Tuesday, April 23, 2013

Healthcare IT Implications of Healthcare Reform

I'm regularly asked how Healthcare Reform will affect IT arranging and usage throughout the following few years.

Initially, some foundation.  The Patient Protection and Affordable Care Act (HR 3590) and Health Care and Education Reconciliation Act (HR 4872)  were gone to address a few issues with health awareness in the US.  We're using 17% of our Gross Domestic Product on social insurance, yet we have more awful populace wellbeing conclusions than numerous other industrialized social orders using half as much.  Healthcare expenses are climbing speedier than expansion.  We have huge variety in practice designs that is not clarified by patient co-morbidities nor supported by relative viability confirmation.  We need to extend access to wellbeing protection to 95% of the populace, bring down our using development rate, and incentivize conveyance framework change.

By what means will we do this?

Wellbeing protection change grows scope, makes gimmicks and expenses of arrangements transparent, and evacuates the boundaries to selection made by prior condition contemplations.

Installment change changes the Medicare installment frameworks from expense for-administration to Value Based Payment - paying for great conclusions instead of amount of consideration.  Pilot undertakings will test new installment routines and conveyance models.  Successful advancements will be generally executed.

We should take a gander at the installment change subtle elements that will prompt conveyance framework change.

Medicare Initiatives incorporate

*medicare imparted funds system including Accountable Care Organizations (Acos)

*national experimental run program on installment packaging

*independence at home show program

*hospital readmissions decrease program

*community-Based Care Transitions Program

*extension of Gainsharing Demonstration

Medicaid Initiatives incorporate

*health Homes for the Chronically Ill

*medicaid Community First Choice Option

*home and Community Based Services State Plan Option

*hospital Care Integration

*global Capitation Payment for Safety Net Hospitals

*pediatric Acos

I accept that Accountable Care Organizations will be the perfect spot to have a few of these developments including packaged installments, the restorative home, and an expanded concentrate on health.

The greater part of this requires imaginative IT help.

Here are my main 10 IT ramifications of medicinal services change

1.  Certified EHR engineering needs to be actualized in all practices and healing facilities which meet up to structure Accountable Care Organizations.  Ehrs are foundational to the catch of clinical and regulatory information electronically so information might be changed into data, learning and shrewdness.

2.  Health Information Exchange among the Pcps, Specialists, and Hospitals is important to facilitate mind.  Data offering will begin to the "pushed" trade of patient rundowns in 2011 and advance to in the nick of time "pulls" of information from numerous sources by 2015.

3.  Health Information Exchange to Public Health registries is important to  measure populace wellbeing over the group.

4.  Quality information warehousing of key clinical markers over the ACO is important to measure results.  2011 will be about measuring practice and healing facility level quality, 2013 will be about measuring quality all through the responsible consideration association, and 2015 will be about measuring patient-driven quality paying little mind to the site of forethought.

5.  Decision help that happens progressively is required to guarantee the right proof based forethought is conveyed to the right patient at the correct time - not excessively little or an excess of consideration, yet simply the perfect measure of consideration to keep up health.

6.  Alerts and Reminders are discriminating to raise the mind-boggling measure of information around a patient to activity that a parental figure (or the patient) can take to keep up wellbeing.

7.  Home mind is required to anticipate clinic readmissions, give mind that is predictable with patient inclination, and to enroll families as a feature of the forethought group.  Novel IT results range from associated purchaser wellbeing gadgets (circulatory strain sleeves, glucometers, scales) to remote telemetry illuminating clinicians about agreeability with medication.

8.  Online access to therapeutic records, secure correspondence with guardians and modified patient instructive materials are required to improve workflow, enhance coordination, and captivate patients.

9.  Outcomes are trying to measures and we'll require new inventive wellsprings of information, for example, a patient reports of wellbeing, activity, and side effects.

10. Income Cycle frameworks will need to be essentially altered as we move from charge for administration models to esteem based installment and gainsharing when Acos convey higher quality look after less cost.

So there you have it - find the Pcps, Specialists and Hospitals you need to structure an ACO then completely execute Ehrs, Phrs, Quality Data Warehouses, Health Information Exchange, Decision Support Systems with cautions and updates, homecare help including shopper social insurance gadget interfaces, and new income cycle frameworks.  Luckily this is decently adjusted to Meaningful Use Stages 1,2, and 3, so you'll be doing it at any rate.

Good Living Life

My daughter was admitted early decision to Tufts University, so the anxiety of the college application process is passed.  One of her essays asked her to describe the environment in which she was raised and how it influenced the person she is today. It's worth sharing her observations on what constitute living the good life:

"At this moment, from a room of windows, I can see tall pine trees framing a beautiful, soft green yard. A little vegetable garden lies to my right, with lettuce enduring the brisk autumn wind. Above it stands a lone maple gradually turning brilliant shades of fire. A heavenly light illuminates the clouds passing overhead in the vast baby blue sky. The wisteria climbs the windows to my left, waiting for a warm spring to show its beautiful lavender flowers. The wind passes through the wooden chimes hanging from our crabapple tree, initiating a clonking chorus. Bamboo lines the white rock river with a little wooden bridge. A stone bench rests near the fence, where my father sits and plays his Shakuhachi (traditional Japanese flute). Cardinals, sparrows, and grackles fly overhead, seeking food, warmth, and family. As I open a window, a rush of sweet, crisp autumn cold fills my senses, making me shiver. These wonders surrounding me in such a welcoming, beautiful, and inspiring home and community fostered an appreciation for the subtle things in life. I learned to openly embrace the world around me, understanding and loving its everlasting beauty. Nature is a teacher and a gift, one never to be overlooked. I’ve grown as a student, an observer, an appreciator, and a believer in the magic and beauty of the world."

As a parent, I want my daughter to feel good about herself.     In her essay, she highlighted the simple things that bring richness to her life  - a vegetable garden, autumn colors, and a supportive community of family and friends.

I can understand her point of view.

As I write this, I'm sitting in an old Morris chair, sipping Gyokuro green tea, breathing in wisps of smoke from Blue kungyokudo incense. Breakfast will be a bowl of steel cut oatmeal with a few drops of Vermont maple, and soy milk.  

The ability to sit quietly and think, enjoy wholesome foods, and enjoy the warmth and comfort of a small home while the weather outside is cold and blustery gives me an overwhelming sense of well being.

I hope my daughter continues to appreciate that the good life comes from the basics of food/clothing/shelter/family/self-worth.

Tufts University is a great fit for her and I'm confident the next four years will polish and amplify the foundation she's already built.    As she creates her own version of the good life, we'll always be available for advice and support, but as of next Summer, she's a fledgling, exploring the world on her own.

Monday, April 22, 2013

Health Care and Swimmer's Ear

During the warmer months of the year, the popular activity with many people is to go swimming. In addition to being a fun way to relax, you can get lots of exercise and great physical stamina from participating in this great water sport. But sometimes, you can experience problems with a common infection in the ear, especially during the summer, called Swimmer’s Ear—an inflammation, irritation, or infection of the outer ear and ear canal. The medical term for swimmer's ear is otitis externa.

Occurring commonly in the outer ear canal, which runs from your eardrum to the outside of your head, swimmer’s ear is often brought on by water that remains in your ear after swimming, creating a moist environment that aids bacterial growth, according to the Mayo Clinic. Putting fingers, cotton swabs or other objects in your ears also can lead to swimmer's ear by damaging the thin layer of skin lining your ear canal.

Swimmer's ear symptoms are usually mild at first, but they may get worse if your infection isn't treated or spreads, according to the Mayo Clinic, at this site: http://www.mayoclinic.com/health/swimmers-ear/DS00473 . Doctors often classify swimmer's ear according to mild, moderate, and advanced stages of progression.

1. Mild signs and symptoms:

• Itching in your ear canal
• Slight redness inside your ear
• Mild discomfort that's made worse by pulling on your outer ear (pinna, or auricle) or pushing on the little "bump" (tragus) in front of your ear
• Some drainage of clear, odorless fluid

2. Moderate progression:

• More intense itching
• Increasing pain
• More extensive redness in your ear
• Excessive fluid drainage
• Discharge of pus
• Feeling of fullness inside your ear and partial blockage of your ear canal by swelling, fluid and debris
• Decreased or muffled hearing

3. Advanced progression :

• Severe pain that may radiate to your face, neck or side of your head
• Complete blockage of your ear canal
• Redness or swelling of your outer ear
• Swelling in the lymph nodes in your neck
• Fever

According to the National Institutes for Health (NIH), ear drops containing antibiotics are usually given, usually for 10 to 14 days. If the ear canal is very swollen, a wick may be applied in the ear to allow the drops to travel to the end of the canal. Your doctor or nurse can show you how to do this. Other treatments may include:

• Antibiotics taken by mouth if you have a middle ear infection or infection that spreads beyond the ear
• Corticosteroids to reduce itching and inflammation
• Pain medication, such as acetaminophen (Tylenol) or ibuprofen (Advil, Motrin)
• Vinegar (acetic acid) ear drops

People with chronic swimmer's ear may need long-term or repeated treatments to avoid complications. Placing something warm against the ears may reduce pain. More details can be found at this website: http://www.nlm.nih.gov/medlineplus/ency/article/000622.htm .

According to the American Academy of Otolaryngology, other factors that may contribute to swimmer’s ear include:

• Contact with excessive bacteria that may be present in hot tubs or polluted water
• Excessive cleaning of the ear canal with cotton swabs or anything else
• Contact with certain chemicals such as hair spray or hair dye (Avoid this by placing cotton balls in your ears when using these products.)
• Damage to the skin of the ear canal following water irrigation to remove wax
• A cut in the skin of the ear canal
• Other skin conditions affecting the ear canal, such as eczema or seborrhea

If left untreated, complications resulting from swimmer’s ear may include:

--Hearing loss. When the infection clears up, hearing usually returns to normal.
--Recurring ear infections (chronic otitis externa). Without treatment, infection can continue.
--Bone and cartilage damage (malignant otitis externa). Ear infections when not treated can spread to the base of your skull, brain, or cranial nerves. Diabetics and older adults are at higher risk for such dangerous complications. To evaluate you for swimmer’s ear, your doctor will look for redness and swelling in your ear canal. Your doctor also may take a sample of any abnormal fluid or discharge in your ear to test for the presence of bacteria or fungus (ear culture) if you have recurrent or severe infections. More info can be found at their site: http://www.entnet.org/HealthInformation/swimmersEar.cfm .

Swimmer’s ear is treatable. Other than being irritating and problematic in its initial stages, it can be properly diagnosed by your doctor and easily resolved. Just don’t delay taking action on any infection of any kind. Remember, your hearing is a vitally important function of life. Don’t abuse it.

Until next time.

Monday, April 15, 2013

You Wouldn't Think This Would Be So Hard

This recommendation on tamoxifen followup from the ob/gyn council confuses me. Basically it says to watch postmenopausal women on the drug carefully but to ignore premenopausal women who also take it.

Premenopausal women don't have problems with it, they say. Or they might say that endometrial overgrowth is expected and not to worry about it. Honestly, I'm not sure.

But either one of those readings doesn't bring me any comfort. I'm a premenopausal woman who had ovarian cysts--simple and complex--and an extremely thickened endometrium throughout my four years on tamoxifen.

Now, almost two years past stopping the drug a year early because of these problems, I still have them.

What does it mean? There is little to no information to help me understand this, it seems.

After burning through ob/gyns whose answer is to take hormones to regulate the cycle, I'm finally self-referring myself to my town's only gynecological oncologist to see if that doctor can shed any more light on what might be going on and what is the best course of action.

Taking hormones when my breast cancer responds to hormones is not the answer for me.

So we need another course of action, because all the research I can find says it's not a good thing to walk around with a constantly-building-up endometrium. If that doesn't indicate cancer today, it's at least a breeding ground for cancer to grow. Not to mention it has to be a sign of whacked-out hormones that I assume have to be affecting me on a daily basis in terms of mood and general functioning ability. And the fact that any period I ever do end up having is a tsunami that makes me immediately anemic.

This isn't a good way to live my life. So here you go, ob/gyns, this can happen in premenopausal women who take tamoxifen. I honestly cannot believe it is such a rare thing. But I guess if no one is watching us closely, we'll never know that. It will continue to be chalked up as "being near menopause" (all my bloodwork says I'm nowhere near that) or "a lingering effect of chemo," etc.

I'm looking for something better than that and a way to really deal with this.  

Friday, April 12, 2013

An Easy One

Have you noticed all the articles debating if you should take social security at 62 or wait until your "full retirement age?"

There are a lot of them. And the most interesting reading always comes from the reader comments that follow the article.

Folks are outspoken about taking the money the moment they can, before they die early or it all disappears because of government mismanagement.

Other folks are equally outspoken about waiting and getting an 8 percent return on their investment for each year of doing so.

Then there are those who trot out mathematical equations and probability tables to show that people might have to live to 80 to break even if they do wait over taking the money right away. And others who use the tools to show that if you've made it to 65, you'll likely live into and possibly past your 80s, so you'll want a bigger check to last the long haul.

It's clearly a big deal for a lot of people, and something more and more people are thinking about.

As someone who has had breast cancer, I feel that I get to avoid complicated analysis on this one, for which I am relieved.

Should I be lucky enough to make it to 62, I will take it the first day I can. And I'll be happy for every month's check I get to cash.

Not such a hard decision. I wish others were so easy.

Saturday, April 6, 2013

Out of the Reference Range

My oncologist's office doesn't include a reference range with bloodwork results. This means patients can see their complete blood count results but will have nothing to compare them to. If a result is flagged as high or low, there is no way to know how high or low it might be.

Useless, no?

Apparently the front office people at this office think it makes perfect sense and told me so. That's the way they do it, they said, and if I want the range, I can go over to the hospital and request it from medical records.

What? A range is not protected information. It is vital information, however. And it is information I need right alongside my bloodwork. I'm not going anywhere else for that information. It needs to come from my oncologist's office at the time I'm presented with the results.

Even doctors and nurses wouldn't know what to do without the range.

But I was laughed at for insisting that they give me the range and for asking them to pass along my suggestion that they provide this information for every patient--that bloodwork never go out without it.

After I didn't leave, they finally checked with a nurse. Apparently, nurses can print a version of the results that also lists the range. Just like I, and any other person in the world, would or should want.

What this tells me is that most oncology patients, maybe most patients, don't actually ask to see a printed copy of their blood results--or any test results. Most of us, I guess, are happy to wait until that postcard either arrives or doesn't arrive in the mail to tell us we're good enough.

Sorry folks, I'm here to tell you that doctors don't always follow up. Sometimes they forget you and your test completely. So to assume it's okay because you haven't heard is dangerous. And to think that a postcard tells the whole story is misguided as well.

I've had too many tests that matter too much to leave this in anyone else's hands but my own. I always want all the results, and I'd suggest others think about it, too.

Along those lines, I have a call in to the office manager to make sure that everyone who does take an active role in their health has the correct tools for the job.

Thursday, March 28, 2013

Health Care and the Easter Celebration

For about two thousand years, Christians worldwide have celebrated the Easter weekend as the most holy of holidays. Believers who have trusted Jesus Christ as their Lord and Savior wait for this holiday as a way to worship and praise God, and focus on all that is spiritual. Much of the world also celebrates this time, but for different reasons. And, for those who do not profess a strong religious bent, the general consensus is that it is a good time to have a long weekend with lots of good food and big sales at the mall.

Regardless of your reason to participate in church activities, special pageants or concerts full of music and drama, relaxing with family members with big dinners and lots of fun activities, or spending time in quiet contemplation, don’t miss the real focus of the Holiday. God performed a miracle on that first Easter Sunday by raising Jesus from the dead. Here is the account of the resurrection according to the Gospel of John, Chapter 20 (NIV) in the New Testament Bible:

The Empty Tomb:

20: 1 Early on the first day of the week, while it was still dark, Mary Magdalene went to the tomb and saw that the stone had been removed from the entrance. 2 So she came running to Simon Peter and the other disciple, the one Jesus loved, and said, “They have taken the Lord out of the tomb, and we don’t know where they have put him!”

3 So Peter and the other disciple started for the tomb. 4 Both were running, but the other disciple outran Peter and reached the tomb first. 5 He bent over and looked in at the strips of linen lying there but did not go in. 6 Then Simon Peter came along behind him and went straight into the tomb. He saw the strips of linen lying there, 7 as well as the cloth that had been wrapped around Jesus’ head. The cloth was still lying in its place, separate from the linen. 8 Finally the other disciple, who had reached the tomb first, also went inside. He saw and believed. 9 (They still did not understand from Scripture that Jesus had to rise from the dead.) 10 Then the disciples went back to where they were staying.

Jesus Appears to Mary Magdalene:

11 Now Mary stood outside the tomb crying. As she wept, she bent over to look into the tomb 12 and saw two angels in white, seated where Jesus’ body had been, one at the head and the other at the foot. 13 They asked her, “Woman, why are you crying?” “They have taken my Lord away,” she said, “and I don’t know where they have put him.” 14 At this, she turned around and saw Jesus standing there, but she did not realize that it was Jesus.

15 He asked her, “Woman, why are you crying? Who is it you are looking for?” Thinking he was the gardener, she said, “Sir, if you have carried him away, tell me where you have put him, and I will get him.” 16 Jesus said to her, “Mary.” She turned toward him and cried out in Aramaic, “Rabboni!” (which means “Teacher”).

17 Jesus said, “Do not hold on to me, for I have not yet ascended to the Father. Go instead to my brothers and tell them, ‘I am ascending to my Father and your Father, to my God and your God.’” 18 Mary Magdalene went to the disciples with the news: “I have seen the Lord!” And she told them that he had said these things to her.

Jesus Appears to His Disciples:

19 On the evening of that first day of the week, when the disciples were together, with the doors locked for fear of the Jewish leaders, Jesus came and stood among them and said, “Peace be with you!” 20 After he said this, he showed them his hands and side. The disciples were overjoyed when they saw the Lord.

21 Again Jesus said, “Peace be with you! As the Father has sent me, I am sending you.” 22 And with that he breathed on them and said, “Receive the Holy Spirit. 23 If you forgive anyone’s sins, their sins are forgiven; if you do not forgive them, they are not forgiven.”
24 Now Thomas (also known as Didymus), one of the Twelve, was not with the disciples when Jesus came. 25 So the other disciples told him, “We have seen the Lord!” But he said to them, “Unless I see the nail marks in his hands and put my finger where the nails were, and put my hand into his side, I will not believe.”

26 A week later his disciples were in the house again, and Thomas was with them. Though the doors were locked, Jesus came and stood among them and said, “Peace be with you!” 27 Then he said to Thomas, “Put your finger here; see my hands. Reach out your hand and put it into my side. Stop doubting and believe.” 28 Thomas said to him, “My Lord and my God!” 29 Then Jesus told him, “Because you have seen me, you have believed; blessed are those who have not seen and yet have believed.”

30 Jesus performed many other signs in the presence of his disciples, which are not recorded in this book. 31 But these are written that you may believe that Jesus is the Messiah, the Son of God, and that by believing you may have life in his name.

On this holy day, celebrate the risen Christ. He is the One who provides health, healing, and eternal life. Just think if you were to live your entire life, and miss the reason you were created. Enjoy Easter, and celebrate. Don’t miss it.

Until next time.

Wednesday, March 27, 2013

Message from the Elite, Hard-Bitten

Doctors and medical professionals, listen up: I am not your ordinary patient. I am most likely someone who has seen, first-hand, more than you.

Your experience with disease has most likely been across a wide swath of people; mine has been personal.

That experience should give me a better seat to all things medical and me.

So when I stop by the office to pick up the results of a test that the tech said would be ready, I expect to leave with the written report.

I do not wish to hear that my doctor will be out for the week, and I can leave her a message, which she will return after she returns.

I know enough to know that message will never be returned. The best that will happen, should I follow that advice, is I will have to call upon her return to make my request again.

But I should not have to wait a week for results that are available today. Not me. I am part of the medical elite, the hard-bitten, who have lived through medical bad news. That bad news is often the reason you keep on seeing me under these circumstances--wanting the results of some test or other that is always related, in some way, to that first ominous result.

Front desk people, please learn to recognize my face and do not attempt to tell me to wait a week. Instead, make the offer to do what you should so I don't have to ask.

Because I will ask. 100 percent of the time. I will say that there's no reason I should have to wait a week. I will ask you to ask the on-call doctor to approve releasing those results. I will ask for a call today.

And I will expect a call today, or I will call and follow up. 100 percent of the time.

And doctors, if you are the one on-call who inherits me, don't ask your office person to call me and tell me to wait until the lab results come back and I can get everything together--when that might be you will never mention.

All I hear when you instruct someone else to tell me that is that you're punting and don't want to be troubled to do your job. Yes, this is also part of your job. 100 percent.

The only other thing I could hear is that something is wrong, according to the test. If it's all good or nothing significant, why wouldn't you just let someone call and tell me that? They're going to make the call anyway.

So either you're lazy, or I'm in trouble. Don't play it like that with the medical elite, the hard-bitten.

What motivates self?

Self-development is an issue that more and more people becoming interested. Many of us feel a need for change in your life, and the reason for this may be many. The goal is well anyway to get as good a life as possible.

Self is the collection of thoughts, experiences and feelings that make you who you are. Self gives you character, personality, and behavior patterns that characterize exactly you. When we talk about self-development, it is about changing the self. A change in the self will usually result in a change in the character, personality and behavior.

As a human, we have a unique characteristic in relation to the animals. We have the ability to reflect. It means that we can sit down and think about who we are and ask ourselves: Have I right? Am I satisfied? Can I get it even better than I have today? Should I change? I MUST change? Is there something more than what we can perceive through our senses?

The questions are endless when we first sit down.

The development of the self
This is a big topic in itself that I just briefly go into here.

There are numerous theories about the development of the self. What is left is that development consists of various phases. We go through several stages during the years of life.

When we are born, we have with us a biological code as a result of inheritance. When we grow up we become exposed to influences from the environment around us as we come in contact with.

A total of heredity and environment in determining how our self develops.

The interaction between us and the environment will always affect our thoughts, experiences and feelings. Boys are treated in a pan than girls. Lange people are met in a different way than low people. Blonde gets different treatment than brunettes.

How can we say that the piece is an interaction between ourselves and the environment. We affect the environment and the environment affects us.

After we have gone through the basic stages that infants, children, adolescents, etc., it is often said that we are fully developed when we are adults. As is our way to think and feel in complete matured, and we are ready to take responsibility for our own lives.

In fact many stops development after they have become adults. One might ask why this is so. Some are happy with themselves the way they are. Whether they have achieved what they wanted to accomplish as an adult, with a job, his own family and own interests. Or that they simply are not interested in further evolves. They feel they are doing well, and the urge to sit down and reflect on his life is nonexistent. Sadly enough, there are also people who simply do not have the ability to develop further in life.

Why is there a need to develop self?
I think there are three groups of people who feel a need for self-development.

The first group are those who were not covered their needs in childhood.
The basic need for care from their parents may have been missed. There may be people who have been unsure of themselves. Maybe they had few or no friends or had family members who gave much criticism and little support.

There may be people who have not learned how to behave in different social contexts. This group also includes people who have experienced traumatic events such as war, abuse, violence or other extreme situations.

The second group are those who despite a good upbringing, yet feel that something is missing.
This may be a better job, more money, more friends, other friends. Simply a need for higher social stauts.

The third group are those who are looking for something more than life on earth has to offer.
They have a need to find answers to existential questions. They are searching for something more in the spiritual sense. There are people who believe in a greater creativity, and I mean not pronounced religious people. Although many find their answers in different religions. It is man who is more spiritual in their approach to self development. They are interested in the New Age.

A fourth group may be a combination of all three. There are people who want development on several levels simultaneously. This can be difficult, and you can end up spending too much time and resources on something that is not successful.

It is difficult not to mention Abraham Maslow's hierarchy of needs when it comes to self-development. The American psychologist summed up the human development in five stages. On top of the pyramid he placed self-actualization, which is a state where we feel that we utilize our capacities and capabilities fully. However, man is constructed so that it will always aspire for something more, and therefore it will always search for further growth.

Whatever your goals with self development is, you've already gone a step further by allowing you sat down and reflected on yourself.

Can you handle criticism?

Constructive criticism on what we are doing is an important measure to control each other's behavior when we belong to a group. If someone does something stupid, negative feedback is a means to prevent the person from making the same mistake again. The same applies if he does something good. Then positive criticism may have a reinforcing effect. Constructive criticism may therefore be both positive and negative feedback.

Criticism is often perceived as negative. Why this is so may be because the society we live in has a generally negative outlook on life. The media provides an indication of this. It is flooded with negative events when we look at Newsnight. But we must distinguish between negative criticism and constructive negative criticism. It is important to find out what kind of criticism we face before we take it under advisement.

To determine if the criticism is constructive or only negative, we must look at who the sender is. Is there a person with a healthy attitude towards life in general, or is that a person who is looking to manipulate others in order to feel better too? Has the person a generally positive outlook on life, or is it a person who is negative to the most? Is there a person who actually want our best, or is there one that does not like us for who we are?

If it turns out that there are people who are manipulative, generally negative or do not like you, you should reject the criticism. It is actually always just negative and not constructive. When you are given the criticism was flawed, and why on earth do you deal with it? You will then have better things to spend your energy on, than to listen to the negative feedback from idiots!

If it is negative criticism from people who otherwise are positive and have a healthy relationship with life, constructive criticism even if it is negative. They want to give you feedback solution and change something you're doing wrong for the better. This is for your own good.

When I get the (negative) criticism of anything I've done, I know that my psychological defenses are activated. I hit the spikes out and wondering who in the world is wanting to hurt or harm me with such statements. Tunnel vision is turned up, and I fail to see the constructive in it right away. It's a shame, because usually it is a truth of constructive criticism, even if it immediately just seems like a negative feedback.

However, I am conscious of the way I react. Therefore, I try to give criticism a little time to settle. I give myself an opportunity to digest the criticism before I give any response. I need some time before I stick the right note on your feedback. Is it constructive negative, or is it only negative? I try to watch an content of the criticism and the one who gives me criticism.

I can hardly see myself from the outside as others see me. In regards to myself, others a unique opportunity to observe me and what I do. I have previously discussed self-observation as a tool to become aware of our thoughts and our behavior, so as to be able to change us. Why not listen to others who actually observing us from the outside all the time?

To help you cope with criticism, and to use it constructively, you can use the following list:

  • Allow yourself to get a response when you receive negative criticism. It is normal psychological defenses will get started when you are critically evaluated by others.
  • Once the immediate reaction has subsided, use a few seconds to decide whether the sender is an idiot who only comes with flippant and unfair feedback. Or if it's a person that's worth listening to, and who have reasonable and constructive criticism. Do you get written feedback you have even more time to make a decision. Take time well.
  • Try to have a general positive attitude to what is happening around you. Consider the criticism, but focus on the positive in what is said. Have the attitude that other people see yourself from the outside better than you do. Constructive criticism is not criticism of you as a person, but it is a response to your actions. In constructive criticism is also much truth. Remember that.
  • When you get constructive criticism, saying "thank you" and be friendly. You should be happy that someone bothered to care. If the criticism is coming from a person you knew before, it can actually be a good place to get yourself a new friend. You do know that the person is honest.
  • Take the constructive negative criticism into account and change behavior. Rise above your own stubbornness, and see the criticism as a unique opportunity for yourself to get better. You earn it, and you shall cooperate with the win.
  • When you get positive criticism, take it as a signal that you've done something right. Give yourself a pat on the back and reward yourself with a soda!

Be a positive person!

When you are with other people, have you noticed that some smile more, laugh more and talk more positive terms than others? It is pleasant to be around these people, right? They send out good and positive vibes that we picks up, and often rubs it over on us. The reason is that we are influenced by others' vibrations, whether we want to or not.

Over the years I have worked to become a more positive person. I've managed. I've learned to focus on the positive aspects, although I do not put blinders on. At the same time I have become more aware of myself, and not least, more aware of the people around me. I have become more aware of how other people talk, their body language and what kind of vibe they send out.

Something I particularly note is that there are so many negative people. When they speak, it is often in a negative tone. They talk about how hard it is to get up in the morning, they talk about how much they hate the winter, they talk about how much money they earn, they are talking about (and the neck) others in a negative way, they say all the time that the job they have a crap job. I can still recite, almost indefinitely. Negative people focus on the negative, and they send out negative vibes. They are simply NEGATIVE!

Being near negative people is very tiring. In the long run it will drain one of energy, and finally have a simply wanted to give the negative person is a real slap in the face, or find rope and go out into the forest itself. Negative people affect the environment in a negative way, and it is impossible not to be affected to some degree.

Do not overdo
On the other hand, I have also seen people who are excessively positive. These are people who outwardly shows a painted up positivity. They are so positive that one can question their reality experience. Many people who are excessively positive can remind people who are in a kind of abnormal state of mind. Ruset, manic, or that they have taken on a false mask to hide the fact that they really are depressive. Or happy-Christians, who are high on Jesus.

Such people are also exhausting to be around for a long time. It is not hard in the same manner as for negative people, but it is laborious because it is stressful. And because an unconsciously notice that something is not as it should be.

It is best to be positive but normal, if such a thing exists.

Pc crash is no reason for negative thoughts!
A while ago my PC crashed. Hard drive went to hell, and all I had saved was gone. This was also draft some posts on this blog. But I was in a bad mood for it? No! Annoying, yes, but it was a minor and I took it as a new start. The posts that I had written could be rewritten again. And it could be that those who were lost, was bad. Also it was a good experience (backup is a good thing!). Moreover, the PC has become very much better after I got the new hard drive. It seems more "smooth" and I've gotten rid of some problems that were present from when I bought it.

I have begun to use " Google Docs "when I write. When I post on the web, and can also write on them from any computer. (Tips!!!)

After that I consciously began to focus on positivity, life has actually become very much easier. I've started reading a lot about positivity and positive thinking. And positive thinking has a link to both the law of attraction and quantum mechanics that I'm going to write about in the near future. Positive thinking is perhaps the most important thing you need to concentrate on to achieve success, happiness and success. I am also sure that the positive focus has a positive effect on health.

So, start to focus positive, too. It will make your life much easier!

What life is really all about?

Wondering what life is really all about? Well, here's the answer: Life is basically about being the best. It means that we humans strive to be at the top of the hierarchy. This applies not only to humans but also plants and animals. All life on earth yearns to be better than "neighbor". But even if life is to be the best, you can skip this rodeo and rather concentrate on what you want.

I know for me that this article could have been very long. I could have written about the theory of evolution, that we are in a constant struggle for existence. A fight only the best wins. I could have written that we humans, thanks to our highly developed brain, has come up with solutions that help us to live in peace with each other. But for most people will bother to read the whole, I will only concentrate on the essence. And that is that you must be aware that other people work to appear to be better than you. All the time!

Two of the most popular articles on your vibes. Now have courses in more confidence and manipulative people . It's really not that surprising. Confidence is perhaps the most important feature in the battle to be the best. And many who are vying to be the best, uses manipulative techniques.

The battle to be the best
Even as children we are aware of who is better than whom. Children become aware early on who is physically strong, who are academically strong, who have parents with lots of money, who are handsome, etc. These are properties that are important when it comes to that asserting themselves.

As adults, we are able to "fight" with the other, and those that are considered better than others, precisely, stronger physically, more intelligent, more money, more beautiful people and have more sexual partners than average .

When you are better than others, you have social value. Others look up to you or want to be friends with you to take part in the social value. They will be proud to say they know you. How often do we hear praise that someone knows someone who has a lot of money? Or know someone who has been to a party with a celebrity?

Speaking of celebrity. When celebrity is a signal that you are better than others. Media focuses heavily on the rich and famous. Although they often portray them in a negative light, we are aware that they are still better than us. Not only are they beautiful, rich and famous, but celebrities are also being looked up to and regarded as better because they get lots of attention. Attention is a need we humans have from when we are young, and we admire those who get it. We go to the people who unknowingly get much attention because attention is a source of relaxation. When we feel good, we are better equipped in the struggle for existence.

Humor is basically about being better than others. The movie "Dumb and Dumber" is funny because it makes us viewers to feel superior. Jokes act almost exclusively on any wins over another in some way or some shit out.

In recent times beauty operations become more and more common. Although it costs more than a month salary, providing people the new boobs, new teeth and new faces, only to emerge as better than others. It is a delusion when they operated beauty says they only did it to feel better. The truth is that they feel better because they see themselves as pretty or prettier than his neighbor.

Commercial advertising provides a picture of people who are better than others. They are often successful and attractive. Celebrities are used over and over again. The commercials that play on humor, is about people who shit out for us prospective buyers may feel better. In funny commercials are main always in some way inferior to us, eg. either ugly or stupid.

What you will learn from this
What you will learn from this, is that you have to be aware that someone is always looking to be better than you. It is part of being a part of humanity. It's hard to get away. Therefore it is important that you equip yourself in battle, and not resign.

You have to learn self defense in a psychological sense. Provide you with more confidence and teach you various defenses when someone is trying to manipulate you. For it often happens when someone actually is better than the other, even if they have a desire to be there, is that instead of getting better though, they try to make others worse. They oppress others, and it may be you who is attempted to suppress.

Jump off!
The problem with being in combat with others, is that we compare ourselves with others. When we compare ourselves to others, we will never be happy and balanced people. We will die more or less unhappy.

To not go into the same trap as most others do, you should make use of the most important assigned to you: Your brain. To assert yourself and also defend you best, you should strive to become a conscious human being. To get a quiet and comfortable life, you must be able to consciously make yourself so much that you're able to get out of and did not even participate in this match. Jump off. Run your own race!

You must be aware of your inner potential and work to manifest it. You can not get better than the potential that exists in yourself. If you are not aware of this you will always struggle to be better than others, even if your potential is not capable of it. You will constantly fight a battle that you will never win. Is not it better to spend energy on highlighting your best I instead?

If you misunderstood my message, do you think I mean you should be so much asshole you can to assert yourself. It is in that case error. My message is that you should work on yourself and get that good with yourself as possible, so that you can manage to rise above others' desire to be better than you. We can not improve than the potential that exists in us. All people have an intention in life that can accommodate what we really are.

Life is about being the best. It's about being the best fit. It's about being better than its neighbor. It's about being the person who is above all others. But it's up to you whether you want to continue that life.

Has your life become a bad habit?

Do you often go around thinking that you want to do something with your life? Hope you are soon to meet some people who show you the way to a better life? Do you have fantasies about that fate will send what you want right in your lap? In that case you have to wait long.

The truth is that it is up to you how your life will be. It is you who must make sure that you get it the way you want. Life is what YOU make it.

But it's so hard to motivate yourself and get going, you think. Yes that's right! It's hard to change your life.

Your life is a habit
The reason is that your life has become a habit. You have fallen into a pattern of behavior that it is almost impossible to get out of. All too often, life has become a bad habit.

A habit is a pattern of behavior or a mindset that is repeated automatically. The habit is learned, but have been implicated in both body and mind, and can almost feel like a behavior you do not have control over. A habit is actually rooted in your subconscious.

However, a habit is not as strong as an addiction or a mental illness. The difference is that you actually have control over the habit. It just requires willpower.

To maintain the habit, requires very little energy. This is what is dangerous. Physiologically, habit forming separate neural pathways in the brain, which helps to reinforce the behavior pattern. In addition, the habit of predictability and structure in their lives, something that feels as safe and well.

There are many areas in life that are controlled by the habits, good as well as bad. Morning Rituals when standing up is a habit. I am quite sure that you have certain things you do when you get up in the morning. Every single day! These habits are positive, then they save you a lot of time and effort in an otherwise stressful morning. Exercise is also a good habit, it adds something positive in your life.

The problem is the bad habits.

When the habit has negative consequences for you, it affects the quality of your life. Usually, when people talk about bad habits include nail biting, smoking, unhealthy diet, etc.

Have you been single a long time and waiting for a girlfriend to come knocking on your door? The problem is that your life as a single has become a bad habit. You have become comfortable with being single, and motivation to find a partner is in fact not present. Consciously or unconsciously.

And what do you do when you get home from school or work? You might make dinner, sit in front of television or computer, and where you are until you go to bed. Are you living your life from your couch? Comfortable, yes, but not very stimulating.

You must be out of your comfort zone!
It takes a lot to break the habit. It requires great effort to break the vicious circle, that is almost a reflexive behaviors.

Begin to be aware that you have a bad habit. Be aware of your behavior. To stop biting nails, there's a way you can put on the nails. Aid tastes terrible, and you are "disturbed" every time you try to bite nails. You become aware of the behavior or habit. As can you avoid and biting nails using willpower. The bad habit is over.

Is the life become a bad habit, is still the solution to be conscious. You must be aware of the patterns that create problems in your life. It can be difficult to "mock" them, since they are a part of you. In addition, maintaining the action patterns because you are comfortable with being the way you are. Some of you clutching habit it is to be you.

If you are single, you have incorporated you some habits that probably will never be appropriate in the company of a girlfriend. You shower as long as you want, you fart and burp loud, you eat what you want and when it suits you, and you have it as messy as you want. You are absolutely your own boss and have no need to take into consideration. These are habits that you feel is very comfortable, but you need to get you if you are with someone. This you know deep down inside. Anyway you might yearn for someone to share your life with.

The solution is referred to consciously make yourself habits, and you must be willing to let go of them. You must convince yourself that the benefits of having a girlfriend, surpassing the benefits of being your own boss in your life. You must be ready to pay attention to others. If you can not, the motivation to get stuck due to be low.

Not always just internal factors
A habit of sitting inside your own head. But you may feel there is anything remotely like holding you back, like. houses to maintain, kids, your job, your dog disease in others you have to take advantage of, lack of money, etc. Much can "prevent" you from changing behavior patterns.

You claim these conditions is an obstacle for you, so it's impossible for you to break the habit. This is completely wrong. Your external obstacles is still something that only exists in your head. But they work very well as an excuse for you to not have to take hold of your life, and continue as before. Remember that there is always room for changing life situation.

Awareness of habit is the first step to break with it. You must be aware of what you do, when to do it and why you do it. Then it is necessary to act.

It's about getting you out of your comfort zone. You must be ready to make an extra effort in your life. You must be prepared to have it a little uncomfortable period.

When Arnold Schwarzenegger built itself up to become the world's top bodybuilder, he did not do it because it was comfortable to train so much. When he trained, he is very uncomfortable. But he learned a technique, and it was that he focused on the comfort that came later. It was uncomfortable just a necessary evil that was inevitable.

The conclusion is that you must do something. You need to take action. You have the force necessary to change your inherent. Find it and get on with life.

Tuesday, March 26, 2013

Disease, it is good there!

In these times of flu we are showered with tips on how to stay healthy, and be as little ill as possible. There's even a vaccine against influenza. But the disease also causes something good with it.

This Christmas has for me been marked by illness. First I had a normal and straightforward colds that have lasted since the end of November, marked by exhausting cough. But 2 day of Christmas went over to fever and aching all over. This year's flu epidemic took my body and confiscated all the resources that exist. It was to be a cozy family dinner two days after Christmas, was a tiring meeting with family members I had not seen in a year.

Now that christmas peace has descended, and the vast majority of family companies is done, I can sit back and relax a little. I can concentrate on getting healthy.

I can not remember the last time I had the flu. It is many years since I've had to lie under the covers for several days, isolated from the outside world. My immune system has now been on my side.

Now I'm thankfully on the mend, and the forces start to come back. It feels great! In fact, it feels like I've been through some sort of purification.

In my opinion, namely disease a form of purification. Both a large and a little perspective. The big picture we get when we look at what the disease does to the Earth. In a cynical way disease affects the poorest hardest. They die.

Disease cleans away those individuals who are too weak, and allows for the healthy to live. To ensure the biology of those with the best genes survive and ensure the best offspring. To the best of life on earth in general.

The little perspective we find in ourselves.

When we get sick, it is a signal that we should take a break from everyday life. It is a signal that we need some focus on ourselves for a while, and that we need rest. Illness forces us simply to pay attention to these signals. Our life is changing in a really short period when we are sick, and purification is in this change.

We eat differently, maybe we only manage to eat fruit or soup. It's almost like a period of fasting . We sleep and rests us more than normal. We have less contact with other people, since we are away from work or school. We can not bear to have visitors, nor to go visit.

Illness can almost comparable to that of a ritual in which the person performing the ritual standing up on the other side as a new person. A ritual can mean a transition from something old to something new.

For it is often the case that when we recover from illness, so a renewed fervor in us that was not there before the illness hit us. We are happy to be healthy and we know that we have new powers. We think positive and maybe we will even see life differently.

I know people who have been cured of cancer. They have changed their lives completely. They got a real eye when they were sick. They have stopped smoking, they have begun to exercise and altered diet. They see their friends with completely different eyes. Both positive and negative. They have cut out friends who were bad, nor focused on the good. The disease has changed their lives in a positive way, after all.

Now you do not need to have cancer to change their lives. It can actually hold a little flu.

My tip here is that when you get sick, take the signals your body gives you. Rest as much as you need, and do only what you feel. Not that you would otherwise have imposed.

And an important thing in the end: Observe the thoughts that pop into your head when you are sick. Since both the physical and psychological defenses are put out of action due. disease, you may begin to think thoughts that you have not been aware that you had. The mind may have something to tell you. There may be thoughts about plans for the future, a project that you have thought of. Or thoughts about yourself, about your friends or other family members. Listen to your inner self.

Monday, March 25, 2013

Health Care and Acne

One of the most embarrassing skin conditions is acne, and you can usually find a lot of it especially on the faces of teenagers. The typical look of acne is red spots that break out due to many reasons— stress, genetics, and other causes. Acne can be serious or moderate, and there are some cases that require ongoing treatment by health care professionals.

Here are some interesting statistics from the AAD (American Academy of Dermatology), which can also be located at this website--  http://www.aad.org/media-resources/stats-and-facts/conditions/acne :

• Acne is the most common skin disorder in the United States, affecting 40 million to 50 million Americans.
• Nearly 85 percent of all people have acne at some point in their lives, most often on the face, chest, and back.
• By mid-teens, more than 40 percent of adolescents have acne or acne scarring, which requires treatment by a dermatologist.
• The total direct cost associated with the treatment of acne exceeds $2.2 billion each year, including substantial costs for prescription and over-the-counter products.

According to Proactiv.com, from the moment you are born, your skin begins a lifelong process of shedding dead cells and producing oil. This process can be disrupted by your hormone balance, which changes throughout your life. The acne cycle is initiated when excess oil and dead skin cells combine to plug the pore of a hair follicle; behind the plugged pore, bacteria grow and multiply, triggering inflammation and swelling. That's an acne blemish.

Acne is what doctors call a chronic condition, which means it can last for years—even decades in adults. Because there is no cure, the key to a clear complexion is control and prevention with medicated daily maintenance therapy. The pimples you see today started as tiny microcomedones, or pre-pimples, deep inside your skin about three weeks before breaking out. Hundreds of tiny pre-pimples may be forming continuously in any of the thousands of pores on your face. Even when your skin looks clear, they may still be there—percolating invisibly under the skin's surface. Much more detail can be found at this website: http://www.proactiv.com/acne-information/what-causes-acne,default,pg.html .

Once a pore becomes clogged, it traps skin oil inside. Bacteria grows in this oil and can cause an inflammatory response in the skin. Acne lesions can be small and hardly noticeable, have a small white or black head, or can appear red with a white/yellow center. Sometimes a clogged pore will become so inflamed that it can lead to larger, more painful lesions called nodules or cysts, which can ultimately scar. Almost no one escapes some clogged pores and pimples, especially during adolescence--a fragile time when self-esteem and confidence is just emerging. Acne afflicts people of all ethnicities and is treated the same regardless, according to this site: www.Acne.org .

Your skin is healthiest and clearest when it is in balance. The more irritation your skin experiences, the more likely it is to break out. Conversely, the less irritation your skin experiences, the better it is able to remain clean. Sources of irritation include anything which rubs, scratches, or comes into prolonged contact with your skin, as well as anything which sends your skin out of balance such as overdryness, sunburns, shaving the face with irritating razors, and pore-clogging cosmetics. To best clear acne, try to keep your skin as untouched as possible. Acne is not caused by dirt, and washing your face, while it is fine to do up to twice per day, is going to do little to help with your acne. Much more info can be found at this site: http://www.acne.org/ .

People with acne often feel incredibly alone but the fact is, acne is the most common skin disease in the world, with tens of millions of sufferers, according to Proactive. More than 85% of Americans have acne breakouts at some time in their lives. Among teenagers, about 90% develop acne, and it can last all their teen years. Many adults have acne, too. Among adult women, about 50% experience acne breakouts at some point; among men, about 25%—and the chronic nature of the condition means adults may have to endure symptoms for decades if not treated with appropriate acne medication.

According to the NIH (National Institutes for Health), there are many myths about what causes acne. Chocolate and greasy foods are often blamed, but there is little evidence that foods have much effect on the development and course of acne in most people. Another common myth is that dirty skin causes acne; however, blackheads and other acne lesions are not caused by dirt. Stress doesn’t cause acne, but research suggests that for people who have acne, stress can make it worse. Factors that can cause an acne flare include:

• Changing hormone levels in adolescent girls and adult women before their menstrual period starts
• Oil from skin products (lubricants or cosmetics) or grease encountered in the work environment (for example, a kitchen with fry vats)
• Pressure from sports helmets or equipment, backpacks, tight collars, or tight sports uniforms
• Environmental irritants, such as pollution and high humidity
• Squeezing or picking at blemishes
• Hard scrubbing of the skin
• Stress.

Acne is often treated by dermatologists (doctors who specialize in skin problems), according to the NIH. These doctors treat all kinds of acne, particularly severe cases. Doctors who are general or family practitioners, pediatricians, or internists may treat patients with milder cases of acne. Depending on the extent of the problem, the doctor may recommend one of several over-the-counter (OTC) medicines and/or prescription medicines. Some of these medicines may be topical (applied to the skin), and others may be oral (taken by mouth).

There are several OTC topical medicines used for mild acne. Each works a little differently. Following are the most common ones:

• Benzoyl peroxide--Destroys P. acnes and may also reduce oil production.
• Resorcinol--Can help break down blackheads and whiteheads.
• Salicylic acid--Helps break down blackheads and whiteheads. Also helps cut down the shedding of cells lining the hair follicles.
• Sulfur--Helps break down blackheads and whiteheads.

Topical OTC medicines are available in many forms, such as gels, lotions, creams, soaps, or pads. In some people, OTC acne medicines may cause side effects such as skin irritation, burning, or redness, which often get better or go away with continued use of the medicine. If you experience severe or prolonged side effects, you should report them to your doctor.

People with moderate-to-severe inflammatory acne may be treated with prescription topical or oral medicines, alone or in combination, according to the NIH. Several types of prescription topical medicines are used to treat acne. They include:

• Antibiotics. Help stop or slow the growth of bacteria and reduce inflammation

• Vitamin A derivatives (retinoids). Unplug existing comedones (plural of comedo), allowing other topical medicines, such as antibiotics, to enter the follicles. Some may also help decrease the formation of comedones. These drugs contain an altered form of vitamin A. Some examples are tretinoin, adapalene, and tazarotene.

• Others. May kill P. acnes and reduce oil production or help stop or slow the growth of bacteria and reduce inflammation. Some examples are prescription strength benzoyl peroxide, sodium sulfacetamide/sulfur-containing products, or azelaic acid.

For patients with moderate-to-severe acne, doctors often prescribe oral antibiotics. Oral antibiotics are thought to help control acne by curbing the growth of bacteria and reducing inflammation. Prescription oral and topical medicines may be combined. Much more detailed material about acne can be located at this website: http://www.niams.nih.gov/health_info/acne/ .

Oil in the skin is a contributing factor to acne. According to a study published in the Journal of the Academy of Nutrition and Dietetics, some of that excess oil production may be diet-related. This study found that high glycemic foods and dairy products can cause changes in the body that lead to increased cellular growth and oil production, which can increase the chances of developing acne. Yikes! Better cut back on that cheddar. But, what’s a glycemic index?

The glycemic index, according to this website, http://www.myhealthnewsdaily.com/3615-high-glycemic-foods-acne.html , is a measure of the speed at which sugar in food enters your bloodstream. High-glycemic foods are those that have the fastest blood sugar response. So, things like cupcakes and white bread are considered high glycemic. It’s important to note, though, that the glycemic index isn’t a measure of a food’s nutritional value, fat content, or anything else. It simply indicates how it will affect your blood sugar levels. It can be confusing, to say the least.

Here are some tips for eating a low-glycemic diet without stressing out:

--Avoid processed foods. Whole foods are usually lower on the glycemic index than processed foods. Apple juice will spike your blood sugar at a much faster rate than eating a whole apple.

--Try a protein pairing. Because protein is harder to digest, it can bring down the overall glycemic index of a meal. Just don’t use cheese or other dairy products as your protein. Remember, those may also cause acne.

--Choose fiber. Since it can’t be digested by the body, fiber is low on the glycemic index. Eat foods that are high in fiber, and there’s a good chance you'll steer clear of high GI foods.

The good news is that acne is treatable, and in many cases does not cause too much damage to the skin. However, if you are experiencing issues with it that are causing concern, see your doctor. He can suggest and prescribe some options to help you. Also, in more severe cases, your physician can refer you to a specialist. Dermatologists can help you with acne that is more chronic and difficult to manage. Although acne can be embarrassing socially, remember that in most cases it is temporary. Watch your diet and your daily skin regimen to self-manage most acne issues.

Until next time.

Friday, March 22, 2013

Health Care and Leprosy

Back in Biblical times, thousands of years ago, when someone shouted “Unclean, unclean,” that usually meant the person was suffering from a dreaded disease, typically leprosy. In that time it was commonly believed that you could catch that horribly disabling and fatal illness simply by being near someone or breathing the same air near the affected individual. Plus, it was a legal requirement for the victim to announce the fact they were in the area by shouting out those words. That way, everyone within ear shot could run the other way. Leprosy was seen as a plague on those who had it and a direct result of sin against their god.

A lot of knowledge about leprosy has been gained since then, as in most all medicine. According to the World Health Organization (WHO), leprosy was recognized in the ancient civilizations of China, Egypt and India. The first known written mention of leprosy is dated 600 BC. Throughout history, the afflicted have often been ostracized by their communities and families. Although leprosy was treated differently in the past, the first breakthrough occurred in the 1940s with the development of the drug Dapsone, which arrested the disease. But the duration of the treatment was many years, even a lifetime, making it difficult for patients to follow.

The WHO reports that leprosy is a chronic infectious disease caused by Mycobacterium leprae, an acid-fast, rod-shaped bacillus. The disease mainly affects the skin, the peripheral nerves, mucosa of the upper respiratory tract and also the eyes. Leprosy is curable and treatment provided in the early stages averts disability. Here are some key facts about this disease:

• Official figures show that almost 182,000 people, mainly in Asia and Africa, were affected at the beginning of 2012, with approximately 219,000 new cases reported during 2011.

• M. leprae multiplies very slowly and the incubation period of the disease is about five years. Symptoms can take as long as 20 years to appear.

• Leprosy is not highly infectious. It is transmitted via droplets, from the nose and mouth, during close and frequent contacts with untreated cases.

• Untreated, leprosy can cause progressive and permanent damage to the skin, nerves, limbs and eyes.

• Early diagnosis and treatment with multidrug therapy (MDT) remain the key elements in eliminating the disease as a public health concern. Here is more detail about leprosy found on the WHO website: http://www.who.int/mediacentre/factsheets/fs101/en/index.html.

The medical name for leprosy is Hansen's disease, according to American Leprosy Missions (ALM). Norwegian doctor Armauer Hansen was the first to view the bacillus under a microscope in 1873. The bacteria attack nerve endings and destroy the body's ability to feel pain and injury. Without feeling pain, people injure themselves and the injuries can become infected, resulting in tissue loss. Fingers and toes become shortened and deformed as the cartilage is absorbed into the body. Repeated injury and infection of numb areas in the fingers or toes can cause the bones to shorten. The tissues around them shrink, making them short.

Early signs include spots on the skin that may be slightly red, darker or lighter than normal skin. The spots may also become numb and have lost hair. Often they appear on the arms, legs or back. Sometimes the only sign may be numbness in a finger or toe. If left untreated, hands can become numb and small muscles are paralyzed, leading to curling of the fingers and thumb. When leprosy attacks nerves in the legs, it interrupts communication of sensation in the feet. The feet can then be damaged by untended wounds and infection. If the facial nerve is affected, a person loses the blinking reflex of the eye, which can eventually lead to dryness, ulceration and blindness. Bacteria entering the mucous lining of the nose can lead to internal damage and scarring which in time causes the nose to collapse. Untreated, leprosy can cause deformity, crippling and blindness, according to ALM.

Leprosy is transmitted primarily through coughing and sneezing. In most cases, it is spread through long-term contact with a person who has the disease but has not been treated. Scientists don't fully understand how leprosy is spread. Most people will never develop the disease even if they are exposed to the bacteria. Approximately 95% of the world population has a natural immunity to leprosy. Approximately 5,000 people in the U.S. are cured but suffer from the effects of leprosy and continue to receive care through outpatient clinics and private physicians. Approximately 150 people are diagnosed with leprosy each year in the U.S, per American Leprosy Missions. More info can be found on their website: http://www.leprosy.org/ .

According to the National Institutes for Health (NIH), most cases are in the South, California, Hawaii, and U.S. islands. Effective medications exist. Isolating people with this disease in "leper colonies" is not needed. People with long-term leprosy may lose the use of their hands or feet due to repeated injury because they lack feeling in those areas. Prevention consists of avoiding close physical contact with untreated people. People on long-term medication become noninfectious (they do not transmit the organism that causes the disease). Call your health care provider if you have symptoms of leprosy, especially if you've had contact with someone who has the disease. Cases of leprosy in the United States need to be reported to the Centers for Disease Control and Prevention. Much more info can be found at this website: http://www.nlm.nih.gov/medlineplus/ency/article/001347.htm .

Leprosy is a disease that largely has been contained in most places in the world, especially in the US, even though there are new cases every year that are diagnosed. However, most people who contract this disease are located in more impoverished third world nations where sanitary living conditions are not readily available, or that have limited access to health care, or who live in a population largely ignorant of disease prevention. As with any health care need, always talk with a medical professional for proper diagnosis and treatment.

Until next time.

Tuesday, March 19, 2013

What Isn't a Risk?

This article about radiation being a threat to heart health even years after treatment has made the bc rounds. I've commented on it in a few places and knew I wanted to write about it, because the topic is important.

It's not new news that nuking the chest would possibly affect the heart. In fact, it's more along the lines of common sense.

It was a concern of mine as I struggled to make the decision about radiation, which was the hardest decision I made regarding treatment.

Thankfully, my radiation oncologist was also concerned about my heart and tried to design the radiation path to miss as much as he could. Also thankfully, my treatment center used the "gated" machine that this article mentions--one that is synced to zap at a certain point in your breathing to shield the heart as much as possible.

But I'm sure I got the highest dose they mention in the article, because my treatment involved daily regular doses and then weekly boosts of intense doses. I suppose you could say "Just don't give me the boosts," but that would risk losing the full benefit of the treatment. I'm an all in kind of gal once I decide to be all in.

I think getting radiation was a very good decision for me. In fact, I have come to think it might have been the thing that made the difference and is the reason I am still here, cancer-free six and a half years later. I'd love there to be more research on this exact point.

But that doesn't mean I don't have a risk for heart problems down the road. My heart took a measurable hit from chemo drugs and from Herceptin. But time and exercise have reversed that.

I file the heart risk away, along with all the other health ailments I may one day face because I had breast cancer and chose aggressive treatment for it.

It's a long list.

To say I don't worry about those things would be a lie, but it is true that I prefer to focus on something certain. That is the knowledge that I have had more than six years past cancer to mother my son, and I anticipate many, many more years to come.

If heart problems or other complications from cancer--or cancer itself--should come back, it'll have to catch me, because I'm already up to a sprint past that whole noise.

Saturday, March 16, 2013

If Only It Were This Simple

As simple as this headline claims, then most of us who have cancer wouldn't. Or if we did, we could somehow "get better" short of chemo, etc.

I support healthy eating, living and exercise. I do it, for the most part. Always have, always will. Didn't stop me from getting breast cancer at 37.5 years old. Doesn't stop a whole bunch of other people from getting diseases either.

The message to do your best for yourself where your health is concerned is good. The undertone that we who are unlucky enough to get sick big are at fault is not.

Thursday, March 14, 2013

Health Care and GERD

When you swallow anything, that item goes through a tube that connects your mouth to your stomach whether it is a liquid or a solid substance. That bodily throughway is called an esophagus. When that area gets irritated, you can suffer from more serious medical issues including a condition called GERD—Gastroesophageal Reflux Disease. If you have symptoms similar to heartburn or acid indigestion that is not caused by eating certain types of spicy food, you may have GERD.

Also known as acid reflux, GERD can cause serious damage to your esophagus over time. The burping, heartburn, and spitting up associated with GERD are the result of acidic stomach contents moving backward into the esophagus (called reflux), according to KidsHealth.org. This can happen because the muscle that connects the esophagus with the stomach (the esophageal sphincter) relaxes at the wrong time or doesn't properly close.

Many people have reflux regularly and it's not usually a cause for concern. But with GERD, reflux occurs more often and causes noticeable discomfort. After nearly all meals, GERD causes heartburn, also known as acid indigestion, which feels like a burning sensation in the chest, neck, and throat. In babies with GERD, breast milk or formula regularly refluxes into the esophagus, and sometimes out of the mouth. Sometimes babies regurgitate forcefully or have "wet burps." Most babies outgrow GERD between the time they are 1 and 2 years old. But in some cases, GERD symptoms persist. Kids with developmental or neurological conditions, such as cerebral palsy, are more at risk for GERD and can have more severe, lasting symptoms. Much more info can be found at this site: http://kidshealth.org/parent/medical/digestive/gerd_reflux.html .

The symptoms of GERD may include persistent heartburn, acid regurgitation, nausea, hoarseness in the morning, or trouble swallowing, according to the American Academy of Otolaryngology (AAO). Some people have GERD without heartburn. Instead, they experience pain in the chest that can be severe enough to mimic the pain of a heart attack. GERD can also cause a dry cough and bad breath.

According to the AAO, GERD can be diagnosed or evaluated by a physical examination and the patient’s response to a trial of treatment with medication. Other tests that may be needed include an endoscopic examination (a long tube with a camera inserted into the nose, throat, windpipe, or esophagus), biopsy, x-ray, examination of the esophagus, 24 hour pH probe with or without impedance testing, esophageal motility testing (manometry), and emptying studies of the stomach. Endoscopic examination, biopsy, and x-ray may be performed as an outpatient or in a hospital setting. Endoscopic examinations can often be performed in your ENT’s office, or may require some form of sedation and occasionally anesthesia.

Most people with GERD respond favorably to a combination of lifestyle changes and medication. Medications that could be prescribed include antacids, histamine antagonists, proton pump inhibitors, pro-motility drugs, and foam barrier medications. Some of these products are now available over the counter and do not require a prescription. Children and adults who fail medical treatment or have anatomical abnormalities may require surgical intervention. Such treatment includes fundoplication, a procedure where a part of the stomach is wrapped around the lower esophagus to tighten the lower esophageal sphincter muscle (LES), and endoscopy, where hand stitches or a laser are used to make the LES tighter. You can find more details about GERD at this site: http://www.entnet.org/HealthInformation/GERD-and-LPR.cfm .

According to the National Institutes for Health (NIH) risk factors for GERD or reflux include:

• Alcohol (possibly)
• Hiatal hernia (a condition in which part of the stomach moves above the diaphragm, which is the muscle that separates the chest and abdominal cavities)
• Obesity
• Pregnancy
• Scleroderma
• Smoking

Heartburn and gastroesophageal reflux can be brought on or made worse by pregnancy and many different medications. Such drugs include:

• Anticholinergics (e.g., for seasickness)
• Beta-blockers for high blood pressure or heart disease
• Bronchodilators for asthma
• Calcium channel blockers for high blood pressure
• Dopamine-active drugs for Parkinson's disease
• Progestin for abnormal menstrual bleeding or birth control
• Sedatives for insomnia or anxiety
• Tricyclic antidepressants

If you suspect that one of your medications may be causing heartburn, talk to your doctor. Never change or stop a medication you take regularly without talking to your doctor, according to the NIH. More material about GERD can be found at this website: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001311/ .

Depending on how severe your GERD is, according to this website: http://heartburn.about.com/od/gerdacidrefluxdisease/a/gerd_acidreflux_3.htm , treatment may involve one or more of the following lifestyle changes, medications, or surgery:

Avoid reflux producing foods--These foods include:

• Fried foods
• Fatty foods
• Citrus fruits
• Tomato products
• Caffeine
• Alcoholic beverages
• Citrus fruit drinks
• Chocolate
• Peppermint
• Pepper

If you smoke, stop--Smoking inhibits the production of saliva. Saliva is one of your body's defenses against damage to the esophagus. Saliva also aids in neutralizing refluxed acid. Smoking also stimulates the production of stomach acid, and can weaken and relax the lower esophageal sphincter (LES).

Do not drink alcohol--Alcohol increases the production of stomach acid, relaxes the lower esophageal sphincter, allowing stomach contents to reflux back up into the esophagus, and can make the esophagus more sensitive to stomach acid.

Lose weight if needed--Obesity increases abdominal pressure, which can then push stomach contents up into the esophagus. Losing weight may help reduce acid reflux.

Eat small meals--Large meals expand your stomach and increase upward pressure against the esophageal sphincter.

Wear loose-fitting clothes--Clothing that fits tightly around the abdomen will squeeze the stomach, forcing food up against the LES, and cause food to reflux into the esophagus. Clothing that can cause problems include tight-fitting belts and slenderizing undergarments.

Avoid lying down for 3 hours after a meal--Gravity helps to keep the stomach juices from backing up into the esophagus. Lying down with a full stomach makes reflux more likely.

Raise the head of your bed--With the head higher than the stomach, gravity helps reduce this pressure. You can elevate your head in a couple of ways. You can place bricks, blocks or anything that's sturdy securely under the legs at the head of your bed to raise it 6 to 8 inches. A foam wedge under the mattress can also be used. You can also use a wedge pillow to elevate your shoulders and head.

According to Fox News, popular over-the-counter medications like Tums, Maalox, Rolaids and Mylanta neutralize stomach acid and provide fast-acting relief in mild or isolated cases of acid reflux. Some antacids come in liquid form to coat the lining of the esophagus and help reduce the amount of acid in the stomach. But they won’t aid in reducing inflammation of the esophagus associated with GERD. More details about medicines to control GERD can be found at this site: http://www.foxnews.com/story/0,2933,412202,00.html .

GERD can be serious. If you suspect you may have it, see your doctor. Don’t put off an appointment if you are suffering from the symptoms. It may be that you have other health related issues, but if you really have acid reflux, your family physician can help you deal with it.

Until next time.

Tuesday, March 12, 2013

Health Care and Colonoscopy

When your primary care doctor raises the topic about any invasive procedure, most of the time people cringe about the thought of any type of surgery or medical treatment involving going inside your body. For men especially, a colonoscopy is typically going to come up in conversation with your physician if you are close to the age of 50, or have any type of abnormal bleeding in your urine or other waste. A colonoscopy can be a “routine” way of finding out if there are any abnormalities in your colon. For any patient, though, there is nothing routine about this procedure.

Additionally, men over the age of 75 have a higher risk of additional health care problems. According to HealthLeaders Media, colonoscopies in seniors over age 75 should not be performed because risks of harm outweigh benefits; as many as 30% of these "potentially or probably inappropriate" procedures were still being performed, with huge pattern variation across the nation, especially in Texas.

For patients between 70 and 74, "procedures were repeated too soon after a negative exam," increasing the odds of avoidable harm, such as "perforations, major bleeding, diverticulitis, severe abdominal pain or cardiovascular events." The guidance, from the U.S. Preventive Services Task Force, which was released in 2008, also set a 10-year interval for routine colonoscopies for people between age 70 to 75 unless the patient develops certain symptoms.

"For example, in adults between the ages of 76 to 85, there are some considerations that would support the use of screening colonoscopy, such as a patient has a higher risk of developing an adenoma. But in general, screening guidelines indicate that should be exception, rather than the rule,” according to a study released in the Journal of American Medicine (JAMA). Much more detail about this particular focus for colonoscopies in seniors can be found at this website: http://www.healthleadersmedia.com/content/HEP-290006/Colonoscopy-Potentially-Inappropriate-for-30-of-Seniors## .

According to the American Cancer Society (ACS), a colonoscopy is an exam that lets a doctor closely look at the inside of the entire colon and rectum. The doctor is looking for polyps (pah-lips) or signs of cancer. Polyps are small growths that over time can become cancer. The doctor uses a thin (about the thickness of a finger), flexible, hollow, lighted tube that has a tiny video camera on the end. This tube is called a colonoscope. The colonoscope is gently eased inside the colon and sends pictures to a TV screen. Small amounts of air are puffed into the colon to keep it open and let the doctor see clearly.

The exam itself takes about 30 minutes. Patients are usually given medicine to help them relax and sleep while it’s done. Your doctor decides how often you need this test, usually once every 10 years, depending on your personal risk for colon cancer. It’s important for you to talk with your doctor to understand your risk for colon cancer, the guidelines you should follow for testing, and whether you need to start having the tests at age 50 or earlier.

Plus, these exams are usually not painful, according to the ACS. Patients are given medicine to make them sleep through a colonoscopy, so they don’t feel anything. During both of these tests, air is pumped into the cleaned-out colon to keep it open so that doctors can get the best pictures. The air pressure may cause some discomfort and cramping, but it should not hurt. As with most medical tests, complications are possible with both of these tests. Some can be serious — for instance, bleeding and puncture of the colon — but they are very uncommon. Make sure you understand how these tests work, how you can expect to feel during the test, and possible problems that may come up. Much more detail can be found at this website: http://www.cancer.org/healthy/findcancerearly/examandtestdescriptions/faq-colonoscopy-and-sigmoidoscopy .

Per the Cleveland Clinic, here is what you should expect after a colonoscopy:

• You may feel some cramping or a sensation of having gas, but this quickly passes.

• If a biopsy was taken or a polyp was removed, you may notice light rectal bleeding for one to two days after the procedure. If you have a large amount of rectal bleeding, high or persistent fevers, or severe abdominal pain within the next 2 weeks, please go to your local emergency room and call the doctor who performed your exam.

• If polyps were removed or a biopsy was taken, the doctor performing your colonoscopy will tell you when it is safe to resume taking your blood thinners. You will also be told if you need to stop taking medications such as nonsteroidal anti-inflammatory drugs (NSAIDs), which include aspirin, ibuprofen (Motrin®, Advil®) and naproxen (Aleve®).

Note: To follow are other important questions to ask your doctor. Keep in mind that each doctor and/or his or her health care facility has their own unique set of instructions for their patients. Most doctors/health care facilities are in general agreement with the following answers. However, ALWAYS ask your doctor for his/her specific instructions. Additional tips are as follows:

--Driving home. If sedation has been given, a responsible adult (a family member or friend) must drive you home.

--Being alone when home. For safety reasons, you probably shouldn’t be alone. Ask your doctor how long you should remain with family or friends.

--Returning to normal diet and activities. Unless otherwise instructed, most patients can return to their normal diet immediately following the colonoscopy. Other typical advice is to avoid alcohol, driving, regular activities, and operating machinery for 24 hours following the procedure.

More details can be found at this site: http://my.clevelandclinic.org/services/colonoscopy/hic_colonoscopy_procedure.aspx .

Also, another option is for a virtual colonoscopy. According to the Mayo Clinic, the virtual colonoscopy is an exam used to detect changes or abnormalities in the large intestine (colon) and rectum. During virtual colonoscopy, an imaging technique known as computerized tomography (CT) is used to produce hundreds of cross-sectional images of the abdominal organs. The images are combined and digitally manipulated to provide a detailed view of the inside of the colon and rectum. Unlike traditional colonoscopy, virtual colonoscopy doesn't require sedation or the insertion of a scope into the colon. Virtual colonoscopy is one option used to screen for colon cancer. Discuss your colon cancer screening options with your doctor to determine whether virtual colonoscopy is the right option for you. The Mayo Clinic has a lot of material about this health care topic and more, beginning at this website: http://www.mayoclinic.com/health/colonoscopy/my00621 .

If you have any concerns about getting a colonoscopy, see your doctor or closest available health care provider. They are painless, and in the vast majority of cases have no lasting side effects. In most cases, your health insurance should cover most of the cost. Additionally, if any abnormalities are found during the procedure, they are addressed at the time and with any required follow up. Don’t be afraid to get one, especially if your physician recommends it. Although preparing for one and recovery can be a little uncomfortable, the results with a clear screening can be worth the aggravation, especially if you have positive results and are clear from any more medical issues. The old saying “An ounce of prevention is worth a pound of cure,” is particularly valid with a colonoscopy.

Until next time.