QOTD: Health

The debate about what exactly health means goes back to ancient Greece. Does health just mean living a long time? Does it mean feeling strong? Are athletes the epitomy of health? In fact, athletes suffer more injuries and illnesses than the rest of the population because they push themselves so hard. So who represents health? What about spiritual health? Ethical health? It’s amazing how much we project onto body type these days, through our grossly oversimplified idea of health.

— Ben Spatz

What does it say about our society

…  that my reaction to feeling low-energy and blah in the morning is “drink coffee” not “eat breakfast”?

(And yes, I spent my teen years either on a weight-loss diet or expected to be on a weight-loss diet.)

Big Fat Sleep

No, it’s not news that lack of sleep is tied to fat.

What sleep researcher Dr. Orfeu Buxton found is more information on how this occurs.

The resting metabolic rate of the volunteers by the end of the five weeks was 8% lower than where they had started. [...]  That could explain why night shift workers tend to gain more weight and have a higher likelihood of obesity than day workers; such weight gain is linked to an increased risk of diabetes and heart disease.

Wow, it’s like the number of calories burned isn’t standard across all bodies at all times!  Or not just affected by exercise!

The scientists learned something else interesting about another mechanism that put the disrupted sleepers at higher risk of diabetes: the combination of having their circadian clocks reversed (sleeping during the day and waking at night) and the poorer sleep they got as a result had an effect on their insulin levels. After three weeks in the lab, the participants produced about a third less insulin from the pancreas in response to meals; with less insulin available to break down glucose, blood glucose levels started to rise and three of the 21 volunteers showed high enough levels to qualify them as pre-diabetic.

Two things struck me about this.  First is that it occurred after 3 weeks.  Second is that only 3 of the 21 volunteers reached the pre-diabetic range, even though they were all living in the same lab undergoing the same regimen.  Again, it’s like they’re individuals or something.

Ending Gender Discrimination in US Health Insurance

These maps from FuseWashington make a point about the Affordable Care Act, aka “Obamacare”.  Right now, most states allow insurers to charge women more for insurance than men.

The Affordable Care Act will ban this practice in 2014.  It will also prevent insurers from refusing to insure those with pre-existing conditions like asthma.  And, y’know, ”obesity” is often considered a pre-existing condition.

Currently the Republican candidates all want to repeal the ACA.  I disagree.

Fat People Die Sooner, Right?

Reading Michelle’s post on death (cached here if you can’t read it on her site)   got me thinking.

How else on earth could you explain a doctor expressing anger and blame at someone for accidentally dying? And to then vent that anger on his grieving wife? You couldn’t. There was no other explanation but the fear of death, utilizing the Just-world Hypothesis as its conduit.

Fortunately that didn’t happen to me when either parent died.  My mother, who died at age 74, reached the point with Parkinson’s and Lewy body dementia where she could no longer eat or drink.  My father died of a heart attack brought on by severe anemia related to bladder cancer.  He was 77.

My mother was fat for most of her life.  My father was thin for most of his.  Neither died due to a health problem for which fat or thin is a specific risk.  My father smoked for decades, which increases bladder cancer risk — but smoking isn’t the only risk factor.

Sometimes it’s not about fat.

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A few related links:

Age is the number one risk factor for dying. My folks were born in the early 1930s. According to the US SSA (Figure 2a) my mother’s life expectancy at birth was  60 years — and my father’s was less.

My mother also struggled with diabetes and depression, both of which increase death risk.

Longer-lived parents tend to have longer-lived children. It’s like it’s genetic or something.

Not News

The website Fark makes fun of news stories that are not, actually, news.

Example:  Students Discover Desks Have More Germs Than Toilets

Why isn’t it news?  Well, it’s a common story that pops up once a year or two, and relies on people not thinking about which is more likely to get janitorial attention.

Today my Google Health section looked a bit like Fark.

First: Paula Deen has diabetes.  Because she’s fat and publishes “unhealthy” recipes, she’s being blamed for “bringing it on herself” with unhealthy food.  Fat people being blamed for their health problems, gee, where have I heard that before.

( Never mind that Ms Deen is 64 and the American Diabetes Association states that the risk of type 2 diabetes goes up with age —  26.9% of people over 65 have it.   Or that the American Diabetes Association states that “Most overweight people never develop type 2 diabetes” and that eating sugar doesn’t cause diabetes.)

Second:  obesity rates?  Were leveling off in 2010.  And 2007.  Lots of stories about it in the last 4 years.   Um….

 

 

Five Things Makes a Post

1. New job! I have a new job.  The place I was temping hired me in late December.  I’m not doing exactly the same job, which is both “new and scary” and “cool and interesting”.   It’s also been interesting to note that the things I was looking forward to ending with the contract (the commute, say) are now things I’m stuck with, and the things I was thinking I’d miss (the walkability of the neighborhood) are now things I get to enjoy longer.
2. According to the New York Times, my household is in the top 48% for the Seattle-Everett area this year (based on my unemployment for the first 3 months + contract for 8.5 months + signing bonus + hubby’s temp gig.)
3. Asthma has been kicking my butt lately.  My nurse practitioner upped my dose of Advair and OMG I had so! much! energy!  this! week!   I have been enjoying it but also crashing harder at the end of the day.
4. A coworker was floored that I am able to pick up my father’s wheelchair and load it into my car.  I pointed out that once I remove the back and seat, it collapses into a big flatish bundle.  ”But isn’t it heavy?”  About 40lbs, really … which doesn’t seem all that much to me.  So I guess the weightlifting is doing me good.
5. I have been reading more about caregiver stress and considering support groups.  I feel a bit strange about doing it, since I’m not doing the daily hands-on care.  But I am taking him to doctor visits, making medical decisions, getting his mail, managing his money, and being a supportive daughter.

Bonus: The new blog banner is a chocolate doughnut with chocolate frosting and Sounders green and blue sprinkles.  These are sold by http://www.toppotdoughnuts.com/ at Seattle Sounders games.

Asthma Not-Fun

I would like to realize I’m wheezing before someone stops me at work and asks, with a look of deep concern, “Are you alright?”

Really.

It’s bad enough to have someone ask me, with a look of deep concern, “Are you alright?” while I’m setting up mics and speakers for a concert.  Or walking around a con.  Or walking at a park.

It’s worse at work.

Maybe I’ve just spent too many years assuming I’m fat and out of shape and thus symptoms short of “chest pain” feel normal to me.  Maybe I need to get a peak flow meter or start a symptoms diary.

But as much as I am really tired of those looks of deep concern, I am also really tired of  walking around and suddenly not being able to breathe.

Vitamin B12 in the news

I’ve written about my vitamin B12 absorption problem before.  The NY Times recently posted a good primer on B12 deficiencies, including those at risk:

Natural plant sources are meager at best in B12, and the vitamin is poorly absorbed from them. [...C]hronic users of acid-suppressing drugs like Prilosec, Prevacid and Nexium, as well as ulcer medications like Pepcid and Tagamet, are at risk of developing a B12 deficiency and often require a daily B12 supplement.

Stomach acid levels decline with age. As many as 30 percent of older people may lack sufficient stomach acid to absorb adequate amounts of B12 from natural sources. [...]

Synthetic B12, found in supplements and fortified foods, does not depend on stomach acid to be absorbed. But whether natural or synthetic, only some of the B12 consumed gets into the body. Treatment to correct a B12 deficiency typically involves much larger doses than the body actually requires.

Free B12 from both natural and synthetic sources must be combined with a substance in the stomach called intrinsic factor to be absorbed through the gut. This factor is lacking in people with an autoimmune disorder called pernicious anemia; the resulting vitamin deficiency is commonly treated with injections of B12.

Although most doctors are quick to recommend injections to correct a B12 deficiency, considerable evidence indicates that, in large enough doses, sublingual (under-the-tongue) tablets or skin patches of B12 may work as well as injections for people with absorption problems, even for those with pernicious anemia.

The latter is something I make use of — I appear not to absorb much B12 from food, but the little I absorb of  ”a lot” is enough.  I also like that supplements are over-the-counter and I can take them daily.  Shots would be prescription and often weekly or monthly.  :)

“Peaceful” and “relaxing”?

From today’s Between Friends comic by Sandra Bell-Lundy comes this exchange….

Maeve:	How’s your walking regimen?
Susan:	Actually, I’m enjoying it.
Susan:	Every evening I walk around the neighborhood … it’s such a peaceful, relaxing way to end the day.
Maeve, shocked:	“Peaceful” and “relaxing”?
Maeve, accusing:	I thought you were trying to improve your health!!

Yes, starting a new exercise program can be hard.

Yes, some people are training for a competition or rebuilding after an injury or illness or surgery. That can be hard.

But it is possible to dance or play basketball or do yoga or walk around the neighborhood and finish relaxed and happy. And it’s still exercise. Even if you your BMI doesn’t automagically register as “normal”.

Maybe if we didn’t all expect that “exercise” is a universal experience with universal results this wouldn’t be so confusing.

Proper Treatment

Knowing intellectually that people can die of asthma is a bit scary.  Reading that a friend of a friend died of an asthma attack is another.

Death from asthma is a relatively uncommon event, and most asthma deaths are preventable. It is very rare for a person who is receiving proper treatment to die of asthma.

However, even when it is not life threatening, asthma can be debilitating and frightening. Asthma that is not properly controlled can interfere with school and work, as well as daily activities.
— From “Asthma in Adults” at the University of Maryland Medical Center

Of course, proper treatment is often dependent on affordable medical care.   I carry with me an albuterol inhaler and antihistamines to deal with allergic asthma.  Not everyone can afford them.

Also: some don’t believe they have asthma.  For decades I didn’t believe I had asthma, despite having allergies, because I was fat — I was supposed to breathe hard, right?  Shortness of breath means “obese”, right?  Wrong.   (Misdiagnosis occurs, too.) But getting properly diagnosed means medical practitioners need to look at the symptoms and not the body weight — and having affordable practitioners and treatments available in the first place.

I live in a country with treatments available, and they’re affordable for me because I have a computer science degree.  Other people aren’t so lucky.

“Light bladder leakage” and Hourglass Pads

Apparently Poise is thinking “light bladder leakage” sounds nicer than “incontinence”, and that framing its products as “feminine” will do better than as “geriatric”.   They are probably correct.

I do know I ran into one problem discussed in the industry. The New York Times quotes market researcher Rob Walker:

“[T]he biggest challenge for the industry is that vast numbers of sufferers are too embarrassed to raise the problem of incontinence with their health practitioner, or worse, even buy available products at a retail outlet.”

Or, in my case, to realize they existed. I initially assumed that if you leaked at all, you needed full-on diapers, which of course would not be available in my size.  It did not occur to me to even look for pads designed for stress incontinence.   I ran across Poise pads by accident one day when the local Rite Aid was reorganizing stock.

To address that, Mr. Walker added, “the commercial opportunity here is for the big international hygiene players to humanize (or even Viagra-ize) incontinence, making products as accessible, consumer-friendly and embarrassment-free as, for example, women’s sanitary protection.”

I first wrote about stress incontinence a few years ago in quite a bit of detail.   I haven’t been finding the “wings”, so I’ve been wearing “moderate” pads.  I will probably try the new “hourglass” shape.  FYI, Poise also has samples and coupons available at their site.

What’s Important?

My mother was fat, though she lost weight shortly before she died.  My father, by contrast, was always thin and muscular.  Yes, he drank like the Navy seaman he’d been and smoked 1-2 packs a day, but he was strong and healthy.  He gained some weight when he retired and quit smoking, but not much.  Heck, he’s  lost some in the last few years. Why?

He wasn’t exercising as much.  Turns out he’s anemic.  Why?  Bleeding from a cancerous tumor.  Oh, and he has some short-term memory problems, which means he shouldn’t live alone.

I’ve been spending a fair amount of time in hospitals and nursing homes and doctor’s offices lately.  I keep expecting to hear “Oh, and you should lose weight because ___________” …. but I’m not.

Maybe it’s because I’m not the one who’s sick.

Maybe it’s because the main risk factor for his cancer is smoking, not weight.

Maybe it’s because I don’t have a history of drinking, and he does.

I can say it’s been interesting dealing with the medical profession in a situation where it’s not about my weight.

I can also say this sort of experience can help focus on what’s important to me.  I’ve alluded in the past to not having the world’s best relationship with my parents, but I’m also not willing to just walk away.  Making the time to deal with this has been challenging.  It’s also made me focus on organizing my life to help me stay sane enough to do what needs doing — priorities like

• The man of the house.
• Close friends.
• Work.
• Eating regularly.
• Sleep.
• Exercise.

These are things that help me stay sane and to have the energy to deal with the other stuff.  (Yes, there’s a reason I’ve been posting about managing stress lately.)  Even so, it’s still been getting me down.  About 2 months ago I saw my ARNP with “Hi, here’s what’s going on.”  We determined that yes, I’m having insomnia, anxiety, and depression symptoms.  She started me on ambien (to help me sleep) and celexa (for depression and anxiety).   The ambien helped almost immediately; the celexa, as is usual for SSRIs, took longer to kick in.   I am feeling more able to cope now, which is good.

Has this changed my priorities or my sense of what’s important?  Yes.  And no.  As is common when I’m stressed, I’m more focused on self-care; this has all narrowed my focus, often to just  ”what tasks I need to get done today” and “what I need (to take of myself) so I CAN get through today.”   But the things that I most want to do, and that I find most rewarding, haven’t changed.

Head, Meet Desk

A friend tells me that he’s been diagnosed with hypothyroidism (TSH 7.5) and he’s starting on Synthroid (Levothyroxine).  Google takes me to the NIH page on Levothyroxine.  Right at the top is the following offset warning:

Thyroid hormone should not be used to treat obesity in patients with normal thyroid function. Levothyroxine is ineffective for weight reduction in normal thyroid patients and may cause serious or life-threatening toxicity, especially when taken with amphetamines. Talk to your doctor about the potential risks associated with this medication.

I know there are people who do risky things to lose weight.  (Less than 600 calories a day, anyone?  I’ve done it.)  But … hello?

Medical Insurance Helps People Feel Better!?

On the one hand, it’s good to have actual research backing this up.  On the other hand, it’s insane that this didn’t exist before.  From the NY Times:

When poor people are given medical insurance, they not only find regular doctors and see doctors more often but they also feel better, are less depressed and are better able to maintain financial stability, according to a new, large-scale study that provides the first rigorously controlled assessment of the impact of Medicaid.

In other news, water is wet?  Not quite.

The study became possible because of an unusual situation in Oregon. In 2008, the state wanted to expand its Medicaid program to include more uninsured people but could afford to add only 10,000 to its rolls. Yet nearly 90,000 applied. Oregon decided to select the 10,000 by lottery.

Economists were electrified. Here was their chance to compare those who got insurance with those who were randomly assigned to go without it. No one had ever done anything like that before, in part because it would be considered unethical to devise a study that would explicitly deny some people coverage while giving it to others.

But this situation was perfect for assessing the impact of Medicaid, said Katherine Baicker, professor of health economics at the Harvard School of Public Health. Dr. Baicker and Amy Finkelstein, professor of economics at M.I.T., are the principal investigators for the study.

In good news, Oregon did end up finding the money to insure the other 80,000 people within 2 years.

Research on the Health Benefits of Moderate Exercise

From an article on “what’s the best exercise” comes a concise summary of the benefits of moderate exercise:

The health benefits of activity follow a breathtakingly steep curve. “The majority of the mortality-related benefits” from exercising are due to the first 30 minutes of exercise, said Timothy Church, M.D., who holds the John S. McIlhenny endowed chair in health wisdom at the Pennington Biomedical Research Center in Baton Rouge, La. A recent meta-analysis of studies about exercise and mortality showed that, in general, a sedentary person’s risk of dying prematurely from any cause plummeted by nearly 20 percent if he or she began brisk walking (or the equivalent) for 30 minutes five times a week. If he or she tripled that amount, for instance, to 90 minutes of exercise four or five times a week, his or her risk of premature death dropped by only another 4 percent.

Yeah.  If you don’t exercise at all, working up to 30 minutes of something (like walking) 5 times a week may very well reduce your risk of death.  Increasing beyond that?  Not so much.

This isn’t always what you read in the fitness / personal improvement press. Frequently exercise is presented as something that can’t be overdone, or as an obligation to improve one’s health, or to cause weight loss.  I disagree.  Yes, moderate exercise is generally good for health.  No, that does not mean it’s a requirement, or that doing more is necessarily better.  Period.

In my case,  I have found that if I do stomach crunches regularly, my back doesn’t hurt.  I do stomach crunches.  I’ve also found that squats and leg lifts prevent knee pain for me, so I do them.  Those things matter to me.  I know people who do other special exercises and stretches to avoid injury; others love a particular activity, be it swimming or tennis or triathlons or hiking or tai chi or yoga.  (I do yoga for fun m’self.)

People tend to assume that someone who does ultramarathons is healthier than someone who walks to work.   That isn’t necessarily so.  Stronger maybe, or faster on their feet, or more practiced.  But healthier?   You can’t know.  And that’s okay.

QOTD: Fitness and fatness

From Reuters, on a study in patients with coronary artery disease that looked at fitness levels and BMI:

[Heart specialist and study leader Dr. Francisco] Lopes-Jimenez said, the lesson for patients is clear: try to improve your physical fitness. “It is much easier to become fit than it is to become slim,” he said. “Anybody who has gone into an exercise program would agree with that.”

While Lopes-Jimenez seems to presume his patients want to exercise (or otherwise take action to improve their health) it is radical to see a heart specialist stating that a person can improve their fitness without being slim.  Or that exercise doesn’t automagically cause slimness.  Or that it can be easier to become fitter than to become thinner — which has certainly been true in my case.