Mobility Is Key to Healthy Aging

A clinical review from geriatricians at the University of Alabama at Birmingham suggests that mobility limitations are a litmus test for healthy aging and urges primary care physicians to take a more aggressive role in ascertaining the mobility of their older patients.

The study was published Sept. 18, 2013, in the Journal of the American Medical Association, as part of their continuing series, Care of an Aging Patient.

The authors, Cynthia J. Brown, M.D., MSPH, and Kellie Flood, M.D., of the UAB Division of Gerontology, Geriatrics and Palliative Care, conducted a clinical review of academic papers published between 1985 and 2012 dealing with mobility issues in a general aging population.

“The review confirmed that increased physical activity and exercise are extremely important for healthy aging,” said Brown. “We’ve also identified mobility-limiting risk factors and created an approach to help medical professionals screen for and treat those risk factors.”

Brown said mobility limitations are often an early sign of impending functional decline in seniors. Recognizing an increase in those limitations at an early stage creates the opportunity for successful interventions aimed at warding off functional decline and keeping seniors living independently for as long as possible.

“Mobility limitations are the edge of that slippery slope that leads to loss of function,” said Brown. “A decline in mobility seems to quickly lead to an across-the-board decline, including the routine activities of daily living. Mobility is a sort of barometer for how well an older person ages.”

The approach that Brown and Flood recommend suggests that primary care physicians should ask all senior patients two questions: for health or physical reasons, do you have difficulty climbing up 10 steps or walking a quarter of a mile; and because of underlying health or physical reasons, have you modified the way you climb 10 steps or walk a quarter of a mile?

“Any modification of a task such as climbing 10 steps raises a red flag,” said Brown. “Asking the right questions can tell a clinician a great deal about the level of mobility in their older patients.”

Brown said that a positive answer to either of the two questions should lead the primary care provider to dig deeper and identify the physical, social or environmental components leading to the limitations, and they should take steps to address those limitations through physical therapy services and/or prescribing appropriate ambulatory devices. She also said primary care physicians are the front line of defense against other identified risk factors like obesity and smoking.

Brown, a physical therapist for 10 years before becoming a physician, suggests greater interaction between doctors and therapists.

“Mobility is one of the cornerstones of healthy aging,” she said. “With an increasing older population in the United States, it is incumbent on us to find ways to help older Americans continue to live well and independently. The major barriers – lack of physical activity, obesity and smoking – are all risk factors that can be successfully overcome with appropriate treatment and assistance

Diabetic Humble Pie

It was Wednesday at 2 AM, and I couldnt sleep. I stared at the walls intently as if they held hidden messages for me; my own hieroglyphs to decipher. Suddenly, just like an omen in a bad movie, the soft light that usually bathes the bedrooms walls was gone; complete blackness engulfed everything. Five minutes later, there was light, alright... Lightning and thunder made their explosive way into the picture. The stuff usually soothes, and helps me sleep, but that wasnt going to be the case on this morning. This morning I had to rise early, and walk to work... and it was going to be a very interesting, and very wet, walk to work.

And I cant begin to tell you just how interesting. 

Lets just say I completely underestimated the situation, and thought it was just... well... an annoying moment of rain, and some fading thunder. At 4 am, though, lets just also say that some things are better left unseen. 

Most of the homes on my citys main avenue are small, and unimpressive. Not a blight, by any means, but just average homes that probably serve as first homes to many newlyweds, or even some retired folks. They dont really have much in the way of yards, trees, or shrubbery, but I got to see a few fallen branches here and there, and thats common out here in Iowa during some of our Spring storms. No biggie. 

But then, you hit a slight bend up the road... and the homes become bigger, stately, and with sprawling large front lawns, gardens, and trees. You might even see a posh car or two, parked on a driveway; testament to how much someone, somewhere, makes. And this is where the horror began. 

Have you ever seen a a tree trunk thats, maybe, a few feet wide, in diameter? Yes? Now, have you ever seen it BENT IN HALF, like the bending of a simple tulip stem; like a Twizzler... Like it was made of rubber? Well, at this point in my walk, very MANY of the trees were in this state.

I got quite scared. The city sirens never rang that morning, and no warnings or advisories were in effect for my county. But I know quite well a few of you KNOW what this represents. Unless the Jolly Green Giants bratty son was out and about, or Godzilla, for that matter... the only two things I know that can do this to such large trees are tornadoes, and hurricanes. And we dont have hurricanes up in the northern Midwest. 

I really didnt know if this was still happening in the vicinity... I sure didnt hear anything in the way of a "freight train" noise. But by then, I was closer to work than to home, so I tried to finish the journey as quickly as possible, and get out of harms way. Stupid? Maybe. Later, in the papers, experts were looking into whether a tornado potentially touched down in Ames. Well, you sure couldve fooled me. :/ 

I was very scared, and when I get scared... I tend to get angry at the impotence of the situation. Scared of being alone, scared I have nothing to rely on to save my own behind, and very angry. I dont know why... like what could I do? Slap the sky? I guess I just want life to happen smoothly, sometimes, and not scare the crap out of me. Not force me into confrontations, or situations I dont want. I JUST WANTED TO DO WHAT I HAD PLANNED - GET TO WORK! 

But life seldom cares what we want, and we have to roll with it...

So we come to Friday, at the second job. I worked an 11-5 pm shift, and Id been sick with a stomach virus for a few days. Really, foolish or not, I didnt have much in my stomach at that moment; I was just too scared I couldnt keep any of it down. 

Lunch rush starts at this Mexican restaurant, and Im quickly into the groove of things, making order after order after order. Its okay...! Im in my element! Things are going awesome... 

And then, without notice, the floor was made of lava, and I was in a movie, and people were watching me. And I was making those burritos... on a compartment, atop a roller coaster ride, and trying to hold on soooo hard to the railing. I think I thought the burritos were the railing, at one point. Everything was funny, and sooo not funny, at the same time. I got scared, and very angry.

I wanted to stop, but there was no one else there. Im pretty knew, so people dont really know much about what I need, or dont need, and frankly... I only work a few hours, part time. I guess I foolishly thought I could get away with it. I *knew* that I was having a quite sudden, and quite low, LOW. But I couldnt stop.

"I can finish this lunch rush," I say to myself... I can. By the time rush was done, Im sure some of my folding, and wrapping, looked as mangled as those trees on my main avenue. I was so sick feeling, and so scared... Like a person drowning, and their head rising in and out of the water. Where the hell are the jellybeans? I quickly announced Im going on break -- whether people like it or not -- and NO ONE refused. They mustve seen something in my eyes, and wisened up. 

Funny, the place is typically crawling in ho-hos, twinkies, and jelly beans... and not a damn piece of sugar was in sight. 

Luckily, I ate through 3 pieces of candy I had in my pocket (too scared to go down the greasy, steep steps to the basement, and find my purse, and get the meter and the glucose tabs), and a cup of regular soda... 30 minutes later things seemed to improve. My break was only 15. 

I will have to ask if I can keep things upstairs -- we cant really keep personal things, nor food, in the work areas. But its going to have to be... an uncomfortable conversation. I just dont like to bring it up.

ALL I WANTED WAS TO DO MY JOB, AND FINISH, AND GO HOME. 

In the end, I took a detour through Alices Wonderland of Diabetic Crap, and finished with a terrible headache... and NOT from the magic mushrooms. :/ 

I hate Diabetes. *&^%#! Diabetes.

Lesson: We cant exactly plan for every situation, in life. Who the heck knows when a tornados going to come in, and rip through your lunch rush, at work... BUT we must be willing to reach out to others, and identify safe beacons along the way. Dont hurt yourself because you want to be tough, and stubborn, and stupid. Just dont. Its so not worth it... 

"One order of diabetic humble pie, please. For here." 

Bhelpuri Chaat SNC Challenge

Being a South Indian, i would love to cook and eat North Indian foods, just i love their foods. Every month, if you get a chance to cook from this part of India, who will say no, definitely not me. When Divya of You Too Can Cook announced a monthly challenge between Southern and Northern part of India, i want to be a part of this group, immediately i joined this group.For this months first challenge, Shruti of Shruti Rasoi challenged Bhelpuri chaat, a popular street food chaat from Mumbai to us (for the Southern group) while Divya of Divyas Culinary Journey challenged Mysore pak to the Northern group.As am  a part of Southern group, i have to prepare bhelpuri chaat for this months challenge. Finally here is my bhelpuri chaat i prepared yesterday and enjoyed thoroughly. Thanks to Shruti for this incredible challenge, loved it.

1cup Puffed rice

5nos Papdi/Papri

1/4cup Fried peanuts

1no Potato (boiled & cubed)

2tbsp Onions (chopped)

3tbsp Cucumber (chopped)

3tbsp Tomato (chopped)

2tbsp Raw mango (grated)

2tbsp Green Chutney

2tbsp Sweet Tamarind Chutney

Lemon juice (as per need)

Salt

2tbsp Coriander leaves (chopped)

1/2cup Sev/Omapodi

Take a large bowl, crush the fried papdis and take them in a bowl, add now the puffed rice,sev, cubed potatoes, chopped onions,chopped cucumber,chopped tomatoes,grated raw mango, lemon juice,salt and give a stir.

Add immediately the green chutney and sweet tamarinf chutney and toss gently until everything gets well mixed.

Serve immediately wiith chopped coriander leaves and sev.

Hitting the gym may help men avoid diet induced erectile dysfunction

Obesity continues to plague the U.S. and now extends to much of the rest of the world. One probable reason for this growing health problem is more people worldwide eating the so-called Western diet, which contains high levels of saturated fat, omega-6 polyunsaturated fatty acids (the type of fat found in vegetable oil), and added sugar. Researchers have long known that this pattern of consumption, as well as the weight gain it often causes, contributes to a wide range of other health problems including erectile dysfunction and heart disease. Other than changing eating patterns, researchers havent discovered an effective way to avoid these problems.

Searching for a solution, Christopher Wingard and his colleagues at East Carolina University used rats put on a "junk food" diet to test the effects of aerobic exercise. They found that exercise effectively improved both erectile dysfunction and the function of vessels that supply blood to the heart.

The article is entitled "Exercise Prevents Western-Diet Associated Erectile Dysfunction and Coronary Artery Endothelial Dysfunction: Response to Acute Apocynin and Sepiapterin Treatment." It appears in the online edition of the American Journal of Physiology: Regulatory, Integrative, and Comparative Physiology, published by the American Physiological Society. The article is online at http://bit.ly/13jYpED.

Methodology

For 12 weeks, the researchers fed a group of rats chow that reflected the Western diet, high in sugar and with nearly half its calories from fat. Another group of rats ate a healthy standard rat chow instead. Half of the animals in each group exercised five days a week, running intervals on a treadmill.

At the end of the 12 weeks, anesthetized animals erectile function was assessed by electrically stimulating the cavernosal nerve, which causes an increase in penile blood flow and produces an erection. The researchers also examined the rats coronary arteries to see how they too responded to agents that would relax them and maintain blood flow to the heart, an indicator of heart health.

Results

The findings showed that rats who ate the Western diet but stayed sedentary developed erectile dysfunction and poorly relaxing coronary arteries. However, those who ate the diet but exercised were able to stave off these problems.

Animals who ate the healthy chow were largely able to avoid both erectile dysfunction and coronary artery dysfunction.

Importance of the Findings

These findings may suggest that exercise could be a potent tool for fighting the adverse effects of the Western diet as long as the subjects remained very active over the course of consuming this type of diet, the authors say. Whether exercise would still be effective in reversing any vascular problems after a lifetime of consuming a Western diet is still unknown.

"The finding that exercise prevents Western diet-associated erectile dysfunction and coronary artery disease progression translates to an intensively active lifestyle throughout the duration of the junk food diet," the authors say. "It remains to be seen if a moderately active lifestyle, or an active lifestyle initiated after a prolonged duration of a sedentary lifestyle combined with a junk food diet is effective at reversing functional impairment."

Finding My Patient Voice My Adventures At Stanford Medicine X

This is the third of a series of blog posts in which I will recount my adventures at Stanfords Medicine X, Conference: An experience which has changed my life, and I will not soon forget. :-) 

Friday had come and gone with a massive amount of information, stories, and knew technologies featured in a relatively small amount of time. To be honest, Im still dissecting a lot of the information, and Im grateful for the live-streams, and videos, which I can always use as a reference.

Im also grateful for the dignity of finding ones bearings. Once we find those bearings, we regain a certain sense of confidence in ourselves, and situations, without which we may falter momentarily.  Finding my bearings came in the form of chit chatting throughout the day with others (encouraged by having to QR scan badges, and introduce ourselves), and by way of having dinner every evening with new friends. It was the validation I needed, really. A validation that comes from others who arent just similar to you, in their struggles, but who also laugh at your jokes, and are probably just as irreverent as you! I made some great friendships I wont soon forget. I felt human... an empowered adult, in her own right, without pretense, instead of an awkward child, sitting at the grown-up table.

Day 2:  Patient Dignity

Okay, so they didnt call it that. They just called it "Day 2." But "Day 2" was ALL about patient dignity, in my mind... or well, the indignities patients have had to suffer for the sake of getting much needed medical treatment for themselves, and their loved ones. 

Being a patient with chronic illness often leaves you feeling like cattle, simply going through a machine where you have no face, no back story... no humanity: just a being going through the system, the motions, the things put in place to achieve an outcome, a quota, or a financial goal, etc. And oftentimes, it matters not how well off you are, who you are, how famous you are... to be reduced to nothing. 

Meet some of the folks who fought back:

Michael Graves

Mr. Graves is an American architect, and Professor of Architecture at Princeton. You might not immediately know who he is, but hes more often known and identified for his creative designs for Target stores. I love Michael Graves. Heck, I have an alarm clock by him that I *adore.* Ive had that thing for 10 years. Its easy to program, very intuitive, and with two separate alarms, it has allowed me to keep ever changing, weird sleep schedules. Best of all, its beautiful to behold. 

But I digress... Michael Graves is an immensely talented human being. A designer, and an artist, in his own right. An optimist, and humorist. He was a person going about his life when chronic illness came striking at his door... In 2003, he became ill with a virus that spread to his spine, and left him paralyzed from the waist down. He recounts his initial symptoms, and his horrific experiences at the hospitals where he received emergency, and therapeutic services. It was his very traumatic, and dehumanizing experiences that gave him insight and a new passion to redesign the hospital room, and create bacterial resistant, patient-intuitive furniture... I could recount his story, but I dont think Id do it enough justice... so you owe yourself the 40 minutes or so to watch his video below, complete with pictures of some of these rooms, and the work hes doing.

Most notably, you can detect a hint of sadness in Graves account -- the sort of sadness of the self realization of not just his own vulnerability, of being at the mercy of someone else... and with little resources to make it through the day, but of others vulnerabilities, as well. At one point, Mr. Graves recounts how CBS was interviewing him when he was in one of the therapy rooms, and they asked him "Michael, what do you think of this room?" to which he replied "Its far too ugly for me to die here." 

Regina Holliday

I cant watch her story without crying. I just cant. Probably one of the most passionate speakers at Medicine X, Regina Holliday is just a beautiful soul. Regina is Artist in Residence for Stanford Medicine X, and she uses her paintings to express the reality of the health care system, the need for clarity, communication, and accessibility to data and patient records, as well as the injustices and indignities suffered by the patient... including her own grieving process, and her own indignities. Regina speaks creatively, and passionately about patients rights, and healthcare reform, and you can see she has invested much of herself in this fight through her national Walking Gallery project.

"You must look at the human face to determine what to do next ... "You must have patient participation in data and access, or you will never get the true story of care."

We must couple peoples data with their stories, and never forget, or give up.

Most telling is the story of Regina pleading with her husbands doctor for his data, wanting desperately to know what was wrong with him... but being belittled, and dehumanized for doing so. "I dont like people that research online ... Im the one with the medical degree." The picture she painted for that one event reflects a thousand emotions of one moment in time... a thousand emotions of desperation, trepidation, and ego. A thousand emotions we have probably felt, as patients, at one moment or another... but like scolded children, may feel a certain pang of shame to recount.

How do we change this reality? We write letters, we speak up, we stand up... we get engaged. We dont need partnership FOR, but WITH.

You must take us as we are... for we will never, ever keep quiet. We will blog it, twitter it, shout it from the rooftops... 

The Crux of Patient Centered Emerging Technologies

Interspersed with all these patient stories, Medicine X had also presented a diverse array of start ups, ideas, visions for the future, etc, for tackling confusing every day health tasks, or complex medical problems or processes. Whether it be shopping for your groceries (with USDA based guidelines, of course... something I will never use as a low carber), applications to help patients get in touch with clinicians at the wee hours of the morning, gadgets to help quantify ones quality of sleep (something I definitely want to use) or ones vitals during exercise, or applications to help simplify the potentially embarrassing scenarios of taking a urinary or fecal incontinence history... even online gaming communities to help scientists solve the puzzles of RNA sequence folding. Medicine X showcased it all.

They also discussed various obstacles to technology advancement, such as getting governments and current clinicians on board, the issues presented by HIPAA as well as personal privacy concerns, the realisticness of expectations on the patient (will many of us really want to self quantify to some of the levels seen, and how well will that go over with feelings of exhaustion, guilt, etc.), and of course... accountability. Getting patients to actually DO, and ACT upon the new information gained.

This last one is a big concern in patient advocacy, as well as in the medical industry... but it is where we can enter a sort of murky territory: how far do we help the patient, without patronizing them, or minimizing their disease? I was a bit annoyed to see that some of the innovators focused on obesity and diabetes (generalized for the audience, without explanation of types) as the example diseases for whatever initiative was presented. One of the presenters (on Day 3) went as far as calling type 2 diabetes the plague of humanity (never mind that he could of stood to lose about 40-50 lbs himself, and therefore heeded his own warnings.) 

I dont want to be a real negative bitch here... but theres really nothing more dehumanizing than someone calling your illness with which you have to live day in, and day out, as the plague of humanity. Whatever shall I do? Shall I wear a D scarlet letter on my sweater? Shall I hide in the closet? Shall I find ways to hide the fact that Polycystic Ovarian Syndrome keeps me very overweight, and that my weight yo-yos off and on, despite best efforts, and low carbing? I wonder... 

Among other pet peeves, one speaker simplified diabetes as something that they proved could be easily prevented -- even though the patients participating in his initiative already had pre-diabetes (and most likely a 40-50% beta cell loss), completely (of course, and probably out of ignorance) ignoring the whole questions of delaying versus preventing, and remission versus cure. All big topics I cant being to cover here... but suffice to say that despite lifestyle choices, many still go right on to developing diabetes, so lifestyle choices really only help us REDUCE risk of any illness; they have not, in our history as people, ever inoculated ANYONE against ANY illness... and then advocates like me have a very hard time bringing peace of mind, and healing, to people who were told they were in the clear. At the end of the day, we ALL need to have a healthier lifestyle -- not just diabetics. 

But, probably the worst offender, one innovator began his speech discussing type 1 diabetes... immediately jumping into scary statistics about diabetes (which vary greatly, depending on who you ask -- and were for type 2, not type 1) and intermixing those statistics with obesity statistics (which is really not 100% correlated to diabetes, otherwise all obese people would be diabetic, and is a disease in and of itself). To top off his confusing non sequiturs, he then went on to make jokes about why people in Great Britain were so overweight, and with diabetes, "so if youve ever had a British breakfast, youll understand," and ended his session of explaining why we need data, and more data... because we dont want to live in a world where obesity and diabetes are prevalent. Really? Honestly, its not that disease is something to be wanted... but the  benefit of having access to data is not really summed into a war against obesity and diabetes, it is summed into patient empowerment and action toward their conditions. THAT is what he should have said. Diabetes does not define me, but it is my REALITY, and as innovators, scientists, clinicians, persons engaged with patients... you had better damn well respect my reality... for when you dont do so, that is an indignity you heap upon me. 

You had better work on
your bedside manner NOW. :) 

And the funny thing of it is that I liked their initiatives! I really did! I liked their rationales, and their analogies... their applications. I *want* to support them... but they forgot my dignity. They forgot I am more than data. I am a FACE behind the data. 

So, at the end of Day 2 of Medicine X... I found my patient voice. And I thank them for that.

I found my voice, my bearings, and my dignity... and I got up, and I spoke out. Yes, on the microphone. Yes, I brought unwanted attention on myself. But, I thought "If I say nothing, now, I dont deserve to be a blogger... I dont deserve to claim I am angry about these things... I dont deserve to be an advocate... and I didnt start my blog to play nice." My apologies to those who paid to have me there.

The last few minutes of Day 2... I ended my day, with my knees shaking, my emotions on my sleeve, my heart rate through the roof, my courage being tested, and reminding the world, with a steady voice... that I am not a fat blob, having English breakfasts, who gave herself diabetes. I AM A HUMAN, AND I HAVE DIGNITY. I am NOT the plague of humanity.

I didnt expect people to get up and clap. I didnt expect all the attention, and comments, and support Ive gotten since. I only went there to learn, and listen... not to make myself "famous," somehow. (Or infamous, really...) But I just said what I had to say. Id probably do it again, too.

Is there some diabetes that is preventable? You know... I dont think anyone FULLY knows the answer to that. BUT SO WHAT? Does it mean I no longer deserve dignity if I do get it? If I "fail" to prevent it? Should I now be excommunicated from the population at large? Should I be made as an example to others? Should I be spoken of as a plague? As an unwanted thing in the world? 

Well, heres Michael Graves, and Regina Holliday... 

YOUR ARGUMENT IS INVALID. 

Beautiful women tend to be more fertile and happy

Beautiful women tend to be more fertile and happy? - Flawless woman rumored to have cortisol levels lower. So they tend to be happier and have good fertility, according to new research.

Beautiful woman is also synonymous with posture and ideal body weight. For example, levels of the amount of fat in the body fit, not too much or little.

Even so, it turned out pretty face does not mean free of disease. Because the immune system of the human body is not affected by a persons face.

"This is an exciting discovery, because a pretty face was associated with lower levels of stress hormones in women," said Dr. Markus Rantala, researchers from the University of Turku in Finland, as quoted by the Daily Mail.

A total of 52 young women aged 20 years involved in the study. Although beautiful woman reportedly tend to be more fertile and happy, strong immune system unfortunately does not include the advantage that they are.

According to researchers, there are several factors that make the immune system is not so strong beautiful women. However, more research needs to be done to make sure.

In addition to women, handsome men are also said to have a better quality of fertility and happier. They even proved to have a good immune system as well.

Ironically, the study conducted by experts from Spain just proves if a woman possessed of beauty can give bad impact on mens health.

Patient Navigators

On June 29, President Bush signed into law the Patient Navigator Outreach and Chronic Disease Prevention Act of 2005.

It sets aside $25 million through the year 2010 to be used on programs that will "recruit, assign, train, and employ patient navigators who have direct knowledge of the communities they serve" to:

• Act as a contact for healthcare services
  
• Involve community organizations to improve access to high quality healthcare services
  
• Involve eligible individuals in clinical trials
  
• Assist individuals in overcoming healthcare barriers
  
• Provide information about health insurance
  
• Seek out and provide services to underserved populations: uninsured, rural, at risk for or have chronic disease

This legislation should help people who may be at risk for, or have, diabetes to obtain healthcare services, especially if theyre in a medically underserved group or area.

________
For a summary of the legislation:
“Patient Navigator” Legislation Will Help Expand Access to Diabetes Prevention and Treatment, USA

For the text of the legislation:
Visit Congresss online legislation database and enter "Patient Navigator" in the search box.

Photo of President Bush signing the Patient Navigator Act thanks to White House News Releases