CJN.ORG | CLEVELAND JEWISH NEWS | 33
SEPTEMBER 9, 2016
HEALTH
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Never too little and never too late for exercise
T
DR. DANIEL FLEKSHER
he Summer Olympics have come and gone, it is already past Labor Day and cooler weather is certainly just around the corner, and yet, for many, those extra pounds we were planning to lose or that body we were hoping to achieve never quite came to fruition.
I consider this a “dangerous” time because I often hear patients start talking about “next year” in regard to getting the exercise they need. Some of it is motivation; a lot of it is the perception that proper exercise can only be done outdoors. Obviously, from my perspective as a doctor and a strong advocate for regular exercise, this perspective is troubling, and I have spent much time trying to find ways to motivate my patients as well as realistic means and planning to perform the right type and amount of exercise. Living in Cleveland, we can’t afford to be workout warriors for less than half the year, waiting for the right weather. Fortunately, the belief that exercise is only worthwhile if performed for hours
at a time is easily shattered. Numerous studies have been done and continue to be done looking at the minimum amount of time needed to see a health benefit from exercise. It seems that almost any amount of exercise will benefit one’s health with increased benefit coming from increased exercise. In general, I recommend getting into a routine of exercising regularly, experiencing the numerous health benefits including improved sleep and clearer cognition, far above and beyond any specific time prescriptions. More than anything, I try to find ways around the “all or nothing” personality by setting the bar low initially and letting the benefits of exercise sell themselves.
While I frequently hear that the weather is not conducive to walking or that going to the gym takes too much time, in reality, an invigorating exercise routine can be performed in one’s home without any equipment at all. There is now a plethora of apps that can be downloaded to one’s smartphone with exercise routines ranging from casual five-minute workouts to intense 25- to 30-minute challenges. Set goals and utilize rewards. Have a favorite TV show? Try to get your workout in before the show starts or choose a workout and do some short intense bursts during commercials and stretch and work on balance while the show is on. Finally, don’t ignore the core. The core muscles of the body refer to the musculature of the back, abdomen and pelvic region and are crucial to balance and stability. Back pain is one of the
most common reasons for acute doctor visits, but may be preventable simply by keeping the core strong. Exercises can be found online, but generally consist of crunches/sit-ups, back bends, and planks. So don’t wait for the “perfect” time. Make your time “perfect” by choosing to fill it with all of the things that are important to you. Start now, have fun, get a friend or significant other involved so you can motivate and feed off of each other. If you have any health conditions or are unsure whether or not you are healthy enough to start an exercise program, make sure to see your doctor first.
Dr. Daniel Fleksher is an internist with University Hospitals’ Beachwood Internal Medicine Associates. Follow Daniel @DrFleksher on
Lack of primary care physician can lead to nightmare DR. IRA TAUB itaub@chmca.org
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n my recurring nightmare, it is a beautiful August afternoon and I am seeing a well-dressed student who just wants to play freshman soccer. I sift through a short stack of photocopied medical records and spot a onepage referral, signed by someone I do not recognize, that says “irregular heart rhythm – needs clearance for sports.” After a few minutes spent interviewing and examining him, it is abundantly clear that nothing is wrong with his heart. I give him the good news and he thanks me graciously.
Then I turn to his mother and say, “I want to talk to you about the episode of chest tightness from a few weeks ago. This has nothing to do with his heart, but problems like asthma and anxiety are common at his age. Have you ever discussed that with his doctor?” She shakes her head. I also noticed that he winced when I touched his right shoulder. Does his doctor know that the injury from spring soccer still hurts? Blank stares from both of them. I sigh, print out a sports clearance letter (which he clutches like a prize) and wish him luck during the upcoming school year. I console myself with the thought that I can still pass along my concerns to his physician. As I sit down in front of his electronic medical record,
a little corner of the screen flashes “No PCP” – no primary care provider. There are many real-world versions of this child – a good student from a middleclass family who has not seen his own pediatrician in several years. He is basically healthy, and when the need arises for a sports physical, he simply goes to the local pharmacy chain. His parents can count on little or no wait time, a predictable cost for the visit and someone behind the desk who, although he doesn’t know him from a hole in the wall, wears a well-starched white coat. A 15-minute visit there is more than enough time to ask a few scripted questions, perform a cursory physical exam and refer to a specialist if anything seems out of line. In his case, the “irregular heart rhythm” which necessitates
an expensive and time-consuming visit to the pediatric cardiologist is actually a normal physical finding. In a good primary care, pediatrics or family medicine practice, the heart exam would not have been flagged as abnormal, and the more concerning issues, like an injury that will not heal, would likely have gotten appropriate attention. Why would a kid from a family that can afford nice clothes and fancy athletic shoes not see his regular doctor? A short study recently published in the journal JAMA Pediatrics shows that, while well over 90 percent of children have a primary care doctor, there are significant financial barriers to seeing that doctor that tend to hit middle-class families hardest. That study demonstrates that out-ofpocket annual costs for children with private health insurance have risen about 20 percent over the past 10 years. Many companies have moved their employees to high-deductible health plans, which have lower premiums but require more costs of care to be borne by the patient. In a recent survey administered by the American Academy of Pediatrics,
pediatricians report that 20 percent of families now forego preventive care visits and over 50 percent have reduced follow-up visits. It is easy to understand the appeal of a service that is quick, convenient and probably won’t cost more than $75. Good primary care, like good bridge design, is seldom noticed when it is functioning well. However, when care is fragmented and the continuity of the physician-patient relationship is disrupted, problems will eventually happen. Potentially life-threatening illnesses will be diagnosed later than they should be, perhaps too late. Children with developmental and educational delays will not receive the intervention that they need. Non-problems will prompt expensive and wasteful diagnostic testing, while real problems fester. When it comes to primary care, children deserve better than 15 minutes in the back of a drugstore.
Dr. Ira Taub is a pediatric cardiologist for Akron Children’s Hospital Heart Center who sees patients in multiple locations throughout Northeast Ohio.