Brown & Toland's HealthLink | January 2005

LEARNING

Why Don’t Antibiotics Work Against the Common Cold?

by Peter Alperin, M.D., Medical Director Brown & Toland Medical Group

HealthLink Winter 2005

3 Diabetic Care Why your checkup should be head to toe.

4 Childhood Obesity Healthy habits help prevent serious medical and emotional problems.

7 Effective Asthma Control An assertive approach to this chronic disease can make a difference.

8 Top Performance We scored in the top 10 percent for quality among California medical groups.

10 Healthy Seniors A food pyramid just for you; plus new HMO options in 2005.

Brown & Toland’s HealthLink editor: Richard Angeloni, Corporate Director, Communications and Public Relations, Brown & Toland Medical Group, 415.972.4307. Brown & Toland’s HealthLink is published quarterly and printed in the United States.

Copyright 2005 by Health Ink & Vitality Communications, 780 Township Line Road, Yardley, PA 19067, 267.685.2800. Articles in this newsletter are written by professional journalists or physicians who strive to present reliable, up-to-date health information. Our articles are reviewed by medical professionals for accuracy and appropriateness. No magazine, however, can replace the care and advice of medical professionals, and readers are cautioned to seek such help for personal problems. Some images in this publication were provided by ©2005 PhotoDisc, Inc. PhotoDisc models used for illustrative purposes only. (105)

uring the winter season, fighting a cold the old-fashioned way — without the use of antibiotics — can be unappealing.

But the implications of improper antibiotic use can affect all of us, clinically and financially.

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Antibiotics are medicines that kill bacteria. They do this in a variety of ways, such as breaking down bacteria cell walls, shutting down protein synthesis and interfering with bacterial DNA replication. As we all know, when we have a bacterial infection, antibiotics are essential weapons in your doctor’s arsenal. The widespread use of antibiotics after World War II has led to significant improvements in our ability to treat a wide range of infections.

Common infections treated by antibiotics are community-acquired pneumonia, skin infections and urinary tract infections. Why? Because these infections are caused by bacteria.

On the other hand, antibiotics are useless

against the other main cause of infections: viruses.

Viruses are small bits of protein that are not quite “alive” and need to “live” in a host to survive. The common cold and flu are caused by viruses, as are most sore throats and many sinus infections. Since antibiotics work by killing bacteria, they are ineffective against viruses. There are anti-viral medicines for certain viral infections, but not for common viral infections.

This is where we get into trouble — we are a culture that relies on pills. We want a magic bullet to make our cold go away yesterday, when, in fact, this is just not possible. I know that many of us have had a cold, gone to the doctor, taken antibiotics, and then gotten better.

In addition to his role as medical director of Brown & Toland Medical Group, Peter E. Alperin, M.D., is in active practice at Mills-Peninsula Hospital and teaches as an assistant clinical professor of medicine at the University of California-San Francisco.

But many studies over the past decade have shown that antibiotics are of NO benefit in fighting viral infections. How about in bronchitis — better known as a chest cold? Nope. Most acute bronchitis is viral.

Bacteria can be cultured from the lungs, but it isn’t causing the problem. In fact, a local University of California–San Francisco researcher, Ralph Gonzales,

How to Communicate Better With Your Physician

by Tammy Fisher, M.P.H. Manager of Health and Quality Improvement Brown & Toland Medical Group ommunicating effecC tively with your physician plays an important role in the overall quality

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Brown & Toland’s HealthLink, Winter 2005

of care you receive. As patients, we expect quality care. Your physician, however, can deliver that care

M.D., has shown that antibiotics are of no benefit in fighting this disease.

The bigger issue is that overuse of antibiotics has many negative implications.

Overuse has led to rampant bacterial resistance, so many of our once powerful antibiotics no longer work when we — and at some point, you — really need them. There is always a risk of an adverse reaction to medication, and these reactions may be very serious.

The cost to our medical system is staggering, resulting from wasted medications and needless doctor visits.

The main reason we feel better after we take antibiotics for a viral cold is that we were getting better anyway. Most people wait a few days to go to the doctor. When they finally start the medicine, they were already on their way to recovery.

Remember what your grandmother said: “Here, dear, rest and have some of my chicken soup.” That, and time, is all that works. Until next time, stay healthy. ■

only if you provide the correct information.

Here are some simple steps you can follow to ensure that you and your doctor are communicating correctly.

Start the conversation with your physician by explaining the reasons for your visit. Are you visiting for a regular checkup?

Do you want to talk about www.brownandtoland.com

DIABETES CARE

Diabetics Must Take Care from Head to Toe Get your doctor to check your eyes and feet each year ost of us could use a head-to-toe checkup now and then.

But for people with diabetes, it is important to get a head and toe checkup every year.

In 2002, there were an estimated 18.2 million people in this country with diabetes. For them, eyes and feet can be potential trouble spots.

The American Diabetes Association (ADA) recommends an eye exam and a foot exam by a medical professional each year.

Why? Diabetes can cause eye problems that can lead to blindness if left untreated. And when diabetes causes poor circulation and nerve problems in the feet, sufferers can develop wounds that are difficult to heal.

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Eye to eye Diabetes is the leading cause of new cases of

some medication you’ve been taking? Be as specific as possible.

Also remember to tell the doctor if you have been taking over-thecounter medications or herbal remedies, or if you use alternative therapies.

Here are some other helpful hints.

Ask questions. Every question is important, www.brownandtoland.com

blindness among adults ages 20 to 74 years. Loss of vision can result from a condition known as diabetic retinopathy, in which the delicate blood vessels in the back of the eye swell and bleed. According to the National Diabetes Information Clearinghouse, diabetic retinopathy causes 12,000 to 24,000 new cases of blindness each year.

“There may be substantial damage before a person is aware of visual problems,’’ says Jeffrey Susman, M.D., of the University of Nebraska Medical Center. “So it is important to have regular eye exams whether you are having problems or not.’’

During the eye exam, an ophthalmologist can look into each eye and check along the inner back wall for damage. “It is something that, if we can catch it early on, we can do a great deal to help,’’ Dr. Susman says.

especially if your health depends on it.

Make a list of your concerns and take it with you on your visit.

Take notes! You can never remember everything your physician tells you.

If you have trouble communicating with your physician, take along a friend or

On your feet More than 60 percent of nontraumatic lowerlimb amputations occur among people with diabetes. According to the National Diabetes Information Clearinghouse, in 2000–2001, about 82,000 nontraumatic lower-limb amputations were performed annually among people with diabetes.

Why? Diabetes can

decrease blood flow and damage nerves in the extremities. Then common scrapes and bumps of everyday life can end up causing some serious problems.

“People can lose sensitivity so that they don’t know if they step on a needle or get a small stone imbedded in their foot,’’ says Christine Beebe, president of health care and

education for the ADA. The decrease in blood flow also impairs the healing process. This can lead to infection and, in the worst cases, amputation.

“Our feet are subjected to a tremendous amount of pressure and wear,’’ says Dr. Susman. “Foot care should be practiced each day in addition to being part of an annual checkup.” ■

Follow These Healthy “Footsteps” Check daily for calluses, cuts or cracks in the skin and look for signs of infection.

Use a mirror, if necessary, to look at the bottoms of your feet.

Keep feet clean. Do not use alcohol or hydrogen peroxide. They dry out skin.

Be careful when soaking feet in hot water. Nerve damage decreases sensitivity to temperature.

You could burn yourself.

Do not go barefoot outdoors. Indoors, wear slippers or sandals if you don’t want to wear shoes.

Make sure all footwear fits properly.

Do not cut calluses yourself. See your doctor, who also can check for ingrown toenails and other potential problems.

family member.

Have any changes occurred in your health? If so, remember to tell your doctor.

Listen to your physician.

Make sure you know the phone numbers and emergency contacts of your physician’s office.

Remember, effective communication can go a

long way to ensuring that you are receiving a correct diagnosis and quality care.

Good communication will keep you better informed, happier and healthier!

Your medical group, Brown & Toland, cares about the care we provide to you. Each year, we send satisfaction surveys to a group of our patients to inquire about their

satisfaction with the care they receive from their personal doctor and medical group. Should you receive a survey from us, we strongly encourage you to complete it so that we can continue to improve the care we provide to you.

Having satisfied patients is most important to us. ■

Brown & Toland’s HealthLink, Winter 2005

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HEALTHY DIET

How to Prevent

Childhood Obesity aby fat is something children are supposed to outgrow, not grow into. According to the American Academy of Pediatrics, one in five children in the United States is overweight or obese.

That’s twice as many overweight children as 20 years ago. Extra pounds and too-big waistlines have serious consequences for children, including low self-esteem, social problems and increased risk for chronic diseases.

Why are so many children too heavy? Experts say there is no single cause of childhood obesity. Genetics plays a role, but too little physical activity and poor food choices are more often the culprits.

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Too little activity Anyone up for a breathless game of tag, kick-the-can, hopscotch? Childhood should be filled with hours of energetic play, but children today are less active than past generations.

With more families living in cities, fewer children walk to school, and parents may keep children indoors more often out of concern for their safety. Adding to the problem, many schools have cut back on physical education programs. A national survey found that 20 percent of children ages 8 to 16 in the United States are vigorously active only twice a week or less.

Instead of getting the

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recommended 60 minutes of moderate activity a day, many children spend hours a day watching television or playing video and computer games.

Television troubles Almost half of all 8- to 16-year-olds watch three to five hours of television daily. Children who watch the most television are also the most likely to be obese.

A study published in the medical journal Pediatrics found that the rate of obesity rose 2 percent among 12- to 17-year-olds for every additional hour spent watching television. A study by the Harvard School of

Brown & Toland’s HealthLink, Winter 2005

Public Health revealed that the risk of being overweight is more than four times greater in children who watch more than five hours of television daily compared with those who watch two hours or less.

And having a television in the bedroom is associated with being overweight, even in very young children.

Food woes Our environment is loaded with food temptations.

High-calorie foods are available everywhere a child turns: in school vending machines, at fast-food restaurants, at corner convenience stores and even in kitchen cupboards at home.

Fruits and vegetables are easily ignored in favor of high-calorie snacks such as potato chips. Hectic schedules mean home-cooked family meals are often skipped and replaced with less nutritious grab-and-go foods eaten on the run.

Families eat more often at restaurants, where portion sizes have ballooned, providing too many calories and too much fat.

Why you should be concerned Being overweight or obese places a child at risk for many health problems. An obese child is more likely to develop type 2 diabetes, a condition that used to occur only in adults.

According to the National Institutes of Health, there has been an alarming increase in diabetes among obese children and adolescents recently.

Obese children often have high cholesterol and high blood pressure, increasing their risk for heart disease.

Children who are obese are more likely to have asthma and sleep apnea, a breathing problem that interrupts sleep, as well as bone and joint disorders.

And overweight children are more likely to become overweight adults.

The psychological stress that overweight children experience can be as

devastating as the medical problems. They are often teased by other children and as a result suffer poor self-image, low self-esteem and depression.

If you’re concerned If you’re concerned about your child’s weight, first talk to your pediatrician or family doctor. The doctor can determine whether your child is at a healthy weight by calculating body mass index (BMI). BMI, a ratio of weight to height, is considered the best method for evaluating weight in children. (To find an online BMI calculator, you can go to www.cdc.gov/ nccdphp/dnpa/bmi.) Your pediatrician will compare this number with a growth chart for children of your child’s same age and sex.

Your pediatrician can help you identify appropriate weight management goals for your child. Often, www.brownandtoland.com

What You Can Do

to Control Obesity

Helping your children to have a healthy body weight is a family affair. Instead of putting the focus on the overweight child, the whole family should get involved in making healthy changes in activity and eating habits, experts say. As a parent, you are the most significant role model for your children, so it’s important that you set an example with healthy lifestyle habits.

Get up and move Physical activity is a great way for you to spend quality time with your children.

Emphasize the fun of an activity, rather than skill.

Build family activity into every day, perhaps taking an after-dinner walk or bike ride or dancing to fast music in the living room.

ePocrates

Plan active family outings, such as hikes, ice-skating, swimming or Frisbee. Try a family vacation that emphasizes canoeing, bicycling, camping or swimming.

Provides Brown & Toland Doctors With On-the-Spot Drug Information

On birthdays, give presents that encourage activity, such as roller skates or a basketball.

the goal isn’t to lose weight, but to change behavior.

Restrictive diets are not recommended for overweight children. Rather, the goal is to help them maintain their weight as they grow taller.

Another approach is to help a child burn more calories by being more physically active. A registered dietitian can provide guidance on eating behaviors, meal planning and shopping.

If your child is at risk for medical problems, your doctor may recommend a formal weight management program staffed by a team of health professionals, such as a pediatrician, dietitian and psychologist.

Most important, let your children know that you love them, regardless of their weight. Give your children plenty of support and approval. Helping to build your children’s selfesteem is a great way to help them develop healthy new habits. ■ www.brownandtoland.com

TECHNOLOGY

Set guidelines for how long your children can watch television or play computer or video games.

Choose healthy foods Use the Food Guide Pyramid as a guide for food choices. Serve fruits, vegetables, whole grains, beans, and lean meats and poultry. Use low-fat or nonfat milk products (except for children younger than 2 years old).

Keep healthy snack foods in the house, such as fresh fruit, raisins, pretzels, string cheese and popcorn.

Have your children start the day with a good breakfast, such as whole-grain cereal with fruit and low-fat milk, whole-wheat toast with peanut butter, a fruit smoothie made with yogurt, or even leftover vegetable pizza.

Involve kids in shopping for and preparing meals.

Children like to eat what they’ve helped prepare.

Don’t forbid “bad” foods. Instead, teach your children about foods that can be eaten every day and those that should be eaten only now and then.

Foster self-esteem Children are more likely to make healthy changes when they feel good about themselves. Experts at the Baylor College of Medicine suggest that parents help their children find things to do that make them feel valuable. It might be community volunteer work, visiting the elderly neighbor down the street, helping Grandma clean her yard, or pursuing a special interest such as art or music. Point out your children’s strengths and help them develop their own interests and abilities.

hanks to new technology, Brown & Toland T providers are now able to make key decisions about prescription medication at the point of care and with the click of a button.

Brown & Toland is offering physicians free online access to the ePocrates RxOnline® drug database, a clinical database that compares the co-pay levels of prescription drugs and provides the most up-todate clinical information, such as dosing and drug interactions.

The technology will help health care professionals avoid medication errors and practice more efficiently. Physicians can access the popular database online via the medical www.brownandtoland.com group’s new Web site, www.brownandtoland.com.

Modeled after ePocrates’ widely used hand-held program, RxOnline operates from PC desktops and provides numerous advantages to physicians. These include the ability to look up dosing and prescribing information, check for adverse reactions or contraindications, and access drug pricing, clinical tables, and guidelines. In addition, RxOnline’s pill checker allows doctors to identify drugs based on their color, size and shape. It also features custom patient drug information sheets that physicians may print and give to patients. Most importantly, using the “Multi-Check” feature allows physicians to check the drug interactions of up to 32 medications simultaneously.

“Brown & Toland is committed to bringing our physicians the latest in technology to improve patient care,” says Peter Alperin, M.D., Brown & Toland medical director. “ePocrates is well-known in the industry for its quality drug information, and using ePocrates will improve patient safety.” ■ Brown & Toland’s HealthLink, Winter 2005

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HEALTHY DIET

A Guide to

Eating Through the Ages t every stage of life, healthful eating fuels fitness. We can benefit from a lifelong eating pattern that promotes health by adapting food choices and physical activity to match our personal needs.

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Yet statistics show not everyone is taking the steps necessary to achieve good health. A 2002 nationwide survey conducted by the American Dietetic Association (ADA) indicates that although 38 percent

“Nutrition is an important issue for people of all ages.”

— Polly A. Fitz, R.D., former president, ADA

of Americans say they have made significant changes in their eating habits over the last two years, 62 percent say they either know they should make changes but haven’t or simply don’t want to be bothered about good nutrition.

“Nutrition is an important issue for people of all ages,” says Polly A. Fitz, R.D., a past president of the ADA. “Eating for good health should start at an early age.

The sooner you develop healthful eating and physical activity habits, the longer, healthier, and perhaps more enjoyable your life may be.”

According to Ms. Fitz, everybody needs the same nutrients, just in different amounts. Age, gender and body size are among the

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reasons people’s nutrient needs differ.

According to Ms. Fitz, it’s sound advice for everyone to enjoy an eating plan in accordance with the Food Guide Pyramid. It’s based primarily on grain products, followed by vegetables and fruits, with moderate amounts of dairy products, lean meats, fish, poultry and legumes, and small amounts of fats, oils and sweets.

In addition to the Food Guide Pyramid recommendations, ADA offers the following advice:

children’s needs for complex carbohydrates, and soluble and insoluble fiber.

Physical activity, whether playing hopscotch or bicycling, and good nutrition are key to developing a healthful lifestyle.

Get enough folic acid before and during pregnancy. Eat a variety of folaterich foods to prevent neural tube birth defects. Foods rich in folate include citrus fruits and juices, dark green, leafy vegetables, wholegrain and fortified breads and cereals, and legumes (beans, peas and peanuts).

Maintain a healthy body weight. “Energy in” must balance “energy out.” Make a commitment to the following lifestyle behaviors: Enjoy a variety of foods in moderation, get regular physical activity, and personalize efforts to match your schedule, family situation and personal preferences.

Women

Children Kids should get a healthy start to the day. They need a good breakfast to get moving in the morning and to do their best in school and play.

Increase daily intake of fiber. Eating a variety of grains, fruits and vegetables is the best way to fill

Brown & Toland’s HealthLink, Winter 2005

Choose iron-rich foods, especially during childbearing years. Make daily selections from lean red meat, liver, pinto and kidney beans, spinach, enriched and whole-grain breads, cereals, rice and pasta.

Select low-fat dairy foods. Build and maintain strong bones throughout life by getting enough calcium. Include three to four daily servings of calciumrich foods such as nonfat or low-fat milk, yogurt, cheese, broccoli, sardines and collard greens to reduce the risk for osteoporosis.

Older adults Enjoy plenty of calciumrich foods. Foods such as milk, cheese and yogurt can slow the progression of bone loss.

Keep moving. Moderate physical activity helps keep blood pressure, cholesterol and blood sugar normal, strengthens muscles and bones, and helps digestion.

Keep drinking water.

Consume lots of fluids to prevent dehydration.

Enjoy a variety of foods.

Perk up the flavor of favorite foods by using herbs, spices and lemon juice to compensate for a diminished sense of taste or smell.

People of all ages Be realistic. Gradually make changes in lifestyle and eating habits. And, remember, nobody’s perfect. Allow for an occasional slip-up, but get back on track as soon as possible.

Be adventurous. Try new foods. By expanding choices, people are more likely to get sufficient quantities of the 40 essential nutrients found in foods, which may increase vitality and reduce risk for many diseases.

Be flexible. No need to worry about just one meal or one day. Balance meals and physical activity over several days.

Be sensible. Enjoy all foods; just don’t overdo it.

Be active. Walk the dog, don’t just watch the dog walk. ■ www.brownandtoland.com

ASTHMA CARE

How Effective Is Your Control of Asthma?

by Charles McDonald, M.D.

rin is a 32-year-old who has a history of frequent asthma symptoms. She relied on Primatene® mist for relief. Last year, Erin was seen in the emergency room once for uncontrolled asthma. She had stopped regular exercise, and had missed work at least once every two months.

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She also had trouble sleeping several times a month, and hesitated to go out with friends, because laughing caused her to have asthma. She ultimately saw a doctor who prescribed a steroid inhaler. She was also given a new inhaler for relief (albuterol).

“I love seeing patients like Erin, because I know that within a few weeks their lives can be turned around.”

— Charles McDonald, M.D.

Subsequently, Erin felt better. She had fewer attacks at night. She could exercise, but frequently had to stop because of asthma. She used her inhaler one to three times a day for symptom relief.

As she felt better, she began to decrease the use of her steroid inhaler. She just didn’t like the idea of taking steroids. Overall, Erin was content with her asthma control. It was, after all, much better than when she was just taking the Primatene® Mist. www.brownandtoland.com

What do you think of Erin’s treatment? Does her improvement mean that therapy was successful?

As an asthma specialist, I hear stories similar to Erin’s almost daily. Most asthmatics believe that some improvement with therapy is all they can expect, and therefore are content.

I love seeing patients like Erin, because I know that within a few weeks their lives can be turned around.

Appropriate asthma therapy is extremely effective.

Most people with asthma can have near total resolution, or at least dramatic improvement in symptoms.

As a result, their quality of life also improves. The good news is that therapy is relatively simple and safe.

There are two primary components of asthma.

The first is spasm of the muscles that surround the airway, resulting in narrowing of the airways, and leading to chest tightness, wheezing and shortness of breath. Short-term relief is accomplished by taking an inhaler, usually albuterol.

This class of drug, called a short-acting beta agonist, results in relaxation of the bronchial muscles and

improvement in breathing.

The second and more important aspect of asthma is inflammation. You can think of inflammation as being similar to a burn on your skin. There is swelling, increased secretions and irritation, with the skin perhaps sloughing off. A similar reaction occurs in the lung, and is present in asthmatics even when they feel well. Treatment of inflammation includes removal of environmental allergens, and treatment of sinus disease or gastroesophageal reflux. The hallmark of treatment, however, is low-dose inhaled steroids.

These steroids are not the same as those you hear about athletes using. Their

function is to decrease inflammation and return the lung to a more normal state. As a result, the airway becomes healthier and the tendency for muscle spasm decreases. So a person with well-controlled asthma can return to a more normal life. If a long-acting beta agonist (12 hours) is added to the inhaled steroid, there is even better control and stability. This is called dual therapy.

Erin saw an asthma specialist, who performed pulmonary function tests.

Although she felt well that day, her tests showed moderate obstruction. She was prescribed dual therapy and entered the free Brown & Toland Asthma Education program, where

Charles McDonald, M.D., has been specializing in pulmonary medicine since he graduated from medical school at the University of Utah in 1976. He practices at the California Pacific Medical Center.

asthma nurse practitioner Vickie Thun, R.N., F.N.P., spent time with her in oneon-one teaching sessions.

Within a week, Erin was back to bicycling, slept better, and in fact had improved overall energy (even mild active asthma is fatiguing). She used her albuterol only before exercise and, in fact, forgot to do that much of the time because she was having no significant symptoms. ■

TAKING CARE OF YOUR ASTHMA How about you? Is your asthma really well-controlled?

If you are experiencing asthma symptoms more than twice a week, waking up with asthma-like symptoms twice a month, or needing more than two inhalers a year for relief, you should consider a re-evaluation of your treatment regimen. The same is true if you hesitate to engage in physical activity because of asthma, or miss school, work or social engagements.

What can you do? First, make sure your doctor knows how much your asthma affects your life. When your doctor asks, “How has your asthma been?” don’t downplay your symptoms. Focus on your degree of control. If you are not on dual therapy, ask your doctor if this is right for you. If you continue to have active symptoms, consider a specialist evaluation. The majority of attacks and emergency room visits can be prevented; if you have been to the emergency room for asthma, this usually represents a failure of your treatment regimen and you should seek a specialist evaluation.

Be sure your sinus problems or reflux are well-controlled. Pay attention to environmental triggers. Is there a smoker in the house? Is there mold?

Finally, with active asthma, do not be content with your level of control.

Be sure you are closely monitoring your asthma and changing your regimen accordingly.

Brown & Toland’s HealthLink, Winter 2005

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CLINICAL CARE

Brown & Toland Medical Group Earns Top Quality Scores “Pay for Performance” initiative gives top rating rown & Toland Medical Group scored in the B top 10 percent among California medical groups in several categories for clinical care in 2003 in the annual “Pay for Performance” (P4P) initiative.

Brown & Toland scored in the 90th percentile for providing preventive care, such as breast cancer screening, cervical cancer screening, childhood immunizations, diabetes care and cholesterol management.

Additionally, the group scored in the 85th percentile for providing care for its asthma patients. The results for the 2003 initiative were released in fall 2004.

“We are obviously very pleased with our clinical results,” says Stan Padilla, M.D., vice president of medical services and chief medical officer. “We have placed an emphasis on providing the correct preventive measures at the right time, both to keep our patients healthy and reduce the overall cost of health care.”

P4P measures and rewards physician groups for chronic care management, investment and use of information technology, and the patient experience. Groups that score well on the initiative are awarded a bonus.

The initiative was first established in California in 2001 by the Integrated Healthcare Association (IHA) and six participating health plans.

Fiona Wilson, M.D., vice president for quality at Brown & Toland, notes that the medical group has a number of programs in P4P rewards physician place to ensure that its patients receive quality groups for chronic care. These include care management, use asthma and diabetes management programs, a of technology, and support report program patient experience. in which the medical group sends reports to primary care physicians to alert them that their patients are due for certain tests, and a $10 million information technology investment that will bring electronic medical record and practice management tools to select Brown & Toland physician offices.

“Health care is light years behind other industries in the application of technology,” says Dr. Wilson. “At Brown & Toland, we are making a concerted effort to close the gap and set the pace by using technology to improve the quality of care we provide to our patients, reduce costs, and give our physicians practice management tools that improve quality and efficiency.” ■

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Brown & Toland’s HealthLink, Winter 2005

MENTAL HEALTH

Are You Depressed, or Just Blue? nyone can feel down from time to time. But a lingering sense of sadness or depressed mood could indicate a more serious depression that won’t go away on its own, no matter how long you try to wait it out or pull yourself together.

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Doctors break clinical depression into five categories of mood disorder: major depression, chronic depression, adjustment disorder with depressed mood, depression caused by a medical condition or medication, and bipolar disorder.

Major depression is not caused by a life event, such as the death of a loved one.

It carries a high risk for suicide. Up to 10 percent of men and up to 20 percent of women may develop major depression at some point in life.

Chronic depression, also

called “dysthymia,” is a milder form of depression.

Doctors diagnose chronic depression when a depressed mood and at least two other symptoms of depression have been present nearly every day for two years.

Adjustment disorder with depressed mood is diagnosed when a stressful life event such as divorce or the loss of a job affects a person more than would be expected. It is diagnosed only within the first six months after the stressful event has occurred. A condition that lasts longer than

STAYING HEALTHY

Protect Yourself Against

Chlamydia hlamydia is the most C frequently reported bacterial sexually transmitted disease (STD) in the United States, according to the Centers for Disease Control and Prevention. Yet many people don’t know about it. For public health officials, stopping its spread is a priority. Fortunately, you can prevent this disease.

Many people with chlamydia don’t have symptoms.

Women especially are unlikely to have symptoms.

If you do, you may notice them as soon as one week after you are exposed to the disease. Symptoms include pain or burning when you urinate and a discharge from the vagina or penis.

Women may have abnormal

six months would be called a depressive disorder.

A medical condition or medication can cause a depressive mood disorder.

Treating the medical condition or stopping the medication eases the mood disorder, but psychiatric treatment is usually also needed.

Bipolar disorder, which once was called manicdepression, is a severe mental illness.

Getting help If you have thoughts of suicide, get help immediately.

Clinical depression may

vaginal bleeding, such as spotting between periods, or heavier periods.

Symptoms can be so mild that you don’t notice them.

Even so, the disease does not go away without treatment. If you don’t get treatment, you can have permanent damage, including pelvic inflammatory disease.

Consider these facts: About one-third of women who get chlamydia also get pelvic inflammatory disease (PID). PID is a serious infection of a woman’s www.brownandtoland.com

a prescription for antidepressants,” says Melodie Morgan-Minott, M.D., a psychiatrist in private practice in Kent, Ohio, and a distinguished fellow of the American Psychiatric Association.

When discussing your treatment plan with your mental health practitioner, ask about its risks and benefits, how you’ll know it’s working, how long it should take for your mood to change and the options and alternatives if your symptoms persist or worsen.

Minding your meds worsen over time if not treated. Still, most people with depression don’t get help, even though 80 percent of people who seek help do recover.

If your company offers an employee assistance program (EAP), you may want to go there first for help. Often, the EAP has a network of mental health

reproductive organs.

Each year, PID makes 100,000 women infertile.

Chlamydia can increase the risk of tubal (ectopic) pregnancy.

A baby born to a woman who has chlamydia may develop pneumonia or an eye infection.

Although it’s rare, men can develop complications. These include swelling in the scrotum and infertility.

You can get chlamydia by having sex with someone who has it. You increase your risk if you have sex without using a condom. www.brownandtoland.com

specialists to whom they can refer you. You also should see your primary care physician to make sure no underlying medical condition or medication side effect is causing your depression.

“If it’s determined you are depressed, your treatment plan is likely to include talk therapy and/or

Your risk is also higher if you have more than one partner. But you can protect yourself. If you have

If you are prescribed medication, be sure to take it as directed. Most people see an improvement in three to four weeks.

Don’t take other medications, especially overthe-counter or herbal medications, without first checking with your health care provider to see if they will interact with your antidepressant medication. To

sex, the best protection is a latex condom. Use a condom correctly each time you have sex.

prevent relapse, don’t stop taking your medication without your doctor’s knowledge.

If you don’t want to take antidepressants, clinical depression can be treated with talk therapy only.

“But because depression involves changes in brain

chemistry, it’s very difficult to recover with talk therapy alone, and it can take years to see a result,” says Dr. Morgan-Minott.

“Meanwhile, the quality and productivity of your life can be severely compromised while you’re waiting for therapy to kick in.” ■

Symptoms of Major Depression Major depression is the most severe form of depression. Symptoms may vary from person to person, but doctors diagnose major depression if at least five of these symptoms are present for at least two weeks: Feeling depressed most of the day, every day Loss of interest in daily activities Weight loss or weight gain when not trying to lose or gain weight; increase or decrease in appetite Difficulty sleeping or sleeping too much Acting agitated or at a slowed pace Fatigue Feeling worthless or guilty Difficulty concentrating or making decisions Recurrent thoughts of death or suicide

Having a screening test can help prevent the spread of chlamydia because it allows for prompt treatment. The CDC recommends a chlamydia test for any woman who answers “yes” to one of these questions: Are you under age 20 and sexually active?

Have you had a new sex partner within the past 90 days?

Have you had more than one sex partner within the past 90 days?

Have you not used a condom or diaphragm each time you had sex?

If you are infected, tell your partner. He or she needs a test, too.

Chlamydia is easy to treat.

One dose of an antibiotic can kill the bacteria.

Having a screening test can help prevent the spread of chlamydia because it allows for prompt treatment.

Tell your doctor if there is any chance you could be pregnant. Only some medicines are safe for pregnant women. ■

Brown & Toland’s HealthLink, Winter 2005

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HEALTHY SENIORS

Seniors’ Food Pyramid Stresses Vitamins

T

he food pyramid stands as the foundation of good eating. Designed by the U.S. Department of Agriculture more than a decade ago, the pyramid succinctly shows how much of each type of food we should eat to stay healthy

If money is a problem, here are some suggestions from the FDA: Buy low-cost foods such as dried beans and peas, rice and pasta.

Use coupons to save money on food.

Look for sales and store-brand foods, which often cost less.

Check with your religious community for free or lowcost meals.

Call a local senior citizen program about meal programs. You may be able to eat there or have meals brought to your home.

Find out if there is a Meals on Wheels program near you. (www.mowaa.org) Get food stamps. The food stamp office is listed under your county government in the phone book.

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But not everyone’s nutritional needs are identical. As we age, our bodies and metabolism change. Although older adults still need plenty of fruits and vegetables, whole grains and fiber, they need to add or subtract a few things from the food pyramid.

Older adults, says Althea Zanecosky, R.D., “have decreased taste and decreased absorption.” They need to make sure they get enough water and nutrients, even if they must take supplements to get them.

Researchers at Tufts University developed a modified version of the food pyramid (nutrition.tufts.edu/pdf/ pyramid.pdf ) for adults 70 and older. One added section of the pyramid for older adults is water. Although we all should drink eight glasses of water a day, it’s critical for older adults to factor in water because they have decreased kidney function and may not feel thirsty.

Yet they still need the same amount of water that they did when they “This pyramid heightens were younger, Ms. people’s awareness to Zanecosky says. focus more on fluids.”

Adequate water intake helps avoid constipa— Althea Zanecosky, R.D., nutritionist and spokesperson for the tion. Older adults’ American Dietetic Association digestive tracts don’t work as effectively as they once did, making constipation more likely. Also, many older adults have dental problems that keep them from eating as much fiber as they need. Fiber also helps prevent constipation.

“This pyramid heightens people’s awareness to focus more on fluids,” Ms. Zanecosky says.

Another addition to the pyramid is a flag at the top for vitamin and mineral supplements. The flag is a warning sign, not a mandate, about supplements. Older adults often don’t get enough calcium or vitamin D in their diets, and a lack of either of those can lead to bone loss and osteoporosis. Vitamin B12 is another nutrient that’s often found lacking in older adults. As the body ages, it becomes less able to absorb B12, so a supplement can help provide enough of this important nutrient, which is critical for nerve function.

Brown & Toland’s HealthLink, Winter 2005

Seniors should discuss the issue of supplements with their doctor. Older adults already purchase more supplements than other age groups. “They are led to believe that many of the conditions that come with aging can be fixed [with a supplement],” Ms. Zanecosky says. “That’s not true.”

But, she adds, recent research has shown that the aging process can be slowed with a good diet. “So we have a lot to benefit from eating well.”

Other aspects of nutrition for seniors The other parts of the modified food pyramid for seniors aren’t that much different from the general food pyramid. Older adults should consume a combined total of at least five fruits and vegetables a day. (Most Americans don’t even eat four servings of fruits and veggies a day.)

Fruits and vegetables are a real plus for seniors: They are lower in calories than other foods, yet high in nutrients, Ms. Zanecosky says. Fruit is much healthier for dessert than cookies or cake — yet many older adults indulge their sweet tooth with sugary treats rather than fresh fruit. Because the aging metabolism slows down as the years pass, even a few extra calories can add up at the waistline.

The dairy products section recommends that older adults consume three servings of milk, yogurt or cheese each day. “Even three is low,” Ms. Zanecosky says, because of the risk for osteoporosis.

When eating is a problem Some older adults have trouble getting adequate nutrition because of health problems or financial difficulties. If these are problems that affect you, there are steps you can take to ease them.

If you have trouble chewing, you might not be able to eat fresh fruits and vegetables, or meat. Instead, you might try the following ideas, from the Food and Drug Administration (FDA): Instead of fresh fruit, try fruit juices or canned fruits such as peaches or pears.

Instead of raw vegetables, try vegetable juices or cooked and mashed vegetables. www.brownandtoland.com

Tufts Food Guide Pyramid for Older Adults

Food Safety Tips From the FDA Refrigerate or freeze all perishable food.

Your refrigerator should be kept at 40 degrees, and your freezer at zero degrees.

Instead of a chunk of meat, try ground meat, or protein alternatives such as eggs, milk, cheese and yogurt.

Instead of sliced bread, try cooked cereals, rice and bread pudding.

If certain foods give you gas, making you uncomfortable, try these alternatives: Cream soups, pudding, yogurt and cheese can take the place of milk.

Green beans, carrots and potatoes can take the place of broccoli and cabbage.

Fruit juices and canned fruits can take the place of fresh fruit.

If you cannot shop for yourself or cook for yourself, you can make other arrangements. Some groceries will deliver food at no charge; others charge a fee. A family member, friend, or church or synagogue group may be able to help with shopping. A senior citizen program in your area may deliver meals. You can use the microwave to cook alreadyprepared meals. You might consider moving to a place where meals are prepared for you — either with a family member or a senior citizens’ community. Eating with other people also is a good way to encourage your appetite; eating alone can be lonely.

Food safety No matter what your age, it’s important to treat food carefully to avoid foodborne illness. As you age, your sense of taste or smell may not always be able to tell you when a food is no longer fit to eat — when milk has soured or meat has spoiled. Your senses may be affected by illness or by the medication that you take.

Your stomach also produces less acid. Stomach acid is a natural defense against bacteria you might have eaten.

Your immune system also may not be as strong as it once was, making it more difficult to fight bacteria. ■ www.brownandtoland.com

Never thaw foods at room temperature.

Instead, thaw them in the refrigerator, in cold water or in the microwave, and cook them immediately.

Wash your hands with soapy water before preparing food. Wash your hands, utensils, cutting boards and other work surfaces after they come in contact with raw meat and poultry.

Never leave perishable food out of the refrigerator for more than two hours. If the temperature in the room is over 90 degrees, the food shouldn’t be left out for more than one hour.

Thoroughly cook raw meat, poultry and fish.

Brown & Toland’s HealthLink, Winter 2005

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FOR MEDICARE BENEFICIARIES

HMO Options Increase for Medicare Beneficiaries in 2005

B

rown & Toland members will have more plans — with lower monthly premiums — to choose

Health Net rolls out lower premiums and lower co-pays and PacifiCare Health Systems enters the San Francisco market.

beneficiaries to access Brown & Toland’s wide network of physicians,” adds Mr. Fisher. “A beneficiary choosing either Health Net or PacifiCare’s Medicare product will also enjoy a long list of additional benefits and access to a number of San Francisco’s finest hospitals.” ■

from in the Medicare arena in January, as Health Net rolls out lower premiums and lower co-pays and PacifiCare Health Systems enters the San Francisco senior market for the first time since 2001.

Health Net’s filings for 2005, pending approval from the Centers for Medicare & Medicaid Services (CMS), indicate that the health plan will lower its premium and lower its specialist co-pay. Primary office co-pays will remain unchanged.

“Health Net will be aggressively promoting these changes with a multi-tiered advertising campaign including newspaper and outdoor ads,” says John Fisher, Brown & Toland marketing manager. “They are working hard to educate the community about the product and all it has to offer.”

Meanwhile, PacifiCare will re-enter the Medicare arena in San Francisco in 2005, with a lower monthly premium for its Secure Horizons product.

“This is yet another product that allows Medicare

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