Lyme Disease on the Upswing

Morgan Messenger Article
We've been seeing an alarming number of Lyme Disease cases this summer. Ticks are evil little creatures and should be taken seriously! If you have been outside for even a moment, and are experiencing any of the symptoms -- even if you don't have a rash -- it's time for a trip to your healthcare provider.

Image from http://www.schohariecounty-ny.gov/CountyWebSite/Health/lymedisease.html

Good deeds done dirt cheap

I apologize for the quality of the reproduction of this newspaper article: The Hancock News does not publish an online version, and Blogger doesn't allow me to insert PDFs. But it demonstrates how just a little bit of thoughtful behavior can translate into a bigger meaning. Thank you Dr. Nelson!

Nice MSNBC health plan and a little local color

This Be Well Be Healthy plan is simple and fun to use! Its simplicity reminds me that the Health Olympics will begin again in September. Why not get started now so you'll be in great shape for the Walk Across Maryland, which kicks off the Health Olympics.

I just want to share a little story that illustrates just one more reason why I love living in this area so much. It's the contrast of the high-tech and the low-tech that impressed me (much like our motto "a new way to practice old-fashioned care" - implementing computers and other high-tech strategies so we can deliver high quality care to our patients the old fashioned way: spending lots of time with them and listening). I had two UPS packages in my car that needed to be dropped off. But I didn't know where any drop-off boxes were located. So I used a high-tech strategy, my amazing smartphone, to locate a drop-off box and was pleased to find that Roy's Service Center has a box. I drove to Roy's, and saw Virgil pumping gas out front where he usually is. I opened my window and asked him where the box was. Before I could park my car, he had opened my trunk, retrieved the two boxes, and dropped them in the box (the low-tech, "quality" care). That's not going to happen at the Sheetz across the street from Roy's, and it's not going to happen at the UPS store. I think I'm hereby going to designate Roy's Service Center the "official service station of Hahn and Nelson Family Medicine" because they exemplify the same kind of service that we strive for.

Vitamin D Deficiency in Adults

By Marilyn Nelson, MD

Most of us are aware of the association of Vitamin D with bone health.  Supplements of Calcium and Vitamin D help maintain normal bone density.  Unfortunately, this is often not addressed until there is already significant loss of bone density, and increased risk of fractures.  Vitamin D deficiency is also associated with muscle weakness, muscle aches and increased risk of falls.  It may cause low back pain, or bone pain.  These symptoms are often vague, nonspecific, and may be misdiagnosed as fibromyalgia, CFS (chronic fatigue syndrome), arthritis, or side effects from other medications such as statins (cholesterol lowering medications).  Vitamin D deficiency may also play a role in increased risk of Heart Disease, Colon Cancer and Depression, but more research is needed.

Vitamin D deficiency is becoming more common. There are estimates that 50% of adults age 65 and older in North America, and 66% of persons internationally have failed to maintain healthy bone density and tooth attachment due to inadequate Vitamin D levels.

Risk factors for Vitamin D deficiency

1. Increasing age

2. Decreased sun exposure -

            Increased use of sunscreen (does decrease risk of skin cancer)

            Shift work - 2nd and 3rd shift workers tend to sleep during the day

            Religious or other beliefs that require covering all skin when outside

            Living more than 40 degrees latitude from the equator

                        north of NYC, or south of Wellington New Zealand

3. Being overweight - more Vit D is bound by body fat, and less available for use

            as needed by the body

4. Dark skin - produces less Vit D than light skin

5. Fat malabsorption syndromes - cystic fibrosis, many forms of liver disease,

            Gastric bypass surgery, inflammatory bowel disease

6. Some Medications - many anticonvulsants (seizure medications),

glucocorticoids, or rifampin (medication to treat Tuberculosis)

General recommendations are for 200 IU Vit D3 for adults under 51yo, 400 IU for those 51 to 70yo, and 600 IU for adults over 70.  However, the best indicator of vitamin D status is a blood test, 25-hydroxyvitamin D.  This should be checked in anyone with unexplained symptoms, or increased risk factors, such as those listed above.  Recommendations can then be based on your Vitamin D level.  It is possible to get too much Vit D, and this may cause nausea, vomiting, headache, kidney stones, pancreatitis, or vascular calcifications.  People with uncorrected hyperparathyroidism, metastatic bone disease, sarcoidosis, or Williams Syndrome should not take Vitamin D supplements.

More information about Vitamin D from WebMD, a trusted source of health and medical information:

Dangers of Low Vitamin D Levels

Low Vitamin D Levels in Americans

Kids and Vitamin D

Stay tuned to Hahn and Nelson Family Medicine for more health and fitness news!

Making that hour count

So the latest news is that women need to work out at least an hour a day EVERY DAY to keep from gaining weight in their middle-age years, according to a study recently published in the Journal of the American Medical Association. And that's for women who are already at an optimal weight, just to keep from gaining the average 5.7 lbs over 13 years. Women who need to lose weight should exercise even more.

So when do we find the time to do this? I was feeling a bit ... jiggly ... two weeks ago and reflected on what had devolved into a very unstructured, haphazard exercise routine. Usually, I would go to work in the morning, planning on leaving at an early enough time to work out in the afternoon. (I'm fortunate that I can work a flexible schedule.) But what was really happening -- I'd end up sitting at my desk trying to solve that one last problem, make that one last phone call, and the next thing I knew, it was evening, time to pick up my daughter, make dinner, and by then, too tired to work out. I'd try to do an exercise video, or go to a class, but if the least little thing came up, I opted out. So I decided to re-schedule myself. Now, I exercise in the morning, and then go to work. If there's an exercise class after work that I'd like to go to, and I make it, it's a bonus workout. I realize not everyone has the flexible schedule that I do. But even when my life was at its most complicated - living in the city with a baby and a teenager, working a full-time job -- I was able to get my workouts in. I really believe morning is the best time to workout. But whether morning or evening is your time, and that time is not happening, it's time to look at your schedule and make *it* work for *you*.

I also realized that my exercise routine was not really a routine. It was a jumble of exercise DVDs, some classes, and some free-weight lifting, all done at home. I thought about going back to the gym, but I really do enjoy working out at home, so I decided to do the P90X thing again. P90X may not be your cup of tea, but whatever plan you follow, be sure it includes cardio, strength, and flexibility training.  Check out fitness magazines such as Shape, most of which also have a web component. I remember when I first wanted to start lifting weights, I didn't know how to get started. I found an awesome workout routine in a Shape magazine, and stuck to it for about 3 months until I knew what I was doing. The web versions of the magazines usually even have video clips to show you how an exercise should be done.

So I think two important elements in getting your exercise to work, is to fit it realistically within your schedule, and have a plan. Good luck!

#1500!

Pictured above: Lindy Morris, Arlene, and Dr. Marilyn Nelson/Arlene and Dr. Matthew Hahn
Arlene Lemmert registered as our 1,500th patient this afternoon! We thought that was worth celebrating. Although she may be our 1,500th, our patients should know that they are all  important and precious to us. We'd like to thank everyone for helping to make this opening year an exciting and fulfilling venture. We look forward to celebrating our first anniversary on July 6, and then many more to come! THANK YOU THANK YOU THANK YOU!!!!!!!!!

Getting Active - Politically

I hesitate to post this next entry because I know not everyone will be happy to read it. You can either ignore it, or let me know how you feel. But to me, there is no middle ground to be found. As long as people are falling into the fissure that this middle ground has become, there is none.

We see mostly insured people in our practice. They either have Medicare, some form of medical assistance, or commercial insurance. Part of my job is to check each patient's eligibility before their upcoming appointment. Most of the time, everything is fine. I don't even have to bother checking Medicare eligibility, since everyone over 65 is eligible. Once I find a patient, usually using an insurance company's online website, I check them off my list and go on to the next patient. But sometimes there's more to the story.

What if a patient "has" insurance, but has a huge deductible? What if a patient "has" insurance, but no mental health coverage? What if the patient is responsible for supporting a family? And what happens when that patient becomes depressed, through no fault of his/her own? They fall into a crack...

A patient "has" insurance but just barely. What happens when this patient who is trying desperately to get over a drug dependency loses employment? The patient has successfully kicked the habit; the job was lost through company downsizing. The health insurance can be continued through COBRA, but the premiums are becoming too much for the meager unemployment to pay for. The patient doesn't know how much longer they can continue paying. Maybe another job will come through, but it's a toss-up whether the new company's insurance will cover the patient, given the "pre-existing condition."

Those patients "have" insurance. What  happens when a man is found on the street and brought into our practice, found to have a horribly debilitating chronic condition, but has no health insurance at all? What happens when he is taken care of initially, sets out to get the medical assistance that he surely qualifies for, applies for it, but then finds out that it's going to take 4 months to get the card? (Hint: he died. Another hint: Poor people have pride too. They don't want to come if they can't take care of their bill).

These are three typical scenarios that play over and over again in some form at our little family practice office every week. Today our government will try to come to some resolution over the healthcare reform bill. I don't have a lot of confidence that the bill they come up with is going to help our patients. It will require that more people buy insurance. If "having" insurance can yield the results we see, it doesn't seem like such a bargain. 


Think of yourself. You may be covered by a great plan by your employer. Next time you get your paystub, look at how much your employer is paying for your coverage, and add in what you contribute. Try to imagine paying that whole thing yourself, especially if you were to lose your job (God forbid).  What is your biggest health problem? What if you found out your insurance company wouldn't pay for it?


Until we are willing to stand in each other's shoes, and agree that we are here to take care of each other, nothing meaningful is going to happen with healthcare reform. I like to compare the right to healthcare to education. As a nation, we have agreed, more or less, that every single child in our country should be educated through the 12th grade. We test our kids to make sure they're learning at least the minimum required. This is good for the whole country, and we are mostly happy to pay the taxes that make it possible. Imagine if families had to pay tuition? I think we'd be a pretty sorry country. And I think, as far as healthcare is concerned, we are currently a pretty sorry country. Having healthy citizens is good for the whole country, and I personally would be happy to pay the taxes to make sure we were all healthy. Of course, this would be in lieu of the $600 a month I'm currently paying for my family's  health insurance, so I would probably not even notice it. 


Something has got to give.