HEALTHY CHOICES
For Colds and Flu,
Pamper Yourself ere it comes again, the dreaded cold and flu season. Chances . are you’ve been dealing with these common illnesses throughout your life. So why should you deal with them any differently now? Because as you get older, your body has a harder time fighting off infection. Once you have a cold or the flu, there is a greater chance that it will develop into a more serious illness. Also, if you have a chronic illness such as emphysema or diabetes, flu can be very serious or even life-threatening.
H HealthLink Fall/Winter 2005
4 Asthma Treatment for children is better than ever. 6 Diabetes How to help someone you love stay healthy. 7 Nutrition The challenge of eating well during this festive season. 10 Your Money How to save on your medical bills.
For these reasons, you need to take extra steps to protect yourself against infection. You also need to recognize flu-related symptoms and learn when it’s time to see your doctor. By doing so, you can prevent your cold or flu from turning into a more serious illness.
Brown & Toland’s HealthLink editor: Richard Angeloni, Associate Vice President, Public Relations and Communications, 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 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. (405)
A cold vs. the flu The following are symptoms of both colds and flu: Sore throat Runny nose and sneezing Headache Overall sick feeling Low-grade fever Because the flu is more likely than a cold to lead to
pneumonia, you need to know which you have. A cold usually does not cause high fever, while the flu may. A fever above 101 degrees is usually considered high. Also, a stuffy nose is probably a sign of a cold, rather than the flu. Overall, cold symptoms are milder and do not last as long as flu symptoms.
Cozy up to self-care Because colds and flu are caused by viruses, there is no cure. You just have to let them run their course. Pamper yourself by resting and drinking plenty of fluids. Talk with your doctor about over-the-counter medicines that may help ease your symptoms.
MENTAL HEALTH
Overcome the Holiday Blues by Peter Alperin, M.D. Medical Director, Brown & Toland Medical Group
“Oft expectation fails, and most oft there where most it promises.” — William Shakespeare, Much Ado About Nothing While Shakespeare wasn’t specifically talking about depression, his admonition applies to the holidays and the unfortunate stress and depression that often accompany them. For most, the season is a time for family and celebration, but for some, it is a time of sadness and loneliness.
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(CDC) recommends that the following people get an annual flu shot: anyone age 50 or older; residents of nursing homes and long-term care facilities; adults and children older than 6 months who have chronic heart or lung conditions; adults and children older than 6 months who have kidney disease, a weakened immune system, or metabolic diseases like diabetes; and women who will be more than three months pregnant during flu season. People who have a severe allergy to eggs should not get a flu shot. Pneumococcal pneumonia vaccine. One of the most serious complications of the flu is pneumonia. You can protect yourself against
the most common kind of pneumonia (pneumococcal) by getting a shot. Most people need the pneumonia shot only once in their lifetime. If you’re not sure if you’ve received this shot, ask your doctor. The CDC recommends a pneumococcal vaccine for anyone age 65 or older and anyone who has a chronic disease or has a weakened immune system. No vaccination can prevent the common cold. The best way to prevent one is to wash your hands often and avoid sharing cups, utensils and towels with people who are sick. It is also helpful to keep your body and mind in good shape by eating a healthy diet, managing your stress and getting enough sleep. ■
giving lots of gifts never changes anything, and may lead to resentment when the gesture is unrequited. Take a measured approach. A free Saturday in December is a ridiculous notion for many. This can be destructive. You don’t have to go to every party or function. Realize that the past isn’t the future. The holidays will never be the way they were when you were a child. The only constant in life is that life is constantly changing. Contribute to others. Discover the real meaning of the holiday season and donate your time for those less fortunate. Do something for yourself. Give yourself a gift. You are not being selfish when you take time to do something that you enjoy. Simple steps can greatly mitigate the holiday blues. In particular, we should all pay special attention to friends and family who may be particularly at risk. Take time to talk and give them the support they may be unwilling to seek for themselves. Nothing could be a greater gift. Until next time, stay healthy. ■
Peter Alperin, M.D., a medical director at Brown & Toland Medical Group, also is in active practice at Mills–Peninsula Hospital and is an assistant clinical professor of medicine at the University of California–San Francisco.
you have any of these symptoms or if any symptoms last longer than usual for a common cold or the flu. The earlier you catch problems, the more easily they can be treated.
Know when to see your doctor The following symptoms may indicate a problem more serious than a common cold or the flu: Chest pain Wheezing A high fever Frequent colds Shortness of breath
that comes with little or no exertion Phlegm or mucus produced for two or more weeks A cough that lasts two weeks or produces blood A persistent cough with a fever, for instance, could be a sign of pneumonia. See your doctor right away if
This seasonal depression, called the “holiday blues” by some, has many causes. Unrealistic expectations, added stress and responsibility, and financial pressures all play a part. In addition, the decreased daylight of the winter may add to the problem for those susceptible to seasonal affective disorder. Often the symptoms go beyond the blues. Headaches, difficulty sleeping, overeating and excessive alcohol intake are all possible indicators of underlying depression. Friends and family members may note irritability, tardiness and work performance issues, which may also emerge as subtle symptoms of depression. So what can we do to keep the holidays from reading like a blues song? Set reasonable expectations. Nothing is more important than this. Just because it is the holiday season doesn’t mean that you will suddenly get along with your brother. Understand your triggers and take steps to avoid these stressful situations. Remember that www.brownandtoland.com
Think prevention The following vaccinations can protect you from the flu and pneumonia. Influenza vaccine. You can protect yourself from the flu by getting a flu shot. It can be helpful if the people you spend time with also get flu shots. Because strains of the virus that causes the flu change each year, you’ll need to get a flu shot each year. It’s best to get the flu shot in the fall before the flu season starts. The Centers for Disease Control and Prevention
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ASTHMA CARE
.Learning to Live With
Childhood Asthma aureen is a registered nurse, but when her youngest sson, Joseph, started having coughing episodes, she became worried. “We would notice him coughing when he was running around after his older brother,” she says. The episodes would start slowly, but within 24 hours Joseph would have a continuous cough.
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Colds also caused problems. “Sometimes he’d cough so much, he could barely talk,” Maureen recalls. When Joseph was 2 years old, he was diagnosed with asthma. Over the next two years, his parents rushed him to the doctor’s office several times because of severe attacks.
With today’s treatments, asthma doesn’t have to stop kids from being kids.
“When Joe’s doctor told us he would be able to do anything, I found it hard to believe. Now that I’ve seen him respond to the treatments, it’s clear he can play any sport he wants.” — John, parent of a child with asthma
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Asthma in the family Joseph’s father, John, who works for the state transportation department, also had asthma as a child. He played hockey and still remembers how hard it was to keep up with the other kids. He felt terrible when he found out that his son had asthma. “I’ve had a couple of asthma attacks,” John says. “I know how scary they are. It was troubling to think that Joe would have to go through that, too.” Asthma is a chronic lung condition. It causes the airways to become swollen and narrowed, which interferes with the passage of air to the lungs. During an asthma attack, a person may cough, wheeze or feel tightness across the chest. This makes it hard to breathe. If an attack becomes severe, the person may have to go to the hospital. If you have a child with asthma, you
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know how hard it is to watch your child struggle during an asthma attack. “The body is a fine-tuned machine,” explains Vanessa Tatum, M.D., a pulmonologist who volunteers for the American Lung Association of California. “Coughing and getting stopped up are normal defense mechanisms against things that irritate your lungs. But with asthma, your body keeps throwing up defenses, even when there’s nothing around to irritate you.” Dr. Tatum helps kids get their asthma under control so that they can stay active. Make a plan If your child has asthma, you can take steps to ensure that he or she leads an active, normal life. First, work closely with your child’s doctor on an asthma management plan. The doctor will prescribe medications to help control asthma symptoms, and show you and your child how these medicines work and when to use them. Knowing how to use medications correctly is vital to controlling attacks. The two types of medicine used to control asthma are reliever and controller medications. Reliever medications ease an asthma attack
quickly by relaxing the muscles around the airways, making it easier to breathe. You can help prevent your child from having an attack by giving reliever medication at the first sign of symptoms. Unlike reliever medications, controller medications are usually taken every day. Controller medications prevent airways from swelling so that attacks occur less often or not at all. Since Joseph started taking these medications, his asthma is better controlled, and his parents haven’t had to rush him to the doctor’s office because of an acute attack. Many people with asthma use a peak-flow meter to measure how well air flows in and out of their lungs.
This device can help keep track of variations from day to day. It can tell if airways are narrowing hours and sometimes days before your child has symptoms. A peakflow meter can help you and your child do the following: Decide when to increase or stop taking rescue medications. Determine if symptoms are getting better or worse. Monitor how well your asthma management plan is working. Identify things that trigger attacks. Every child responds differently to medications, so work closely with your child’s doctor to find a plan that works best for your child. www.brownandtoland.com
learn to sit out an activity when symptoms flare up. Using an inhaler before exercising can also help keep asthma under control. “When Joe’s doctor told us he would be able to do anything, I found it hard to believe,” John says. “Now that I’ve seen him respond to the treatments, it’s clear he can play any sport he wants.” Joseph plays basketball, soccer and baseball. The best part for Joseph may be that he can keep up with his older brother, Johnny. “He’s a competitive kid,” his father says. “He wants to do anything he sees his brother do.” Words of wisdom John and Maureen have two pieces of advice for parents of children with asthma. First, don’t take asthma lightly. You can help manage
your child’s asthma by trying to control triggers and by staying on top of the treatments. “It’s foolish for kids to suffer when there are good treatments around for asthma,” John says. Second, don’t be afraid to give your child asthma medication at the first sign of discomfort. “Don’t wait for things to get bad,” Maureen says. “You can stop the attack from happening if you give your child medicine as soon as you see symptoms.” Dr. Tatum advises parents not to assume the worst. “Parents have to fight their own stereotypes,” she says. “A lot of people may remember a distant relative who had asthma and was too frail to do anything. With today’s treatments, asthma doesn’t have to stop kids from being kids.” ■
THE ABCs OF ASTHMA Maureen and John decided to move to a new home. Before buying the house, they made sure it didn’t have a forced-air heating system, which their doctor told them could trigger asthma. In addition, they made sure Joseph had a bedroom with hardwood floors and a dustproof cover on his bed. Keep kids active Although exercise can bring on asthma, it is one trigger your child shouldn’t avoid. Exercise is very important for a child with asthma. “Kids with asthma can be just as strong and run just as fast as kids who don’t have asthma,” Dr. Tatum says. Your child can learn to monitor his or her asthma. For example, your child can www.brownandtoland.com
You should learn all you can about your child’s asthma and then teach your child. Every child has different asthma triggers. Learning to identify and avoid these triggers can help you and your child manage asthma symptoms. Here is a list of asthma triggers and suggestions on how to reduce your child’s exposure to them. Tobacco smoke. Do not allow smoking in your home or anywhere around your child. Animal dander. It’s best not to have pets with fur or feathers. At the very least, keep animals out of your child’s bedroom and vacuum often. Cockroaches. Use traps to keep roaches out of your house. Keep food out of your child’s bedroom. Dust mites. Dust mites live in cloth or carpet. Use a dustproof cover on your child’s mattress and pillow. Wash sheets and blankets once a week in hot water. Keep stuffed toys out of your child’s bedroom. Remove carpets. Mold. Clean moldy surfaces with bleach. Pollen. Try to keep your child inside when pollen counts are high.
SERVICE
We’re Listening Brown & Toland Medical Group Surveys Members for Satisfaction by Fiona Wilson, M.D. Brown & Toland Medical Group
Brown & Toland Medical Group, we care AThat’st_about what you think. one of the reasons Brown & Toland participates in statewide consumer assessment surveys, and it’s the primary driver behind Brown & Toland conducting its very own comprehensive survey of members. As physicians, it is important that we know and understand how our members feel about the care and services we provide, including: Timely care and service Patient–physician communication Availability of treatment and specialty care Office staff Coordination of care Results are in from the 2005 California Consumer Assessment Survey (CAS) project. The CAS survey is part of a national research effort to create a common way to measure patient experience at the medical group or office level. In the survey, Brown & Toland obtained higher scores in 2005 across all questions when compared with the 2004 survey. While the medical group improved statewide across all measures, the greatest improvement occurred in the timely care and service category, with a 7.3 percent increase over 2004. To view all the results from the statewide survey, please visit the California Cooperative Healthcare Reporting Initiative Web site at www.cchri.org. So what are the next steps? Based on results from both surveys, we know we must improve patient–physician communications. To do this, we held a series of workshops for our physicians to help them improve their communication skills. Also, we will identify additional steps that we need to take to improve our services, including, but not limited to, our patients’ timely access to care across our entire network of doctors. If you do receive a survey, please take a moment and complete it. Your responses and comments go a long way to helping us improve. ■ Fiona Wilson, M.D., is Brown & Toland Medical Group’s Vice President of Quality Initiatives, and also serves as the Medical Director for Internal Medicine Practice at Parnassus at the University of California–San Francisco. Brown & Toland’s HealthLink, Fall/Winter 2005
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DIABETES CARE
Helping Your Adult Family Member With
Diabetes Management eal planning, medications, monitoring physical activity and blood sugar. The day-in and _day-out requirements of diabetes management can overwhelm those with this chronic disease.
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“That’s where loving family members can help,” says Eve Gehling, R.D., a certified diabetes educator and author of The Family and Friends’ Guide to Diabetes. “The best way to help someone with diabetes is to first learn what diabetes is and how it’s treated.”
“The amount of support available from family and friends is an important predictor of successful diabetic management.” — Eve Gehling, R.D., author of The Family and Friends’ Guide to Diabetes
This will help you support their efforts to manage blood-glucose levels, give TLC when they’re ill and prepare healthful meals they’ll enjoy.
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Steps to take Offer to go to doctor appointments together or attend a diabetes education program. “Check with your local health care providers or the local chapter of the American Diabetes Association to find out what diabetes conferences or workshops might be in town,” says Ms. Gehling. “Offer to attend with them, or provide a ride or baby-sitting so your loved one can attend.” Be active together. Go walking, go dancing or rake the lawn together. Not only does being physically active help diabetes management, it also reduces stress and increases energy levels.
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Help with food shopping and meal planning, especially if your family member should lose weight. The diabetes diet is one of the healthiest, promoting heart health and weight control. The entire family can benefit from following it. If you don’t want to follow the entire diet, try to avoid foods high in sugar and fats, and opt for whole grains, fruits and vegetables. Be aware of how you think about and use food. “Many people are brought up to express their love for others through food,” says Ms. Gehling. “Try to show your affection in ways other than baking or buying sweets.” Encourage your loved one to use a meter to
check blood glucose levels. Blood sugar monitoring often is the most stressful aspect of diabetic management. “Every blood glucose test gives useful information,” says Ms. Gehling. “It provides the person with a better understanding of the fluctuations that can be caused by hormones, illness, exercise, stress or diet.” Frequent blood testing also helps people with
diabetes learn how to finetune their diabetes control. Ms. Gehling suggests family members not focus solely on the numbers; instead, she says they should congratulate their loved ones for checking their glucose levels regularly and encourage them to continue. Family members should learn the signs and symptoms of hypoglycemia and hyperglycemia. They should learn how to help the loved one manage diabetes if he or she contracts the flu or other illness. Ms. Gehling also recommends family members provide support by giving positive reinforcement, rather than pointing out negatives or nagging. “The amount of support available from family and friends is an important predictor of successful diabetic management,” she says. “The type of support needed will differ from person to person, so rather than assuming what’s best for your loved one, simply ask how you can help. And after you ask, the most important thing to do is listen to the answer.” ■
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NUTRITION
Visions of Light Desserts
Brighten Holidays h, the holidays. Visions of sugarplums, cookie _exchanges and company parties dance in our heads. Trouble is, we often find ourselves with several post-holiday pounds dancing around our hips. Research has shown that the average person gains nearly 7 pounds between Halloween and New Year’s Day.
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The good news? You don’t have to entirely give up your holiday favorites, including delicious desserts, in order to lighten up the season. There are a few simple ways to indulge without guilt. “It’s all about striking a balance between enjoying food, and not overindulging,” says Michelle Kuppich, a Registered Dietitian for Brown & Toland. “Just focus on eating the foods you really enjoy.”
or prune puree instead of oil when baking. They contain cellulose, a natural vegetable fiber that traps moisture in your breads, cakes and muffins. You can substitute half — or more — of the fat, this way. Cut back on sugar in pies. Nutritionists say that most pie recipes contain much more sugar than needed. Cut back by half and see if you’re pleased
with the results. And try using only a bottom crust on pies. Make cakes without the frosting, or reduce the amount of frosting. If you’re worried that holiday guests may detect your changes, test your recipes beforehand, so you can make sure that they taste just as delicious as the original versions. Change only one ingredient at a time, so you know which
Modify your recipes Simple changes to your dessert recipes, for instance, can significantly reduce fat and calories while keeping all of the flavor. Try a fruit puree such as applesauce, apple butter
GENERAL RECIPE MODIFICATION TIPS Use nonstick cooking spray to grease the pan when cooking and baking. Use heart-healthy margarine spreads, rather than butter or shortening, for baking. Use 3 tablespoons of unsweetened cocoa powder to replace 1 ounce of unsweetened chocolate. Use equal amounts of marshmallow creme in frostings to substitute for butter or margarine. Try finely crushed cinnamon graham crackers instead of traditional piecrusts. Use egg substitute when baking, or use two egg whites instead of one whole egg. Use equal amounts of applesauce or baby food prunes to replace oil. Use equal amounts of fat-free plain yogurt to replace sour cream.
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changes you like best. “If you’re hosting a party, balance heavier foods with choices that are a little healthier,” Ms. Kuppich says. “Your guests will appreciate the lighter fare.” Plan for parties When you’re the guest at a holiday party, you don’t always have control over the types of foods available. The trick here, Ms. Kuppich says, is to cut back on portions and avoid grazing. “If seating is available, fix a plate with some healthy items, find some company and sit down,” she says. “If you’re grazing at a buffet table, you’re more likely to overeat because you won’t have an accurate idea of how much you’ve eaten.” Stick near the fresh fruit platter, she recommends — and stay away from alcohol, which can cause a reduction in blood sugar, causing you to want to eat more. Fill up, instead, on healthier foods, such as turkey, lean cuts of beef and vegetables. Finally, find a way to add healthy foods at the party. Ask the host or hostess if you may contribute a
dessert. Then, bring one of your low-fat, light and healthy desserts. Keep your balance! Health experts say you shouldn’t get overly concerned if you don’t lose weight over the holidays; you’ll be ahead of the game if you simply don’t gain. Therefore, don’t set unrealistic weight-loss goals.
“It’s all about striking a balance between enjoying food, and not overindulging.” — Michelle Kuppich, a Registered Dietitian for Brown & Toland
Focus, instead, on the joys of the season: spending time with friends and family, and showing them you appreciate them. Plan some healthy family activities, such as a game of touch football, ice-skating or an evening walk to work off dessert. At parties, mingle and converse, rather than sticking by the food table. Wait for about 20 minutes after a meal before deciding to eat dessert; your blood sugar will have increased after the meal, decreasing your craving for sweets. ■
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PREVENTIVE CARE
Osteoporosis is Common, But You Can Reduce Your Risk by Jacqueline Kiang, M.D.
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steoporosis is the most common disease of the bones and affects approximately 15 percent of women, and 5 percent of men over the age of 50. It is characterized by a decrease in bone density and loss of its structural support.
Diagnosis is important because of the increased risk of fractures associated with the disorder. More than 1 million osteoporotic fractures occur in the United States each year, with most occurring in the lower spine and hips. Fractures are related to the degree of bone loss in these areas. Your bone mass is determined by the balance of bone formation and bone loss. Your body uses calcium to build strong bones until about 30 years of age, when your bones peak in density. In addition to age and hormonal influences, bone density is affected by nutrition. Inadequate intake of calcium leads to increased bone loss. Studies show that taking calcium with vitamin D (which is essential to the absorption of calcium) may reduce the rate of bone loss, promoting stronger bones. Adequate calcium intake is also linked to modest reductions in blood pressure and cholesterol. Women are at much greater risk than men for both osteoporosis and fractures. This is believed to be due to women having lower average bone masses and increased bone loss after the onset of menopause. Pre-menopausal women and men should aim for 1,000 mg of elemental calcium per day, and postmenopausal women need 1,500 mg per day. Calcium should be taken with 400 to 800 IU of vitamin D per day. Calcium may be found in dairy products such as milk, cheese and yogurt, as well as leafy green vegetables, broccoli, nuts, tofu, salmon and sardines. Each serving of dairy foods provides about 300 mg of calcium. If you don’t get enough calcium through your diet, supplements are a good way to boost your intake. Most calcium supplements are well tolerated, but some people may experience upset stomach or constipation. Calcium comes in a variety of forms, including calcium citrate, calcium carbonate and calcium phosphate. You
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are likely to find at your grocery or pharmacy a dizzying array of calcium in chewable, liquid and pill forms, some with calcium only and others in combination with vitamin D and magnesium. All types of calcium have limited absorption and are best absorbed when taken several times a day in amounts of 600 milligrams or less. Calcium citrate may be taken at any time, and calcium carbonate is best when taken with meals. What I recommend for my patients is a combination calcium and vitamin D pill with 500 mg of elemental calcium and 200 IU of vitamin D twice a day with meals for pre-menopausal women and men, and three times a day with meals for post-menopausal women. When calculating your calcium dose, remember to check the label for the amount of elemental calcium in each tablet (the amount actually absorbed). Speak to your doctor about the need for screening if you believe that you are at risk. Diagnosis is made with specialized X-rays. If osteoporosis is detected, there are medications to prevent further bone loss and prevent fractures. It is important to know about osteoporosis and your risk factors. Taking charge of your health by eating right, getting adequate dietary calcium and exercising regularly will promote strong bones and reduce your risk of developing osteoporosis and fractures. ■
Jacqueline Kiang, M.D., is a member of Brown & Toland Medical Group and an Internal Medicine physician at BaySpring Medical Group, a group practice providing primary care and gynecology to the San Francisco community. Her practice Web site address is www.bayspringmedical.com, and her telephone number is 415.885.8135.
OSTEOPOROSIS RISK It’s important to note that osteoporosis risk also increases in men and women who smoke. Other risk factors include: Lack of weight-bearing exercise Malnutrition Being underweight A family history of osteoporosis Having taken certain medications, such as steroids Medical conditions including overactive thyroid and parathyroid glands, celiac sprue and cystic fibrosis In men, low levels of testosterone also contribute to osteoporosis.
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YOUR MONEY
How to Save Money on Medical Bills
T
he best way to save on medical bills is to stay healthy. But when you do need a doctor, a prescription or a hospital stay, the following tips can help you cut expenses.
This information is especially important if you are in a consumer-directed health plan, such as a medical savings account. These plans place more responsibility for health care on your shoulders. Doctor bills Come prepared to a doctor’s office visit. Write down any questions beforehand and include a history of symptoms for the problem that is being treated. During the office visit, write down any advice the doctor gives you, and make a note of when you are to return for follow-up care. You can treat simple things like a cold, diarrhea, headaches, and muscle aches and pains with over-thecounter (OTC) medications. Ask your pharmacist if you’re unsure which medications to take. Seek medical care if your symptoms linger or worsen, or if you have a chronic condition that makes seemingly simple problems more serious. Follow your doctor’s advice. Your doctor may suggest that you stop smoking or drinking, start exercising, improve your diet, get more rest or take prescribed medications. Get a second opinion. Ask another doctor to concur before agreeing to expensive diagnostic tests, treatments or surgery. Ask if simple medical tests or screenings, such as a blood pressure check, can be done without a full office-visit charge. Medication costs Ask for generic drugs, if they are appropriate and available. They are often much cheaper than name-brand drugs. Choose store brands. Many chain pharmacies, supermarkets and discount stores offer their own brands of OTC medications. These products contain almost the same ingredients as name-brand products but cost less. Ask your doctor for free samples of medications. Many drug companies regularly give such samples to doctors. Ask about special discounts. Your pharmacy may offer price breaks for seniors, infants, children and students. Some pharmaceutical companies offer discounts to lowincome patients.
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Buy OTC medicines in large quantities to save money. Manage your medications. Many unnecessary doctor visits result from people taking their medications incorrectly, at the wrong times or in the wrong doses. If you know exactly how to take a newly prescribed drug before leaving your doctor’s office, you’re less likely to need a repeat visit. Avoid filling prescriptions at hospital pharmacies, which generally charge more than other pharmacies. See if you can save money by ordering prescriptions online or through the mail instead of buying them at a local pharmacy. Be sure to include extra charges for shipping and handling when figuring comparative costs. Compare prices for each medicine at several pharmacies. Some medicines are cheaper at one drug store than another. General expenses Be sure you understand your health insurance policy. Read your manual and updates as they arrive. Ask your supervisor or health benefits representative to explain anything that confuses you, especially any precertification procedures for operations or outpatient procedures. Discuss all costs with your doctor or his or her office manager if you’re scheduled for an operation, outpatient procedure, extensive therapy of any kind or expensive medical tests. That way, you won’t be surprised as your bill adds up. You also should check with your health insurance representative to determine which procedures will be covered and at what percentage. Don’t request unnecessary screening tests, and ask your doctor why you need any recommended procedure or test. Even with insurance, you may pay 10 to 20 percent of the cost yourself. Keep a family medical record file at home. That way, if a question comes up about immunizations or whether a family member had a certain procedure, you’ll have the information at hand and won’t risk having a test or screening duplicated unnecessarily. Brown & Toland offers the ihealthrecord, a personal health record, for all Northern California residents. For more information, please visit our Web site at www.brownandtoland.com. Learn about chronic conditions such as diabetes, asthma, heart disease and arthritis you or other family members suffer from. Information about these various conditions, including hundreds others, if available on the Web at www.brownandtoland.com. Knowing as much as you can about your treatment options can help you stabilize your health and reduce the cost of managing the condition. ■ www.brownandtoland.com
BENEFITS FOR SENIORS
Brown & Toland and Medicare Advantage Offer a
Wide Range of Benefits and Medicare Part D Coverage
P
eople with Medicare have more choices now than ever before on how they receive their health care coverage. Additionally, for the first time in the history of Medicare, prescription drug coverage will be available to all Medicare recipients through Medicare Part D. Brown & Toland contracts with two Medicare Advantage HMO plans that bring Medicare beneficiaries a wide range of comprehensive benefits, including hospitalization, preventive care, prescription drug coverage and lower out-of-pocket costs. These plans are Health Net Seniority Plus and PacifiCare Secure Horizons. Brown & Toland is a leader in the health care industry and is widely recognized for our outstanding physicians. Our health care initiatives, including programs to help patients manage diseases such as asthma, diabetes, HIV and obesity, are dedicated to improving the quality of life for our members. We believe that these programs,
along with the wide range of Health Net Seniority Plus and PacifiCare Secure Horizons HMO benefits and low out-of-pocket costs, are extremely attractive options for Medicare beneficiaries. ■
For more information about Medicare Advantage and Brown & Toland, please call 866.488.7088, or return the enclosed reply card.
BETTER HEALTH
Conquering Hard-to-Break Habits in the New Year
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f you want to lose weight, quit smoking, improve your diet or change practically any other bad habit, roll up your sleeves. “Habit change is work,” says Matthew A. Budd, M.D., retired assistant professor of medicine at Harvard Medical School and co-author of You Are What You Say. Dig deep. To break stubborn bad habits such as overeating, “you need to get behind the emotion that’s driving the behavior,” says Dr. Budd. “Determine the recurring circumstances that drive you to food or any other substance,” he advises. If you notice you head to the vending machine whenever your boss gives you a new project, think about what’s causing the anxiety that’s causing you to eat. “Only when you address the emotions underlying the addictive or habitual behavior can you really begin to
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produce positive results,” says Dr. Budd. Create a game plan. Design a doable behavior-change plan. If you want to give up high-fat takeout dinners but don’t have time to cook, make sure you stock your kitchen with low-fat meals, prepared salads and fruits and vegetables so you’ll have easy, healthy meals on hand. Snap back after a slip. There will be times when you don’t stick to your plan — perhaps you’ll eat too many goodies at a holiday party. Don’t despair. “To slip is to be human,” says Dr. Budd. Instead of giving up on your plan and reverting to bad habits, ask yourself what caused the slip. Was it something practical — such as going to the party too hungry? Or was it something emotional, such as feeling stressed about a work project? Once you’ve nailed what caused the slip, “let it go and forgive yourself,” says Dr. Budd. And then move on. ■ Brown & Toland’s HealthLink, Fall/Winter 2005
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Important Dates for Medicare Part D Nov. 15, 2005 First day you can enroll in Medicare Part D.
Jan. 1, 2006 Medicare Part D prescription drug plan begins for those who join by Dec. 31, 2005.
May 15, 2006 Last day you can join a Medicare drug prescription plan without paying a penalty (unless you have drug coverage from another plan). The penalty is 1 percent for every month you delay. So if you wait 10 months after May 15 before you sign up, your monthly premiums will always be 10 percent higher than they would be if you enrolled during the initial enrollment period.
May 15, 2006 The Medicare-approved drug discount cards many people obtained in the last couple of years will no longer be valid.
To find out more about Brown & Toland Medical Group and Medicare Advantage, please call 866.488.7088. PRSRT STD U.S. POSTAGE The Doctors Behind Every Good Health Plan
P.O. Box 640469 San Francisco, CA 94164-0469
PAID Effingham, IL Permit No. 148