Getting rid of toxins

This has been a newer fad or rage or whatever you want to call it - getting rid of toxins in our lives and living happier and healthier. We now know to skip the aerosol containers, teflon isn't good for us, and nuclear waste is dangerous for a long time. There are the people who do a 'cleanse' where they eat healthy and drink weird things to purge their digestive system of toxins. (I'm not a fan of that one.)

The latest media hype is the toxic relationship - get rid of the people or relationships which are unhealthy for you. I can understand this. Do you have a 'user'/toxic friend? You know what I mean - the one who takes and never gives? Or the one who always talks about themselves and never wants to hear what is going on in your life? Or the one who constantly makes everyone wait on them? Or the one who never can get together - they say they want to get together and constantly cancel? Or the one who criticizes you and your choices continuously? Or the ones that are deceitful or untruthful? Some times it is the boss who motivates their employees through public humiliation. Or the co-workers who throw you 'under the bus' constantly or present your ideas as theirs? I can go on and on. These relationships can also occur between siblings, family members and spouses as well as friends and colleagues.

Toxic relationships are ones which hinder your happiness and cause stress and other problems. It is not a good relationship if they never do their share to help support it. A relationship is a two way street and both sides need to contribute. A relationship doesn't require daily contact to be a good one but it requires a level and quality of communication with which both sides are comfortable. Sometimes we need to take a step back and regroup and focus on getting rid of toxins in our lives. This may include cleaning out your kitchen cabinets or refrigerator, quitting a job, and ending other relationships.

I may have changed in the past few years and my feelings on this may have changed as a result. Through cancer treatment and then ensuing periods of recovery from gall bladder surgery and restrictions in my life due to my back issues, I no longer feel it is important or required that I waste time on toxic relationships or situations. I require a certain level of quality in the things I do in the more limited time that I have. I weigh opportunities to socialize and interact based on the physical and emotional effort required to participate. I can't just run off for a day of shopping with a friend as that would result in a few days of pain after to recover. If I go to a party, I can't stand around for hours chatting, I will need to sit down. But if I am sitting in the living room in the only chairs and all the action is in the kitchen (why do parties always end up in the kitchen), why did I waste my energy on a situation which causes physical pain? So correspondingly, why do I want to spend time with someone who causes emotional stress?

Sometimes relationships end because our circumstances change. Maybe we move far away. Maybe we change jobs. I have friends who I used to see regularly on hiking, snowshoeing, or skiing trips. Now because of my back I don't participate in those activities so we have grown apart. If I see those friends, I am happy to spend time with them but since our activities don't intersect anymore, we get together much less frequently.

Life goes on and we change and need to accept that. We re-prioritize the important things in our lives. We do not mean to offend or hurt others but sometimes we need to move on. A social 'detox' is sometimes what is needed to regain or retain a feeling of happiness in our lives. Just was we clean out the toxic chemicals in our cabinets, we clean out the toxins in our address books.

Insurance costs

Finally its about time is all I can say. By August 1, all employers must provide coverage for birth control for women at no extra cost. Religious employers such as churches had wanted an exception to the rule but the president has denied this. I support that decision. I realize that birth control may not agree with some religious beliefs but it is not up to the employer what medical decisions an employee makes. I am sure there are medical procedures out there that violate other beliefs. I am glad to see the end this bias. Viagra has been a covered medication since it was approved by the FDA, its about time birth control is as well.

This year the requested health insurance rate increase in Massachusetts, is (are you sitting down?) 2.3%. That's not even double digits. That is an amazing change from previous years.

'... the state Division of Insurance temporarily froze 2010 rates at 2009 levels after insurers that year requested average premium increases of 16.3 percent. While the health insurance companies initially protested, contending they would lose money, most eventually agreed to limit 2010 increases to about 10 percent. 

Since then, insurers have been cutting administrative costs while also taking a harder line in contract negotiations with health care providers. Hospitals and doctors, for their part, have been working to deliver care more efficiently and fend off the possibility that the state might move to regulate how much they receive from insurers.'

This looks more and more like change for the good to me.

Finally, more than 1.2 million people, or approximately 1/5 of the total population of Massachusetts, are being treated by doctors who are given a budget instead of paid on a fee for service basis. The legislature is working to create laws to make this the standard but it is already in place for many.

'Adoption of these "global payment" plans is driven by a desire to control soaring health insurance premiums by giving physicians an incentive to be more sparing in their use of expensive procedures, such as sophisticated scans. But it is also motivated by an eagerness to encourage more preventive measures, and that in turn improves care, which often is disorganized as doctors lose track of patients who need follow-up calls, visits, or tests.'

Does this sound like more change for the good as well? I think so.

Why do I make such a big deal about the health insurance system in MA? Well first of all that is where I live. And second of all the state wide health care system has been in place for several years now and we are seeing the results of a similar system to the national plan. I think the health insurance coverage rate here is in the upper 90%. When people lose their jobs they have a choice in where to get health insurance - either COBRA which is expensive or a state provided plan which usually is cheaper. The state plans are not as comprehensive as some private plans but are more affordable and available to all - no pre-existing condition exemptions, etc. Actually in MA, there has been a law preventing bias in insurance for pre-existing conditions for about 20 years now.

So what we have here is a little example for the rest of the country on how a change in health care might actually work. I see stories on Facebook and elsewhere about people who have a pre-existing condition and now can get health care through a government run plan. They are appreciative of the plan and happy to be alive.

I am not sure why people are against national health care. I know some people are Obama haters and hate everything he has touched just on principle. I know that people don't like the idea of being told what to do and being forced to have health insurance or be penalized. Some people are scared of change and are concerned that they couldn't go to their same doctors, etc.

The Obama haters can spend their time hating, being narrow minded, and bigoted but frankly to me that is just a waste of energy. He's president, if you don't like him vote against him. You can't get rid of him before November so suck it up and deal. Also, let's take the politics out of health care. People on both sides of the aisle get sick and need health insurance.

For people who don't like being told what to do - well I am a rebel myself but I like having health insurance. Without health insurance and two cancer diagnosis, I am not sure I would be here now and I'm quite happy to be alive. Finally, for those who are concerned about having to change their doctor or place of treatment, I'll just say doctors aren't like marriage - you don't always get them for life. And we don't know if that will be the case yet anyway. So don't count your chickens before they are hatched. Okay?

Its just a sunburn - hah!

I am not sure why this article is so upsetting. Basically this woman in England was told for five months that she had a sunburn and it turned out she had inflammatory breast cancer - a very aggressive type of breast cancer with a 5 year survival rate of just 40%. I can't believe on how many levels this is so wrong. She had chemo and then a bilateral mastectomy and now it sounds like a recurrence has already happened.

To the doctors I want to say, 'you were stupid'. If your initial diagnosis isn't right, then you need to think a little harder. I can understand thinking a rash is sunburn. That is logical but if it didn't go away in a few days, then the diagnosis is wrong. I can understand thinking that a woman in her mid 30's is not a prime candidate for breast cancer and inflammatory breast cancer is very rare. But don't doctors go through the process of elimination and start with the most common diagnosis and work from there? If a sunburn doesn't go away its not a sunburn. What about a skin biopsy? What about a referral to a specialist? And please, a badly fitting bra? Get real. This is just bad medical practice if you ask me.

To the patient, I think you were right to keep pushing and questioning - it is your body and you know when something isn't right. The internet research you did led to the truth in the end. I hope the treatment you received isn't representative of the UK National Health because I am very unimpressed with the care you received that is documented in this article..

To the hospital, please accept some of the blame here. Your statement is wrong - you don't have excellent breast service.

"A spokesman for Warrington and Halton hospitals said: ‘We have an excellent breast service at the hospitals that provides a first-class screening and diagnostic service and aims to ensure that care is provided as quickly as possible when a positive diagnosis is made. 

‘We have met Mrs O’Neill and are pleased that her treatment is progressing well. We will be responding in full to the concerns she has raised about her treatment and looking at the steps that we took at the hospitals and if anything could have been done differently.’"

I certainly hope you will take review the process of diagnosis and treatment. By the way from the article it sounds like she has already had a recurrence. How can you be pleased?

Numbers and research

Numbers and statistics are the backbone of medical research analysis. I am not a statistician by any stretch. I took a statistics class in college to meet a distribution requirement. After college I took a summer class at the little college down the street, Harvard, where it didn't matter if we had the numbers right (we took a vote - if everyone thought that 47.3% of 6,329,145 was around 3,000,000, we used 3,000,000) because it was the principle of the process. We needed to focus on learning the importance of how the numbers are determined and how to figure out their significance.

Another big part of statistical analysis is ensuring the numbers that are being analyzed are what you think they are - that if you think you have a pool of people who were born west of the Mississippi between 1950-1960 and now live in Florida, that you don't have anyone from Connecticut in it as that would skew your data. And that the same information was collected from all of them so you are not comparing apples and oranges. You want to compare red apples and red apples, not red apples and slightly yellow apples.


Here's an example of data being reanalyzed and people saying well maybe not but maybe yes. In 1995, the million woman study was started in Great Britain to compare diet and lifestyle and health factors such as cancer. One significant result was the link was seen between Hormone Replacement Therapy and breast cancer. Then everyone stopped HRT and breast cancer rates went down so the proof is there. But now there are claims of shortcomings and lack of causality. The new claims are: 'HRT may or may not increase the risk of breast cancer, but the MWS did not establish that it does...'

But still '"This report would not change how I counsel women, as multiple studies, including a randomized trial, have shown an increased risk of breast cancer from combination hormone therapy," Kathy Helzlsouer, MD, director of the prevention and research center at Mercy Medical Center in Baltimore...'

So where does this leave us? Somewhat doubting this one study but based on the findings of other studies and the drop in breast cancer diagnoses, we can still state it was correct.

Blah, blah, blah

As we approach the end of the month, the media is full of advice on how to keep your resolution to lose weight.Blah, blah, blah. This clip tells you to write down what you eat, get exercise, eat right, and weigh yourself once a week.

Here's my non-professional advice:

1. Eat right. This means no ice cream, french fries, pie, cake, donuts, candy, chips, fried food, or anything snack with more than 5 g of fat or 200 calories except on special occasions. And special occasions do not happen every day. Also, eat a piece of fruit or a serving of vegetables with every meal. Have an apple as a snack, instead of a bag of chips. etc. If you must go to fast food, pay attention to those evil calorie count signs and get a healthy option and not a double bacon cheeseburger, large fries and a large soda. How about a regular burger with an apple and a bottle of water? Plan your snacks by bringing them with you. Don't over complicate things with fancy diets unless you can cook.

2. Get moving. Go to the gym, go for a walk, yoga, zumba, weight training, bike riding, skiing, snow boarding, roller blading, surfing, Just move your butt. No excuses. No drive throughs - park and walk into the bank, restaurant or whatever unless you have three screaming small children in your car. (If you do have three small children you are probably running non stop after them but take them to the playground and run around with them - that counts too.)

3. Its not a diet its a life style change. A diet implies a short term effort. A life style change is permanent. You didn't get fat in six weeks so you won't get skinny in six weeks. Be realistic. Change your eating habits and expect to lose a pound or two a week or 5-8 lbs a month for a permanent change.

4. Weigh yourself once a week at most. If you weigh yourself every day you are on the perpetual yoyo. You lost a pound so you celebrate and eat a pizza. You gain a pound and you are depressed so you eat a pint of ice cream.

Here at our house we are trying to lose weight. I had a banana for breakfast and will go to the gym and come home and have egg beaters for a second breakfast. (I don't have time for breakfast first because I snoozed after the alarm.) Lunch will be a turkey sandwich and maybe some pretzels and an orange. Dinner is asparagus and chicken or something in a crustless quiche, omelet, or souffle (which are all the basically the same ingredients but cooked differently) and a salad. I might have some crackers for a snack this afternoon too. And maybe some wine with dinner. I am not expecting miracles from my scale but I am trying.

So blah, blah, blah. Go figure out your healthy plan and start moving to meet your resolutions.

That Avastin Debate

This is now either 'the debate that will not die' or plot number 9,487, 321 to confuse the patients. Two new studies have shown that treatment of Avastin with chemotherapy reduces breast cancer tumors to the point that they are non-existent at surgery. How wonderful, how exciting, how confusing.

Avastin is that drug that has been determined by the FDA not to be helpful in treating late stage breast cancer. But two new German studies have shown positive results for early stage breast cancer treatment. However, there are three big ifs here before anyone starts jumping up and down with excitement:

1. Avastin has nasty side effects.
2. The long term outcome of the women in the study is not yet seen so there is no guarantee the cancer won't return.
3. Different types of chemotherapy were used in the two studies so we may not be comparing apples and oranges here.

I am not sure if this is news or not. Yes it does show new research (and there is always new research going on) but there are too many ifs here. I think eventually it will be news when we know about long term results and the issue is resolved of the different chemo protocols used.

As usual I believe this is a case of the initial results being over hyped without knowing if it will really work in the long run. The drug companies announce the latest results of research and some how the media takes it and it ends up being news before its time.

As long as they don't nag

In a new payment system in Massachusetts, doctors will be paid per patient and not per service. The better a patient does the higher the reimbursement for the doctors. Go read this article to explain the whole thing but here's the basics:

This new system works like this:

"Primary care doctors, specialists and hospitals typically have billed insurance companies and government programs such as Medicare and Medicaid for each individual service they provide to patients, including office exams, lab and imaging tests, emergency room visits, and hospital admissions - with few limits on the number of services.

Critics say this system, called fee-for-service, encourages doctors to provide more treatment than is necessary and discourages coordination of a patient’s care among different providers.

In the new system of “global payments,’’ insurers generally put doctors on an annual per-patient budget. This budgeted amount is higher for patients with complex medical problems.

Doctors are expected to cover all costs associated with caring for the patient with this flat fee. When primary care doctors keep patients healthy and prevent expensive hospital stays and specialists’ visits, they get to keep more of the budgeted payment. If a patient’s care exceeds the budget, doctors lose money on the patient.

This arrangement may sound uncomfortably familiar to “managed care’’ popular in the 1990s - when patients accused doctors on budgets of withholding needed care. But insurers and doctors insist this time will be different, because the budgeted amounts are more generous, and because insurers are tracking the quality of care doctors provide to make sure they are not denying necessary care to stay within their budget."

Everyone will need to have a primary care physician or nurse practitioner or physician's assistant to oversee their care. By getting people in for preventative care they hope to keep costs down. Sounds logical - it turns the practice of medicine into a proactive system as opposed to a reactive system as much as possible.

I think I like this idea. It will help catch bad things before they get really bad. The more expensive the medical adventure is the sicker you probably are.

I don't mind being reminded to get annual mammograms and annual physicals but just don't start nagging me about the rest of my health issues. I really am trying to lose weight - for the record I wear a size 12 and would prefer to wear my size 8 wardrobe - and I know its going to take a while. I also like wine with dinner and cheese and crackers for a snack and have zero self control when faced with a box of donuts (but only eat one). At my job that I go to my desk has a clear view of the snack tray in the kitchen as well as the table which frequently has an open box of donuts, bag of bagels or hermits. If I am nagged I get cranky and we don't the world with a cranky me.