When Your Arms Are Too Short…

 

As someone who grew up with myopia (nearsightedness), I never imagined that my reading vision would fail me.  Yet I have spent the last four years holding menus at arm’s length to make it easier to read the food selections.  Within the past year, I adopted the habit of grabbing my reading glasses first thing in the morning when I grab my phone.  Do you know why?  Because my close-up vision has become so dim that if I dare to construct a social media post without my glasses, I end up finding typos on my caption or hashtags.  I’ve even gotten to the point where I wear my glasses when sitting at the computer and reading a considerable amount of material, because it reduces eye strain.  

The end result is that I either grab glasses, or wish that my arms were longer.  I also wish that restaurants filled with romantic ambience would scrap the low light conditions in favor of slightly brighter light which would make it possible for all but the most elderly and vision-challenged to see.  

Presbyopia (the age related stiffening of the lens of the eye, which interferes with its ability to contract and diffract the light) has reared its ugly head and taken up residence permanently in my daily life.   And despite the fact that I had the knowledge base to realize that presbyopia would color my life after the age of 50, I am still surprised at how sudden and noticeable the vision changes have been.  

I went from not being able to see the big E on the Snellen eye chart from my childhood into my late 40’s, to struggling to read receipts in my 50’s and wondering,  “Is that a 6, or an 8?”, or, “Is that a 3 or a 5?”  It’s pretty frustrating.  There have been instances in which I have picked up products with the intention of reading the product ingredients, but I often cannot read them at all.  

What’s really strange is that it makes me feel a bit disconnected from the world, since once sense is noticeably dulled. Who else feels that way as a result of having age-related loss of near vision?

Disrespect

Last month, while working an urgent care shift, I caught a bug from one of my patients which progressed very quickly from a viral upper respiratory illness to a bacterial infection. Because I was so congested, the infection also seeded in my upper airways, and I developed bronchitis. Whenever bronchitis sets in, I am in for a world of hurt, because the coughing jags are so violent that I almost pass out from them since I can’t get a breath in.

In an effort to keep social media world happy, I posted my health status just so people would know why I sort of backed off from social interaction during that time. I felt horrible, and my voice was reduced to a strange, congested baritone mumble.

What irritated me was that several people jumped onto social media with health advice. I understand that people were concerned and trying to be helpful. However, there were two facts which kept floating through my head, and which left me scratching my head over how people thought it was appropriate to post advice.

FACT #1: I never asked for any advice from anyone. I was merely posting facts about my condition.

FACT #2: I am a board-certified family practice physician who works regularly in the urgent care setting. Don’t you think I would KNOW how to take care of myself? Why would anyone offer unsolicited health advice to a physician?

I couldn’t help but be bothered by the influx of posts suggesting things like, “drink tea with honey”, or “take zinc”. As an urgent care doctor, I am just as likely to give general, common sense advice about upper respiratory infections as I am to give prescriptions for medications and order in-office nebulizer treatments. I know all about zinc, tea with honey, vitamin C, salt water gargles, etc.

Besides, I ended up needing a course of antibiotics, two prescription inhalers, two prescription cough medications, and three over-the-counter decongestants. No amount of tea with honey, zinc, or salt gargles would have fought off the infection and reactive bronchitis I had developed. One person on Facebook hounded me via Messenger, and when I said I couldn’t chat, sent me a bizarre set of instructions for a concoction which included red wine. I became irritated and berated him for giving me health advice, whereupon he took the opportunity to insult me for no good reason. His disrespect was so blatant that I blocked him. I don’t need that kind of hostility in my life.

Sorry, but I think it is presumptuous and insulting to attempt to give health advice to doctors. In the age of Google, so many people fall under the assumption that they are suddenly experts when it comes to just about everything. Don’t trust everything you read on Google!

When I really think about it, I doubt that people would give automotive advice to an auto mechanic, or financial advice to their CPA’s. So why insult someone with 7 years of medical training and 14 years of experience as a practicing physician?

I believe I have made my point.

Understanding The Costs Of Diabetes Treatment And Planning For The Future

Original post can be found at:
https://www.thesimpledollar.com/understanding-the-costs-of-diabetes-treatment-and-planning-for-the-future/


by DeVonne Goode
Updated on 06.05.18

Diabetes is a prevalent disease. However, it can still take many by surprise, and leave them struggling to pay medical bills.
With the complexities of the condition and the wide range of costs involved with treatment, having a financing plan is necessary. Health insurance is obviously one of the primary methods of assistance. But not everyone has the adequate coverage to cover
the costs – let alone the out-of-pocket cash to put on the counter every time out.

Opening a savings account, particularly one with high interest, could be a worthwhile investment toward consistently managing the disease today and into the future.

Diabetes at a glance
Type 1 Diabetes

A condition that keeps the body from producing enough insulin. Insulin shots are used to control blood glucose levels. Most diagnosis occur among children and young adults, which is why it is also referred to as juvenile diabetes.

Type 2 Diabetes

The most common form of the condition where the body doesn’t properly use insulin to convert sugar, starches and other food into energy.

Gestational Diabetes

Occurs when women experience high blood glucose levels during pregnancy. It’s usually easily managed and goes away after pregnancy.
Prediabetes

When blood glucose levels are higher than normal, but not high enough to be diagnosed as Type 2 diabetes. A large number of Americans are living with prediabetes (1 out of 3 adults). But taking early action to manage glucose levels can prevent diabetes from forming.

People who have diabetes are at higher risk of developing the following health conditions:
Blindness
Heart disease
Stroke
Kidney failure
Blindness
Loss of lower appendages (toes, feet, or legs)

Keep in mind – these conditions occur in the case of severe complications with the disease. With consistent attention to diet and other medical treatments (like most living with type 1 or type 2 diabetes undergo), these conditions are avoidable.
Diabetes by the numbers

According to a recent report from the Centers for Disease Control and Prevention (CDC), more than 100 million U.S. adults are now living with diabetes or prediabetes. Of that, only 12% were aware that they had it. And with approximately 1.5 million new cases being diagnosed every year, the need for education and financial support is clear.

Prevalence
Infogram

Rates of diagnosis for the following ethnic groups
7.4% of non-Hispanic whites
8.0% of Asian Americans
12.1% of Hispanics
12.7% of non-Hispanic blacks
15.1% of American Indians/Alaskan Natives
Breakdown among Asian Americans:
4.3% diagnosed were Chinese
8.9% diagnosed were Filipinos
11.2% diagnosed were Asian Indians
8.5% diagnosed were identified as other Asian Americans
Breakdown among Hispanic adults:
8.5% diagnosed were Central and South Americans
9.0% diagnosed were Cubans
13.8% diagnosed were Mexican Americans
12.0% diagnosed were Puerto Ricans

Underreported deaths due to diabetes

Diabetes is one of the leading causes of death in the United States (seventh as of 2015). However, studies have found that it is also among the most underreported. According to the American Diabetes Association®, only 35% of people who died with diabetes had the disease listed on their death certificate. And of that number, only 10% had diabetes identified as the cause of death.

Underreported Deaths
Infogram

There are a number of possible reasons for the underreported rate. But a lot points to the lack of ability to pay for adequate diagnosis and proper medical treatment.

What specific costs will someone with diabetes have to address?

If you or your child are diagnosed with diabetes, or you’re told that you have prediabetes, management and prevention take center stage. While a lot involves diet and exercise, medication will inevitably have an effect on your finances as well.

According to the American Diabetes Association® (ADA), medical costs for a person with diabetes averages out to $16,750 per year (a total of $327 billion nationwide in 2017). Of that amount, $9,601 is attributed to treatment specifically for diabetes. That’s more than twice the medical cost for people without diabetes.

Of the $327 billion nationally, $237 billion was attributed to direct diabetes medical costs and $90 billion was attributed to indirect costs – absenteeism and reduced productivity at work. Understanding the different forms of diabetes treatment, as well as the direct and indirect costs, is important for wrapping your head around plans for financing.


Type
Treatments

Type 1 Diabetes
Diet
Exercise
Insulin therapy
Regular blood glucose tests/monitoring

Type 2 Diabetes
Diet
Exercise
Insulin therapy
Other medication
Gestational Diabetes
Diet
Exercise
Monitoring sugar intake
Monitoring the baby
Direct Medical Costs ($9,601/year)
Indirect Medical Costs ($90 billion nationally)
Prescription medication (30% of total cost)
Loss of productivity due to mortality ($20 billion nationally)
Hospital care (30% of total cost)
Inability to work as a result of diabetes ($40 billion nationally)
Routine doctor’s office visits (15% of total cost)
Reduced productivity while at work ($30 billion)
Other medications and supplies (25% of total cost)
Reduced productivity due to increased absences and loss of employment from diabetes ($6 billion)

Insulin

Insulin injections are one of the primary forms of medical treatment used to manage diabetes. Especially for those living with type 1 diabetes, who can’t produce insulin of their own, these types of injections are vital for survival. However, the cost for insulin has skyrocketed in recent years, leaving many in the position of having to choose between going into debt or cutting back on medication.

Average cost for insulin as of 2015: $100-$200 per month
Average cost for insulin as of 2018: $400-$500 per month

WIDELY USED INSULIN BRANDS AND INSULIN INJECTION TOOLS
Insulin
Apidra, Humulin, Lantuo, Lente, Levemin, Novolog, Novolin, NPH Insulin, Regular Iletin, Regular Insulin, Velosulin
Insulin Syringes
BD Ultrafine, Levemir®, Monoject, NovoFine®, Ulticare, UniFine, UltiGaurd
Insulin Pumps
Animas, Deltec, Medtronic

Diabetes screenings and other medications

Along with your normal doctor’s visits, diabetes screenings are an important part of the process for identifying the disease. Specifically, if you have been diagnosed, testing your blood glucose levels will become a regular part of your life. Much of the costs for medications involved should be covered by your health insurance. And there are a number of home testing devices you can invest in to help make things more convenient and cost-effective.


WIDELY USED DIABETES TESTING BRANDS AND OTHER MEDICATIONS

Blood Glucose Test Meters and Test Strips
Abbott Freestyle®, Abbott Flash, Accu-Chek Compact®, Ascensia Elite, Ascencia Breeze, Ascensia Contour, Lifescan One-Touch©, Prestige
Injectable Medications
Byetta (Exenatide) injection and Symlin (Pramlintide Acetate) injection, Victoza (lLiraglutide- rDNA origin) injection
Oral Medications
Acarbose, Avandia, Chlorpropamide, Diabinese, Glipizide, Glucophage, Glucotrol, Gylset, Meglitol, Metformin, Prandin, Precose, Repaglinide, Rosiglitazone (These drugs act in different ways to lower blood glucose levels and may be prescribed in combination with other medication.)


Diabetes health expenditures according to group

Depending on whether you or your child has type 1 or type 2 diabetes, total expenditures can vary. Those who manage their condition at home, through diet, exercise, and home testing will have different averages than those needing regular appointments with specialists. According to the American Diabetes Association®, average total healthcare expenditures for diabetes treatment differ according to gender, race, and states with the highest populations of people diagnosed.

Gender
Men: $10,060
Women: $9,110

Race
Hispanics: $8,050
Non-hispanic Blacks: $10,470
Non-hispanic Whites: $9,800
States with highest population of people with diabetes
New York: $21 billion in healthcare expenditures
Florida: $24 billion in healthcare expenditures
Texas $25 billion in healthcare expenditures
California: $39 billion in healthcare expenditures

Options for diabetes treatment financing

In a recent online survey of 500 adults with diabetes, more than half of the participants acknowledged the medical costs involved has had a negative impact on their finances. Many also admitted to going to “extreme lengths” to cover the costs. These lengths include accruing credit card debt, borrowing money from family or friends, and tapping into a savings or retirement account. Many may feel the need to take some extra financial risks because they don’t feel as supported as they’d like. Understanding your options will help you make the most informed choices.

Insurance

Government insurance, such as Medicare and Medicaid provides most of the financial assistance for diabetes care. The military also takes care of a good amount of costs for veterans. The remainder of the cost is covered by private insurance or out-of-pocket cash. According to the National Conference of State Legislatures, 46 states mandate that diabetes be covered under state insurance.

Diabetes Health Insurance Coverage
Infogram

These states require coverage for diabetes treatment as well as equipment and supplies for home use (insulin, pumps, syringes, test meters). Four states do not have that same insurance mandate, however – Ohio, Alabama, North Dakota, and Idaho. Anyone with diabetes who live in any of those four states will most likely need to deal with a private insurer or explore other methods of financing.

Coverage from private insurers usually come through employer-sponsored group plans or individual health plans. Advisors would suggest going with employer-sponsored plans, because they offer higher protections due to being subsidized. On the other hand, if you are unemployed and venturing into the individual market, it may be difficult to find affordable coverage. The reason is that diabetes is considered a “high risk” disease. Insurance companies anticipate a high amount of claims, especially from those with pre-existing conditions. So it will be reflected in the pricing.

HSA

People who have diabetes but don’t have coverage that’s comprehensible enough for their needs may utilize a health savings account (HSA). An HSA is primarily useful for people with high deductibles (at least $1,350 individually, or $2,700 for family). Also, those who are a part of low-income families or don’t live in a “mandate state” may see this as a helpful tool. One big benefit of an HSA is that you take the money with you. There’s no “use it or lose it” policy like some other savings plans. Being able to set aside pre-taxed dollars to help pay for medical expenses can go along way when trying to manage diabetes.

FSA

Another way to set aside dollars for medical expenses is through a flexible spending account (FSA). An FSA is provided through your employer with a $2,650 limit. You can also use it to cover medical expenses for your spouse and dependents. One thing to keep in mind with FSA’s is that they do have an expiration period. You’re generally required to use the funds within your plan year. But your employer may offer extensions at their choosing. The benefit is, it can be used with any type of health plan. And diabetic supplies are eligible to be paid through FSA’s.

High interest savings account

If you’re not interested in dealing with your employer for coverage or a flexible spending account, a high interest savings account could be a good option to explore. It’s just like any other savings account, only with fewer restrictions. Not only are you saving for your medical needs, but your money is also making money. High interest savings accounts are opened through online banks – which means they don’t have to worry about maintaining branches all over the country. They can offer you higher interest rates, with the benefit of accessing your money whenever you want.

Unlike an HSA, a high interest savings account isn’t tied to a high deductible health plan with a dollar limit. And unlike an FSA, there’s no expiration date on when you can use your money. It removes any additional stress so you can concentrate on managing your condition properly. And as you earn interest, you can still take advantage of a number of outreach resources available for people with diabetes.

This condition can be a tough one to get a handle on, but it’s not insurmountable. Let your understanding of diabetes, your knowledge of its treatments, and your strategy for tackling costs work in your favor.

Sex After 40

By: Dr. Stacey Naito – Physician and IFBB Pro

The Shifting Tide

Those of you about to turn the corner and enter the 40 and over zone may be concerned about the impact that getting older will have on your sex life. You may have questions about whether you must resign yourself to becoming a dried-up old lady, with no fun to be had in the bedroom. Thankfully, the reality is that you can have more fulfilling and enjoyable sex than you had in your 20’s or 30’s.

What’s more, society has gotten wind of the idea that people want to live completely fulfilled lives into their advanced years. It’s true that 40 has become the new 20, and the concept is supported by empowered celebrities like J. Lo proclaiming their eternal youth and sexual vitality without shame. So instead of allowing the aging process to shut you down, it’s time to look forward to a new and more sexually fulfilling chapter in your life.

Why Getting Older Is Great For Your Sex Life

I don’t know about you, but I wouldn’t trade the knowledge and life experience I obtained over my 52 years on the planet to return to my 20’s, because aging has positively impacted every aspect of my life, including what happens behind closed doors. With age comes acceptance of who we are, body flaws and all. Let’s face it, we accumulate stretch marks, cellulite, scars, etc. over time, all of which could send us into a meltdown if we stressed out about them. We have become more comfortable with who we are, which translates to greater body confidence. That body confidence works to our advantage in the bedroom, because we no longer feel uneasy or ashamed of how we look sans clothing. When we are comfortable naked, we can finally relax and enjoy intimate encounters to the fullest.

A woman in her 40’s or 50’s is less likely to take desperate measures to entice her man, such as dressing up in sexy but uncomfortable lingerie, or wearing a pair of high heels guaranteed to aggravate her plantar fasciitis or her bad back. In contrast, it seems there are plenty of women in younger age brackets who follow ridiculous wardrobe guidelines to garner the attention of potential sex partners or followers on social media channels. A woman in her 40’s of beyond doesn’t have the inclination to make a fool out of herself to guarantee a romp in the bedroom. She is older, wiser, and doesn’t have time for such nonsense. She doesn’t feel like she needs to try so hard to win her partner’s favor. Her attitude tends to be more along the lines of, “This is what I got, take it or leave it.” Besides, I am willing to bet that such an attitude is far sexier to a man these days. In addition, most men tend to be more excited about the notion of getting you naked, and once you are in the buff, they aren’t scrutinizing your body for flaws.

Older women are also less selfish in bed, and bolder about declaring what they want. They know their bodies, their likes and dislikes. If single, they are more discerning about how they procure partners, so they are less likely to engage in risky activities which expose them to sexually transmitted diseases. For older women in a relationship, there is a greater likelihood that they have been with the same partner for many years, and have developed a level of intimacy which only comes from a longer term committed relationship. A 40-something woman is usually confident enough to turn to her partner and say, “I really like it when you use your hands on me more”, and not fret about whether her partner will accept her sexual preferences.

Chances are that for older women, there are far fewer household distractions which can impede the natural progression of an afternoon of flirting into a full-blown lovemaking session. Such interludes are pretty much impossible if a baby is crying, or young children are demanding attention. Once children have become old enough to be relatively independent, say from pre-teens on, there may be more opportunities to roll around in the sheets with your partner without any interruptions. That kind of freedom can result in more spontaneous sexual encounters and greater satisfaction.

For those past menopause, Aunt Flo’s monthly visit no longer interferes with any amorous advances. Furthermore, there is no concern about getting pregnant and having an unplanned family addition. It’s incredibly liberating.

Sexual Issues and Aging

Though I have painted a rosy picture of the sex life of older women, there are some issues which can interfere with optimal sexual activity. However, this doesn’t mean that all women over 40 will experience sexual dysfunction. As geriatric psychiatrist and Caring.com senior editor Ken Robbins states, “Impaired sexuality and sexual function aren’t normal consequences of aging.” (https://www.caring.com/articles/sexless-after-40).

Women can experience symptoms of perimenopause as early as 35, and the diminishing estrogen and progesterone levels can result in vaginal dryness and thinning of the vaginal mucosa, both of which can make intercourse painful. If this occurs, make sure to obtain a pelvic exam with a physician who can diagnose and treat the condition. In many cases, a lubricant is sufficient, but hormone replacement therapy may be offered as an option as well.

Some women may experience a decrease in sexual desire as they age, but many others experience a surge in libido from the increased testosterone to estrogen ratio, which increases as estrogen levels continue to diminish. The sexual benefits of testosterone are also enhanced by regular weight training, which naturally boosts testosterone levels in the body. However, the ebb and flow of sexual desire often fluctuates more in women over the age of 40, a result of associated dips and surges in hormonal levels. In addition, the hot flashes, night sweats, and mood swings associated with plummeting progesterone levels don’t exactly make a woman feel amorous.

If you are a woman over 40 who is experiencing symptoms of perimenopause, such as hot flashes, and they are frequent enough to disrupt your daily life, seek the advice of a physician. During your visit, you may ask if the addition of hormonal support supplements like maca or dihydroepiandrosterone (DHEA) would be helpful in decreasing the symptoms you are experiencing.
Most importantly, reduce stress in your daily life, get plenty of rest, and communicate with your partner about any sexual concerns you may have.

Ham, Cheese and Pickles

During a recent urgent care shift, I encountered a man in his mid-50’s who had presented to the center with complaints of sinus pressure and cough. After I gathered more history and conducted a physical exam, the patient went on a tangent, asking me numerous questions about healthy foods. A commercial construction foreman, he was accustomed to being on site during the day, and insisted that his daily lunch was quite healthy and acceptable. As he prepared to tell me about this daily meal, he beamed with pride. What was it? Several slices of ham from the refrigerated section of the supermarket, a few slices of cheese, and a handful of pickles. He truly believed that the meal he consumed daily was incredibly healthy and nutritious. He even stated that he was consuming a high protein meal with produce (the pickle). The patient went on to tell me that when he was done with work, he often stopped at Arby’s to pick up a sandwich for dinner, and felt that the animal protein from these sandwiches wasn’t harmful in the least.

I shake my head in amazement when I encounter patients who have completely convinced themselves that somehow, their eating habits are completely clean and healthy, when they are actually abysmally deficient in nutritional value. What is more surprising is how insistent these people are on continuing their unhealthy habits, even when they ask for advice. The patient I mentioned above listened to me discuss the power of food as fuel, as sustenance, and nodded when I suggested he visit the fresh produce section of local grocery stores, select uncured meats, and avoid frequenting fast food establishments like Arby’s. I also mentioned that his blood pressure readings of 181/125, 179/127, and 185/122 (non-symptomatic) were rather alarming, especially since he stated that he had “forgotten” to take his blood pressure medications that morning. Was it fair to shake him out of his fog and inform him that with malignant hypertension, and a diet sure to compound the problem, he was on a short course to an unfavorable event like a stroke or heart attack? Did he even care if he was at high risk?

This is the kind of situation which I as a physician must often dance around. I have to determine how receptive a patient is to advice, and I also have to figure out the best way to speak to the patient without offending or discouraging him or her. It can be very tricky to reason with someone who has most likely gone through his entire life somehow believing that ham, cheese and pickles constitute an acceptable daily meal in anyone’s life!