for prostate cancer is controversial, it's possible to stratify a man's risk of the condition with some questions, examination data and test results.  That risk can be portrayed in lay terms (there is a "42-in-100 chance" that cancer is present, but doing a biopsy has a "4-in-100 chance of causing an infection..."). 

The points of the well-written article is that 1) risk-stratification can be used to identify persons at high vs. low risk, 2) the decisions to screen, perform additional testing and embark on treatment can be, based on that risk, "tailored" to maximize a good outcome and 3) patients can use their level of risk to ultimately decide how they want testing and treatment to achieve the outcome they want.

Bravo, says the PHB.  While we're on the cusp of understanding whether a more sophisticated approach to screening ultimately leads to better outcomes than the standard all-or-none guideline (USPSTF "recommends against prostate-specific antigen (PSA)-based screening for prostate cancer"), there is enough face-validity to believe that patients will ultimately benefit.

But there is a fly in the ointment and a monkey in this wrench.

The fly? Variation will not go away. While health system bureaucrats everywhere would prefer that 0% of men undergo prostate screening, that 100% women over 50 get mammograms, and that 0% of us have a body mass index in excess of 25, individuals - after looking as the risk-benefit here, here and here, may choose otherwise.  We don't know what the "right" screening rates are.  In fact, we may not be asking the right questions.

The monkey?  Some "bad" decisions will occur. Once persons truly understand the benefits, risks and alternatives (including not dying prematurely of a preventable illness and side-effect risks that are less than driving in a car), they are allowed to make "stupid" decisions.  Physicians and bureaucrats may not like it when anemic patients, like the one described above, refuse no-brainer recommendations, but in a free country that's the price we pay. Our challenge is to make sure that our patients have all the information they need (which is apparently not the case here) to make a truly informed decision.

Image from Wikipedia

The Latest Health Wonk Review Is Up!

Are you proud to be a "wonk?"  Well, you can burnish your wonky credentials by clicking here and checking out David Williams' latest edition of the Health Wonk Review. You can learn about using the Medicare fee schedule to rationalize pricing, bundled payment, old problems and new proposals for U.S. healthcare reform, the VA and much, much more.

FIGHT FRUSTRATION WITH MOTIVATION

I know in the midst of frustration it is hard to be motivated, especially when results are not happening as fast as we may want them to.  Sometimes the feelings move past frustration straight into “pissed off” and angry about not losing the weight, gaining the muscle, losing the inches, or just feeling right out BLAH about it all.  This is the time giving up may enter our brain, “what’s the use” dominates our thought processes, and “I might as well go back to eating the crap anyway” defeatist attitude comes calling with a vengeance.  Before all that mental non-game takes completely over, consider fighting the frustration with motivation.

We are all fighting for our health and best self each and every day.  Health is a process of small steps taken over time that provide big results.  Just know that each positive change to improve our health IS improving our health.  That does not get lost and our bodies know that something good is happening, even when we are unable to see it.  It is during times of the unseen that we must have faith in the process and be motivated by the good being done to become a healthy person. Throwing in the towel and going back to the old habits that created nothing but unhappiness and frustration in the first place does nothing for me or you except rob us of all the effort accomplished so far.  This is not the time to quit, but to stand strong in your efforts, and kick frustration to the curb with motivation.  

Fighting the frustration with motivation will require an inner strength that all of us possess, and it will be a choice to love ourselves at this moment no matter what a scale says.  It will require a celebration of that healthy meal, that one workout, a daily goal achieved, that completed food journal, or whatever has been the most difficult struggle that was finally accomplished today.  Having a positive attitude will fight off the frustration one motivation at a time, and eventually and with patience and a consistent habit of healthy eating and exercise, results will happen.  If we begin to focus not so much on the goal, but what can be achieved daily to be a healthy person the tendency to become frustrated is also minimized, and replaced with feeling motivated.  It is at that point, the stress of trying so hard is superseded by an inner peace of doing our best each day.  When relaxation and motivation take over our thought process of becoming fit and healthy, it all just seems to fall into place, and adopting that healthy lifestyle feels like it just flows as natural as breathing. 

Want to promote your business through low cost Ad Space or a fun Giveaway with Stay Healthy Fitness? Check out my pages for Ad Space or Host a Giveaway and I look forward to assisting you!

 

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Stay Healthy!

Darla