• Archives

  • Jul12

    Prescription for Abnormal Lab Test Syndrome

    Posted in: Aging and Costs of Aging, Obesity and Weight Loss, Wellness and Health

    Recently I’ve seen several patients with terrible looking numbers: 260 LDL cholesterol, 35 HDL cholesterol, 375 triglycerides, 180/85 blood pressures, 222 blood sugars, 9% glycohemoglobin.

    The standard treatment for such numbers is clear: prescribe the right medicine in the right amount, and recheck in a few days or weeks.

    People with metabolic syndrome are up to 2.5 times more likely to die of heart-related causes and to have heart disease, a heart attack or stroke, compared to people without the syndrome.

    But these data don’t move people to action, even though they have Abnormal Lab Test Syndrome. I think it’s because they don’t know how good they can feel…and they usually feel ok.

    In my office, having one or two numbers as goal posts is very helpful for people who like to measure.  It gives us something to shoot for.  I usually gather my own numbers too: pedometer counts, body fat percentage, waist:hip ratio ( your waist should be half your height, as well).

    But people come to see me for a healthy direction and, usually, nonpharmaceutical approaches to their problems.  So writing recipes and exercises on prescription slips, recommending websites and books, and culling useless supplements are part of my job.

    The real challenge, now especially seen in companies that aim to create a culture of wellness, is how to motivate people to create real lifestyle change.

    For me, the key is finding out what people love to do–dance, build kites, plant trees, read–and then driving their individual program so that they have more energy for what they love, not less of a number they don’t.

    Getting to know patients as people instead of numbers is its own reward–and usually rewarded with less body fat, lower blood pressure and blood sugar, and less prescription medication.

     

  • Apr6

    Return to Work: How Absence Can Make the Heart Grow Fonder

    Posted in: Cancer, Environmental Health, Wellness and Health

    Return-to-work (RTW) coordination programs are successful in reducing long-term work disability.  But they vary a lot from one employer to the next.

    What doesn’t vary is why employers undertake them: to save money and boost productivity.  And they do save money: 94% of savings coming from reduced medical expenditures, with even a modest effort at coordination.

    Coordination is the key–not medical training or medical assessment. Caring, job accommodation, communication and conflict resolution are part of successful RTW coordination. It’s about problem solving much more than diagnosis and treatment.

    It’s well known that a brief psychological intervention can reframe a person’s impression of the heart attack they just had, and make it less severe: fonder, in a way.

    It’s less well known that functional restoration significantly and consistently reduces sick-leave days, much more than for physical therapy for chronic back pain.

    Or that cancer interventions for RTW are being seriously studied.

    Absence (short term disability, long term disability, workers’ compensation, Family Medical Leave and absenteeism) is even more of a hot button with job insecurity rampant in America.

    Millions of Americans have lost their jobs, and many of those who have had a long absence want to return to productivity.  And their employers want them to.

    The core questions are “What will most help them do so, cost-effectively?” and “How should employers keep employees healthy and safe at work, so they don’t become disabled?

     

  • Feb2

    Wellness in Business Comes of Age

    Posted in: Aging and Costs of Aging, Environmental Health, Wellness and Health

    To build a culture of health, develop policy, engage stakeholders, focus on healthy lifestyle changes, recognize success and measure impact is a long, worthwhile, profitable journey. So, it’s best tackled in bite sized portions.

    There are several great places to look.

    • The National Business Group on Health makes a business case for prevention and provides resources to members.
    • HERO has assembled a large, retrospective multi-employer health promotion research database.
    • PeopleMetrics has broadened corporate wellness (a poor sister, underfunded idea) to Employee Engagement, a robust notion of passion, retention, effort and advocacy.
    • The 3rd Corporate Health, Wellness & Benefits Summit just concluded.
    • The American Psychological Association (APA) celebrates psychological health in the workplace with annual awards and honorees. And #cohealth has a terrific monthly tweetchat.

    Among the 2010 APA honorees are Leaders Bank, which has amazingly kept people on course with a “comprehensive Adapting to Change and Effective Stress Management program, motivated from the ground up and endorsed by senior management.”

    I’m going to help Lincoln Financial later this month and next with starter-tips, and a unique How Job-Stressed Are You? Now quiz now in beta. It’s bite-sized, tasty and I hope really fun. Try it.

     

  • Nov3

    Stress Reduction and Corporate Wellness

    Posted in: Aging and Costs of Aging, Environmental Health, Hypertension, Wellness and Health

    I am getting more calls about managing stress among employees. Thoughts impact physiology in about 1/18th second, so it’s worth preparing for them.

    What many companies, now asking employees to do with more with less, don’t know is that stress can be measured, reduced and managed.  And that their health care costs will go down, and their productivity rates will likely go up.

    Chronic stress interferes with memory, concentration, judgments and decisionmaking.  It is the most common cause of absenteeism and a prime cause of job turnover. It’s probably the most important benefit of corporate wellness.

    And it boosts health costs.  A lot.  But HeartMath has found $1200 per employee per year in correctional officers’ annual cost savings with simple training programs over time.

    Stress is a complex emotional and physiological reaction.  It is a natural feeling, one that involves hundreds of biochemical changes which are fatiguing.

    Stress can be controlled with practiced actions

    • Communicate clearly (does not mean shouting)
    • Diminish the drama (helps reduce biochemical impact)
    • Practice a positive emotion on purpose: appreciation, care, compassion or gratitude (verbalize or write these, every day)

    This looks pretty simple. And it is.

    But like eating healthfully, people know what they should do, but don’t usually have the tools or skills to do it.  That’s why teaching tools are essential.

    For example, rhythmic breathing can be relaxing.  But it doesn’t neutralize stress over the long term  What does is actively adding a positive feeling like those above.

    I’m going to be teaching on-the-job ways to manage stress around the country next year, and I can’t wait. Because effectively managing stress can:
    1. Increase resilience  – ability to prepare for, and recoup from challenge
    2. Improve blood pressure, depression, asthma
    3. Reduce fatigue, burnout, hostility, anxiety, distress and anger.
    4. Increase brain clarity, focus, attention span, accuracy and learning ability
    5. Improve decision‐making, (reduction of decision fatigue)
    6. Improve communication skills
    7. Improve work/life balance

    This means lower health care costs, better presenteeism (defined as the level of performance on the job), less abseenteeism and improved employee satisfaction.

    Learning the tools–in even a single hour, and even better, a single day–may be the ticket to less tired, less worried, less annoyed, less anxious employees.

     

  • Sep14

    No Meds Rx III: Why Patients Stop: Communication

    Posted in: High Cholesterol, Uncategorized

    Why do patients stop taking their medication? 3 reasons: reminders, money and communication. 

    Nonadherence is costly, physically dangerous, unnecessary and important. One in four patients prescribed antihypertensives stop them within 6 months.  One in three patients are off their statins within 12 months.

    And not because they have lowered their cholesterol level with food (although they could learn how in the WSJ. Or by ChefMD video).

    To improve the chances that people will take their meds:
    *For clinicians: provide clear written instruction, anticipate side effects, and have another person available to answer questions within a few days of Rx.

    In the office, have patients repeat back to you how they will take the meds and for how long.

    *For patients: empowerment. Keep a daily log of blood pressures/sugars (here is one I use for weight control; adapt it). Is the medicine helping? You need to know.

    Bring it every visit and ask the doctor to review it.  Show how you were feeling when your blood pressure/sugar was high or low. Does the pharmacy’s have an automatic refill program? Use it.

    *Both: discuss pill splitting (which ones?). A larger quantity purchase (means lower co-pays). Look for duplicate medications to omit. That’s the first thing I do when I look at a list.

     
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