eh_notsomuch

WASHINGTON -- When Rep. Debbie Wasserman Schultz steps to the lectern at the Capitol on Monday to push for greater awareness of breast cancer risks in younger women, she'll be speaking from experience.

The Broward County Democrat and mother of three told The Miami Herald on Saturday that she successfully battled breast cancer for the past year and is going public with her story in the hope of alerting young women to its prevalence. She'll introduce legislation Monday that calls for a national education campaign targeting women between 15 and 39.

'I wanted to be able to not just stand up and say, `I'm a breast cancer survivor.' . . . I wanted to find a gap and try to fill it,'' said Wasserman Schultz, 42.

In the past year, she underwent seven major surgeries, including a double mastectomy and reconstructive surgery, while balancing motherhood, Congress and her roles as a chief fundraiser for House Democrats and a political surrogate, first for Hillary Clinton and then for Barack Obama.

''I had a lot going on last year,'' she said with a laugh, sitting in the living room of the Capitol Hill town house she shares with two other members of Congress when she's in Washington. ``I'm a very focused, methodical person, and I wasn't going to let this beat me. I wasn't going to let it interfere with my life.''

To monitor the multiple sclerosis attacking Ann Pietrangelo's central nervous system, her doctor recommends an annual MRI. Last year, the 49-year-old Winchester, Va., woman had to pay a $3,000 co-payment to get the imaging done.

This year, she's skipping the test. Even with insurance, it's more than her budget can tolerate, especially with the roller coaster on Wall Street devouring her retirement savings.

"I'm doing everything I can to avoid going to the doctor," she said.

From Park Avenue dental offices to the Arlington Free Clinic, the global economic crunch is forcing a growing number of Americans to scale back on medical care. Consumers are attempting their own form of triage, pushing off seemingly less-urgent services in the hope that their financial health will improve. But the danger, say physicians, is that the short-term savings may translate into more severe long-term health implications.

At the extreme are cases such as the Texas woman who went to the hospital complaining of back pain. Physician Doug Curran immediately spotted cancer on the X-ray.

"She'd had a lump in her breast for a while, but things were tight and she said she couldn't get it looked at," he recalled. "We're going to see more of that..."

We are in the middle of a shift and one of our mates asks us if we could do a job for them as a favour - they are off shift in a hour and the job is for an emergency transfer from someone's home to a hospital waaaay outside of our patch. We do it because it's awful to get off shift late, and to be honest, for us a change is as good as a rest.

The job is a simple one - pick up patient from their home and take them to hospital as quickly as possible - no thinking required and I don't even need to do any vital sign measurements on this job.

The patient is a one year old child in liver failure and her parents have just been told that a donor organ may have become available.

When we arrive at the home the whole place is in uproar, it's late in the evening and every member of the family is scrabbling around gathering things into no small number of bags. Clothes, food and the sort of supplies you need for a very sick little one year old.

I do my best to try and bring a little calm to the chaos but the family aren't having any of it, they are in near panic and their emotions are somewhere between fear and joy. I know when to admit defeat and I leave them be.

The transport itself is fairly smooth although the child alternates between crying and griping for the whole trip, I can't really say I blame her as I would imagine that she isn't too happy to be going back into hospital again. Her parents do pretty much everything that they can to keep her happy but unfortunately for my sanity nothing seems to work.

They seem like nice folks, they have another older child and from what little I saw of them they were well behaved and happy, always a good sign when there is a seriously ill sibling in the family.

We reach the hospital and the nurse beds them down, there is going to be a lot more testing before any operation but I've done my bit.

I like going to strange hospitals, the nurses on the ward always offer us cups of tea and I am way too polite to refuse...

So it's a nice job and we manage to get back into our area for the end of our shift, but I do wonder about the donor.

The donor must have been young, and their last journey was probably in an ambulance staffed by colleagues of ours. Their parents would have been distraught and panicky, and then they would have had to made the decision to allow the doctors and nurses to stop trying to save their child.

And then they made a decision to allow their child's body to be used to help others, a wonderful and brave decision. And because of that decision a one year old child they will never know is going to get a chance of life.

I've been an organ donor for years, why don't you think about it?

Dear friend,

I just wrote to Congress about the Pill.

Millions of college-age and low-income women no longer have access to affordable birth control. To me, solving that problem is a priority.

Just two years ago, providers on college campuses and at safety-net clinics could offer discounted birth control. But in 2006, Congress made an honest error in new Medicaid legislation that accidentally banned the discounts. Congress can restore access to affordable birth control, and is willing to do it. It just hasn't made it a priority yet.

I wrote to my representatives to remind them that restoring access to affordable birth control should be a priority, because it's a critical component of women's health care. Will you sign a letter to your representative, too? Click here:
http://www.ppaction.org/campaign/bcprice_ppan/?source=abc428_ppan_taf

This isn't one of those controversial issues that people are fighting over -- popular opinion supports Congress restoring access to affordable birth control. The public is together on this issue, and we all need to let Congress know how we feel.

Please join me by signing a letter now:
http://www.ppaction.org/campaign/bcprice_ppan/?source=abc428_ppan_taf

Millions of college-age and low-income women deserve access to affordable birth control right now. You and I -- we can help just by filling out a form online. It couldn't be easier.

When it comes to medical fees, $12 may not seem much, but it is enough to deter many women from getting a mammogram, a new study finds.

Writing in the Jan. 24 New England Journal of Medicine, researchers say that when insurance plans require patients to make co-payments of $12 to $35 for mammograms, many decide to take a pass. This finding was true even when factors like income and education were taken into account.

( Rest of article under cut )

I guess it's because they focused on older women, and maybe the co-pay is harder for them to afford. But what is wrong with this country where a woman has to choose between her bills and her health?

Listen: if you're a woman reading this, and you need to go for a mammogram, and you can't afford the co-pay? Write to me. I will send you the money. I promise.

lubedpumpkin

Aug. 29, 2007 - ZIP codes are more than just a way to deliver mail,they can say a lot about their residents—and not just the ones living in California’s famed 90210. In a study published in the September issue of the journal Social Science & Medicine, University of Washington researchers found that adults living in ZIP codes with the highest property values were the slimmest, and those living in ZIP codes with the lowest property values were the fattest. The findings show that there is significant geographic variation in the obesity problem, and that this variation is very much tied to socioeconomic status and diet. Is this yet another reason for Americans to feel bad about not living on McMansion row? Would people lose weight if they moved to a tonier town? NEWSWEEK’s Karen Springen talked to the study’s lead author, Adam Drewnowski, director of the Center for Public Health Nutrition and professor of epidemiology and medicine at the University of Washington in Seattle. Excerpts:

NEWSWEEK: You looked at 8,803people in 74 ZIP codes in the Seattle area and found that those living in areas with the highest property values were the thinnest. The inverse was true for those living in the lowest-property-value ZIP codes. Why? Is it because they have less disposable income to spend on healthy food, and they feel less safe going outside and exercising?
Adam Drewnowski:It's a combination of everything. We're using where people live as anindex of what's called socioeconomic position, which is usually predicted by education and income and occupation. We think that knowing where people live—not the exact address, but the neighborhood—tells youa lot about poverty and wealth. For most Americans, their biggest single asset is their house. If you live in a nice neighborhood with nice property values, that tells us something about who you are. For example, property values determine taxes, which in turn determine support of schools. The nature of the neighborhood determines access to healthy foods.

Do ZIP codes affect grocery stores?
Take a look at Whole Foods [the organic supermarket] in Seattle, I think now they're in three locations. One is by the University of Washington, which means education. The second is on the east side, close to Microsoft, which means income and education. The third is downtown. Nice stores set themselves up in areas with buying power. In underserved or disadvantaged poor neighborhoods, you will not get very much other than, in some cases, fast food. People will be buying their groceries at the gas station.

13-Year-Old Follows up Lipo and Tummy Tuck with Lap-Band

Big Fat Blog has a post today about Brooke Bates, a 13-year-old girl who underwent liposuction and a tummy tuck at 12, gained back most of the weight, and has now been fitted with a Mexican Lap-Band. Her parents had trouble finding a doctor to do it in the States, stunningly enough — for starters, Brooke’s BMI was well under the usual cut-off of 35, and it’s just so much more expensive to go through all the screening required to make sure the surgery will be, you know, safe.

“It’s so much paperwork that you have to go through — so much red tape is what I call it. They want you to get psychological testing, they want you to get sleep apnea testing and all those things I’m sure are very important, but it’s money,” said [mother Cindy] Bates.

Yes, god forbid you spend the money on psychological testing for a child whom you said in the previous breath is a “compulsive overeater.” Those greedy American bastards might have actually wanted to treat your child’s eating disorder before performing another surgery on her. The nerve!

For employees at Clarian Health, feeling the burn of trying to lose weight will take on new meaning.

In late June, the Indianapolis-based hospital system announced that starting in 2009, it will fine employees $10 per paycheck if their body mass index [BMI, a ratio of height to weight that measures body fat] is over 30. If their cholesterol, blood pressure, and glucose levels are too high, they'll be charged $5 for each standard they don't meet. Ditto if they smoke: Starting next year, they'll be charged another $5 in each check.

Clarian has been making headlines for its aggressive and unusual approach to covering escalating health-care costs. Rather than taking the more common step of giving employees incentives for merely participating in its wellness programs, such as joining a smoking cessation group or using a health coach, Clarian is actually measuring outcomes. And unlike most employers, it is penalizing workers for poor health instead of rewarding them for taking healthy steps....

At Clarian, employees who have blood pressure that's above 140 over 90, blood glucose levels over 120, low-density lipoprotein cholesterol over 130, or a BMI over 29.9 could be subject to the paycheck deductions. Of the company's 13,000 employees, about 8,000 are enrolled in the company's health plan. The company estimates that as many as 34% of its employees will meet the definition of being obese, while it expects lower levels for other health measures. About 26% are tobacco users. The fines are waived for employees who can provide a doctor's note stating it's not advisable for them to try to meet the benchmark -- employees will be able to submit new notes from their doctors quarterly -- and that they are complying with the proper diet, exercise, and treatment plan.

Omega-3s are polyunsaturated fats found in fish, nuts and green vegetables. They can fend off prostate cancer,protect your eyes from macular degeneration, cut risk of heart disease and fight diabetes. A recent study published in the American Journal of Clinical Nutrition found that those who routinely consumed at least 300 grams (about 11 ounces) of fish per week had 29 percent less risk of irregular heartbeat than those who consumed less.

Our bodies produce a small amount of omega-3s, but most of what we need has to come from our diet or supplements. The richest food sources of omega-3s are oily fish such as salmon, tuna, trout, herring and sardines. Fish and shellfish contain eicosapentaenoic acid (EPA) anddocosahexaenoic acid (DHA), the two most potent forms of omega-3 fats...

The problem is, either because Americans don't like the taste or are worried about mercury contaminants,we don't eat nearly enough fish. On average Americans consume only about 3 ounces of fish per week. The American Heart Association recommends two servings, or 8 ounces, of fatty fish per week.

If you're not a fish fan, you can get a good supply of another omega-3 fatty acid, alpha-linolenic acid (ALA) from plant foods such as flaxseed, walnuts and canola oil. Unlike EPA and DHA, ALA cannot be made in the body, so it needs to be obtained from food. Not enough dietary ALA can cause scaly skin, poor healing of cuts and bruises and delayed growth.

When consumed, ALA must be converted to EPA and DHA to exert its effects. But only a small amount of ALA ends up getting turned into EPA and DHA in the body (estimates range from 0.2 percent to 18 percent). Since the foods and beverages enhanced with omega-3s — eggs, vegetable oil spreads, cereal, yogurt, cheese and milk — are typically fortified with ALA, you don't get the biggest bang from them.

That's why fatty fish — not pumped-up products — are the best dietary sources of omega-3s.

From today's "Ask Amy" column, which I read in the Philly Inquirer, but is carried in plenty of other papers:

Dear Amy: I am the nanny of two 10-year-old girls this summer, and I am concerned with comments they have made about their looks.

Both are normal-size, healthy girls with regular bodies, but I have heard them say how fat they think they are at least five or six times. One time one girl complained about her "big belly," and the other said, "I need to work out soooo bad. I'm so fat."

Amy, these girls are 10!

After they say these things, I always tell them that they aren't fat, that they are a healthy size and beautiful girls.

I am wondering if this is the proper way to handle this, or what I could possibly do to make these girls believe that they are healthy and not fat.

I do not want them to suffer the same self-esteem issues so many women (including myself) face.

- Wondering in Illinois

Dear Wondering: You are right to be concerned, and you are responding just as you should. You can help further by exposing them to positive girl role models, rather than the stick-insect pop tarts and cultural "icons" in vogue.

If your summer charges haven't yet started the Harry Potter books, now would be a good time to read J.K. Rowling's Harry Potter and the Sorcerer's Stone (1998, Scholastic) with them. The Hermione character is one that any 10-year-old girl should emulate. On TV lately, I'm enjoying Ned's Declassified School Survival Guide on Nickelodeon. The character Moze is a girl who is tough, savvy and funny.

Girls should be encouraged to be smart and creative problem-solvers, not miniature workout queens.

Obviously, let a parent know what you're observing. Unfortunately, the girls might be re-creating talk they hear at home. You would be doing these young girls a service to let them know that the content of their character is always going to be the most important thing to you. They're watching and learning from you.

If you care enough about your health to be reading up on the latest research, you are unusual...

But what do we do when a truly perplexing and dispiriting study comes out? For example, let's say new research says: "That Supplement You've Been Taking Might Give You Cancer Instead of Preventing It." Or,"The Meditation You've Been Forcing Yourself to Do for Twenty Years isUseless." Or, "Diet Soda Will Give You Heart Problems."

How do you keep such news from Messing With Your Head?

...I am, in fact, recently single again for the first time in many years. Also: no mortgage. No debt. No daily array of behavioral meds (yet). No significant or particularly dangerous skeletons -- none that can speak or call the CIA or reveal the location of the photographs buried on my hard drive, anyway.

This, as you might imagine, is a weirdly fascinating position to be in, and not only because many of my long-coupled friends think I must've won some sort of amazing social lottery, with the prize being a debauched free-for-all of sybaritic adventure. Nor is it because I'm now apparently supposed to learn the skill that is pornographic text messaging or that I must now stock up on loathed condoms and certainly not because I have to practice sifting out all the women who insist on listing Dave Matthews and/or their five cats as their BFFs on Craigslist or Nerve personals.

No, when you're single and you've finally made it past the age when you've felt both love's deepest tongue probings and also its most random horror-flick slashings, past the age when getting moronically drunk every weekend and hooking up is the ultimate goal, and you've had enough sex to fill a thousand porn movies, and everyone around you is no longer on some sort of giddy, wide-eyed first-adult-relationship must-get-married must-have-babies track of impossibly optimistic utopian desire, what it means, at least for me, is that you get to become this odd sort of sounding board -- a blank slate of love's warped potential, a reason for others to extrapolate on the nature of love and life and sex and how goddamn difficult/wonderful/impossible it all really is...

Forget Survivor and The Amazing Race and all the other reality shows that feature generally good-looking, generally physically fit people running around doing generally silly things. In our nation of overstuffed couch potatoes, The Biggest Loser hits closer to real reality by combining the TV genre's outlandishness and greed with the more mundane goal of shedding unwanted pounds. With its $250,000 grand prize and dramatic stories of weight loss, the show is a natural for the nation's chubby, if not huddled, masses yearning to breathe free without having to unbutton their pants after a meal. More than 100,000 people applied to be on the show's fourth season, now in production,and more than 5 million have had their diets assessed on the show's biggestloserclub.com

But while the message of the show is inspiring, it is also unrealistic. The Biggest Loser achieves rapid transformations--contestants often drop more than 20 lbs. in a week--through calorie restriction, endless exercise and no small amount of dehydration that occurs behind the scenes. Ryan Benson, 38, an actor who works for a DVD distributor in Los Angeles, lost 122 lbs. to win the first season in January 2005 but says he regained 32 lbs. within five days simply by drinking water. Matt Hoover, 31, a motivational speaker based in Seattle, had a 15-lb. rebound within a day of winning Season 2. Last season's runner-up, Kai Hibbard, 28, an aerobics instructor in Alaska who says she spent the night before her final weigh-in hopping in and out of a sauna for six hours, consumed only sugar-free Jell-O for several days and wolfed down asparagus, which is a natural diuretic. "It's amazing the things you learn in a weight-loss competition," she says.

The show tries to prevent unhealthy behavior by making contestants keep food journals (to make sure they're not starving themselves) and threatening penalties if tests show they are too dehydrated (although an executive producer says no violations have been uncovered yet). But like the $55 billion U.S.diet industry, The Biggest Loser places the bulk of its emphasis on shedding pounds rather than maintaining the loss. After all, a show called The Biggest Maintainer wouldn't have nearly the same zing. Contestants learn how to make healthy choices, but total-immersion exercise accounts for most of the weight loss. And it's not as hard to work out for four or more hours a day when urged on by professional trainers. It's also easier to resist high-calorie temptations when the cameras are rolling. Two and a half years after Benson's final weigh-in at 208 lbs., the new dad has slipped out of the spotlight and into old habits. "No one sees me get an apple pie in the drive-through," says Benson, whose weight now hovers at around 300 lbs.

Kelly Minner...the first-season runner-up dropped from 242 lbs.to 163 lbs. by the finale and now weighs 140 lbs. A school administrator in Bethlehem, Pa., Minner, 31, says she works out from one to four hours a day, six days a week. She exercises while watching TV--and did so throughout our phone interview. For motivation, she keeps a souvenir from the show in her office: a life-size photo of her old fat self.

Do trans-fat bans miss the bigger picture?

(My op-ed was recently picked up by McClatchy newspapers and ran in the Salt Lake Tribune on March 2, 2007.)

Junk-food lovers rejoice, for government officials are on the job protecting your health. Or are they? Philadelphia recently became the first city to pass legislation to ban artificial trans fat - that artery-clogging, industry-created substance used in frying oil and many baked goods. Following the lead of New York City’s Board of Health, which enacted regulations in December, more than a dozen states are now considering similar laws.

As an advocate for good nutrition, I’m pleased to see major cities take action on one of the most pressing public health problems of our time - the way we eat. Given that the food industry continues to lobby hard against common-sense nutrition policies at federal and state level, we need more local governments protecting the public’s health. Moreover, removing trans fat from the food supply could help reduce the risk of heart disease.

Yet the current effort threatens to overshadow the bigger dietary picture.

Focusing on this single ingredient misses the fact that most of the items prepared with trans fat are junk foods to begin with. Fried chicken, french fries, chips, cookies and cakes are unhealthy no matter what type of fat is used. What good is a trans-fat-free donut?

...If our own accounts of our actions are often so slanted and embellished, is composing them simply a misbegotten quest? Surely not. To a therapist, the attempt signals that patients are aware that they have a problem worthy of attention. And the narratives themselves can help them make sense out of confusion. This, in turn, can diminish anxiety and exaggerated guilt. Such relief might be sufficient in and of itself for some, or, depending on the goals of therapy, it could embolden a patient to make further healthy adjustments.

But the grail-like search for insight can also backfire when it becomes a way for patients to avoid the hard work of change... insight has no guaranteed relationship to change. A colleague of mine treated a 45-year-old woman, Joan, who came for therapy because she hated her chunky body. Joan firmly believed that once she discovered The Reason for her overeating she would stop.

After a few months, Joan told my colleague that her father had developed cancer the year she went off to college.

“You know, I never made the connection until now,” she announced triumphantly, “but I started overeating when he began to waste away. It’s like I was trying to nourish him through myself.”

A poignant metaphor, yes, but months later she hasn’t lost a pound.