Healthline Magazine - April

March 26, 2015

MINDFUL AGING Advance Directives - Why is it important to be prepared?

Healthy aging made simple: Tips from a geriatrician

+ Exercise tips your heart will love +Get rid of groggy mornings

UCHealth handles life’s emergencies – big or small.

EMERGENCY CARE Medical Center of the Rockies 2500 Rocky Mountain Ave., Loveland

EMERGENCY SERVICES uchealth.org/JustWalkIn

URGENT CARE UCHealth Urgent Care 2121 E. Harmony Road, Fort Collins UCHealth Urgent Care Poudre Valley Hospital 1900 16th St., Greeley 1024 S. Lemay Ave., Fort Collins Greeley Emergency and Surgery Center UCHealth Urgent Care 3850 N. Grant Ave., Ste. 200, Loveland 6906 10th St., Greeley WALK-IN CARE Family Medicine Center Walk-in Clinic 1025 Pennock Place, Fort Collins

contents

s

FITNESS: Exercise tips for your heart

also inside

Page 10

sHEALTHY

AGING made simple: tips from a geriatrician Page 16

Hearing Aids and Alternatives.................................................................................. 4 Social Security Q&A ................................................................................................ 5 Drink more water .................................................................................................... 6 UNCOMMON SENSE .............................................................................................. 8 Doctor decries how we approach the end of life .................................................... 14 HEALTH EVENTS: Healthy Weight Book Club ........................................................ 19 NUTRITION: Eating your way HEALTHY ................................................................ 20 Wake up feeling refreshed .................................................................................... 22 HEALTH NEWS: Children’s health coverage losses outlined.................................... 24 Health Calendar .................................................................................................... 25

Health Line of Northern Colorado is a monthly publication produced by the Loveland Daily Reporter-Herald. The information provided in this publication is intended for personal, noncommercial, informational and entertainment purposes only and does not constitute a recommendation or endorsement with respect to any company, product, procedure or activity.

You should seek the advice of a professional regarding your particular situation.

For advertising information contact: Linda Story, advertising director: 970-635-3614

For editorial:

Misty Kaiser, 303-473-1425 kaiserm@reporterherald.com

on the cover Don’t underestimate the importance of

ESTATE PLANNING _________ PAGE 12

March 26, 2015

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HEALTHLINE 3

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H E A R I N G H E A LT H

NOT READY FOR A HEARING AID? Alternatives break tradition (BPT) - Your spouse’s voice, the traffic signals, your favorite TV show - you probably don’t think about your sense of hearing often, but without the ears’ ability to collect and translate invisible sound waves, many important things would go unheard. Unfortunately, missing out is a reality for 98 million Americans who experience some degree of hearing difficulty.

The ability to hear is directly related to one’s quality of life. Nearly half of online U.S. adults have some hearing problems, reports the Consumer Electronics Association (CEA), and many choose not to seek medical advice regarding their condition and ignore possibilities for correcting the problem.

In fact, according to the CEA study “Personal Sound Amplification Products: A Study of Consumer Attitudes and Behavior,” 24 percent of people reported a device was cost prohibitive and 18 percent did not want a hearing aid.

Hearing problems can occur at any age and are often exacerbated by being in noisy places like restaurants or trying to hear things that are at a distance. If you feel you have been missing out on listening to the world around you, there’s no reason to delay taking action - a solution may be simpler than you think. If you strain to hear in certain situations, you

4 HEALTHLINE

have two primary options: a hearing aid or personal sound amplification products (PSAPs).

HEARING AIDS Hearing aids cater to a small group within those 98 million who have moderate to severe hearing impairments. To get a hearing aid, a trained professional will test the levels of hearing difficulty, determine the right solution, and fit the person for a device. While they can be an effective solution, hearing aids are costly and many people want to avoid the negative associations with wearing one.

Hearing aids are the best

option for those with persistent hearing loss, but there are many others who struggle with hearing in everyday situations like talking in a loud restaurant, watching TV or attending business meetings.

People in these situations would be good candidates for alternative solutions that do not require medical intervention.

PSAPs Personal sound amplification products are a hearing-assistance alternative that is quickly gaining popularity. PSAPs work by using technology to augment a person’s ability to hear.

One example is Soundhawk,

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a system that includes a lightweight earpiece called the Scoop that features dual-microphones to elevate desired sounds while minimizing disruptive background noise.

For really noisy situations, Soundhawk also includes a small wireless microphone that picks up sound at its source and delivers it to the Scoop in your ear up to 33 feet away - making it easy to hear the TV and have conversations in a loud restaurants. The system can be customized for each user with a simple mobile app on your smartphone or tablet.

Personal soundamplification products can be ordered and used without medical intervention, plus they are more affordable; this makes them a good option for people that experience situational hearing problems. While a hearing aid can cost $2,000 or more, PSAPs typically range between $100 and $600 much more in line with what people with lower-level hearing problems are willing to invest. Visit www.soundhawk. com to learn more.

Hearing the world around you is too valuable of an experience to miss. Now, thanks to new hearing-assistance alternatives, nobody is stuck with the stigma or cost of traditional solutions. Learn more today about what options are best for your needs.

March 26, 2015

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SOCIAL SECURITY Q&A

Does marriage affect SSI benefits?

Tribune News Service(TNS)

Q

: I am receiving Social Security and Supplemental Security Income (SSI) benefits.

I just got married, and I am wondering if my benefits, and my new spouse’s benefits, will stay the same.

A

: If you marry, your spouse’s income and resources may change your SSI benefit. It is your responsibility to report your status change to Social Security as soon as possible. If you and your spouse both get SSI, your benefit amount will change from an individual rate to a couple’s rate.

If you are receiving Social Security benefits as a widow, divorced widow, widower or

divorced widower, other factors to keep in mind are: •You cannot get benefits if you remarry before age 60; and •You cannot get benefits if you’re disabled and remarry before age 50.

Generally, your benefits end if you were receiving divorced spouse’s benefits and you remarry. You can read more about SSI and Social Security benefits at our publications library at socialsecurity.gov/pubs.

———————— : I know that some of my resources affect my Supplemental Security Income (SSI). Is there a list of resources Social Security takes into account when providing pay-

Q

ments?

A

: Resources are things you own and can use to pay for food and shelter. Resources include bank accounts, personal property and real estate. We use the value of your resources to determine if you can get SSI. We don’t count all of your resources, including the value of the home and property where you live. Some resources we do count include: •Cash; •Bank accounts, stocks, U.S. savings bonds; •Land; •Life Insurance; •Personal Property (excluding the value of your home); •Vehicles; •Anything else you own which could be changed to cash and

used to pay for food or shelter; and •Deemed resources.

Sometimes we deem a portion of the resources of a spouse, parent, parent’s spouse, sponsor of an alien or sponsor’s spouse as belonging to the person who applies for SSI. You can learn more about which resources Social Security uses to determine your SSI payment at www.socialsecurity.gov/ssi/ text-resources-ussi.htm .

——— (This column was prepared by the Social Security Administration. For fast answers to specific Social Security questions, contact Social Security toll-free at 800-772-1213 or visit www. socialsecurity.gov.)

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HEALTHLINE 5

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UROLOGY Northern Colorado 6 HEALTHLINE

The easiest thing you can do for your health and looks: drink more water (BPT) - You probably already know that exercising and eating right are key ways to improve your health.

But, you may be overlooking one major health necessity that is as close as your kitchen faucet - water. It’s vital all year long, even during winter months when you might think hydration is less important.

“Staying hydrated is a very important component of staying healthy,” says physician assistant Tricia A. Howard, a faculty member at South University, Savannah College of Health Professions . “Most people know they need to stay hydrated when they are doing vigorous exercise or in very hot weather, but they don’t realize the importance of making sure they are getting enough water every day.”

Why water is important Sixty percent of your body weight is made up of water. Since water carries nutrients to cells in your body, and flushes toxins from vital organs, Howard says it is important to replace what you lose daily.

“Our bodies are always losing water - even when we breathe we are losing small amounts,” she says. “So, it is important to know how much water you need daily and to make a point of drinking it.”

Your daily intake Howard says men need three liters, or 13 cups, of water a day. Women should drink 2.2 liters or nine cups daily.

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“If you drink water with each meal, and at least one glass between each meal, you will be very close to what you need to drink every day,” Howard suggests.

And there is good news if you want some variety. Howard says beverages like milk and even coffee can take the place of some of the water that you need to drink daily.

“Drinks that are high in water, and low in calories, are acceptable substitutions for water,” Howard explains.

“But watch out for sugary, high-calorie drinks that will cause weight gain.”

Beauty benefits Howard says the benefits of staying properly hydrated every day go beyond good health. Staying hydrated also approves the appearance of your skin.

“Drinking a glass of water is one of the easiest things any of us can do,” Howard says. “It is important to how your body works on the inside, and how it looks on the outside. Adding this simple step to your daily routine is well worth the many benefits.”

Editors Note: See suprograms.edu for program duration, tuition, fees, and other costs, median debt, federal salary data, alumni success, and other important info. Programs, credential levels, technology, and scheduling options are subject to change. 709 Mall Boulevard, Savannah, Ga. 31406 ©2014 South University. Our email address is csprogramadmin@ edmc.edu.

March 26, 2015

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HEALTHLINE 7

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UNCOMMON SENSE

Disparity in money and technology can put strain on relationships OK to talk about future retirement plans, travel and similar issues or if this is rude and may offend my friends who have less than I do. Your thoughts?

Dear Dr. Beth, I have friends from all walks of life. Rather than surrounding myself with people who are just like me educationally and financially, I have a great variety of friends.

Some are professionals like myself, some are in construction or other blue collar occupations and others are “starving artists” and musicians. I don’t see myself as better than my starving artist friends or blue collar friends just because I make more money than they do. How-

ever, as we have gotten older it seems like the difference in our financial circumstances has grown larger and larger.

I have always had open and honest conversations with my friends in the past, but now I don’t know whether it’s

LOCAL MATTERS!

Socioeconomic disparities are a reality of our society and a major source of passionate emotion and disagreement. Economic disparities are a major source of tension that can also affect our personal relationships. You are right to be sensitive to these issues and

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March 26, 2015

how they play out with friends whose lives have taken different directions.

Some people in positions of socioeconomic privilege find it much easier to socialize and develop friendships with others similar to themselves. However, many people have long-term and new friends who are in different circumstances. All of these friendships may remain very important throughout life.

There are no clear guidelines or book of etiquette I am aware of that deals with these issues so the best approach combines common sense, awareness and communication. Since people are often reluctant to talk about money, even with close friends, it is important to pick up on verbal and non-verbal clues about your friends’ comfort levels talking about retirement, investments and other money-related subjects.

Depending on individual circumstances and personality, discussing these kinds of topics may be just fine or may be uncomfortable. Such discussions can inadvertently stir up feelings of anger, hurt and resentment that could mar your friendship. Here are a couple of things to be aware of as you choose to approach or avoid these topics.

If you have had an open, disclosing type of relationship that has always included discussion of your respective financial situations, plans, retirement and so forth, there is probably no reason to discontinue discussing those subjects. If you do have that level of open communication, it may also be fine to talk about your own comfort level and concerns about your

March 26, 2015

friend’s potential discomfort.

This conversation will provide information valuable to you in making future decisions.

Second, be conscious of maintaining a balance in the give and take of the discussion of these and other topics. Whatever your friend’s issues may be, their feelings and struggles are just as important as yours and conversation should not revolve around you.

Third, if there is an especially large economic disparity, it is not uncommon to feel an emotional tug to help your friend financially and try to shoulder some of the responsibility for their situations. This is tricky territory. Your assistance may be welcome at times, but it can also foster an unequal power relationship between you.

As most people have discovered at some point in their lives, issues of money often contaminate relationships. Resist the urge to step in unasked. If you wish to help, do so out of a sense of choice rather than obligation and be clear as to whether the money is a loan or a gift.

If it is a loan, it is important to have a clear, preferably written, agreement about terms of repayment.

The topic of money is delicate to navigate. With good will, sensitivity and regard for your differences, this need not become a barrier to a lifetime of sharing with new and long-term friends.

Dear Dr. Beth,

I am in my late 40s and old enough to remember life before cell phones. I married at 19 and my wife passed away a couple of years ago

from a serious unexpected illness. Now I am starting to date again. My problem may seem trivial, but several of the women I have dated have annoyed me due to how they use their cell phones on our dates. I really don’t know what the etiquette is for cell phone use especially in dating situations. Am I right to be annoyed or is this just something I need to accept?

This is a great question.

I, too, remember well the days before cell phones.

Dating seemed simpler then, although it has never really been simple. Dating 30 years ago in your teens is quite different from trying to form romantic relationships today, especially following a long marriage and divorce or widowhood.

Clearly, one of the many things that has changed in the past 30 years is technology and its role in our lives.

Cell phones, computers and tablets, are very much a part of our lives. Cell phones in particular are both a convenience and potentially intrusive. Sometimes it seems like they use us more than we use them. A clear etiquette for their use in various social circumstances has not yet been well-developed so people handle their connectivity in many different ways.

I think the role of technology in our social lives is becoming one of the aspects of potential compatibility or incompatibility within relationships.

It is obviously

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not whether we have a cell phone, but how we use it that determines our compatibility. It is a legitimate topic of conversation with a dating partner.

The modest consensus on cell phone etiquette that has emerged so far suggests that it is discourteous to answer non-urgent calls during an activity with another person. A clear exception is when both people are equally comfortable with a norm of answering calls and texts regardless of the activity.

Most of this is contingent upon your personal preferences. If someone you are dating uses their cell in ways that really bug you, you need to bring the subject up in a straightforward but tactful way. Express your opinions and see if your date is open to modifying their habits when you are spending time together. If your date isn’t interested in changing, you may be better off finding a partner whose relationship with modern technology more closely matches yours.

Uncommon Sense with Beth Firestein Dr. Beth Firestein is a licensed psychologist. She has 27 years of therapy experience and has practiced in Loveland for more than 16 years.

She may be reached by calling her office at 970-635-9116, via email at firewom@webaccess.net or by visiting www.bethfirestein.com.

HEALTHLINE 9

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FITNESS

ASK THE PHARMACIST: Exercise tips your heart will love (BPT) - A regular exercise routine is an important component of heart health, yet less than one-third of Americans get the minimum 30 minutes of daily exercise five days a week, as recommended by the American Heart Association (AHA). Nationally, as many as 250,000 deaths annually are attributable to a lack of regular physical activity.

While exercise is important for everyone, regular aerobic activity can be critical to ensuring healthier outcomes for cardiovascular patients. Even a little exercise goes a long way.

“Just 5-10 minutes of daily running, even at very slow speeds, can significantly lower the risk of mortality among cardiovascular patients,” says Ed Dannemiller, a specialist pharmacist in the Express Scripts Cardiovascular Therapeutic Resource Center. “Simply getting the recommended minimum amount of exercise can help reduce cardiovascular events such as heart attack and stroke by 30-40 percent.”

Ed and his team counsel heart patients about the benefits of regular exercise in addition to following the medication regimen and other lifestyle changes.

Regular exercise has many other benefits for your heart as well, including: strengthening the heart muscle, lowering blood pressure and cholesterol levels, gaining better control of one’s blood sugar and maintaining

10 HEALTHLINE

bone strength. Exercise can also help heart patients lose weight and lead more active lives without chest pain.

If you are considering starting an exercise regime, keep these precautions in mind to minimize your risks and prevent an adverse reaction.

• If you recently had a heart surgery or procedure, experience chest pain or shortness of breath, recently had a heart attack, or have diabetes you should consult a physician before beginning any exercise regimen.

• If you are on beta blockers, anti-arrhythmic drugs and calcium channel blockers, you may have a reduced heart rate and may experience lower gains in heart rates when exercising. Medications

such as the decongestant pseudoephedrine, antidepressants, and thyroid medications can increase exercise heart rate. It is important to know the right aerobic heart rate target to prevent overtraining or under-training your heart if you are on any of these medications.

• If you are a cardiovascular patient, high-intensity exercises such as push-ups, sit-ups and heavy lifting may not be recommended for you, so it’s a good idea to first speak with your physician.

• You may also need to avoid certain everyday activities that can overly affect the heart rate, such as raking, shoveling and mowing.

• Walking, swimming and light jogging are good

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beginning exercises if you have a cardiovascular condition.

But what if you’re already on a work-out schedule? Then keep these useful tips in mind: • Maintain a steady pace and rest between workouts.

• Do not exercise outdoors in extremely humid, hot or cold temperatures. Extreme temps can make breathing difficult and cause chest pain. Try mall-walking instead.

• In cold weather, cover your nose and mouth when exercising outside.

• Stay hydrated by drinking water, even when you’re not feeling thirsty and especially on hot days.

• Avoid overly cold/hot showers or sauna baths after exercise.

March 26, 2015

• Avoid exercising in hilly areas because it may cause your heart to work too hard. Closely monitor your heart rate with your target rate in mind.

• Stop exercising if you experience pain, dizziness, shortness of breath or excessive fatigue. Consult your physician.

• Stop the activity in the event of a rapid or irregular heartbeat. Check your pulse after 15 minutes of rest and consult your physician if the rate is still higher than 100120 beats per minute.

A regular exercise routine, along with adherence to the medication regimen, can put you on the path toward better health. For more information, visit lab.express-scripts.com.

IF YO U G O …

Finding the right exercise option is important if you have physical limitations. If you and your doctor are looking for a way for you to get a little more active, Chilson Recreation and Senior Center offers such a wide variety of adapted fitness classes, it’s easy to find something that fits your goal.

From lower-impact exercise classes to SilverSneakers® programs, the classes are designed to accommodate various fitness levels, depending on individual choice.

The wide selection of aqua fitness classes work the cardiovascular system without stressing joints. Several of which can be especially beneficial following injury or for those with arthritis or other joint issues. Be sure to ask which classes are tailored for this purpose.

Chilson Recreation and Senior Center 700 East Fourth St., Loveland, 970.962.2783 www.ci.loveland.co.us/index.aspx?page=1561

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HEALTHLINE 11

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F E AT U R E : M I N D F U L A G I N G

Don’t underestimate the importance of ESTATE PLANNING

By Judy Finman, Healthline Magazine

More than 50 percent of Americans die without leaving critical estate-planning documents – such as a will or living trust, and advance directives for healthcare and finance – according to the AARP Foundation.

Yet, it is important to create an estate plan to ensure that your loved ones are protected if something happens to you, and that you are in charge of your finances and your medical care and can be sure your wishes are known and followed.

In a study at The National Institute on Aging (NIA), scientists funded by NIA found that advance directives can make a difference, and that people who document their preferences in this way

12 HEALTHLINE

are more likely to get the care they prefer at the end of life than people who do not.

Making your wishes known

Loveland Attorney Nevin Seeger says, “It’s important that you make your wishes known, because otherwise your family will have to make a decision and agonize over whether it’s what you wanted.”

He explains that advance care planning involves learning about the types of decisions that might need to be made, considering those decisions ahead of time, and then letting others know about your preferences, often by putting them into an advance directive.

“An advance directive is a legal document that goes into effect only if you are

incapacitated and unable to speak for yourself. This could be the result of disease or severe injury—no matter how old you are. It helps others know what type of medical care you want. It also allows you to express your values and desires related to end of life care. You might think of an advance directive as a living document—one that you can adjust as your situation changes because of new information or a change in your health.”

Seeger says that a basic estate plan should include a Last Will and Testament, a living will (advance directive), medical durable power of attorney for medical and related decisions, and a durable power of attorney for financial decision-making. “It is critical to also review the deeds, bank account ‘pay on

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death’ directives, retirement account TODs (‘transfer on death’), and life insurance beneficiaries.

“It is rare that my clients are not surprised by what they find in these documents,” he notes.

A Will for a family with dependents such as children should include a trust for care of them, as well as a statement of the preferred guardian (who takes care of the person) and conservator (who takes care of the money) for the dependents.

A living trust is for financial affairs. It is similar to a traditional Will because it gives instructions for the disposition of your assets after you die. But, unlike a traditional will, a living trust also provides instructions in the event you become incapacitated before you die.

March 26, 2015

There are also other documents you can choose that can supplement your advance directive or that stand alone. These documents may include DNR (do not resuscitate) orders, organ and tissue donation, dialysis, and blood transfusions.

A living will is a written document that helps you tell doctors how you want to be treated if you are dying or permanently unconscious and cannot make decisions about emergency treatment. In a living will, you can say which procedures you would want, which ones you wouldn’t want, and under which conditions each of your choices applies.

A durable power of attorney for health care is a legal document naming a healthcare proxy, someone to make medical decisions for you at times when you might not be able to do so. Your proxy, also known as a surrogate or agent, should be familiar with your values and wishes, so that he or she will be able to decide as you would when treatment decisions need to be made. A proxy can be chosen in addition to or instead of a living will. Having a healthcare proxy helps you plan for situations that cannot be foreseen, like a serious auto accident. A durable power of attorney for health care enables you to be more specific about your medical treatment than a living will.

For people who are reluctant to put specific health decisions in writing, naming a healthcare agent might be a good approach, especially if there is someone they feel comfortable talking with about their values and preferences.

March 26, 2015

Can you do any of these documents and procedures using Internet forms and instructions? Seeger says that “Wills or business contracts from Internet sources that are not put together by attorneys and have ambiguous terms in them” may prove to be ineffective, and “the entire thing is thrown out by the court and the person is intestate [without a will].”

If you do go the Internet route, it is probably prudent to show your completed documents to an attorney for verification.

Funeral pre-planning Mike Nebeker, a specialist in advanced funeral planning with Allnutt Funeral Service, says, “People often ask why they should preplan their funeral or cremation services. There are four primary benefits: (1) Peace of mind.

Most people say, “I don’t want to leave this burden to my children.” (2) Get what YOU want. This avoids two concerns – spending what your family might otherwise spend in an environment with lots of emotion, and not having family disagreements over final choices. When you choose, you give your children a gift of knowing what you want. (3) Prices guaranteed not to go up for you. With a pre-arranged funeral or cremation plan, the funeral home guarantees you won’t pay more for those items in the future, regardless of inflation. (4) Protection from Medicaid or Social Services. Advance funeral plans are an exempt asset and cannot be liquidated to pay for long-term care costs.

“Because insurance companies are not allowed

to go bankrupt, funeral plans funded by insurance are safe and secure for seniors and others who pre-arrange.

These plans are transferable if you move out of the area.

When transferred, the receiving funeral home accepts the policy and determines the status of the price guarantee. Everyone will qualify – regardless of health.”

Attorney Nevin Seeger says: “I think it is important for people to communicate with their loved ones what their final wishes are regarding burial or cremation, memorial services or gatherings. I even have a play list of favorite music, things that will make my friends smile.” He says that paying in advance for cremation or burial is a personal decision.

ANdrew Moore

RESOURCES The National Institute on Aging (nia.nih.gov/health/ publication/legal-financialplanning) is a good resource for information about advance care planning and end of life matters, among many topics.

Mike Nebeker, Advanced Funeral Planning Specialist, Allnutt Funeral Services, 650 West Drake Road, Fort Collins, 970.482.3208, mnebeker@allnutt.com Nevin Seeger, Seeger Law, 1302 North Cleveland Ave., Loveland, 970.744.4810, info@seegerlaw.com.

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HEALTHLINE 13

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FEATURE: MINDFUL AGING

Doctor decries how we approach the end of life

By Stacey Burling, The Philadelphia Inquirer (TNS)

It may be the fact that Atul Gawande is a doctor — a Harvard doctor, yet — that draws readers to his books on our flawed medical system.

But he wouldn’t make the best-seller lists if he wrote — or thought — like most doctors.

This is a guy with one of those renaissance-man resumés that makes even quite accomplished people look like slackers. Stanford undergrad. Rhodes scholar studying philosophy. Healthcare adviser to President Bill Clinton. Medical degree and master’s in public health from Harvard. Writer of four books and many New Yorker articles. MacArthur fellow.

Surgeon. Founder of a lab that studies health quality.

Now, after working on a PBS Frontline segment on his book, he’s learning filmmaking. He’s 49.

What seems to hold all that together is, obviously, a fine brain, but also relentless curiosity, an eye for story, and an attraction to complex problems. What sets him apart as a writer is his ability to make what he’s learned seem simple. Or at least simpler.

His latest topic — aging and dying in America — is immense. “In Being Mortal: Medicine and What Matters in the End,” Gawande tackles the joyless way many people live in their later years and the excesses of medicine that many endure in their final months and

14 HEALTHLINE

Author and surgeon Atul Gawande.

(Tim Llewellyn/Courtesy Metropolitan Books/TNS) days. The 263-page book interweaves stories about his own family and patients with reporting on how we die, trends in housing for the elderly, and the value of geriatricians and palliative-care specialists.

Gawande — pronounced guh-WAHN-dee –spoke recently to about 2,500 doctors and nurses at a joint meeting of the American Academy of Hospice and Palliative Medicine and the Hospice and Palliative Nurses Association at the Convention Center.

The book is selling well — it’s the No. 1 nonfiction title on the New York Times best-seller list — but it is un-

likely much of what Gawande says in it will be news to this crowd. Asked by phone what he would tell the pros, Gawande laughed and said he was still figuring that out.

“At one basic level,” he said, “it’s, ‘Thank you, and why the hell aren’t people listening to you?’”

Gawande’s book, which includes some material previously published in the New Yorker, is partly a personal journey: A doctor discovers he has been seeing only a fragment of the medical picture as his wife’s grandmother declines with age and his father, also a physician, copes with a fatal

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cancer.

Gawande the surgeon has focused on keeping people alive. As he explores what aging and disability are really like, he sees that he has shied away from talking with his patients honestly about the problems he can’t fix.

Asked how someone steeped in medicine and health policy could have been so naive, he referred to the first line of the book: “I learned about a lot of things in medical school, but mortality wasn’t one of them.”

Many doctors go into medicine because they like the idea of saving people, he said. He did, too, but he was soon troubled by suffering he was unable to relieve.

Still, his perspective was limited. “Your glimpse of people’s lives is the glimpse you get in a 30-minute office visit,” he said. “That’s not their real life.”

Researching the end of life like a reporter took him into houses, nursing homes, and assisted-living facilities, places where most doctors don’t go. Seeing firsthand the tough decisions his family had to make added to the picture.

“I’d not seen what it was like to be the husband dealing with the wife who couldn’t eat anymore,” he said, “or the daughter with the father who’s become a quadriplegic.”

He had set out to write about the end of life but realized the need for better

March 26, 2015

communication about what people want and need starts much earlier, as age and debility begin to erode independence. Their children want them to be safe, Gawande said, but what older people want for themselves — what we all want for ourselves — is autonomy and a sense of purpose.

These attitudes should have been entwined in medical decision-making, but they weren’t. Faced with choosing among eight or nine chemotherapy regimens for his father, Gawande realized he needed more information.

How would each affect his father’s desire to maintain mental clarity and function? Ultimately, his father’s condition declined, and he had no chemo at all. Soon, it was time for hospice.

If there’s one message Gawande would want people to take from the book, it is that doctors need to talk to their patients, and we need to talk to our families about what really matters at the end. “People have priorities beyond just living longer, no matter what,” Gawande said. Those priorities vary.

“The most reliable way of knowing is to ask them.”

Gawande comes across as low-key and serious, not flashy like, say, TV’s Dr. Oz. He came to this topic after studying medical quality.

He is big on checklists as a way to reduce errors in complex care. So, of course, he asked experts on patient communication for key actions to check off.

One of the suggestions that stuck with him is to talk less than half of the time while he’s with a patient. He

March 26, 2015

was horrified to learn he was talking close to 90 percent of the time. A palliative-care doctor told him, “You’re an explainaholic.”

Once he talked less, he saw what patients need is “some opportunity to explain themselves, what their fears are . . . what they’re willing to sacrifice, what they’re not willing to sacrifice.”

He has become more comfortable with the topic and is hopeful others will too as more people witness hospice and palliative care.

Each of his own three children, now teenagers, has been exposed to at-home hospice through a friend or teacher, he said. “That idea that there’s someone in the neighborhood who might die and in their home” has led to questions and good discussions at his house. More of that, in other families and other doctors’ offices, will bring the barriers down and, he hopes, drive policies that will restructure long-term care and how we pay for care of the sick and elderly.

Gawande does not spend much time in the book on the nuts and bolts of how to change end-of-life care. He thinks better care will flow from awareness, talking about what makes life meaningful and what reduces suffering when time is short. The “fundamental barrier” to change, he said, is not money, but “tremendous anxiety on the part of clinicians and family members.”

Ariadne Labs, his research center with Brigham and Women’s Hospital and the Harvard School of Public Health, is an effort to provide tools that improve care

at key points in people’s lives. Those include childbirth, surgery, and, now, serious illness.

A current project is testing the impact of routinely discussing end-of-life goals with patients at risk of dying in the next year.

Susan Block, a Harvard palliative-care specialist who heads that study, said it would involve 400 patients, 400 family members, and 90 oncologists. “This is one of the largest palliative-care trials of a complex intervention,” she said. It likely will take three years to complete.

She said Gawande’s interest in checklists made her rethink what she does.

She was also impressed with his ability to illustrate how aging and palliative care’s emphasis on non-medical goals flow together.

It is true, she said, that others have already said much of what’s in the book, but she thinks Gawande framed the information differently and found a way to make it especially moving.

“Atul has a unique voice and a way of telling stories and synthesizing information that is quite extraordinary and compelling to people,” she said.

Gawande thinks sales of the book — even as Christmas presents and airport purchases — are a sign people are ready to talk more openly about death.

Where will he focus his energy next? He was cagey about that. “I can’t give it away yet,” he said.

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HEALTHLINE 15

HL

FEATURE: MINDFUL AGING

HEALTHY AGING MADE SIMPLE: Tips from a geriatrician

By Martha Ross, San Jose Mercury News (TNS)

When geriatrician Mehrdad Ayati first met Lee Katz in 2011, he encountered yet another patient — and her spouse — who were in despair over the conflicting and contradictory information they received in her care.

The Menlo Park woman was in a downward spiral of multiple chronic conditions that would lead to her death in April 2013 at age 84.

But the different specialists who rotated in and out of her case made things worse, with mix-ups and questionable interventions that took her in and out of the hospital and added to her suffering, husband Martin Katz says.

“They didn’t know what one another was doing,” says Katz, who is a retired a pharmaceutical researcher and executive. “Then Dr. Ayati appeared on the scene. He started looking at the entire patient, her personal and social history, all her medical problems.”

Ayati coordinated Lee Katz’s care and the information coming at them from different directions.

“He put it all together,” Katz says.

What Ayati did for Lee Katz, he is now doing for everyone in his new book, “Paths to Healthy Aging.”

This “guidebook,” as Ayati calls it, is designed as a concise overview of the basic ways people can improve

16 HEALTHLINE

Martin Katz works on a wood sculpture in his home on Oct. 30, 2014 in Menlo Park, Calif. Katz is an 87-year-old pharmaceutical executive and sculptor. He is a patient of Stanford University assistant professor and geriatrician Mehrdad Ayati, who has written a book that is a simple, step-by-step guide for aging in a healthy way. Katz belongs to clubs, travels, exercises and most of all sculpts. He recently installed one of his works at his temple in the Los Altos Hills He lives up to the principles Ayati discusses in his book. (Patrick Tehan/Bay Area News Group/TNS)

their physical and mental health and enjoy life as they age.

Ayati is an assistant professor at the Stanford School of Medicine and treats geriatric patients at the Stanford Medical Center and the Veteran’s Administration hospital in Palo Alto.

He specializes in providing comprehensive care with a focus on prevention.

With his wife and coauthor, Arezou Azarani, who

has a Ph.D. in physiology, he synthesizes his experience and the latest research on nutrition, exercise and geriatric medicine into a book that emphasizes healthy lifestyle choices.

Ayati says those choices can be just as important as cutting edge medicine in fending off many common complaints, from high blood pressure to sleep disorders, from depression to frailty.

These choices include eating

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a balanced diet, exercising regularly, being socially involved, and pursuing creative, stimulating activities.

Ayati also is a fan of keeping things simple and affordable when it comes to eating better and exercising.

People don’t need to join expensive gyms or start a strenuous program, he says.

“Physical health is achieved by persistent and enjoyable workouts,” he says.

Ayati’s book similarly tries to keep things simple with how it uses concise explanations and short chapters to acquaint people with key concepts.

“There is so much information out there, but it’s hard to know which information is valid,” Ayati says.

“My goal is to simplify the journey.”

Ayati loves working with older patients, in part because he was born and raised in Iran, where the culture reveres its elders.

“They are considered very sage, are highly respected and have a central position in the family and their community,” Ayati says.

“Gray hair is considered an asset, and the day you get your first gray hair, you don’t dye it — you brag about it.”

Unfortunately, he works in a specialty facing a shortage of experienced practitioners. About 80 percent of adults 65 and older require care for chronic conditions.

To meet their needs, the

March 26, 2015

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HEALTHLINE 17

United States would need about 17,000 more geriatricians, according to the American Geriatrics Society.

When students show an interest in geriatrics, Ayati gives them all the encouragement he can. One thing he especially likes about geriatrics is that doctors are encouraged to spend much more than just 10 minutes with patients, who typically have a complex set of medical issues.

For Ayati, some of that time is spent just talking to patients and learning their work and family history and how they live.

“I learn a lot from my geriatric patients,” he says.

Ayati uses that same conversational approach in his book to correct misconceptions, including his view that people should stay away from nutritional and vitamin supplements unless a doctor has found a serious deficiency that needs to be addressed. Taking too much vitamin D, for example, can be toxic, he says. Generally, people can get all the nutrients they need by eating a balanced diet.

Ayati devotes a chapter to the problem of over medication, because he has seen too many patients suffering the ill effects of taking drugs they don’t need.

Sometimes misdiagnosis can lead to the “drug cascade syndrome,” where doctors pile on medications to treat the side effects of other medications.

He recalls one patient who ended up in a skilled nursing facility after falling at home and breaking his hip.

This downward spiral started sometime earlier when the

18 HEALTHLINE

man went to see his primary care doctor for depression.

The doctor prescribed anti-depressants, but failed to get to the root cause of the depression. The man had restless leg syndrome, which caused him to lose sleep and go through his days exhausted, unable to concentrate or remember things.

The anti-depressants didn’t alleviate his depression. They only made his leg cramps worse, so he lost more sleep. He became disoriented and fell, breaking his hip. By weaning him off the anti-depressants and treating the restless leg syndrome, Ayati was able to help the man fully recover from both his hip injury and his depression.

The last chapter of Ayati’s book offers tips on how to find a geriatrician, which he knows can be a daunting task. He points out that most patients don’t need to see a geriatrician too often, sometimes just once a year.

After his wife died, Martin Katz, 87, signed Ayati as his geriatrician. The two have also become friends; Katz endorsed Ayati’s book and its tips for healthy aging.

Katz says he is in excellent health and admits he is “genetically blessed.”

Despite his background in pharmaceuticals, Katz shares Ayati’s belief that less is better when it comes to drugs.

Katz may be one of Ayati’s model patients, eating right, exercising regularly and staying active. Katz belongs to two senior centers that provide wonderful “social interaction, friends

and activities.”

Most importantly, he has “an avocation.” He has taken up sculpting, and this artistic endeavor keeps him physically active, challenges him mentally and constantly introduces him to new people.

He began learning to sculpt in the early 1990s, even before he retired. He had never thought of himself as artistically inclined; he was just curious. Many workshops and classes later, he has launched a second career as a professional artist.

“I dreaded seeing those retired guys following their wives around at the supermarket,” he says.

In late October, he unveiled his newest bronze work, “Kaddish,” at Congregation Beth Am in Los Altos Hills.

Long before meeting Ayati, he put into practice one of Ayati’s favorite tips: He signs up for classes.

“My mantra is, if you don’t join a class, you’re not going to do it,” Katz says. “I tend to be a Type A, highly motivated, but with all that self-motivation, if I’m not signed up for a class, and unless it’s on my calendar for 9 a.m. Thursday, I’m not going to do it.”

Katz, who also travels extensively, probably is busier than he is, says Ayati, who also has a 1½-year-old son.

For his part, Katz wouldn’t have it any other way and notes the health benefits of everything he does to take care of himself.

“The number of pills that I have reduced or dropped,” he says, “is amazing.”

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TIPS FOR HEALTHY AGING

Below are prescriptions for mental and physical health from Stanford geriatrician Mehrdad Ayati in his book “Paths to Healthy Aging.”

• Avoid trendy and drastic diets or exercise programs, especially rigorous programs you won’t stick to.

• Vitamins aren’t necessary unless a doctor identifies a deficiency, and be wary of nutritional supplements. You can generally get all your nutrients through a balanced diet of mostly whole, organic foods; limit your intake of canned, frozen or instant foods, as well as alcohol and caffeine.

• Find a hobby, or sign up for a class. Trying a new subject or activity can challenge you mentally and physically.

• Don’t just hang out with seniors; find ways to spend time with people of all ages.

• Keep in touch with your network of friends.

• Find a geriatrician. While there is a shortage of geriatricians, you won’t necessarily have to see one often. This specialist will offer care that is comprehensive and focuses on prevention.

Mehrdad Ayati’s “Paths to Healthy Aging” is available at www.pathstohealthyaging. com.

March 26, 2015

HL

EVENTS

Healthy Weight Book Club

By Misty Kaiser, Healthline Magazine

With so much conflicting and secondhand information out there, figuring out exactly what “healthy” means can be difficult and frustrating. For a more guided approach, you might consider attending the brand new Healthy Weight Book Club at the Loveland Public Library.

While on her own journey to healthy weight loss, instructor, Toni Gammage, found that “intelligent, common sense data” contradicted many of the mainstream diets that consumers so often try and fail.

“It’s a gigantic topic (pardon the pun)--with is-

sues ranging from global to micro-organism, environment to genes, economic to social, etc. There have been scores of recent studies about the issues above that promote a mindful awareness that we would otherwise miss out on-due to our super-busy lives,” she explains.

She got so excited about her revelation that she wanted to share it others through the book club by focussing on research supported literature and the internal and external influences everyone deals with in their pursuit of a healthy weight.

“I hoped to address the issues of weight that blame the individual when we are

surrounded by the accessible, cheap, processed, unhealthy food,” Gammage said.

It is important to note that the club meets simply to discuss the chosen material and relative information. No specific diets will be promoted, nor will and specific foods or supplements be endorsed.

The Healthy Weight Book Club meets on the first Thursday of each month on a drop-in basis. If you are interested in joining or just seeing what it’s all about, show up at the library on April 2 at 6:30 p.m. The next book will be “The Diet Fix”

by Dr. Yoni Freedhof, and for a complete list of materi-

als and information, visit cityofloveland.org/index.aspx? page=1096&recordid=67360.

Toni Gammage holds M.A.’s in adult education and in special education.

The information to be read and discussed is for informational purposes only. It is not intended as a substitute for the advice and care of your doctor, and you should use proper discretion in consultation with your physician in utilizing the information presented. The Loveland Library and the presenter expressly disclaim responsibility for any adverse effects that may result from the use and application of the information read and discussed in this book club.

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HEALTHLINE 19

HL

NUTRITION

Eating your way HEALTHY Dominique Del Grosso, Healthline Magazine

Wellness is a broad term, and these days, it’s thrown around so much that it can be hard to know what it really means exactly. Although the definition can be simplified as being in good physical and mental condition, living in wellness can mean a lot of different things to different people.

Reaching the pinnacle of wellness isn’t quite as simple as choosing to eat a healthy diet or just exercising; wellness is much more than one lifestyle change. In fact, it’s a combination of many factors, as its true definition suggests.

However, Kelly Leonard, owner of Peak Nutrition Works in Longmont, says living a wellness lifestyle is a matter of finding what makes sense for you.

Once you find what’s important or what matters most, the heights of wellness don’t happen in an instant

20 HEALTHLINE

with a snap of fingers, but not many things that are worth the reward do. When evaluating your diet, committing to a healthier and more conscious way of eating is a change that will have a great impact on your body.

Simply put, if you’re eating unhealthy foods, it’s unlikely that your body will feel good. And if your body doesn’t feel good, it’s likely your mind won’t either.

“Often times, people disconnect from the importance that food plays in our health.

Everything you eat has either a negative or positive effect.

Every bite matters,” Leonard says. “It’s OK to eat a cookie every now and then, but 90 percent of your food should have good nutrition. When you make a food choice, it has to be the right decision for your body.”

The truth is that it’s so easy to put all our emphasis on the numbers on the scale.

We get caught up in quick

fixes with fad diets, cleanses or yo-yo dieting. But as we all know, a quick fix doesn’t usually last long-term, and it certainly doesn’t help to sustain healthier habits.

To turn your focus to a healthier way of eating, you have to be willing to be accountable to selecting better food choices throughout the day.

“When I focus on a healthy diet, I focus on what does the body and brain need to function healthfully and properly,” Leonard says.

“Eat foods you enjoy, but make sure you get all the nutrients that your body needs.

People should eat the things that they enjoy eating and make sure to get the nutrients that they need. If people don’t like what they’re eating, they won’t stick to it.”

Let’s face it; we all know the difference between healthy and unhealthy foods.

We know that consuming a fast food hamburger

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rather than baked chicken from home isn’t the best or healthiest protein option, and we certainly know that fries don’t count as the best vegetable of choice.

“Accountability is one important key to any change that you’re making in life. If you’re serious about your goal, then you’ll be seeking accountability for it. For example, if you really want to cut out drinking soda, then you start by purchasing less of it, and perhaps setting up a guideline that you’re only going to have two each day instead of six,” Gail Longenecker, owner of Longmont Nutrition, says.

Longenecker also says that if you are willing to positively verbalize the results you see from the changes made, you’re more likely to gain confidence about the choice and continue to stick with it.

Before diving headfirst into overhauling your fridge and kitchen cupboards,

March 26, 2015

being nutrition conscious doesn’t mean going to the extremes. The first step to living a life of wellness is to make a choice to start right now, exactly where you are.

Instead of chips with lunch, try carrots—a healthier, crunchy alternative. Instead of devouring a candy bar for a late-night treat, try some sweet, fresh strawberries.

By making small, manageable and enjoyable food choices instead of junk, the effects will stick around because you’ll be creating healthy—and equally delicious—habits that will be hard to break.

One of the phenomenal benefits of living in Colorado is that surrounding communities live healthier lifestyles than those in other states. As such, there are many farmers

markets with fresh produce and local nutrition experts that offer nutrition guidance and education at no cost.

At Sprouts in Loveland, the natural food selection and healthy options abound.

Although they don’t offer instore educational classes or training for customers, they can answer customer questions and give appropriate guidance.

“We do a lot of aisle training, which is free,“ Donna Cruz, vitamin manager, says.

To get the nutritional ball rolling, get excited about your change first. Next, take advantage of free resources throughout the community.

Then, make a plan because as the saying goes: “Fail to plan. Plan to fail.”

Once you’re moving along, stay accountable with

friends, a spouse or someone you trust, or you can use a food journal to track your progress. Leonard suggests that her clients use the free app MyFitnessPal because it’s always with you, and it helps you to keep track of what you’re eating.

“You should be eating at least three meals a day and one or two snacks in between, and every time you put food on

your plate, you always put a protein or a fruit or a vegetable. It doesn’t have to be complicated in that you don’t have to go out and buy all organic or become a vegetarian to be healthy. Keep it simple.

Get your protein, and eat your fruits and vegetables.

That’s a good starting place,” Leonard says.

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HEALTHLINE 21

Feel groggy in the mornings?

Here’s how to wake up refreshed

By Elizabeth Hamilton, The Dallas Morning News (TNS)

When Susie Phillips wakes at 5:30 a.m., before the sun rises, before cars zoom down the street bearing the bleary-eyed to work, before children stomp down the sidewalk on their way to school, it isn’t drudgery.

She slips out of bed, fills a hefty mug with coffee and listens to the birds chirping outside her Dallas home.

Early morning sunlight streams through the window.

For Phillips, this is the most peaceful time of day.

“It’s just nice to be up as the world wakes,” she says.

She reads a few pages of a novel or inspirational blog, pauses to set an intention for her day, prepares a frozen berry smoothie and then

22 HEALTHLINE

heads out the door for either Jazzercise or yoga at 7. Energized, she returns to the rest of her smoothie and another cup of coffee before settling into her art studio for a good three hours of creative work.

Phillips, 66, is among those who enjoy early mornings. Not all of us do, but even those who don’t have to wake eventually, and a good morning can be the difference between a great, a so-so or a downright terrible day.

Many components go into having a good morning.

As it turns out, Phillips’ routine, which she’s followed for more than 35 years, provides an excellent model for how to have a good morning.

Most important of all: She gets enough sleep.

The main reason some

people feel groggy and others refreshed in the morning is a good night’s sleep, says Jennifer Neily, a registered dietitian and nutritionist in Dallas who’s worked with Phillips.

“Solid research indicates we need seven to nine hours of good sleep for optimal performance, health and even weight management,” says Neily, adding that people who get less than seven hours of sleep per night are 30 percent more likely to be overweight.

Sleep is not the only factor contributing to whether we feel refreshed. According to Dr. Joseph Takahashi, a professor of neuroscience in the Howard Hughes Medical Institute at UT Southwestern Medical Center, there’s a genetic component as well.

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In an area in the base of the brain called the hypothalamus, which regulates many basic functions of the body, there is a group of cells called the suprachiasmatic nucleus. A set of genes in each of these cells performs on roughly a 24-hour cycle, controlling the daily rhythms of basic bodily functions, including the sleep cycle.

When light hits our eyes, a signal travels down the optic nerve to the suprachiasmatic nucleus. How one’s cellular clock synchronizes to the light determines when a person is alert and when they are drowsy.

“Humans show incredibly wide variation in sleep need and in preferred wake-up time and bedtime,” he says.

In other words: Whether you’re a morning person

March 26, 2015

may, in part, be the result of your genetic structure.

What if you want to become more of a morning person? How can you have a good morning despite your genes?

Because the interaction of light with one’s cellular clock affects the sleep-wake cycle, Takahashi says that darkening the room when you want to sleep and letting in light in the morning will help reorient your clock.

A good nighttime routine will yield restful sleep, as well, he says, and this will lead to an invigorated morning.

Takahashi cautions against drinking caffeine after noon because caffeine stays in the body for up to 12 hours, which means that afternoon cup of Joe may be keeping you up later than you’d like.

Moderating caffeine intake during the morning may help cognition as well, adds registered dietitian and nutritionist Angela Lemond of Plano, Texas. She suggests limiting yourself to 6 ounces of coffee in the morning, which is about one regular-size mug.

Takahashi also points out that intense exercise late at night can wind you up right before you try to sleep, though Lemond says exercise in the morning — like Phillips’ Jazzercise and yoga classes — can help start your day right.

“It gets the blood flowing naturally,” she says. “Any exercise is great, but to really feel the benefits for several hours after, do some vigorous exercise that really gets the heart rate up for at least 30 minutes.”

She suggests going for a light jog, bike ride or morning kickboxing class.

Lemond also suggests waking up at least two hours before you need to be anywhere.

This provides time for preparing a plan for the day — something Phillips takes seriously. In fact, Phillips conscientiously avoids the Internet in the morning because it’s easy to get sucked into checking email and Facebook instead of planning her day.

“That is a morning killer,” she says.

What about that timeworn advice, “Breakfast is

the most important meal of the day”?

“Some experts might say don’t skip breakfast, but you know what? Contrary to everything you’ve heard, it’s not a mandate for everyone,” says Neily.

If you’ve never eaten breakfast and maintain a healthy weight, there’s no reason to start, she says.

For those who choose to begin their day with a scrumptious meal, breakfast might include a protein source, some whole grains, a veggie, fruit and maybe some low-fat dairy, says Lemond.

Her suggestion: a whole wheat burrito with spinach, cheese and egg and a side of mixed berries.

It’s these seemingly mundane morning rituals, like that mug of coffee, berry smoothie and exercise class, that spark Phillips into motion.

“I feel like my energy is best in the morning,” she says. “I’m more creative and focused and optimistic in the morning, and just have kind of a better attitude of the world.”

TIPS FOR A

GOOD MORNING • Have a good nighttime routine. Moderate your caffeine intake after noon and refrain from intense exercise before bed.

• Get between seven and nine hours of sleep at night.

• Wake up at least two hours before you need to be anywhere so you can prepare for the day.

• Exercise in the morning to get the blood flowing. A light jog, bike ride or morning kickboxing class are good options.

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HEALTHLINE 23

HL

HEALTH NEWS

Children’s health coverage losses outlined in multiple scenario study

By Rebecca Adams, CQ-Roll Call (TNS)

More than 3.3 million children could lose their health care coverage if Congress does not renew the Children’s Health Insurance Program, the Supreme Court strikes down subsidies in the federal marketplace and states scale back coverage.

That scenario is the most dramatic of seven situations affecting children’s coverage that the Urban Institute analyzed in a report released this week.

Coverage for kids faces a number of challenges in the next few months. Funding for CHIP expires Sept. 30 absent congressional action. The Supreme Court could rule in the King v. Burwell case that federal health law subsidies are only allowed in state-run

24 HEALTHLINE

marketplaces and not in the federal marketplace, which could erode coverage for families.

And if Congress does not renew a requirement in the health care law that states must maintain coverage for children through 2019, some states could decide to scale back eligibility levels. States might decide to stop offering Medicaid coverage for kids in families with income above 138 percent of the federal poverty level. States that choose to expand Medicaid have to offer Medicaid benefits up to that amount.

The Urban Institute researchers looked at several possible scenarios in which the Supreme Court allowed tax credit subsidies to continue for people in all marketplaces. If the credits remained available but

coverage under certain CHIP programs that stand apart from the Medicaid program is eliminated, the researchers estimate that about 1.1 million children would lose coverage. If Congress also got rid of the requirement that states maintain their current eligibility for children and states stopped providing Medicaid coverage for kids in families over 138 percent of the poverty level, an additional 828,000 kids would lose coverage.

Tuesday’s report also examined what would happen if the Supreme Court struck down subsidies in the federal marketplace. That type of ruling would leave about 730,000 more children without coverage compared to what would occur if the marketplace tax credits were available in those states. The

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researchers noted that under that scenario, eligibility for Medicaid and CHIP would not change. If CHIP under standalone state programs expired on top of a court ruling eliminating subsidies in the federal marketplace, another 1.2 million kids in addition to the 730,000 kids would lose coverage.

Adding the possibility of states cancelling Medicaid coverage for families above 138 percent of the poverty level, an additional 1.4 million children would lose coverage.

Altogether, those three categories of children who would lose coverage would total more than 3.3 million kids.

If none of these circumstances happen, the health care law under current law is expected to reduce the number of uninsured children by roughly half, said the report.

March 26, 2015

HL

HEALTH CALENDAR

BLOOD PRESSURE SCREENING

Have your blood pressure checked by a Wellness Specialist.

Where: McKee Wellness Services, 1805 E. 18th St. When: Mon.- Thurs., 8 a.m.4:30 p.m.

Cost: FREE Call: 970.669.9355

BREAST CANCER SUPPORT GROUP

Where: McKee Cancer Center Conference Room B When: 2nd Thurs. of each month, 5:30 - 7 p.m.

Cost: FREE Call: 970.622.1961

BREAST-FEEDING SUPPORT GROUP

Where: McKee Medical Center When: Mon. Wed. and Fri. (except holidays), 10-11 a.m.

Cost: FREE. No need to register Call: 970.669.9355

CAREGIVER CANCER SUPPORT GROUP

Where: McKee Conference and Wellness Center When: Twice per month, 10:30 a.m. -12 p.m.

Cost: FREE Call: 970.635.4129 for dates

CAREGIVERS SUPPORT

For caregivers of elderly adults. The group focuses on providing support and education about community resources and behavior issues, particularly those people with Alzheimer’s and memory impairment.

Where: First Christian Church, 2000 N. Lincoln Ave. When: 3rd Thurs. of the month, 1:30-3:30 p.m.

Cost: FREE. Care of elderly adult family members or friends is available through Stepping Stones Adult Day Program during meeting times at no charge.

Call: 970.669.7069

March 26, 2015

CHRONIC OBSTRUCTIVE PULMONARY DISEASE Where: McKee Conference and Wellness Center, 2000 Boise. Ave. When: Tues., 1-3 p.m.

Cost: FREE Call: 970.635.4015

DIABETES INFORMATION GROUP

Information, resources, and support to people with diabetes and the general public.

Where: McKee Wellness Center, Kodak Room When: 4th Thurs. every other month, 7- 8:30 p.m.

Cost: FREE May 28: Diabetes & Depression/Burnout – How to “Stay Up” When Diabetes “Brings You Down” Renee Rogers, LMFT – Behavioral Health, Banner Health July 23: Bringing the Eyes into Focus Jennifer Cecil, MD, LLC – Comprehensive Family Eye Care Sept. 24: Diabetes & Avoiding the Medicare Donut Hole (& Other Tips for Open Enrollment) Phoebe Hawley – Outreach Program Manager - Season’s Club Nov. 19: Sugar Substitutes, Short & Sweet Ann Walker, MS, RDN, CDE – Banner Health Dietitian

GENERAL CANCER SUPPORT

Where: McKee Cancer Center Conference Room B When: Tues. (except holidays), 5:30-7 p.m.

Cost: FREE Call: 970.635.4129

PROSTATE CANCER SUPPORT GROUP

Where: McKee Cancer Center Conference Room B When: 4th Thurs. of each month, 5:30 -7 p.m.

Cost: Free Call: 970.622.1961

SCLERODERMA SUPPORT GROUP

Open to scleroderma patients, family, caregivers, and friends looking for a forum to share feelings, concerns, and information.

When: 4th Sat. of even numbered months, 10 a.m.-12 p.m.

Where: Medical Center of the Rockies, Poudre Canyon Room

TOTAL JOINT EDUCATION

Physical therapists and occupational therapists prepare patients for surgery. This program is coordinated through your physician’s office as part of the surgery scheduling process.

Where: McKee Conference and Wellness Center When: Thursdays, 11 a.m.

Cost: FREE - Registration not required.

Information: 970.635.4172

WISE WOMEN DISCUSSION GROUP

A supportive environment for women to explore the rewards and challenges of aging. Facilitated by Dr. Beth Firestein.

When: 2nd & 4th Tues, monthly, 11:15 a.m. – 12:30 p.m.

April 7 & 21 Where: Perkins Restaurant (W. Eisenhower) in Loveland Cost: FREE Info: visit bethfirestein.com, email firewom@webaccess. net or call 970.635.9116.

YOGA SUPPORT GROUP

For anyone touched by cancer.

Where: McKee Medical Center Cancer Center Lobby When: 1st and 3rd Thurs. every month, 5:30-6:30 p.m.

Cost: FREE Call: 970.635.4054 to register.

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PARKINSON’S LSVT “BIG” EXERCISE REFRESHER CLASS

Open to anyone with Parkinson’s disease who has completed the LSVT “Big” program with a physical or occupational therapist and wants to practice exercises.

Where: McKee Conference and Wellness Center, Boettcher Room When: 3rd Tues. of every month 5:30 - 6:30 p.m.

Cost: FREE Information: 970. 635.4171

DAY OF DANCE FOR YOUR HEALTH

Not your typical health fair!

Bring your entire family for dance demonstrations and lessons, health information, games and giveaways. Fun for all ages!

When: Sat., April 18, 9 a.m.1 p.m.

Where: Loveland High School, 920 W. 29th St. Cost: Free Information: 970.203.6631 or email McKeeSpiritofWomen@bannerhealth.com A not-so-typical health fair that is sure to get you moving! Bring the whole family for dance demos, health education, screenings, CPR instruction,fun and prizes!

SPIRIT GIRLS AND MOMS TOO! SURVIVING YOUR DAUGHTER’S PUBERTY When: April 4, 9 –11 a.m.

Where: Banner Health Center, 702 W. Drake Rd, Ft. Collins Cost: FREE for all girls and Spirit Members; $10 nonmembers RSVP to: (970) 203-6631 or email McKeeSpiritofWomen@bannerhealth.com

HEALTHLINE 25

PAID ADVERTORIAL

Spring cleaning in the medicine cabinet Question: It’s nearly time for spring cleaning and our family goes

through everything, including the medicine cabinet. How should I decide what to toss and what to keep? Is there a proper way to dispose of different medications?

There are several dangers associated with keeping unneeded medication around.

Children and animals may get into them, they could be expired, or you might confuse them with currently used medication which could lead to poisoning. It is a great idea to clean out medicine cabinets once a year to throw away your old prescription medications and over-the-counter remedies that have expired.

There are many misconceptions about medication disposal. Should you throw the medication in the trash?

Is it best to flush it in the toilet or rinse it down the sink?

Unfortunately, these methods of disposal are not safe in all cases, and could be harmful for the environment, wildlife and waterways.

The best way to get rid of unused or expired medi26 HEALTHLINE

cation is to bring them to a “take-back” program.

Ask your pharmacy if it will accept unused medicine for proper disposal. Costco members can bring unwanted medications to a Costco pharmacy. Also, search earth911.com for programs in your neighborhood.

If the above options don’t work, then another alternative would be to safely dispose of the medication yourself. You should first refer to the printed material that accompanies your medication for specific instructions.

If none are provided, be sure to remove all personal information from the bottle to avoid identity theft, and follow the disposal instructions below.

Experts suggest making medicines unusable before trashing so they don’t end up in the wrong hands. Some

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ideas?

• Crush pills or dissolve capsules in water.

• Mix in with kitty litter, coffee grounds or other unappealing kitchen waste.

• Add salt, ashes from your fireplace, dirt, charcoal or spices to liquids.

• Put the medication in a plastic container, not glass, duct tape the lid and place it in a sealed bag before tossing it in the trash.

• To avoid mistreatment once it has been disposed, it’s best to put the sealed bag in a brown paper sack so that the medicine is more difficult to identify.

——————————— Kevin Johnson, MD, is a family medicine practitioner at Banner Health Center in southwest Loveland.

March 26, 2015

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Enhanced image clarity provides our experts the opportunity to detect breast cancer with shorter exam times for patients. It’s just another way we take care of our own. For more information or to schedule your appointment, call (970) 593-6191 or visit BannerHealth.com/McKee.