Make Time for Your Health - Pay Yourself First

The COVID-19 pandemic has thrown many of us off our game. With gyms and dance studios closed, long lines at grocery stores and many other businesses either shuttered or their services altered, we've had to change our schedules, our lifestyles and our workout routines - and that's just for starters. 

Now the holidays are here. The holiday season is a busy time for all us. But don't let the pandemic or the holidays deprive you of your health and fitness.

Here are some tips to help you stay healthy:

• Make time to exercise each day. We know that daily exercise is good for the cardiovascular, respiratory and musculoskeletal systems. Exercise also helps to reduce insulin resistance (so it improves insulin sensitivity) which helps to control blood glucose levels. Exercise also helps to improve mood.

• Shop for healthy, whole foods (not processed) either in-person or by utilizing the many grocery shopping apps. Plan your meals and invest in a little extra time to cook nutritious meals.

• Stay away from foods with additives. Unhealthy foods that contain food additives such as artificial colors, flavors and preservatives are inflammatory. They are not good for our bodies and brains. 

• And don't forget your sleep. Health experts generally advise to get between 7 - 9 hours of sleep per night. This helps to strengthen our immune system, and reduce the stress hormone known as cortisol. Cortisol can wreak havoc on the body when levels are too high for too long.

Pay yourself first. Make time for daily exercise, healthy eating and ample sleep each night. Why? If you don't make time for your health today, there's a good chance you'll be forced to spend time with an illness (such as high blood pressure, type 2 diabetes or heart disease) tomorrow. 

Poorly Managed Medical Offices and their Staff Can Make You Sick: Common Errors in Outpatient Care

When most people think of medical mistakes, their minds immediately jump to dramatic life-threatening errors that can occur from emergency care by first responders out in the field, in emergency rooms, or on hospital floors. While errors can and do occur in any patient care environment, staff errors that happen in private medical offices and clinics can occur on a frequent basis, and sometimes continue for a long time with no supervision, correction or resolution by the physician in charge. And if there is not a nurse manager to oversee patient care and operations, many times the doctor in charge is not even aware that problems exist.

Sometimes mistakes are made by unlicensed personnel, while other times it's the doctor or another licensed provider. While to error is human as the famous quote goes, it's how errors are handled and resolved that makes the difference when caring for patients. If no attempt is made to correct errors that affected you or other patients - it's a red flag warning that you may want to consider changing healthcare providers.

While many outpatient providers consist of hard-working, dedicated staff that truly care about providing professional, timely, safe patient care and friendly services, sadly…some do not. 

Errors in outpatient care can and do severely impact patients’ lives in profound and negative ways, just as mistakes at a hospital or at the scene of a car accident can. From billing errors, to office procedural errors, to errors with hands-on patient care, all can make life miserable for you and other patients. If you were not in an ill state already, dealing with the fallout of others' mistakes, can truly make you sick. Just like the delicate flowers in the photo below, care must be taken to prevent harm to all patients, and especially those who are experiencing acute medical problems, are in delicate conditions, and difficult situations.

Delicate spring flowers by Carole Jakucs. May, 2017. Image subject to copyright.

Many times, the perpetrators of outpatient/ambulatory care errors continue their negligence and, or, sloppy care without appropriate intervention from management or the physician, due to a lack of having licensed staff (RNs or LVNs) to provide care and serve as a staff resource to supervise unlicensed staff, a lack of time for the physician to maintain proper oversight of unlicensed staff, or simply due to a laissez faire attitude on the part of the doctor(s), practice manager, and, or, clinic management.

Below are some common errors and unethical practices that occur in private medical offices, clinics, urgent care centers, dental offices, and surgery centers.

I've personally witnessed the errors below either as a patient, while accompanying loved ones and friends to appointments, or in my professional capacity as a registered nurse while working to help patients who were on the receiving end of irresponsible care.

Breaches of Patient Confidentiality by all Staff:

• Paper charts or test/lab results being left on counters and desktops for all to see.

• Electronic medical records: Patient charts not being exited and the staff member not logging off and out of the system when they leave their desk or the patient’s exam room; patient charts left up on the screen for anyone to see.

Billing Errors:

• Negligent billing staff that submits overcharges to patients’ insurance companies for services not received, or sending duplicate bills (charges for the same date of service twice or more).

• Negligent billing staff that tells patients’ insurance companies they have another insurance provider (in addition to them) when in fact, they do not. This causes an alert in the insurance company’s data base system to place this person’s medical insurance on hold, as the company then seeks out information on who the other company is – when in fact, the patient has no other insurance. This causes a delay in all subsequent bills being paid, requires patients to make multiple phone calls to straighten out the problem with their insurance company, and alert the doctor’s billing staff to their mistake.

Calling Wrong Numbers or Not Calling at All:

• Negligent office staff that call the wrong number, leave a phone message on the wrong voicemail of with someone other than the patient, or worse yet, saying and charting that they spoke to a patient when they did not - engaging in outright lies.These phone calls can pertain important issues such as, but not limited to, confirming patients’ future appointments, advising patients they need a follow up visit with the physician, or a new diagnostic test is needed (MRI, lab test, etc.)

Unlicensed staff practicing beyond the scope of their training and the law, such as when:

• When unlicensed staff are trained to conduct invasive procedures on patients that are beyond the scope of their practice, or dispense medications that are not properly labeled according the state medical board’s requirements.

• Unlicensed staff such as medical office workers and medical assistants providing telephone triage or in-person triage, dispensing medical or nursing advice without the license, education, or training to do so. This is not legal and just plain wrong.

Poor Practices:

• Medical offices and clinics that have no process in place for double checks to be done for staff for fellow staffers, prior to injectable medications being given to patients.

• Medications left unattended in exam rooms.

• Inaccurate blood pressure readings - and usually they're false highs. This can lead to a mistaken diagnosis of high blood pressure (hypertension/HTN) and prescriptions you don't need, all due to the fact that the person tasked with taking your blood pressure is doing it WRONG.

Problems with Prescribed Medications: 

• Concerns about adverse drug reactions (side effects) from a medication you've been prescribed are ignored by the prescriber (MD, PA, NP).

• The prescribing of medications that cause known side effects such as liver damage, kidney damage, muscle damage, B-12 deficiency, and magnesium deficiency, to name a few; and no follow up lab work is done to monitor the patient for the development of these complications. Some common drug culprits are proton pump inhibitors, statins, oral antidiabetics, and blood pressure medications. 

• The prescribing of medications YOU DON'T NEED or, the prescribing of too high a dose, or for too long of a time period. 

Other Lapses in Care:

• Staff that call in (or fax) the wrong prescription drug to a pharmacy for a patient, and, or the wrong dose. 

• When physicians refer to their assistants as “nurses” when they are not licensed nurses such as an RN or LVN. Thus, patients think they are speaking to a licensed nurse such as, an RN or LVN, and if they are not, it's misleading. *In some states, is illegal to refer to someone as a “nurse” when they are not.

• Medical offices and urgent care centers that don't have licensed RNs or LVNs on staff. While it may not be financially feasible for every medical practice and clinic to have licensed staff present, this can be problematic, as unless the physician(s) in that practice has a tremendous amount of time to supervise their staff, (which most do not), staff errors and bad practices can go on forever, unchecked by anyone. *Even licensed staff members need a resource person, peer consultation, peer-review, and a supervisor to help maintain standards and high-quality patient care.

• Clinics, offices, or ambulatory surgery centers that could benefit from an outside resource reviewing the quality of the patient care they provide, policies, and procedures, but have not spent the time or resources to do so. One example of a commitment to quality is when organizations seek accreditation from a third-party such as a nationally recognized accreditation organization.

• When concerns about the care you received, a problem you've encountered with a staff member or, a mistake you've been dealt due to an office procedure are ignored; your request to speak with the manager goes nowhere, no one calls you back, no one take responsibility for the error, no one apologizes for the incident, and, or you are not given a chance to speak a supervisor (or there is no designated supervisor) who has the power to resolve the situation for you and ensure that it won't happen again.

Coming soon: How patients can avoid some of the common errors that occur in outpatient care, and inaccurate blood pressure readings.

Five Ways to Help Your Heart

February is “American Heart Month." While February is also the month we celebrate Valentine's Day, think of flowers and all things dear to our heart; it's also a good time reflect on the health of our heart. Heart Disease is the number one killer of both men and women in the United States. While any disease and its causes can be complex, here are five things you can do that may help to reduce your risk of developing heart disease. 

Roses by Carole Jakucs, 2014. San Marino, CA. Image subject to copyright.

• Exercise at least 30 minutes daily most days of the week. Consult with your doctor or health care provider before beginning any exercise program.
• If you smoke, STOP! Smoking damages blood vessels which can lead to high blood pressure, strokes, heart attacks and kidney disease in addition to raising your risk of developing Cancer and COPD.  
• Eat a healthy diet that includes plenty of fresh organic produce (vegetables and fruits), whole grains and lean protein. Follow a diet that is low in saturated and trans fats (trans fats are also known as "partially hydrogenated oils") salt and sugar (including high fructose corn syrup). Try to incorporate healthy monounsaturated fats in your diet such as olive oil. Following a Mediterranean diet is generally considered a heart healthy diet.
• Monitor your blood pressure to keep it within the normal range which is generally considered 120/80 or lower. High blood pressure damages blood vessels setting the stage for heart attacks, strokes and kidney disease. Consuming a healthy diet that is low is salt (sodium) and contains appropriate amounts of potassium, calcium, magnesium and fiber also helps to control blood pressure. Incorporating these into your diet is part of what's known as the DASH Diet (Dietary Approaches to Stopping Hypertension).
• Maintain a healthy weight for your height and frame size. Obesity raises your risk of a wide range of illnesses and diseases.

*Contact your physician or health care provider for any questions or concerns you may have about your health.

Fat and Fit is a Fantasy - Five Ways to Control Your Weight

Reports over the last few years have lead us to believe that carrying some extra weight was OK for some people if they still had normal readings for blood pressure, blood glucose levels and cholesterol.  This has now been proven to be wrong!

New medical research from Toronto revealed this week confirms that extra weight is indeed a threat to your health even if initially everything appears to be fine. Eventually, the extra weight can wreak havoc on your body and raise your risk for premature death. 

Don't let the sunset on your diet and exercise plan for any reason. Whether it's a holiday(s) or you're on vacation, try to resist the onslaught of temptations to overeat and and/or miss an exercise session. Here are five ways to help you control your weight.

 Sunset at El Porto, Manhattan Beach, CA by Carole Jakucs, 2013. Image subject to copyright.

1. Pay yourself first: No matter what you have scheduled, make time to exercise. If you usually exercise five days per week, try to maintain that schedule. You'll burn calories at your normal rate which will help prevent packing on pounds (as long as you don't start over eating). If you're on vacation, be sure to bring a good pair of walking shoes. If you're working long hours, be creative and look for a blocks of time to exercise.
2. Drink plenty of water throughout the day and before and during special events such as parties. Doing so will help keep you full and prevent you from overeating. (Add a twist of lemon or lime for a refreshing taste).
3. Don’t drink alcohol: Alcohol is loaded with empty calories (it has no nutritional value). The extra calories end up becoming extra fat on your body. If you decide to imbibe remember to drink in moderation and never drink and drive (don’t let others drink and drive either).
4. Eat plenty of fresh fruits, vegetables, lean proteins and whole grains each day to help keep your blood sugar and energy levels stable.  These foods also have a high nutritional value so are good for your health and help keep you slim. When you need fat or oil, use Omega 3 Fatty Acids on your foods when cooking and at the table such as olive oil and canola oil. These contain heart and brain healthy fats.  
5. Don't eat junk food. If you eliminate fatty chips, cookies, cakes, pies and fast foods, you'll help keep your overall fat and sugar intake in check. Remember that many commercially prepared foods contain high fructose corn syrup and trans fats, both of which are extremely unhealthy and contribute to the development of obesity, cardiovascular disease and Type II Diabetes. If you're baking for a holiday or special occasion, try using half the sugar in your recipes and replace shortening/butter with canola oil. 

High Salt Intake and the Development of Autoimmune Disease

Here is another good reason ditch your high salt diet and reduce your salt (sodium chloride) intake: Recent research has pointed to a high salt intake as a possible risk factor for developing autoimmune disease. The research indicates that while genetics may play a role to predispose someone to developing autoimmune disease, a high salt diet may pull the trigger (so to speak) and push their body over the edge to develop actual disease. 

Many people consume too much salt in their diet. However, salt is an important electrolyte in the human body; too much (hypernatremia) or, too little (hyponatremia) can make you ill and in extreme cases, can cause death. 

(Photo Attribution: Ketchupfreak88 at the German language Wikipedia)

The general recommendation for salt intake is:  Less than 2300 mg per day for healthy adults and much less for people with certain health conditions at: Less than 1500 mg per day.  A high sodium diet is also one of the risk factors for the development of high blood pressure (hypertension).

You can lower your sodium intake by:

• Limit your consumption of sodas, fast food, packaged foods, canned foods, junk foods, condiments and use less salt when you cook.
• Learn to read your labels, as there is an abundance of sodium in many packaged foods.
• Choose lower sodium versions of packaged foods, but beware, as sometimes, these items have extra added fats and sugars to make the food taste good (given that it has less salt).
• Use fresh or organic herbs to flavor your foods to enhance the taste, give your foods more flavor, and lessen the need for added salt.