Hawaii Filipino Chronicle Supplement - September 16, 2023

COMMUNITY and WOMENS’ HEALTH

Filipinos’ Close Encounters with Suicide and Learning Prevention Strategies That Could Save Lives

ARTICLES INSIDE

Hawaii Healthcare Still Hurting; Here’s What We Can DoS2

Breast Health Saves LivesS6

Understanding Vitamins: What You Need to KnowS7

Sjögren Syndrome: What Is It, Who Gets It, And How Is It Treated?S8

Ensuring a Meaningful Life S10

Got A Benefits Question? The National Asian Pacific Center on Aging is Here to HelpS11

Diabetes Technology: Modernizing Diabetes CareS13

Suicide: It’s Time We Start Talking About ItS14

Breaking the Cycle of Anxious Parenting S15

For our last issue’s cover story, we did a highly sensitive and often taboo subject – Filipinas and domestic spouse abuse (see thefilipinochronicle.com archives). In this special supplement issue’s cover story, we report on a crisis arguably even more sensitive and rarely discussed, which is death by suicide. It’s a public health concern on the rise. The statistics on suicide in the United States and Hawaii are staggering. They show suicide is the second-leading cause of death between the ages of 10 and 34.

Mental health professionals say unlike many incurable diseases, suicide is preventable if we are 1) educated on the risk factors (situations that can influence suicide like financial trouble, loss of a relationship or lack of access to healthcare) and 2) aware of the warning signs/symptoms (for example being preoccupied with dying, giving away belongings and acting recklessly). Experts say to begin with we should talk about the subject with family and close friends. It could end up saving a life. September is National Suicide Prevention Awareness Month; and it’s a perfect time to educate ourselves, know the dangers and open dialogue. Mahalo to our Filipino interviewees who shared their sensitive stories in this cover story. We hope you enjoy our September Health Supplement.Story on S4

Hawaii Healthcare Still Hurting; Here’s What We Can Do

By Keli‘i Akina

We have known for years that Hawaii’s healthcare system is in bad shape, but recent events have shown just how much of a crisis medical providers and patients are experiencing.

Lahaina’s suffering has been unfathomable. The wildfires that destroyed much of the historic town claimed over 100 lives, and possibly many more.

Many survivors who experienced severe burns had to be transported to Oahu’s Straub Medical Center, which has the only burn unit in the North Pacific between Asia and California.

Three medical clinics were among the thousands of buildings that burned down, throwing into question how long West Maui might suffer from a lack

of basic medical care. Even before the fires, area residents had to drive more than an hour to visit the island’s only hospital in Kahului.

Meanwhile, on Kauai, the nonprofit Kauai Community Health Alliance finally called it quits, announcing it would be closing its two clinics in Kilauea by this month.

James Winkler, Alliance president and CEO, told reporter Emma Grunwald of The Garden Island that the finances of the Alliance “have always been tenuous, but the last few years have pushed us over the edge.”

He cited the state’s low Medicare and Medicaid reimbursement rates and its high cost of living.

At a forum last fall, Winkler also cited the state’s 4% general excise tax. Hawaii is one of only two states that tax healthcare services, and Hawaii’s private practice physicians may not pass on that cost to their Medicare, Medicaid, or TRICARE patients, who typically comprise a large portion of their patients.

“Taxing medical care is

criminal,” Winkler said, expressing his frustration with Hawaii’s current healthcare system.

The Legislature did consider a bill to exempt medical services from the GET earlier this year, but it was killed before its last hearing.

Another contributor to Hawaii’s healthcare woes is the requirement to obtain a “certificate of need” before building a new medical facility or offering a new healthcare service.

Not only is the process time-consuming and costly, but it even lets existing clinics that could be competitors have a say. It would be like asking Wendy’s or McDonald’s if Burger King should be allowed to open a new restaurant nearby.

It might be a good idea for the existing restaurants, which might say a new restaurant would be a wasteful duplication of their service, or that allowing a new restaurant could harm them financially and threaten their ability to provide reliable service.

And in fact, those are the

types of arguments that CON law advocates make for medical services. Unfortunately for patients, however, studies show that medical CON requirements result in fewer hospital beds, fewer healthcare professionals, and worse treatment and higher costs for patients.

Which is to say, state lawmakers should reform the state’s medical CON process to make it easier to build new healthcare facilities or offer new medical services.

To its credit, the Legislature this year did allow Hawaii to join the Interstate Medical Licensure Compact, which will let licensed physicians from the compact’s 40-plus member states and territories to practice in Hawaii without having to waste time and spend large amounts of money obtaining a Hawaii license.

Once the compact goes into effect, this will go a long way toward relieving the state’s acute doctor shortage, estimated at almost 800.

I urge the state legislators to build on this good move and

enable Hawaii to join interstate agreements for nurses, physical therapists, occupational therapists, and other licensed medical professionals. Doing so would further improve Hawaii’s healthcare situation.

However, Winkler on Kauai told The Garden Island that it’s “highly unlikely” he will continue in the medical field, and more medical professionals are bound to follow his lead if conditions for medical professionals in Hawaii do not significantly improve soon.

And it’s not just burdensome healthcare regulations that are the problem. Hawaii has the highest cost of living with the highest median home prices in the nation, which are concerns for medical workers just like anyone else.

Hawaii lawmakers should work overtime to address these conditions too, if we really want to improve healthcare access in our state.

KELI‘I AKINA is president and CEO of the Grassroot Institute of Hawaii.

Filipinos’ Close Encounters with Suicide,Talking About Suicide Saves Lives

By Edwin Quinabo

Suicides are preventable, unlike an incurable disease –this is what health experts say people should know first and foremost about this public health crisis. Experts say knowing these two myths alone can help to save lives. The first myth: suicides are committed only by people with a history of mental illness. The reality: there are life stressors that also have been documented to influence suicide among those who’ve never suffered from clinical mental illness. The second myth, people commit suicide unexpectedly without giving it much thought. The reality: there are warning signs, but most don’t know what they are and must be better informed.

September is National Suicide Prevention Awareness Month and public health educators say it’s a good time to be educated on suicide that could save the life of a loved one in your life. While talking openly about suicide is uncomfortable and difficult, it’s also the most meaningful attempt to saving a life, experts say.

Just how common is suicide in the U.S.?

Suicide is the 10th-leading cause of death in the United States, overall. Statistics show it is the second-leading cause of death between the ages of 10 and 34, and nearly 5% of Americans 18 and over have had serious thoughts about suicide over the course of a year, according to the National Institute of Mental Health.

According to the Centers for Disease Control and Prevention suicide rates increased approximately 36% between 2000–2021. Suicide was responsible for 48,183 deaths in 2021, which is about one death every 11 minutes. The number of people who think about or attempt suicide is even higher. In 2021, an estimated 12.3 million American adults seriously thought about suicide, 3.5 million planned a suicide attempt, and 1.7 million attempted suicide.

According to the Hawaii State Department of Health, data from 2016 shows suicide in Hawaii is the most common cause of fatal injuries among residents, outpacing car crashes, homicide, poisoning and drowning. It’s estimated that one suicide is committed every two days in Hawaii.

Within the Filipino community, higher rates of suicide have been reported among immigrants because of uncertainty of their legal status and added pressures of assimilation.

Suicide in Hawaii as well as throughout the country could be characterized as a silent epidemic, a silent crisis. Not many are talking about it due to the taboo associated with suicide. Because of the stigma behind suicides, it’s believed suicides are underreported, and that the problem could be more widespread than it already is.

Suicide rates among Asian Americans (5.24 deaths per 100,000) are lower than the national average. But Asian immigrants are at higher risk of suicide, according to the National Latino and Asian American Study, a first-ever study conduct-

ed on the mental health of Asian Americans.

Within the Asian ethnic group, Filipino Americans have the lowest rate of suicide (3.5 per 100,000) while Japanese Americans have the highest rate (9.1 per 100,000), followed by Chinese Americans (8.3 per 100,000).

Mabel, Kalihi, said “Suicide is a very private issue and I’m willing to comment under strict confidentiality because it involves my daughter. I cannot go into detail, but I will comment because this might help people in our community.

“In 2015, my son came to me saying he had a deep secret involving my daughter. He looked very nervous and choked up when telling me this. He said I must promise him not to tell my daughter. He said my daughter confided in him that she wanted to kill herself. I was devastated from hearing this. I cried and couldn’t believe what I was hearing. He told me her reasons, which I cannot say here. But I can tell you what we did in response to this secret.

“Immediately, I had to tell my husband and we had to come up with a plan as a family. The first week, my son was to be our go to person to monitor how serious she was about suicide. The plan was for one week of very cautious monitoring then we would reassess this situation after the week is up. But that didn’t last a day.

“The next day after hearing this news my husband and I approached our daughter delicately. She’s in her 20s and still lives with us. After work her normal routine is to go to her room. After about an hour we both went to her room to talk about it. We still remember that day vividly. It was an outpouring of emotion, sadness, understanding and joy that she hadn’t acted on it. Suicide, she confessed, was something she’d thought about for years. But we were clueless to the signs.

“We knew we needed professional help because it was serious. We got help. At first, she saw a psychiatrist who put her on medication. After about a year, she switched to a psychologist who she sees regularly. The dosage of her meds went down and she’s doing a lot better. Suicide is something today we will talk about as a family periodically. But it’s still our family’s secret.

“What I can say to look out for is when personal trauma happens like a death of someone close and if it coincides with

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other serious trauma happening about the same time, these traumas collectively can be the beginning of serious suicidal ideation especially if your child is naturally sensitive. Pay close attention to how your children deal with personal traumas. Not everyone responds to trauma the same, even if these traumas are as natural occurrences in life to most people,” Mabel said.

“I am so thankful to God that she reached out to my son initially. That saved her life. And it saved us from what would have been a lifetime of grieving if she had committed suicide. Thank you, Jesus.”

Mabel said she’s been looking into the topic on her own and found out suicide ideation is more common among millennials than most people think. She said in her findings, the millennial generation is far more open to seeking mental health counseling far more commonly than those in her generation, Gen X. “This is good that the younger generation is getting the help they need,” Mabel said.

“It’s difficult to have a family member with mental illness together with suicidal ideation. It takes a toll not only on the person but also on the people around her. The family’s continuous effort, patience, and care must always be present. The family must always be on our toes due to this threat to life. As a relative, it breaks my heart to see my cousin struggle through this and fight her battles each day. The most significant contribution I could give is my love and endless support for my cousin.”

and battles. I would encourage him to seek professional help from a doctor and a therapist.”

But like Mabel, experts say most people just don’t know if someone is thinking about suicide because they are unaware of what could trigger suicidal thoughts.

Risk Factors for Suicide

• Family/loved one’s history of suicide

• Loss of relationships

• High conflict or violent relationships

• Social isolation

Community Risk Factors

These challenging issues within a person’s community contribute to risk:

Dr. Mariel Eusebio told the Filipino Chronicle she has a cousin who is diagnosed with major depressive disorder. She said her battle began after her father’s death due to cancer. They were both 18 years old and roommates in college when this started.

“I vividly remember arriving home from school and finding her in a corner of our room - bawling and ‘hearing voices’ in her head. When I asked her what these voices told her, she said, ‘They told me to take my life away.’ That night, I did not sleep as I watched her closely and made sure she would not do anything to hurt herself. It was challenging for us, especially for her mother and sister. After informing her mom, she immediately took a leave of absence from work in Saudi Arabia. She took the earliest flight to the Philippines and then decided to admit my cousin to a mental health facility,” Dr. Eusebio said.

She adds it’s difficult to have a family member with mental illness together with

suicidal ideation. “It takes a toll not only on the person but also on the people around her. The family’s continuous effort, patience, and care must always be present. The family must always be on our toes due to this threat to life. As a relative, it breaks my heart to see my cousin struggle through this and fight her battles each day. The most significant contribution I could give is my love and endless support for my cousin.”

While people may not want to talk about suicide openly in public if it involves a family member or someone close to them, experts say most are open to talk about it on a personal level with those who they love.

Dr. Eusebio said, “Since me and my sister come from a broken family, we are left with each other for support, especially with topics like suicide. We openly talk about suicide; as Christians, we are reinforced that this is an act we will not do. If we are ever placed in that situation, we will try our best to support each other and remind our-

selves that this is an act we would never and should not do.”

Rae Ann Benitez, Honolulu, said she doesn’t know of anyone personally who’s had suicide ideation. “I haven’t had any conversation about suicide, but I feel like I’m comfortable enough to open up about it if I have to.”

She said if she found out that someone who she knows has suicide ideation, she would offer her time and would ask her if she’s comfortable talking about it with her or if there’s anyone that she would want to talk to and be more comfortable with.

Similarly, Dr. Eusebio said she would invite the person thinking about suicide to talk about his thoughts. “First, I would ask about his plans if he has any suicide plans already. Next is to give reassurance that I am available if he needs someone to talk to. Then, I would tell him that life may be difficult and cause us to fall sometimes, but he is not alone. We all have our struggles

The Centers for Disease Control and Prevention (CDC) says suicide is rarely caused by a single circumstance or event and lists a range of factors — at the individual, relationship, community, and societal levels — that can increase risk.

Individual Risk Factors

These personal factors contribute to risk:

• Previous suicide attempt

• History of depression and other mental illnesses

• Serious illness such as chronic pain

• Criminal/legal problems

• Job/financial problems or loss

• Impulsive or aggressive tendencies

• Substance use

• Current or prior history of adverse childhood experiences

• Sense of hopelessness

• Violence victimization and/or perpetration

Relationship Risk Factors

These harmful or hurtful experiences within relationships contribute to risk:

• Bullying

• Lack of access to healthcare

• Suicide cluster in the community

• Stress of acculturation

• Community violence

• Historical trauma

• Discrimination

Societal Risk Factors

These cultural and environmental factors within the larger society contribute to risk:

• Stigma associated with help-seeking and mental illness

• Easy access to lethal means of suicide among people at risk

• Unsafe media portrayals of suicide

Warning Signs/Symptoms

The National Suicide Prevention (NSP) says there are warning signs people thinking of suicide exhibit. The NSP wants to convey that people who commit suicide don’t want to die; what they really want is to end their pain. These individuals are suffering deeply; they feel helpless and hopeless.

– Dr. Mariel eusebio

Breast Health Saves Lives

By Dr. Jon Avery Go

Breast cancer is the most common cancer in females across the United States, and it is the second most common cause of death in women.

However, a common misconception is that breast cancer only affects females–instead, it is only more common. Cancer doesn’t discriminate and can affect both men and women.

Around half of breast cancers are caused by known risk factors. A few key elements are increasing age, with the highest number of breast cancer cases found in those 70 and older. Breast cancer also occurs 100x more frequently in women than men.

In the United States, the highest cancer risk is among white women, although breast cancer is still very common among women of

every major racial group.

Risk factors that increase the risk of breast cancer include obesity (a BMI higher than 30), women with dense breast tissue seen on mammograms, women with a high bone mineral density, and higher hormone levels, specifically estrogen.

Also, oral contraceptive use can briefly increase the risk. Other risk factors include an early onset of menstruation (before 13 years old), a late onset of menopause, and women whose first pregnancy comes after the age of 35.

A person who is previously diagnosed with breast cancer in one breast is also at high risk of developing invasive breast cancer in the other. Lastly, a positive family history of breast cancer and inheritance of genetic mutations increases the overall risk of breast cancer.

The most common

symptom of breast cancer is a painless lump in the breast area or underarm.

Any sudden or unexplained changes in breast appearance should also be checked out. Unusual nipple skin changes, inversion, or discharge is also a common sign.

Lastly, breast pain. Gen-

erally, breast cancer is not painful, however, any consistent discomfort should be discussed and examined by your healthcare provider.

Ways to lower breast cancer risk include limiting alcohol intake, avoiding smoking, and increasing physical activity. For women who have recently giv-

en birth, breastfeeding (if able) helps lower the risk of breast cancer.

For postmenopausal women, weight loss and a low-fat diet also help decrease the risk of breast cancer.

The United States Preventive Services Taskforce (USPSTF) recommends that women start screening for breast cancer at 40 years old and get screening mammography every other year from ages 40 up to 74 years old.

According to the American Cancer Society, when breast cancer is detected early and is in the localized stage, the five-year relative survival rate is 99%.

Breast cancer screening and early detection saves lives.

JON AVERY GO, MD, ABIM is a board-certified Internal Medicine primary care physician. He is currently practicing at the Primary Care Clinic of Hawaii.

Understanding Vitamins: What You Need to Know

By Rainier Dennis D. Bautista, MD

When it comes to vitamins, we often hear about them being good for our health. But how much is enough, and when is it too much? Let’s break it down in simpler terms.

How Much Vitamin Do We Need?

Imagine vitamins as the fuel for your car. Just as different cars need different amounts of fuel, each person might need varying amounts of vitamins. Experts have come up with some guidelines.

RDA (Recommended Dietary Allowance): Think of this as the ‘ideal’ amount of vitamin most people should aim for daily.

AI (Adequate Intake):

Sometimes, we aren’t sure about the ‘ideal’ amount, so we have a best-guess amount called AI.

Should You Get Tested for Vitamin Levels?

While we can test the level of many vitamins in our blood, it’s not always needed. It’s like checking the oil in your car; you only really need to do it if you think there’s a problem.

Taking Extra Vitamins to Avoid Diseases: Does It Work?

Folate (a type of B-vitamin): For expecting moms, taking extra folate can help ensure their baby develops healthily.

Vitamin D: This can be like a safety net for older

adults, helping them avoid brittle bones and falls.

Antioxidants: Imagine these as the body’s rust protectors. Eating veggies and fruits is great for getting these, but taking them as a pill? Not proven to be as effective.

Vitamin A: Important for kids in areas with fewer food and healthcare resources. But too much, especially during early pregnancy, can be harmful.

Vitamin C: While it’s fa-

mous for fighting colds, there isn’t solid proof that taking extra will fend off major illnesses. And in big doses? It might harm your kidneys by increasing your risk for kidney stones.

Vitamin E: Some folks take this hoping to dodge diseases, but the evidence is slim. In fact, too much might be bad for you.

Vitamin B2, B6, and B12: These are like the engine oils of the body, but the average person on a normal diet doesn’t need extras. Though, B12 checks might be useful for some, like strict vegetarians or the elderly.

What About Those All-inOne Vitamin Pills?

For most of us eating a variety of foods, taking a multivitamin pill isn’t needed. But,

for certain folks – like those on strict diets or after specific surgeries – it can be helpful. If you want to take one just in case, it’s usually okay, but always best to ask a doctor.

Can You Have Too Much of a Good Thing?

Absolutely! Just as overfilling your car with fuel can cause issues, taking too many vitamins can be harmful. Water-friendly vitamins (like vitamin C) are usually okay in large amounts, but fat-friendly vitamins (like vitamin A) can be harmful if overdone.

In Short: Vitamins are essential, but more isn’t always better. It’s like a balance - not too little, not too much. Always consider what your body needs and when in doubt, reach out to a health expert for guidance.

RAINIER DENNIS D. BAUTISTA, MD is a board-certified Family Medicine Physician with the Primary Care Clinic of Hawaii, serving the communities of Oahu and Kauai.

Sjögren Syndrome: What Is It, Who Gets It, And How Is It Treated?

By Dr. Arcelita Imasa

Sjögren syndrome (pronounced as SHOWgrin) is one of the most common autoimmune diseases. An autoimmune disease occurs when your body’s immune system attacks your own cells.

Sjögren syndrome is a disease that causes a dry mouth and dry eyes. Most people with Sjögren syndrome have very mild symptoms.

Sjögren syndrome may affect other organs including the joints, the bowel, kidneys, lungs, skin, and nerves.

People affected with Sjögren syndrome can have symptoms of dry mouth and dry eyes for months.

Your eyes may feel gritty or itchy. Your mouth may feel dry, and this may cause swallowing difficulties especially with eating dry foods, or even speaking.

While doctors don’t know

what causes Sjögren syndrome, we see that it usually affects women in their late 40s and early 50s.

People with Sjögren syndrome may have other autoimmune diseases like rheumatoid arthritis or lupus.

This is because Sjögren syndrome can involve other organs beyond the exocrine glands or in what is called extraglandular manifestations. These other organs include the skin, joints and muscles, the bowel, kidneys, lungs, and nerves.

It is believed that some extraglandular manifestations result from Sjögren syndrome itself, while others result from a comorbid (the simultaneous presence of another medical condition) autoimmune disease.

Thus, some people with Sjögren syndrome may have skin issues such as abnormal dryness, purpura (purple-col-

ored spots on the skin), and eyelid inflammation. Joints and muscle pains, feeling fatigued or tired or having sleep issues are also very common in Sjögren syndrome.

As lungs are affected in 10 to 20% of people with Sjögren syndrome, cough and breathing difficulties can also occur. Nerve issues affect about 10% of people with Sjögren syndrome.

It is also estimated that there is a 5 to 10% lifetime risk of non-Hodgkin lymphoma, a blood cancer, in Sjögren syndrome, and when it occurs, it is seen to occur approximately seven years after the diagnosis of Sjögren syndrome.

Other ways that Sjögren syndrome affects the blood system is by causing low blood count conditions called anemia and leukopenia. The heart and cardiovascular system can also be affected and there is an increased risk of

cardiovascular disease.

In addition to oral (mouth) involvement, Sjögren syndrome can also affect the entire gastrointestinal tract and cause issues such as dysphagia (difficulty swallowing), nausea, and dyspepsia, as well as the liver and pancreas.

Kidney and bladder symptoms can also occur in people with Sjögren syndrome. Gynecologic symptoms including vulvovaginal dryness and itching, and dyspareunia (painful penetration during sex) can also be seen.

Lastly, many people with Sjögren syndrome also suffer

from depression.

There is no cure for Sjögren syndrome, and it is a lifelong disease. You should see your doctor if you think you might have Sjögren syndrome.

There are medications like artificial tear and saliva substitutes that may help with your symptoms. You might also need medicine for your immune system.

DR. ARCELITA IMASA is a practicing family physician and the secretary of the Hawaii Workers Center’s Executive Committee of the Board. She grew up in the Philippines before immigrating to Hawaii with her family more than a decade ago.

Ensuring a Meaningful Life

By Dr. Maria Ver

We have a natural fear and aversion to talking about death and dying. The reality, however, is that we, and our family members, will all die someday on an “unknown expiration date,” as I tell my patients

The question, therefore, that I pose to the reader is: What does living mean?

As a surgeon, I do a lot of emergency surgery, often on very sick, elderly patients. I also see patients in my outpatient clinic with new diagnoses of cancer.

I often have the potential to “fix” these issues, but with downstream consequences. The most important question for me to ask patients and their families is: Is this the right thing to do?

Palliative care is a field of medicine that focuses on patient- and family-centered care in the setting of advanced disease, serious illness, and end-of-life.

Palliative care does not just mean hospice, and the palliative care specialists are not the ‘death squad.’ It is team-based care that helps to ensure living a dignified, meaningful, and respectful life, knowing that one’s time may be limited.

The focus is on relief from the symptoms and stress of serious illness. The goal is to improve the quality of life for the patient and the family.

Inpatient palliative care specialist Dr. David Kalir mentions that these conversations are important and can take a lot of time.

Intensive Care Unit (ICU) physician Dr. Emilio Ganitano states that having these conversations in an ICU setting are especially difficult because the patient is acutely severely ill with a chance of dying and may not be able to make decisions,

nor participate in their own care.

Decisions by patient and family are highly stressful and are often based on emotions, fear, anxiety, and guilt. Moreover, ICU doctors need decisions made quickly because it determines what they can and can’t do for a dying patient.

Often, the family members want to be involved and “want everything done” for their loved ones, but without really understanding the consequences such choices may have.

“Doing everything” can be traumatic and prolong suffering, rather than prolonging life. For example, chest compressions to restart the heart (CPR) can cause painful rib fractures and pneumonia.

Proceeding with dialysis to help clean the blood of toxins may leave the patient feeling even more sick, confused, anemic, and even in need of blood transfusions.

For those familiar with medical care across the Asia-Pacific, an “everything can be done” approach may be fairly limited due to a lack of technology, specialized training, and equipment.

In the United States, however, where medicine and technology continuously advance, doctors can offer a lot. But again, the most important question becomes whether it is the right thing to do for the patient.

For one patient, living on permanent life support with a breathing tube and feeding tube is not meaningful living, and that patient would prefer to pass comfortably.

For another patient, living on life support so that family can visit and be comforted is a meaningful life. We cannot assume either.

It would really help if the patient made their wishes very clear before sick-

may never be able to get back to baseline and will only decline more with time.

Therefore, she starts these conversations at least two-three years prior to the patient’s passing. In her practice, about 90% of her patients state that they don’t want to die in the hospital.

with curative treatment.

Palliative care referrals do not have to come from the PCP office; other specialists can refer as well. Another colleague of mine, cardiologist Dr. Kahea Rivera, routinely discusses and refers her patients to palliative care services when she notices increased frequency of hospitalizations for heart failure. Caregivers and family can also request it directly.

ness even happens. Many inpatient (hospital) providers, including myself, advocate that these conversations should start in the outpatient setting with the patient’s primary care provider (PCP), who would know the patient the best.

When I surveyed a few of my PCP colleagues, I was surprised to find that about half of them do not have these conversations with their patients as often as they should.

A real barrier to addressing this sensitive topic is available time, as PCPs now have other things to focus on to meet the performance measures required by insurance carriers.

Further, PCPs also need to balance cultural sensitivity, family dynamics, and not scaring the patient away from seeing the doctor regularly. Lastly, physicians and advanced practitioners in general may have different comfort levels in even broaching the topic.

Family practice physician Dr. Melanie Payanal is a palliative care specialist who routinely addresses this topic with her mainly geriatric (older patient) practice. She starts having these conversations with patients when she begins to see functional decline or increasing frequency of hospitalizations.

Dr. Payanal notes that when a patient’s Alzheimer’s or dementia gets worse, or when a patient is admitted to the hospital for illnesses like heart issues or sepsis, they

It is routine that families are invited to participate in health care planning. She states, “Your loved one is sick, expect more to come.”

Palliative care referrals are introduced, “Patient will eventually benefit from hospice.”

Hospice is a part of palliative care that focuses on the patient and family’s needs during the last few weeks and months of the patient’s life. The goal is to provide the best compassionate care and support.

This involves keeping the patient comfortable at home or in their facility. There is no longer a need to go to doctors’ visits, go to the ER, or have aggressive treatments.

The hospice team will adjust care purely for emotional, physical, and spiritual comfort and for quality of time until a natural death comes.

The decision to proceed to hospice is multifold. Again, culture and perceptions on death and dying play a large role. Older patients are more accepting to hospice compared to younger patients, as older patients already have lived a long life.

In Dr. Payanal’s experience, the patient and family often state that they appreciated the support, education, and anticipation for the end of life that palliative care services provided over time.

Palliative care is based on the needs of the patient, not on the prognosis. It is appropriate at any age and at any stage for a serious illness and can be provided along

When the inquiry is made to a palliative care group, an intake by a palliative care liaison, usually a nurse or social worker, is completed. Education and resources for the patient and family are provided, as comprehensive assessments are ongoing.

Care is coordinated and communicated. Clinical services are offered. There is a full team to help plan for and provide individualized care, which includes physicians, advanced care practitioners, nurses, chaplains, nutritionists, therapists, and other support staff.

These services value the concept of time. If a patient needs a hospital bed and other equipment for the house, arrangements and deliveries can be made as soon as 24 hours.

These services can happen at an inpatient facility or at home. If a patient lives in a care home, then patient, family, and caregiver decide if these services can happen in that care home. If not, then palliative care services will arrange for another facility.

After referral and prior to hospice, there are also supportive care services, which can be insurance dependent. These are for patients with advanced or terminal illnesses who still want to be treated but need to be supported.

Another aspect of endof-life planning is the Advance Care Planning paperwork. The palliative care team helps to guide filing the necessary legal documents for a smooth transition after (continue on S11)

death, which helps take the burden off the families.

It is important to file an Advance Health Care Directive (AHCD), which states your designated surrogate and wishes for treatment, comfort care, and any religious or spiritual instructions.

The AHCD is signed by the patient and two witnesses or a notary. A Provider Orders for Life-Saving Treatment (POLST) is a green form that states one’s wishes for immediate treatment (CPR, intubation, tube feeding, interventions), signed by the patient and medical provider.

The POLST is a mobile order that is active once it is signed. The POLST form is green so that it can be easy to find and can be kept at the patient’s home in an obvious place, like on the fridge, so that when an emergency happens in the home, the paramedics will know how to proceed.

Both ACHD and POLST forms should be scanned in

the patient’s medical record.

Your surrogate, “health care agent.” “health care power of attorney,” or the person who will make decisions on your behalf is a tricky topic in Hawaii. In medical school, we learn that the next of kin is the spouse, then the adult children or parents.

In Hawaii, however, where there are large families, extended families, and Hanai families, the “next of kin” by lineage may be inappropriate. It would be ideal if the patient designates and documents a surrogate (patient-designated surrogate).

However, if unable to do so, then “interested parties” (i.e. family members, caregivers, etc.) can select by consensus a non-patient designated surrogate. Surrogates should be available and be able to make decisions based on the patient’s, NOT the family’s, wishes. The ACHD and POLST should be used as guides.

It is worth mentioning that in my practice, I routinely bring up advance care planning with all my patients 65 years and older, and with those who have a lot of medical problems, as all surgical procedures have a risk of complications. Risks increase with age and presence of medical issues.

Another controversial topic is screening tests like mammograms and colonoscopies. It is not uncommon that doctors tell patients no need to continue screening tests when they reach a certain age.

In Hawaii, where patients live well into their 80s, 90s, and 100s, and are mentally sharp, gardening, and sometimes still driving, perhaps we are limiting care. I discuss this controversy with my patients and ultimately it is up to them whether to continue such tests, because if something is found, they may still be an appropriate candidate for treatment.

I do state, however, that

once a patient gets functional or health decline, or keeps going to the hospital, then it is nature taking its course, and we should stop screening tests and focus on end-of-life planning.

In summary, palliative care should be seen as a type of “VIP service” that adds an extra layer of support. The focus is on living. The team facilitates open conversations and provides resources for the patient and family in an individualized manner.

I hope that my medical colleagues take this useful information and apply it to their own practices. Hawaii is a blue zone where people live longer, therefore it is my opinion that having these tough conversations early should be the social norm, so that people can focus on living a meaningful life.

These conversations and documentation should be updated yearly, as health and social situations can change quickly over a short period of time.

Q & A- SENIORS MEDICAL INSURANCE ELIGIBILITY & BENEFITS

I’d also like to empower patients to ask their providers to have these discussions. My advice to the reader is:

1) Meet with your loved ones when everyone is feeling ok;

2) Decide who is the decision maker and who is the back up;

3) Discuss what the patient’s acceptable life and wishes are;

4) Document these wishes in the AHCD and POLST; and

5) Once all that is completed, go live life to the fullest.

I’d like to acknowledge and thank my Hawaii colleagues sited in this article and to those who helped me put this together. For more in depth information and resources on this topic, visit www.kokuamau.org.

DR. MARIA “MAREL” VER is a board-certified general surgeon for Hawaii Pacific Health, previous Trauma Medical Director of Pali Momi, and past PMAH president.

Got A Benefits Question? The National Asian Pacific Center on Aging is Here to Help

By NAPCA Staff

National Asian Pacific Center on Aging (NAPCA) is a non-profit organization dedicated to improving the quality of life of AANHPI older adults and their families.

In this article, we chose several questions about senior benefits eligibility from the calls and letters we received and want to share the information in this month’s column.

Question: I have received SSRB (Social Security Retirement Benefit) since I turned 62. Will my retirement be increased when I reach my FRA (Full Retirement Age)?

Answer: No. Because you started receiving retirement benefits earlier than your FRA, it was fixed with the reduced amount permanently. Bene-

ficiaries can collect the full amount only when they start to collect retirement at their FRA. They can delay applying for benefits up to age 70 and it will grow by around 8% every year during those delayed years.

Q: I am a US citizen and 58 years old. My husband just passed away. He had received Social Security Retirement. Can I receive survivor’s benefits now or should I wait until I reach my retirement age? Can I get additional assistance for living even when I can receive spouse’s benefits?

A: When you reach 60 years old you can apply for a lifetime reduced Surviving Spouse benefit. If you qualify for retirement benefits on your own record, you can switch to your own retirement benefit as early as age 62. You can re-

ceive whichever is the higher benefit. If you wait to apply for the survivor benefit until your FRA, you will receive 100% of the SSRB your deceased spouse received.

You may be eligible for Medicaid now if your income is limited. At 65, you should apply for Medicare, and you can try to apply for SSI (Supplemental Security Income) and/or MSP (Medicare Savings Programs) depending on your income and assets.

Q: I am 65 years old and have been in the US for 10 years this September. I applied to be a permanent resident and will be getting my green card soon. When can I enroll in Medicare? I heard there is 5 year waiting period. Do I have to wait 5 years after I receive my green card?

A: To be eligible for Medicare, a person must be 65 or older and must be either a US citizen or lawfully present in

the US for at least 5 continuous years. You don’t have to be a permanent resident for the entire 5 years but need to be a permanent resident when you enroll in Medicare. Your IEP (Initial Enrollment Period) starts when you receive your permanent resident notice with card and lasts for the following 3 months.

Q: When will my Medicaid Redetermination happen? When will I get my renewal letter from the state? I haven’t gotten a letter from the state. What should I do?

A: When you receive Medicaid Redetermination notice depends on when your Medicaid end date is. In general, Medicaid recipients receive renewal notice 30-60 days prior to their coverage end date but every state has its own rules. Medicaid Redetermination is currently in progress and will continue for 2023 and is expected to continue on a rolling basis through 2024.

It is very important to pay close attention to all communications sent by your State Department of Health, so your renewal goes smoothly and to avoid a loss of your insurance. That is why it’s important to keep your contact information up to date. If you think you should have received your redetermination paperwork but haven’t, you can call your local Medicaid office.

If you have additional questions on Medicare, Medicaid, Affordable Care Act Health Insurance Marketplace, Social Security Retirement Benefit, Supplemental Security Income, or COVID/Flu vaccination, there are three ways you can reach us today.

You can call our Senior Assistance Center at: (English) 1-800-336-2722, email us at askNAPCA@napca.org or send a mail to NAPCA Senior Assistance Center, 1511 3rd Avenue, Suite 914, Seattle, WA 98101.

Diabetes Technology: Modernizing Diabetes Care

By Dr. Anna Melissa Lo

In recent years, technological advancements have reshaped the landscape of healthcare, and one area where these innovations have made a significant impact is diabetes management.

Diabetes, a chronic condition affecting millions worldwide, requires constant monitoring and careful control of blood sugar levels. Traditional methods of managing diabetes have often been invasive and time-consuming, but with the emergence of diabetes technology, patients now have access to more efficient and user-friendly tools to monitor, manage, and lead healthier lives.

One of the groundbreaking advancements in diabetes technology is the development of Continuous Glucose Monitoring (CGM) systems.

Unlike traditional glucose meters that provide a snapshot of blood sugar levels at a single point in time, CGMs offer real-time data by continuously measuring glucose levels throughout the day and night.

These devices utilize a

Here are signs to look for:

• Preparing for death: suddenly updating wills, giving away cherished belongings, saying goodbyes

• Talking about suicide — for example, making statements such as “I’m going to kill myself,” “I wish I were dead” or “I wish I hadn’t been born”

• Getting the means to take your own life, such as buying a gun or stockpiling pills

• Withdrawing from social contact and wanting to be left alone

• Having mood swings,

tiny sensor inserted under the skin to monitor interstitial fluid glucose levels.

The sensor then transmits data to a paired device, such as a smartphone or dedicated receiver, allowing users to track trends, set alarms for high or low glucose levels, and make more informed decisions about insulin dosing and dietary choices.

Insulin pumps are another critical component of diabetes technology, offering an alternative to multiple daily injections. These small devices deliver a steady stream of insulin to the body, mimicking the function of a healthy pancreas.

The integration of insulin pumps with CGMs has led to the development of closed-loop systems, also known as artificial pancreas systems. These automated systems use real-time CGM data to adjust insulin delivery, providing a more precise and personalized approach to diabetes management.

Closed-loop systems help stabilize blood sugar levels and reduce the risk of severe highs and lows, ultimately enhancing the quali-

such as being emotionally high one day and deeply discouraged the next

• Being preoccupied with death, dying or violence

• Feeling trapped or hopeless about a situation

• Increasing use of alcohol or drugs

• Changing normal routine, including eating or sleeping patterns

• Doing risky or self-destructive things, such as using drugs or driving recklessly

• Giving away belongings or getting affairs in order when there’s no other logical explanation for

ty of life for individuals with diabetes.

The widespread use of smartphones has paved the way for diabetes management apps that allow users to log blood sugar readings, track food intake, and monitor physical activity.

These apps provide a comprehensive overview of the factors influencing blood sugar levels, empowering users to make proactive decisions to maintain optimal glucose control.

Moreover, many CGM and insulin pump manufacturers offer apps that seamlessly integrate with their devices, enabling users to access real-time data, share it with healthcare providers,

doing this

• Saying goodbye to people as if they won’t be seen again

Mental health experts say it’s never out of place to ask someone if he or she is thinking of committing suicide when warning signs are present.

Reducing risk for suicide

While Mabel’s daughter continues her counseling sessions, she said her family has gotten closer. They have more regular family outings. They’ve worked on communicating and connecting at a

responds dynamically to blood sugar levels, and bioengineered pancreas constructs for a more permanent solution.

Additionally, integration with telemedicine and virtual healthcare platforms could enhance remote patient monitoring and consultation.

Diabetes technology has transformed the lives of individuals managing this complex condition.

and receive remote assistance in adjusting treatment plans.

While diabetes technology has revolutionized the management of this chronic condition, challenges remain. Accessibility and affordability are crucial concerns, as these cutting-edge devices may not be accessible to all individuals with diabetes.

Furthermore, ensuring the security and privacy of personal health data transmitted by these devices is paramount.

Looking ahead, the future of diabetes technology is promising. Researchers are exploring advancements such as smart insulin, which

deeper level. They got a family pet. “Most important is that we always tell each other that we’re here to support each other, no matter what,” Mabel said.

The CDC says building tighter family and community bonds helps to reduce risks of suicide. When people feel that they are needed and know how their loss would greatly impact those around them, this becomes a powerful deterrent against suicide, the CDC says. It also says learning effective coping and problem-solving skills are important factors that reduce suicidal tendencies.

From continuous glucose monitoring systems to artificial pancreas technologies, the advancements are offering improved glucose control, greater convenience, and enhanced quality of life.

As research and innovation continue, the synergy between healthcare and technology holds the potential to bring us even closer to a future where diabetes is managed with unprecedented precision and ease.

DR. ANNA MELISSA LO is board certified through the American Board of Internal Medicine, both in Internal Medicine and Endocrinology, Diabetes, and Metabolism. She is currently practicing at the Primary Specialty Clinic of Hawaii across different islands including Oahu, Lihue, and in Hilo.

Dr. Eusibio believes the rates of suicide are on the rise because society has evolved in such a way that places many expectations and stress on individualsespecially the youth. “Additionally, as the number of divorce rates also increases, the number of children from broken families is also growing, which leads to the loss of their primary support system,” she said.

Dr. Eusibio said she had never thought of committing suicide. “Due to life’s challenges at an early age, this has molded me to become independent and strong-mind(continue on S13)

(COVER STORY: Filipinos’....from S8)

Suicide: It’s time we start talking about it

By Jay Valdez, Psy.D.

As a psychologist, I want to bring attention to an important mental health crisis affecting our community: Suicide.

The American Foundation for Suicide Prevention (AFSP) has made September National Suicide Prevention Month.

Suicide is the 11th leading cause of death in the United States with 48,183 Americans committing suicide in 2021. The average amount of suicides committed per day is 132 and men are 4 times more successful in committing suicide than women.

I’m sure that as you’re reading this article, you personally know of someone or an acquaintance who has committed suicide.

We as people cannot turn a blind eye, ignore, or deny that suicide exists and can potentially happen to someone we know.

We have a responsibili-

ed. I have learned to have a firm and goal-directed vision.”

Mabel said she thinks most parents in her generation don’t think of suicide as something that could happen in their own family. “It’s something that our parents never talked about with us. And growing up, I never had those thoughts. But every generation is different. My hope is that every parent has a serious talk about suicide. You just never know what’s in the mind of your children.”

Getting help

Contact the 988 Suicide and Crisis Lifeline if you are experiencing mental health-related distress or are worried about a loved one who may need crisis support. Call or text 988. Chat at 988lifeline.org. Connect with a trained crisis counsel-

ty to ourselves, family, loved ones, and the community to feel comfortable talking about suicide or asking for help.

The American Foundation for Suicide Prevention is a great site to educate yourself on suicide.

They have resources on understanding what suicide is, how to talk about it, how and where to get help, how to be an advocate and help create and pass policies both on a federal and state level and last but not least, how to deal with the loss of losing someone to suicide.

In a nutshell, talking about suicide would be the first step in preventing it. Don’t be afraid to approach someone you’re concerned about and ask them how they’re feeling and if they’re having thoughts of wanting to hurt themselves.

Even if they say they’re feeling fine, clarify and ask them if they’re really feeling

or. 988 is confidential, free, and available 24/7/365.

The Hawaii State Department of Health’s Adult Mental Health Division (AMHD) has a statewide ACCESS line program. On Oahu callers can reach the Crisis Line by dialing 8323100. Neighbor island residents may call toll free at 1-800-753-6879.

If there is an urgent threat, it’s recommended to call 911.

If you’re feeling suicidal, but you aren’t immediately thinking of hurting yourself: Reach out to a close friend or loved one — even though it may be hard to talk about your feelings.

Contact a minister, spiritual leader or someone in your faith community. Make an appointment with your doctor.

Seeing a mental health

fine or are they just saying that they’re fine. Hopefully, they will feel comfortable enough to open up to you.

And yes, it’s a topic that people don’t normally talk or ask about but it’s our duty as family, friends, and citizens. Even if you feel awkward asking them if they feel like hurting themselves, ask anyway to show that you’re concerned.

As you’re reading this, you can think about and rehearse in your mind how you would ask someone you’re concerned about.

professional when suicide ideation occurs is lifesaving. Professionals can help people deal with healthy coping strategies and emotional

For example, you can say “Hey, I feel awkward saying or asking you this but are you having thoughts of hurting yourself?” or “I might be totally off base but I just want to make sure you’re okay but are you having thoughts of hurting yourself?”

Next, listen to them, and allow them to express how they’re feeling and what they’re going through in their lives. Show them you understand by paraphrasing or summarizing what they said.

If you don’t understand

management. They can help the at-risk individual with techniques to get through life stressors.

Mental health profes-

what they’re going through, it’s perfectly okay to ask more questions to help you understand their experience. Asking them questions shows them that you really care and want to understand their issue.

Next, connect them to resources such as ASFP (mentioned above) so they can get further help or mention Hawaii CARES Crisis hotline.

Hawaii CARES is a local resource. They can call 988, text 988, or chat 988 for local assistance.

This hotline is not only for people experiencing a mental health crisis but also for people who need advice for dealing with a family, friend, or loved one you’re concerned with.

They’re available 24/7 and are handled by trained mental health professionals. They also can send a mobile crisis team to the individual in crisis.

Other options include calling 911 or going to the emergency room.

The point is if they want help, they will open up to you or use the resource you recommended to them.

sionals say, “Remember, acute suicidal feelings are temporary. Take one step at a time and don’t act impulsively.”

DOH: Be Aware of Urinary Catheter, Glucose Monitors and Supplies Scam

The Hawaii Department of Health advises the public to be aware and cautious of fraudulent claims regarding urinary catheters, glucose monitors and similar supplies. To spot the scam, here are the red flags to look out for:

• You don’t recognize the ordering physician’s name nor have you been seen by

•

•

Explana-

tion of Benefits (“EOB”) or Medicare Summary Notice (MSN) with a large quantity of supplies you’ve never received

• You don’t have a medical condition that would require the supplies

If you have encountered a suspicion billing activity, contact Senior Medical Patrol Hawaii at (808) 5867281 or toll-free at 1-800296-9422. 

(COVER STORY: Filipinos’....from S12)

Breaking the Cycle of Anxious Parenting

By Karen K.C. Gibson

Children think differently, face so many distractions, and endure overwhelming stress. A primary goal of parenting is to prepare our children for adulthood.

Parents are exhausted by frequent conflicts and worries that fill them with uncertainty, wondering if their child is equipped to navigate life as an adult successfully.

Shifting one’s mindset is the key to breaking the cycle of anxious parenting.

Accessing the right mindset to crush your limiting beliefs

Once we are mindful of our thoughts, we can understand which negative thinking patterns we engage with most and detach from believing they are true. Questioning whether your thoughts are helpful or destructive is the key to taming your inner critic.

Are your thoughts filled with worrying about future adverse outcomes? Will your child fail? Will your child find a career that provides financial security?

Pausing and reflecting on how worrying just drains your mental and emotional energy sometimes provides the incentive to let go and choose peace.

Is the stress, sleepless nights, and frustration worth it? Creating the right mindset and having a healthier perspective will pave the way to crushing limiting beliefs.

Understanding your fears to face them and build resil-

ience

Fears are mental worstcase scenarios our mind conjures up that have spiraled further, causing mental paralysis, sleepless nights, and constant knots in our stomachs.

Acknowledge that fear has shown up to teach you

HEALTHLINE NEWS

a valuable lesson and allow you to grow. Thank fear for showing up. Fear is used to being avoided, not embraced. Once you understand your fear, fear will lose more power and no longer steal your peace.

Ask the following questions: What exactly are you afraid of? What if your fears don’t come true? How do you handle resistance?

Fears operate through our imagination, much like storytelling does. Understanding fears helps build resilience, which reduces stress and increases peace.

Retraining your brain by asking self-reflective questions

Retraining the parenting brain helps overcome limiting beliefs which can cause unnecessary stress and conflicts as parents tend to lecture more rather than listen. Sometimes we use mental filtering to filter out the positives and only focus on the negative.

Other times we engage in “black & white thinking, which is when we believe there is no middle ground, either something is perfect or a failure. We often make

Kilauea Eruption Raises Concern For Air Quality Hazards

The Hawaiʻi Department of Health advises the public to be prepared for air quality impacts due to the recent Kīlauea eruption.

As of Sunday, September 10, permanent air quality monitoring stations across the state report that air quality levels are elevated at the Ocean View and

Pāhala air quality monitoring stations.

The eruption has caused vog conditions to return to the west side of Hawaiʻi Island.

Particulates in the air and levels of sulfur dioxide may increase and fluctuate in various localized areas on Hawai‘i Island, causing poor air quality.

Hawai‘i residents and visitors are advised to be

prepared for and aware of the surrounding conditions, and how they may react to poor air quality or vog. In the event of voggy conditions, the following precautionary measures are advised:

• Reduce outdoor activities that cause heavy breathing. Avoiding outdoor activity and exercise during vog conditions can reduce exposure and minimize health risks. This is especially important for sensitive groups, such as children, the elderly, and individuals with pre-existing respiratory conditions including asthma, bronchitis, emphysema, and chronic lung and heart disease.

• People with asthma or

a judgment without considering all the facts.

Question your thoughts the next time you take something personally and compare yourself to others, making you feel unworthy. Also, if you believe you are right, you usually argue to prove your point. Adapt your thinking. Don’t underestimate the power of deep breathing, a mini walk outdoors, or listening to your favorite music when you find your chaotic thoughts hijack your peace. If you’re interested in an online course, “Breaking the Cycle of Anxious Parenting,” visit LettingGowithAloha.com. The course covers overcoming limiting beliefs, understanding and conquering fears, and retraining your brain to parent with peace instead of anxiety.

KAREN K.C. GIBSON is a mother of two adult daughters, wife, author, parent coach, and educator. Visit her website lettinggowithaloha.com, to learn more about her services or follow her on Instagram @karenkcgibson.

windows and doors. If an air conditioner is used, set it to recirculate. If you need to move out of an impacted area, turn on the car’s air conditioner and set it to recirculate.

other chronic respiratory disease should always have medications available. Daily prescribed medications should be taken on schedule.

• People experiencing health effects should contact their medical provider as soon as possible if any symptoms develop, as respiratory conditions might worsen rapidly in heavy sulfur dioxide or vog conditions.

• Stay indoors and close

• Face masks (surgical, cloth, KF94, KN95, N95) do not provide protection from sulfur dioxide or vog. However, they can be effective in outdoor environments in reducing inhaled hazardous particulates associated with falling ash and Pele’s hair.

• Do not smoke and avoid second-hand smoke.

• Drink plenty of fluids to avoid dehydration.

To learn more about vog information, visit vog. ivhhn.org/. To monitor air quality levels in the state, head to air.doh.hawaii.gov/ home/map.

Fighting Inflammation – The Key to Healthy Aging from Dr. Bradley Willcox

By Robert Kay

Dr. Bradley Willcox trained at the University of Toronto, the Mayo Clinic, and Harvard Medical School. His work has appeared in cover articles for Time Magazine, National Geographic, and on Oprah, Good Morning America, and the BBC.

Dr. Willcox also is Principal Investigator of several National Institute on Aging-funded studies. He is also Professor and Director of Research at the Department of Geriatric Medicine, John A. Burns School of Medicine, University of Hawaii.

Question: What is the connection between inflamma-

tion and aging?

Dr. Bradley Willcox: Oxidative stress and inflammation are the key factors for the development of chronic disease and other ravages of old age. Oxidative stress— let’s call it inflammation, is believed to be a principal mechanism of aging.

Q: How do you prevent inflammation and chronic disease?

Dr. Wilcox: The good news is that most of these ailments can be markedly delayed and largely prevented by a healthy diet, exercise, and other lifestyle factors.

Q: Can you talk a little about astaxanthin, why is it so important?

Dr. Willcox: Yes. It’s known as a marine carotenoid, found in seaweeds and kelp. It’s part of the Okinawan diet and shows particular promise in our research. The compound has powerful, broad-ranging anti-oxidative and anti-inflammatory properties.

Q: What’s the difference between the natural product and the “nature identical” product?

Dr. Willcox: The natu-

ral compound (sold as Bioastin) is derived from algae, whereas the nature-identical version (ZanthoSyn) is synthesized. They are both good for you. ZanthoSyn, however, has greater 3x more bioavailability, meaning it’s absorbed better by your system. (Full disclosure, I’m on the scientific advisory board for Cardax, the company that produces ZanthoSyn).

Q: What’s the bottom line of your research regarding the FOXO3 gene and longevity?

Dr. Willcox: In short, the FOXO3 gene, which everyone has, is strongly associated with human longevity. However, people who have certain variants of this gene have a 2-3 times greater

chance of living to 100. I’m also convinced that FOXO3 is connected to mitigating inflammation.

Q: Can you discuss any recent research you’re involved in that might be of interest?

Dr. Willcox: I’m glad you asked. My colleague Richard Allsopp, a Ph.D. Professor over at the John A. Burns School of Medicine has reported preliminary findings from a trial focused on how astaxanthin impacts FOXO3 in mice. What he’s found seems to confirm what we believe about the efficacy of astaxanthin.

Q: Any parting advice?

Dr. Willcox: Eat lots of vegetables and fish, engage in regular physical activity, avoid tobacco and drink moderately. Wouldn’t hurt to take astaxanthin either.

Here’s What you Need to Know to Avoid a Gap in Coverage and How HealthCare.gov Can Help

By The CMS Staff

Millions of people across the county are at risk of losing health coverage starting now and over the next several months. Medicaid is a lifeline for millions of children, parents, seniors, people with disabilities, and so many others.

The Centers for Medicare & Medicaid Services (CMS) have complied commons questions regarding coverage. Below are the answers with information provided by the U.S. Department of Health and Human Services.

What should people do to keep their health coverage?

If you still have Medicaid or CHIP, make sure your

contact information is up to date and check your mail for a renewal form from the state Medicaid agency. Fill out the form and return it immediately to avoid a loss of coverage.

Why is this happening now?

During the COVID-19 pandemic, states were generally allowed to temporarily stop renewals for Medicaid and the Children’s Health Insurance Program (CHIP). This kept people from losing their health coverage. On December 29, 2022, the Consolidated Appropriations Act (CAA) was signed into law and required states to return to normal operations by restarting their eligibility reviews. Now millions of adults and children may lose their Medicaid or CHIP coverage.

What if I am no longer eligible for Medicaid or CHIP?

If you have lost Medicaid or CHIP, visit HealthCare.gov to see if you are eligible to enroll in a lowcost, quality health plan. Due to the Inflation Reduction Act, enhanced financial help is available to purchase health coverage through HealthCare.gov. In fact, 4 out of 5 customers can find a plan for $10 or less per month with financial help.

What you pay is based on your age, your family size, your household income, where you live, what plan you choose, and other factors.

What do the health insurance plans available on HealthCare.gov cover?

Plans available on

HealthCare.gov offer a wide range of benefits and comprehensive coverage. All medical coverage plans at HealthCare.gov cover essential health benefits, including preventive services like annual checkups, hospitalizations, prescription drugs, birth control, doctor’s visits, emergency care, and more.

All plans at HealthCare. gov are prohibited from excluding coverage based on preexisting conditions. Marketplace health plans are offered by private insurance companies that offer quality coverage.

How do I apply?

You can begin or update your application from the comfort of your home at HealthCare.gov. In fact, many people complete their

application in one sitting. For assistance, you can visit Find Local Help on HealthCare.gov at localhelp.healthcare.gov/ to search our online directory and set up a time to talk in-person, over the phone, or by email with an agent, broker, or assister in your area who can help you with your application and more. Or, consumers can get help filling out their application by calling the HealthCare.gov call center at 1-800-318-2596 with assistance in 200 languages. The HealthCare.gov call center is open 24 hours a day, 7 days a week.

When can I apply?

Visit HealthCare.gov today to see if you are eligible to enroll in a low-cost, quality health plan.