The Matadors and El Capitan

The Simple Tool of Assessment

Tomorrow marks another birthday. As I age, I recognize that good health is more and more important than anything. It’s everything.

We’ve all heard the “be proactive” call to action. In a sense, this is assessment from a bird’s eye view. We can assess our lifestyle by repeating the mantras we’ve all heard before: Follow a healthful diet. Get plenty of exercise. Channel our stress. Don’t smoke. Moderation is key. Be engaged, be mindful. Okay, okay….let’s say that we do all that. Are we where we should be in the preventative health maze?

When I conduct an on-line search for “How to Assess Your Health”, my computer screen urges me to take a health report card quiz so that I can determine what my risk factors might be and use my overall score to evaluate my health. Been there, done that. I’m healthy, according to my on-line test results. Is there anything else included in proposed self-diagnostic test kit? Yes. One more thing: I need to trace my family history, which will give me clues about what diseases I might be susceptible to. According to my on-line guides, I am now complete. I can feel assured that I can head off problems before they ever come to the surface.

I’m not a medical professional and sincerely don’t profess to be, but through a devastating illness which my husband is currently combating, I’ve learned that assessment is key to everything. The assessment that my husband’s doctors and nurses speak of is that of learning about your own norms by following a road map and listening to your body. So this year, I’m challenging myself to actually learn something about my own norms, to “look under the hood of my engine” so to speak. I’m making my first attempt to understand how I run.

Last week, I had my annual physical. Although I get blood work done every year or so, this was the first time I requested a hard copy of my lab results. I also requested that my physician walk me through the results. He consented, and was happy to empower me to learn about the person whom I think I’ve known all too well for many-a year now. This was a valuable lesson. Having seen the same physician for years, he told me how my norms have been running for everything from blood sugar to iron, from blood pressure to cholesterol, both good and bad. I asked about hemoglobin, thyroid, and Vitamin D. And the list didn’t stop there.

I feel as though for the very first time, I’ve practiced the best prevention method: understanding. Not only did my physician take the time to teach, I became an inquisitive student. I followed up his assessment by utilizing a primer I found on the New York Times which allows the user to look at blood counts and understand what they mean. This served as a great follow up to help me interpret my test results.

As we continue to drown in this information age, it’s easy to get lost between multiple health blogs, hundreds of internet sites, and countless medical apps. The daily bombardment of drug advertisements and the conflicting (but well intentioned) studies about medical tests can be confusing at best. Ironically, the very best person to advise us, our doctor, is now more likely to spend less time with each and every patient. This is especially why we all need to get acquainted with ourselves, know our baselines and understand what they mean. How else will we recognize a change of status if and when a change happens?

Of course, when you’re sick, knowledge is power. But I’ve just learned that knowledge is power when you’re healthy as well.

It’s Never too Late to Have oomph

I just watched “The Green Buddha” video again for the first time in few months, and am still struck with how my 81 year old mother, Jeanne Dowell, still skis, hikes and travels with great agility and flair. My friends still ask how she is able to stay that active. I always say it’s probably do to her genes, but also the fact that she has kept active all her life. There are scientific studies that back this up.

In a newly published book, “Treat Me, Not My Age”(Viking), Dr. Mark Lachs, director of geriatrics at the NewYork Presbyterian Healthcare System, discusses two major influences (among others) on how well older people are able to function.

The first, called physiologic reserve, refers to excess capacity in organs and biological systems. We’re given this reserve at birth, and it tends to decrease over time. In an interview, Dr. Lachs said that as cells deteriorate or die with advancing age, that excess is lost at different rates in different systems.

The effects can sneak up on a person, he said, because even when most of the excess capacity is gone, we may experience little or no decline in function. A secret of successful aging is to slow down the loss of physiologic reserve.

“You can lose up to 90 percent of the kidney function you had as a child and never experience any symptoms whatsoever related to kidney function failure,” Dr. Lachs said. Likewise, we are born with billions of brain cells we’ll never use, and many if not most of them can be lost or diseased before a person experiences undeniable cognitive deficits.

Muscle strength also declines with age, even in the absence of a muscular disease. Most people (bodybuilders excluded) achieve peak muscle strength between 20 and 30, with variations depending on the muscle group. After that, strength slowly declines, eventually resulting in telling symptoms of muscle weakness, like falling, and difficulty with essential daily tasks, like getting up from a chair or in and out of the tub.

Most otherwise healthy people do not become incapacitated by lost muscle strength until they are 80 or 90. But thanks to advances in medicine and overall living conditions, many more people are reaching those ages, Dr. Lachs writes: “Today millions of people have survived long enough to keep a date with immobility.”

The good news is that the age of immobility can be modified. As life expectancy rises and more people live to celebrate their 100th birthday, postponing the time when physical independence can no longer be maintained is a goal worth striving for.

Gerontologists have shown that the rate of decline “can be tweaked to your advantage by a variety of interventions, and it often doesn’t matter whether you’re 50 or 90 when you start tweaking,” Dr. Lachs said. “You just need to get started. The embers of disability begin smoldering long before you’re handed a walker.”

Lifestyle choices made in midlife can have a major impact on your functional ability late in life, he emphasized. If you begin a daily walking program at age 45, he said, you could delay immobility to 90 and beyond. If you become a couch potato at 45 and remain so, immobility can encroach as early as 60.

“It’s not like we’re prescribing chemotherapy, it’s walking,” Dr. Lachs said. “Even the smallest interventions can produce substantial benefits” and “significantly delay your date with disability.”

“It’s never too late for a course correction,” he said.

I certainly agree to Dr. Lachs. I have my own mother to observe as a living example. My mother no longer runs at 81, but she does walk a lot and keeps her active yoga practice. The whole idea here is to keep moving no matter how young or old you are.

Revealing German Study on Runners and Lifestyle

A German study recently published in the latest issue of Deutsches Arzteblatt International reveals a link between lifestyle and exercise.

Sports scientists have revealed that impairments to health and physical performance are not primarily a result of aging but of bad lifestyle habits and lack of exercise.

Dieter Leyk and his team analyzed the stamina of more than 600, 000 marathon and half marathon runners and asked them about their lifestyle habits and their health.

Marathon running is particularly suitable for studying because participants have to put in sufficient training hours for the competition, and the athletes accommodate this into their day accordingly.

The scientists found that unfavorable characteristics such as obesity, smoking, and lack of physical activity were rare in runners, and reductions in physical performance were more likely to be the result of biological aging processes.

These reductions make their presence felt only after the 54th year of life and are but slight. More than 25 per cent of 50- to 69-year-olds had taken up running only in the preceding 5 years and participated in a marathon nonetheless. You can see this connection highlighted in the short video on oomphtv.com about the 94 year old runner Jack Kirk-The Dipsea Demon.

Something to think about when making your New Year’s resolution.

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A Slight Shift Towards Prevention?

Many agree that the recent historic overhaul of the nation’s health care system does a lot of things, but it may be more challenging to understand how the legislation will make an impact on us as individuals. While some will not see much change in their coverage, others will be greatly affected, depending on if insurance is provided through work, or if one has pre-existing conditions. As the mother of two girls in college, the benefit that allows them to stay on my insurance past the age of twenty three was one element that I could deftly recall.

Most agree that the bill can be divided into two major categories: It tightens regulation of the insurance industry, and it expands access to care for the poor and for low-income working people. But what does this reform actually do for you, as a consumer, taxpayer, and a patient?

Like many of you, I tend to make annual appointments towards the end of a calendar year, hoping my deductible has been met. Thus, with the last few months of 2010 upon us, I had scheduled a few preventative screenings, even though my insurer’s coverage would be minimal at best as preventative services are minimally covered. Regardless, some of these exams are important. As a newly minted fifty year old, the annual ob/gyn appointment is a must for me. I added a trip to my opthymologist (it’s been way too long), along with a mammogram. The colonoscopy exam is one more thing that I’ve thought about, but haven’t scheduled. Three appointments is plenty for December, right?

But wait. Perhaps the newly passed insurance legislation affects me in some small way. And thus began a phone call to my health insurer to ask that very question. After enduring sixteen minutes on hold, I was politely greeted by a young sounding voice who was all too eager to answer my question of how the new law impacts my specific insurance plan.

Turns out that if I push off all of my appointments to January of 2011, my insurer will pick up a minimum of forty percent of preventative services, including a diabetes test, vision test, mammogram, pap smear, bone density test and colonoscopy. This came as a great surprise. The representative even offered me a prostate screening test. (Yes, I am female.) Sadly, I explained to her why I’d have to decline this one.

While forty percent of adult preventative services is no windfall, it is possibly enough motivation to get myself and others into a screening mode. This small flirtation with coverage inspired me to find out more about the bill. This is where it gets more complicated. If you’re curious about the particulars, I offer this useful breakdown of the major pieces of the legislation, provided by a website I highly recommend healthycal.org.

The following legislation is categorized by the dates on which they take effect:

Taking effect in 2010:
–Increase in Medicare prescription drug benefits. A one-time rebate of $250 for seniors who have exhausted the first part of their drug benefit and are paying 100 percent of the cost of their medication. The following year, low-income and middle-income seniors would begin getting a 50 percent discount on brand-name drugs.
–A high-risk insurance pool for people with pre-existing conditions who have been turned down for regular coverage. This pool would be available until 2014, when new regional insurance exchanges will be created and take over this function.
–Insurers prohibited from imposing lifetime limits on a person’s benefits.
–Insurers prohibited from rescinding coverage when a person becomes sick or disabled, except in cases of fraud.
–Insurers required to cover dependent children on a family policy until the age of 26.
–Subsidies for small business. Tax credits covering up to 35 percent of premiums for employers with 10 or fewer workers and average wages of $25,000 or less. This subsidy would climb to 50 percent of premium costs in 2014 but would phase out as a firm’s number of employees and average wages grows. The credit would end once a company had more than 25 workers or average wages of $50,000 or more.
–Tanning tax. A 10 percent tax on the purchase of indoor tanning services.

Taking effect in 2011:
–Insurers required to spend at least 80 percent of their revenue on medical claims.

Taking effect in 2013:
–Higher payments for doctors who treat the poor. The federal government would reimburse states that increase payments to primary care doctors in the Medicaid program to match what is paid under Medicare. These federal subsidies are intended to entice more doctors into the Medicaid program in advance of major expansions in enrollment in 2014. But the new subsidies to the states expire in 2015.
–A higher Medicare payroll tax rate, adjusted for the first time according to income. The rate would increase from the current flat 1.45 percent to 2.35 percent on income above $200,000 for individuals and $250,000 for couples. These groups would pay an additional 3.8 percent tax on capital gains, dividends, interest and other investment income.
–A new cap of $2,500 on the amount of money people can set aside tax-free to pay for medical expenses.

Taking effect in 2014:
–Individual mandate, requiring most people to buy insurance. People who did not comply would face penalties beginning at $95 a year or 1 percent of their income, whichever was higher. These penalties would rise over time.
–Insurance exchange. States or regions would organize new insurance marketplaces for people who could not find coverage in the private market. There would also be two national plans, including one non-profit. Insurers competing to win customers through the exchanges would have to justify rate increases and could be barred from the exchange if they raise rates excessively.
–Insurers prohibited from charging older people more than three times what they charge younger people.
–Insurers required to offer minimum benefits, to be determined later by the federal government. The minimum plan would cover 60 percent of the costs and limit out-of-pocket costs to consumers to about $6,000 annually for individuals and $12,000 for families.
–Subsidies for individuals. Tax credits would be available for low and moderate income people who buy through the exchange. People with incomes below about $33,000 for a family of four would pay 2 percent to 4 percent of their income in premiums, and health plans would be required to pay 94 percent of the cost of their benefits. These subsidies would continue at a lower level for families with incomes up to four times the poverty level, or about $88,000 for a family of four.
–Employer penalties. Employers would not be required to offer coverage to their employees, but if they did not and their workers used the exchange, employers with more than 50 employees would have to pay a fee of $2,000 for every worker who used the exchange, after the first 30 employees. Employers that do offer coverage would also have to pay a fee if their workers opted for insurance sold through the exchange.
–Expansion of Medicaid (Medi-Cal in California). This government-subsidized insurance would expand to cover everyone with incomes up to 133 percent of the poverty level, or about $29,000 for a family of four. Currently, families with children, the aged and disabled qualify for this system, and at lower income levels. The federal government would pay the full cost of this expansion until 2016, then phase down its contribution to 90 percent by 2020. The state would be responsible for the remainder of the cost.
–Higher reimbursement rates for states that cover children through the program for the working poor, known as Healthy Families in California. The federal government currently pays an average of 70 percent of the cost. This would increase to 93 percent.

Taking effect in 2018:
–A new tax on so-called “Cadillac” or expensive health insurance plans. This 40 percent tax would take effect on individual plans costing more than $10,200 a year and on family plans costing more than $27,500.

You may want to pick up the phone and call your insurer, and ask what, if any, changes will be implemented to your plan.
After all, it’s not like they’re going to tell us. We have to do the asking.

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