Ever have so much to do, that you have actually felt paralyzed?  What about feeling so overwhelmed it was if you had the weight of the world on your shoulders?  Well, join the club.  This has been my reality for the past two months.  So please forgive the lack of blog posts. But...

                         I’m baaaack!

Not to say that I have any less to do (smile) but I was able to take a much needed vacation – the first of 2013!  I just returned last week, and really could use another vacation.  But I must say that taking 7 days away from my “normal” life has given me enough of an infusion to get back on the horse and to refocus.  So while I am hoping that another quick trip is in my near future, it is good to be back writing and fostering discussion.
      ___________________________________________________________________

I often wonder what people who are not in the medical field think about what healthcare providers do.  Is any thought given to the intense relationships, stressful scenarios, life and death situations, poor reimbursements, litigation risks, etc. that doctors face on a daily basis?  While some practices or practitioners may be less intense, the daily grind and incredible responsibility that comes with doctoring can be overwhelming.  Yet many patients who utilize the medical system are unaware of the pressures that doctors face.  Our healthcare system has voided the true doctor-patient relationship and even divorced users of the system from the costs associated with their care.  For example, when was the last time you paid a complete medical bill, versus just handing over the $30 co-pay?

Lack of personal responsibility for health care makes it easier for a parent to take their child to the emergency room for a cough instead of calling their pediatrician.  Or creates a scenario where women are inappropriately demanding MRIs for breast cancer screening instead of mammograms.  Who pays for this?  Not the individual – at least not directly.  But eventually we all do, via the rising healthcare costs, diminishing insurance coverage despite higher prices, or the ridiculous percentage of the US gross domestic product (17%) that spent on healthcare (see The Rundown on PBS NewHour), instead of other goods and services.

What happens when those who don’t qualify for Medicaid/Medicare develop a major medical problem and are uninsured or underinsured?  Unless they are independently wealthy, the costs of their medical care can be burdensome.  Healthcare expenditures are the #1 cause of bankruptcy in this nation.

The U.S. healthcare system needs an overhaul.  Anyone who says different, is making money off of the way things are currently run. The Affordable Care Act (ACA) is a first step towards trying to remedy a system that has been broken for decades.  Will not be the only step and will require some revisions and changes (gotta get that website working!!).  I am not savvy enough to know all of the ins-and-outs, but I think we all should at least educate ourselves about the basics of the ACA before pouting and turning our backs in defiance.  Here’s a link to a simple explanation of the ACA, but don’t let it end there.  

Be more invested in your personal health and the health of the nation – get involved!

Have you found ways to advocate for your health and the health of your family?  Please share your comments below.

                  ~One drop of knowledge can ripple through an entire community

Ok guys – time to get a little graphic here.  Let’s talk about sex.

Now that I’ve got your attention, the real conversation is about screening for prostate cancer, but sex and sexuality are very much related.  If you had a chance to read the article I referenced in Tuesday’s post entitled “Culture, Black Men, and Prostate Cancer: What Is Reality?” one of the reasons black men gave for NOT getting screened for prostate cancer is their concern about sexuality.

The prostate – pronounced prah-STATE, not prah-STRATE (y’all know what I’m talkin’ about) – is a small, walnut-shaped gland situated at the base of the bladder (see picture below).  It produces a milky fluid that helps protect the sperm during ejaculation; the prostatic fluid makes up about 75% of the volume of semen. The prostate has a few muscle fibers that also help force out the semen during ejaculation.  

Prostate cancer is the most common cancer in men, after skin cancer. Fortunately, it can be detected by screening exams. Some are embarrassed by the way the exam is done. 

 A single gloved finger inserted into the rectum enables a physician to feel the gland. It should be smooth, but occasionally a lump or a firm area is felt. Any abnormal areas are typically biopsied. A blood test evaluating prostate specific antigen (PSA) levels can be included as part of the exam.

Some men refuse to have a physician put a finger in their rectum.  They think it is demeaning or has some sort of sexual connotation.  If women felt that way about cancer screening, they would NEVER get a mammogram to detect breast cancer or a pap smear to look for cancer of the cervix (the opening to the uterus). Men – you just have to get over it!!  It’s a short exam that can save your life, particularly if you are at risk.  And guess what – black men have the HIGHEST risk for developing prostate cancer!!

The fear of “what happens if” takes over next.  What if cancer is found?  Will I be able to have sex? Fear of losing one’s ability to have sex, whether due to erectile dysfunction, incontinence, or performance anxiety is a HUGE deterrent to screening.  Although there may be some risks to sexual function after treatment of prostate cancer, every case and every man is different.  If you are not alive, you cannot have sex either. 

So men, if you are over age 50, or age 40 with a high risk of prostate cancer (black race and/or have a family history), PLEASE, talk to your doctor about prostate cancer screening this month!!!  It can save your (sex) LIFE!

                           ~One drop of knowledge can ripple through an entire community

A busy summer filled with meeting dozens of energetic young students – all eager to consider or continue their careers in medicine. I was so encouraged to see this group of stellar students from backgrounds traditionally underrepresented in medicine (URM), each with an incredible story. And even more encouraged to see the number of black men whose numbers in medicine have been dwindling over the last decade.

The 2010 Census shows that nearly 35% of the U.S. population is comprised of minorities or what I will refer to as URMs, since this subset of the population is projected to become the majority by 2042. Yet URMs only comprise 15% of the students in medical schools.  Workforce diversity in medicine is essential to providing quality healthcare to our diverse communities.

Already these young students are feeling the isolation of being one of a handful of URMs in the field; sometimes they are the only URM in the class, lab, etc.  And speaking from personal experience, the isolation can become more intense moving through training and particularly if one decides to remain in academia.

What can be done to support these students through their journey??

                                                   Mentoring is essential!!

Mentors come in all shapes , sizes and colors.  They can be in one’s chosen field or without. The important thing is that mentorship is a relationship – one that requires trust and confidence that the mentor has the mentee’s best interest at heart. 

This does not remove the responsibility of the mentee – the onus is on them to maintain the relationship and to follow through.  In my journey, I found that a key to developing direction is to mentor others, to model what it is you need!!  My hope is that the young folks I met this summer will remain in contact with the folks they have met this summer and find a good mentor who will help direct them.  But just as important, I hope they make time to reach out and mentor their peers or other youth who need a word of encouragement.

Who will you take time to motivate, challenge, and inspire today??

                                ~One drop of knowledge can ripple through an entire community

Let me apologize in advance for any typos; I am typing this blog on my iPhone while waiting to board a flight at Logan. So this one will be short - well, short for me.

This past Saturday I spoke at a prostate cancer symposium sponsored by Prostate Health Edication Network, Inc. (PHEN). This was intended to be a Fathers Day Rally - a time to celebrate and educate folks about an important aspect of men's health: cancer screening. The event was being held simultaneously at 7 locations across the country. A mammoth job coordinating, with experts from urology, medical oncology, radiation oncology, an even sexual health representing the various facets of men's genitourinary health. It was being held at black churches across the nation since, as I have discussed on the radio show and tweeted in he past, black men die of prostate cancer 2.5 times more than any other race/ethnic group in the US. An epidemic indeed!!

I was therefore a bit miffed by the lack of attendance at this well-coordinated event. Boston should have had a packed house!! Free medical education by expert clinicians AND lunch to boot!

So, where was everyone!?

I find it so intesting that Angelina Jolie writes one short essay and Michael Douglas makes one off-the-cuff statement and the media - and inevitably the nation as a whole - is abuzz with discussions and anecdotes about cancer and cancer care. some of what is being said is just not accurate!! How awesome would it be people would show as much interest in being properly educated by local experts willing to spend their Saturday mornings rallying around their community.

Will you commit to rallying around your health and the health of your family?

                               ~ One drop of knowledge can ripple through an entire community

This morning I awoke and decided to finally tackle the mound of medical receipts that were slowly piling up.  Although I have excellent health insurance that covers the majority of our expenditures, I elected to enroll in the flexible spending account (FSA) benefit offered by my hospital.  For those of you who are not aware, an FSA is a mechanism by which pre-tax dollars can be set aside for medical expenditures (see more info here).  This is a smart way to cover expenses you would have any way.   You determine the amount you want set aside and small disbursements are taken from your paycheck – before taxes are calculated. It is almost like getting a discount on co-pays since the dollars spent are not taxed.  If your company offers it and you are NOT taking advantage, you may want to consider enrolling next year.

Of course, there are some stipulations, such as the dreaded “Use it or Lose it” and the new government-mandated cap at $2500.  My family’s out-of-pocket medical expenses run in the thousands each year, so I rarely run the risk of losing money. However, if you are an individual or family with limited medical costs, it’s important to take time each year to calculate what your potential costs might be before selecting how much money you want to put into the account.  I particularly loved this benefit when my daughter needed braces; so don’t just pick a number – spend a little time thinking about what medical costs you might have the following year and plan accordingly.

One bummer is that the FSA no longer covers over the counter (OTC) meds.  This is horrible for those who suffer from chronic pain that is relieved by nonsteroidals (Advil or Aleve) or allergy sufferers whose meds are now OTC but cost ~$0.30-0.70 per pill. Another challenge occurs when your plan requires you to submit receipts.  

 Check out my many stacks  -- and this is just from 2 months!!  There are the never-ending copays, parking fees, prescriptions, etc. and every receipt must be accounted for.  This can be a bit cumbersome, but I figure if it’s going to save me $1,000 annually, I will keep doing the paper shuffle.  

Do not despair if your employer does not offer a FSA benefit. check with your local bank.  Some offer Health Savings Accounts  that can perform a similar function.   This may be a great way for folks who have a high-deductible insurance to stretch their healthcare dollar! 

                            ~One drop of knowledge can ripple through an entire community

The World Health Organization (WHO) defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”  I absolutely love this definition.  So often folks consider themselves “healthy” if they are not feeling sick!  This is one of the misperceptions that contributes to the lack of preventative care and health maintenance that leads to chronic illness, such as high cholesterol, heart disease, obesity and diabetes.  The WHO definition of health encourages everyone to focus on our well-being, which includes a whole host of factors, including mental health AND social status. 

On Sunday, May 5th, I again had the pleasure of chatting with Sister Andrena on Touch 106.1FM as part of our ongoing monthly health segment that is being supported by Sister Yvette as part of the Confirmation Hour.  This time, we discussed the impact finances have on our health.  Instead of just focusing on money, we began our discussion by exploring the concept of socioeconomic status (SES) and its impact on health. 

A report from Northwestern University’s Feinberg School of Medicine defines SES as “a measure of an individual’s or family’s economic and social position based on education, income and occupation.” (reference)  When evaluating health effects, these three basic components can be explored independently, or lumped together as a single measure of SES that typically is separated into three categories, high SES, middle SES, and low SES.  Studies have shown that low SES is directly correlated to poorer health outcomes.  The Feinberg report goes even further, and concludes that SES “is such a strong predictor of health that an assessment of the health of [a city] would be incomplete without consideration of the socioeconomic status of its residents.”

So, today I will comment on the first component of SES:
EDUCATION

Sister Andrena and I briefly discussed the lack of literacy in our nation. The 2003 National Assessment of Adult Literacy (NAAL) is the nation's most comprehensive measure of English literacy among American adults age 16 and older. More information about the assessment can be found here.

 The study shows that 43% of Americans have basic or below basic literacy rates. What does that mean?  It means that they may not be able to fill out a job application, read educational health brochures, or understand instructions on how to take their medicine.

In fact, Boston has a functional illiteracy rate of 24% - Detroit 50%. These are people who lack the skills to manage daily living or job related tasks that require reading skills beyond a basic level!!  If this doesn’t impact health, I am not sure what would. Medicine is frequently about paperwork – intake forms, prescriptions.  How do patients who are functionally illiterate handle this?  For the first time, the NAAL included a Health Literacy Assessment as part of their standard literacy assessment.  A snapshot is found below. 

The numbers are sobering. When one considers that an intermediate level of proficiency is required just to calculate a BMI (see BlogPost on Obesity), is there any wonder why health disparities exist?   Education is key.

                                 ~ One drop of knowledge can ripple through an entire community

Teen and childhood obesity rates are rising at alarming rates in the US. Between 16 and 33 percent of children and adolescents are obese. The health effects of obesity in these formative years can last throughout a lifetime.  Some of the common health conditions related to teen obesity are similar to problems seen in adults:

•   Type 2 diabetes
•   Asthma
•   Sleep problems, including sleep apnea
•   Bone problems due to an inability of the developing bones to support the excess weight
•   Hypertension (high blood pressure)
•   Heart disease

Additionally, teenage obesity can lead to psychological problems associated with negative body image and social issues associated with being treated as an outcast.  It is estimated that the societal costs of obesity are almost $100 billion PER YEAR.

The American Academy of Child and Adolescent Psychiatry (AACAP) has an excellent site that discusses what obesity and lists some of the causes (click here).  While poor eating habits and lack of exercise are critical factors, family history of obesity and medical illnesses also contribute.  Many children today are placed on a number of psychiatric medications (for example, antidepressants or medications for attention deficit hyperactive disorder) that can cause weight gain.  So it’s important to ensure that medical causes of obesity are ruled out.

Additionally, our children are under so much stress today.  This can be family stressors (divorce, job losses, frequent moves) or environmental stressors (school pressure, unsafe communities, bullying, etc.) Part of the strategy then for addressing and/or preventing teen obesity must include finding ways to identify and reduce teen stress (see this excerpt of an article from Johns Hopkins School of Public Health).

What Can Be Done to Prevent Teen Obesity

Once again I will point to folks to the WeCan! (Ways to Enhance Children’s Activity & Nutrition) website from the National Heart, Lung, and Blood Institute.  The site contains excellent background information about the childhood obesity public health crisis and strategies that you can implement in your household.  

Here are a few additional suggestions:

1. Get the entire family involved. Parents, grandparents, aunts/uncles MUST set the example. This includes making healthier food choices and finding ways to increase physical activity. Plan family activities that can get everyone moving.  A simple walk after dinner or if your neighborhood feels unsafe, how about turning on the radio and having a 20-minute dance party right at home!   

2. Limit sugar sweetened drinks. A recent article from Forbes notes that the U.S. ranks #3 among countries for the most deaths related to sugary drinks (see article). New York City Mayor Bloomberg understood this statistic and had great intentions, but each of us must take personal responsibility for what we put into our bodies. Please have your kids drink water.

3. Provide healthy snack choices at home.  Limit potato chips, cookies and other snacks that have high caloric content and low nutritional value.  Opt for nuts, popcorn, veggies, fresh or dried fruit or one of my favorites - peanut butter on celery.  Help your kids refuel and prevent over-eating at meal times by providing fun, great-looking, nutritious snacks.  

Each of us needs to get involved -- help prevent obesity in the next generation.

~One drop of knowledge can ripple through an entire community

During the month of March, we’ve discussed the importance of food choices and how much of it we are putting into our bodies.  But as you know, the other component of health and fitness is EXERCISE.  I have truly been avoiding this topic for a while. 

Exercise is the absolute bane of my existence.  

The sad part is I used to LOVE working out. As a child growing up on Long Island along with my 5 siblings, there were tons of kids in my neighborhood. Everyone loved playing outside. Could be a simple game of kickball, tag, or red-light-green-light (remember that game?). A park was within walking distance from my parent’s house where we would play handball, basketball, or go hiking in the woods.  Or maybe we just grabbed a jump rope, went for a bike ride, or broke out the roller skates. But kids spent time outside – exercising!!

In middle school, I joined the track team.  Not that I was a great runner, but it was the only sport I could join without needing to purchase equipment!!  Even ran for a year in high school, but then had to stop when we were required to purchase real track shoes – with 6 kids, our family had to make some sacrifices. The bottom line – exercise was part of my daily routine.

So what happened?!?  Well – LIFE!!  In my previous blog, I talked about how hectic my life has become and acknowledged the many of us find ourselves stretched between making ends meet and the day-to-day stuff of life.  But if we are honest with ourselves, each of us can find 30 minutes a day to do some form of physical activity.  Whether you decide on aerobic activity, stretching, weight lifting… the primary thing is to do something you like. 

There are so many benefits to regular physical activity (see a few listed here).  If you are new to exercise or beginning a new program, most experts agree that it’s best to start out slow and steady.  I’ve certainly tried to jump back in to a fitness program full steam after a long hiatus, but found that I burned out very quickly.  I have also spent hundreds of dollars on gym memberships or fitness DVDs that I seldom used.  Instead of spending money on a fitness program, my husband and I decided to go back to basics.  

There are so many simple exercises that can be done at home without equipment. The number one activity that almost anyone can do is walking!!!  Take a brisk walk around your block or through a nearby park.  Perhaps consider walking in the mall or around a high school track.  Neighborhood not safe? (Yes folks, there are some neighborhoods that might not be safe enough to walk around.) What about turning on the radio and dancing for 15-20 minutes?? Or how about some simple calisthenics: push-ups, sit-ups, jumping jacks, etc.  These can be done inside with very little space and no equipment.  Check out this site for a brief overview of stretches and exercises. In fact, calisthenics are a great way to use your body weight as resistance to help build fat-burning muscle.

In the same way that creating a food plan can help us maintain healthy eating habits, an exercise plan can help keep us motivated and get back to making movement part of our daily routine.  There are some excellent on-line food and fitness trackers that can make the job easier.  But just writing down a plan is a great start.  Bottom line – gotta get moving!



                        ~ One drop of knowledge can ripple through an entire community.

Each and every one of us could be in fantastic shape if we had the financial resources, and frankly, the time, to devote to health and nutrition.  But many of us schlepp through the day, working 8+ hours on a job that barely allows us to pay our bills, only to come home to cook, clean, care for children, work a second job, go to school…  need I go on?  

When I get home after working a full day, I am TIRED.  The mere thought of exercise, or even healthy cooking, can be a bit daunting.  Yet it is critically important to maintain our health through proper nutrition and exercise.

So what is the solution?!?   
                                           The key is planning ahead.

Remember when I talked about keeping a food diary (see Blog dated 3/16/13)? This serves more than one purpose. Not only does it help you keep track of what you are eating, it also helps you hone in on WHEN you are eating.  Are you a late-night snacker?  Get hungry mid-day?  Do you skip breakfast??  Knowing your “feeding schedule” will help you plan ways to ensure you have healthy options when it is time to grub.

Your body needs fuel in order to run effectively.  Each of us has an ideal caloric intake that is based on our age, gender, and body habitus.  This is called our basal metabolic rate – BMR (read more here). 

But note that severely restricting caloric intake, either by strict dieting or skipping meals can lower the metabolic rate as the body tries to conserve energy.  For those of us who have ever tried a very strict diet, ever wonder why it was so easy to gain that weight back?  It may be due to a slowed BMR.

Determine what your ideal caloric intake is and then plan accordingly.

Plan your meals – ALL of them, even your snacks for the day.  And when I say PLAN, I actually mean WRITE IT DOWN!!  Create a menu for the week, taking into consideration your daily schedule.  Check out this sample 1500 calorie meal plan.  

It helps for me (really my husband) to pack my lunch the night before; usually just leftovers from dinner, or a nice salad. This way I can just grab and go in the morning.  And I now always have breakfast; keeps me from making bad food choices when I am over hungry.

These are my tips for the day. Take time to develop your healthy eating plan.

                                      ~One drop of knowledge can ripple through an entire community 

I grew up in NY and remember those special days when we would head to the buffet after church.  Now this wasn’t a frequent occurrence; there were 8 of us in my family, so eating out was a luxury.  On special occasions, we would eat at a restaurant and very infrequently, a buffet. My mother had been studying the bible with a young single mom whom we took out for lunch.  Unfortunately, her son took the “all you can eat” slogan to a whole new level.  This young boy couldn’t have been more than 7 years old, but he ate more than the two grown men sitting next to him at that table combined!!  He paid for it, right there in the dining room.  It seemed like every bit of food he consumed, ended back up on the restaurant floor.  YUCK!! 

Now most grown folk have a bit more control than to eat until we regurgitate, but I guarantee the majority of people who attend a buffet eat more than they should and frequently feel “stuffed”.  Haven’t you heard people say “I’m gonna get my money’s worth.” When we lived in North Carolina, there was an establishment that we affectionately called the ‘golden trough’ –  yes, like a pig trough.  It was absolutely disgusting to see people waddle back and forth from the buffet with mounds and mounds of food that they would sit and indulge in.

All-you-can-eat establishments are by far the extreme.  My husband and I have sworn off most buffets for other reasons (ever wonder how many people wash their hands between using the restroom and touching serving utensils?), but occasionally we will attend a nice brunch.  But when we do, we pay close attention to portions.

So, what is a portion?!?!?  For those of us who eat or cook with processed foods, read the food label.  It’s important to remember that there is a difference between a portion and a serving size.  Did you know that there are 2.5 servings in a 20oz. bottle of soda?  So the nutritional information provided is for a single SERVING not for the portion you have purchased (and likely will consume in a single setting).  PAY ATTENTION TO LABELS.

While there are some tools that suggest using body parts as surrogate measuring tools, you have to be careful.  So 1 cup is the size of your fist??  Check out the size difference between my fist and that of Chef Jeff's below.  What serving size would you choose?  In my estimation, it’s better to use inanimate objects for the portion test; things whose size remains relatively stable. Check out this downloadable guide from LiveBetterAmerica.

The very BEST way to get an idea of what an appropriate portion is – start to measure your food! The best weight control I ever had was when I forced myself to keep a food diary and measure everything instead of assuming I knew what a portion was.  Truly was NOT HAPPY when I saw how small a serving of cereal was (sigh).  But it taught me a valuable lesson and showed me just how much I had been over-eating.

Try it, even if you do it for just a day.  You might be surprised!

Let us know what tools you use to manage your portions.

                                               ~One drop of knowledge can ripple through an entire community.