More Chocolate Benefits

Elaine Magee, over at the Healthy Recipe Doctor, currently has a post up about her favorite chocolatier, Moonstruck Chocolates.

Another study* has demonstrated the benefits eating chocolate, this time on blood pressure reduction. The research, done at the University Hospital of Cologne, Germany, included 44 adults between the ages of 56 and 73 years of age; there were 24 women and 20 men with mildly elevated blood pressure. Participants were allowed no more than 30 calories per day of dark chocolate, about the amount of chocolate in a Hershey's Kiss. At the end of the study the participants eating dark chocolate lowered their systolic blood pressure (top number) an average of nearly 3 points and their diastolic blood pressure (bottom number) an average of almost 2 points. The control group, who were given white chocolate had no appreciable change in their blood pressure for better or worse.

If you decide to try to replicate the study results please remember to keep your daily portions very small; if over-eating chocolate causes you to gain weight your blood pressure will increase, negating all the benefits of your sweet treat.

You might try Elaine's Moonstruck truffle suggestion if they are available to you or my favorite may be an option: Dagoba's organic dark chocolate bar with wild blueberries and lavender oil (yes lavender!). The lavender is really subtle, and if you didn't know what was in there you'd never guess because it doesn't taste like the smell of lavender. This is the best chocolate that I have ever tasted, available widely in the northeast in health food stores and Whole Foods markets. A very tiny square is all that you need to satisfy your sweet tooth and possibly to lower your blood pressure. For the wine drinkers in the group, a really nice treat is one small square of a Dagoba (there are lots of flavors to choose from if you don't like my suggestion) and a small glass of red wine, full of flavonoids and resveratrol, which are both good for heart health. Enjoy!

~Laurie

*Study source: Journal of the American Medical Association, as referenced in WebMD the Magazine (September/October 2007)

Related Topics:

• Chocolate Lovers: You Can't Help It!
• Chocolate: Cardiovascular Superstar?

Technorati Tags: chocolate, Dagoba, Moonstruck, blood pressure, healthy heart

I Hate Brown Nosers

Recently I was talking to an acquaintance who works both in my ED (emergency department) and in the office of a local physician group that gets a lot of ED referrals. I told her that I had gotten a complaint from a patient about his interaction with the group's appointment scheduler, whom he reported as very "rude and condescending." The individual felt that that the scheduler had been more interested in what health insurance he had and that she was questioning whether or not he really needed to be seen by their office. I noted to my acquaintance that I was surprised by this complaint, but she said that she was not. Today I had a personal experience with this office and now I know what she means.

Recently a member of my family had an injury and was seen in my ED. He is home recovering well, but I offered to make his follow-up appointment with this same office and assist him in getting there. So this morning, the first day off that I have had since the injury occurred (the second business day), I called to schedule the appointment.

Before I relate this conversation, let me tell you that I don't normally use my credentials to impress anyone under any circumstances. I do sometimes say to a provider who is trying to explain something to me and is struggling to find non-medical terms that I am a nurse practitioner, because then they know that we have a common language, in the same way that a multilingual person would offer up that they speak another person's native tongue. It's polite. So here's my recall of the conversation, which is pretty darn close to the exact words used.

Receptionist: (after recording that tells me I have reached the correct office and to "dial 3" to schedule an appointment. "Good morning this is Suzie Q, how can I help you?"

Me: "Good morning Suzie Q, this is Laurie Anderson. I am calling to schedule a follow-up appointment for my (relative) who was seen in the ED on the 18th. He injured his (body part) and was referred to either Dr. X or Dr. Y" (both names are on the discharge paper work).

Receptionist, tersely: "What are you talking about? What is the ED?"

Me: "I'm sorry, the emergency room."

Receptionist: "Oh the EMERGENCY ROOM. And why was he seen in the emergency ROOM?"

Me: "He injured his (body part)."

Receptionist: "Was this a work-related injury?"

Me, wondering if they don't see worker's comp patients?: "No. It was not."

Receptionist: "When was he seen?"

Me: "Last Thursday, the 18th."

Receptionist, in scolding voice: "And what was he told?"

Me, getting irritated: "Excuse me, I don't understand the question."

Receptionist, in continued scolding voice: "When was he told that he needed to be seen?"

Me: "I don't know, I wasn't with him. But I imagine he was told what they always say, 7-10 days."

Receptionist: "Yes, so you should have called me on the day that he was seen. I am going to have an awful time finding a place for him in this schedule within that time frame."

Me, now getting upset at the attitude: "Look, he's fine. I am a nurse practitioner in that emergency department and I am perfectly capable of assessing the situation. He is on (appropriate medications for the injury) and he is doing well. He just needs a recheck."

Well, suddenly the ice melted...

Receptionist: "OK, would you mind holding on for a minute please?"

After a brief pause she was back, asking if I thought that an appointment that was actually 11 days after the injury was soon enough? "Certainly it would be fine," I assured her, "after all he is under my care" (smile in my voice). Then she went on to ask, "How did he injure his (body part) again?" and after I explained she said, "Oh, I'm so sorry, that must have really hurt..." I assured her that it did, but he was much better, and that I certainly appreciated her concern...

Man, it really ticks me off to know that the "usual care" of that receptionist is different for other patients than it is for me, just because I have the potential to tell her bosses that she has a lousy attitude.

~Laurie

Related Topics:

• Do I Need to Go to the Emergency Room?
• Tips for a Successful Doctor Visit

Technorati Tags: health care, medicine, emergency, health and wellness

Pfizer Pulls the Plug...

Well, it came as no surprise to me that Pfizer pulled the plug on the first inhaled insulin, Exubera, yesterday. This product has been fraught with problems since its launch: from a prescriber's point of view this included dosing that was difficult to equate with traditional insulin use, the need to perform pulmonary function testing before prescribing and at regular intervals after starting the medication, and restrictions on prescribing the drug for those who may have compromised lung function, such as smokers and those with asthma.

From the perspective of the user, there was a fairly large administration device to carry, and the potential to have to load and inhale several capsules per single dose. Personally, in addition to the other prescriber concerns, I thought the fact that fully 1/3 of the medication was lost in the upper airway was such a waste, that I couldn't get enthusiastic about using it. Thank goodness I didn't, because now of course everyone will have to be transitioned off the medication.

The member survey at Present Global Diabetes didn't surprise me either. When I took the survey 55 members had responded. Respondents overwhelming believe that Exubera failed because medical providers didn't believe in it, as opposed to a lack of patient acceptance. Their top two reasons for this belief were that the administration device was too big, and that there were problems with the frequency of administration and the "relevant" insulin dose.

The really interesting part of this survey was that it supported my long-term contention that an aversion to injecting insulin is a problem for health care providers, not for people living with diabetes. An overwhelming majority of respondents (74.5%) agreed that "insulin injections are not as big of a deal as people thought." Well, no kidding! When I teach diabetes classes and talk to people about insulin injections, most are a bit fearful, but once they feel the needle they are surprised that it hurts less than measuring their blood sugar by finger stick.

In my opinion, health care providers need to look at their own concerns about prescribing insulin, and ask their patients how they feel about it.

Take care, Laurie

Related Topics:

• Cold and Flu Treatments for Diabetes
• Diabetes Guide

Technorati Tags: diabetes, Exubera, Pfizer

The Devil in My Head

There is a Devil in my head; you know, like the one in the cartoons and on the sitcoms, that try to talk the person into doing or saying something bad. I don't give in, but some days it's really hard not to give voice to my frustration. Let me explain...

A report on Yahoo News (10/2/07) notes that obesity is a "big factor" that is causing higher rates of chronic illness in the US than in Europe. In this country we spend at least twice what European countries do on health care costs according to Kenneth Thorpe, a lead researcher at the Rollins School of Public Health at Emory University (Atlanta, GA). Thorpe notes that "Seventy-five percent of what we spend in this country" on health care costs is due to patients that have one or more chronic health problems due to obesity.

This is an expensive problem; chronic illnesses like diabetes and cardiovascular disease cost between $100-150 billion dollars annually in direct costs, including office visits, hospitalizations, procedures, and medications. This figure does not account for the additional costs of lost worker productivity due to sick days.

Thorpe's study team compared 2004 data on the frequency of certain disease states and their treatment among adults aged 50 and older in the United States and Austria, Denmark, France, Germany, Greece, Italy, Netherlands, Spain, Sweden, and Switzerland. They found that about 17 percent of European adults are obese, compared with about one third of American adults (33%!). Americans were more likely than Europeans to have heart disease and diabetes; both are associated with obesity.

Face it folks, obesity comes from our choices. We aren't born obese, but we learn to overfeed ourselves at every turn: restaurants that serve too much; teaching our kids to make themselves feel better with cookies, ice cream, and chips; telling ourselves that we should not be deprived. Why not? Food is a choice: how much, what kind, how often, and eating for real hunger versus feeding our emotions are all options.

Thorpe believes that the only way to reduce health care costs in the US is to find ways to reduce obesity and thus prevent the related chronic illnesses. I agree, but I'm not sure how we're going to do it. We have got to find a way to help people in the US become more active, eat less and lose weight, and to care enough about themselves to be motivated to change unhealthy behaviors. As a health care provider I want to help people to change, but I'll admit, sometimes I just get disgusted and discouraged.

I was looking at someone who came into the ER a few days ago. I have seen this individual a number of times for the same complaints of chronic pain in the knees and hips, caused by being morbidly obese.

The whole time I was nodding my head and verbally being empathetic, a part of my brain wanted to say out loud, "You need to quit whining and get your butt out of the chair and walk every day. Even if it's only 10 feet, just start! You need to stop stuffing your face with food and eat smaller amounts. You need to get outta my ER, because I am not giving you pain meds. You caused your own misery, and it's not my job to stop that misery."

What do you think - I wouldn't have gotten the Girl Scout badge of honor for that one, would I? Some days it's just too hard to keep that Devil out of my head.

Laurie

They always say time changes things, but you actually have to change them yourself.
Andy Warhol (1928 - 1987), The Philosophy of Andy Warhol

Related Topics:

• Chronic Disease Costs 'Staggering'
• Health Risks Associated With Obesity

Technorati Tags: obesity, chronic illness diabetes heart disease, emergency medicine, health and wellness