Managing Your Own Healthcare: How Many People’s Jobs Do I Have to Know How to Do?

My personal Tricare experience: I have received several years of harmful care, after decades of inadequate care, from Tricare.

Recently, my soon-to-be-former PCM defended his negligent/health-threatening care by telling me that I had not been aggressive enough in managing my own care.  I countered that aggressively managing one’s own healthcare is very difficult when one has a chronic debilitating condition (especially a condition that affects one’s cognitive abilities).

But today I’m having a good day, abilities-wise, so let’s talk about fighting fire with fire.  You want me to aggressively manage my own healthcare?  Look out, buddy, you just summoned a pissed-off veteran, and you’re about to regret it very, very much.

A friend of mine has a saying about dealing with others, especially those who work in any area interacting with clients/customers.  When encountering roadblocks in daily life having to do with the ignorance, apathy, or incompetence of others, my friend asks exasperatedly, “How many people’s jobs do *I* have to know how to do???”  (Meaning, since you can’t do your job correctly and give me the information and assistance I need, I will have to learn all of the information, procedures, laws, regulations, etc. myself in order to get the result I need.)

We have decided that the answer to this question is “ALL of them.”

ALL of the People.  ALL of the Jobs.

To be fair, there are some *awesome* people in this word who like their jobs, know how to do their jobs well, and like helping others.  When these magical unicorns cross your path, you do whatever you can to make them stay in your life, and you let them know how appreciated they are.

For the Non-magical-unicorn days, which is most of them, you learn how to do ALL the jobs.

Alright, soon-to-be-former PCM, you want me to aggressively manage my healthcare?  You got it.

Today I visited a Tricare Patient Advocate.  I walked in to the largest MTF near me, went to the information desk, and asked for the Tricare Patient Advocate and they hunted around until they found one, who came out and spoke to me face-to-face.

[I had previously located a Tricare Patient Advocate email address for a local advocate.  I emailed in November, and am still waiting for a response over five months later.  (Not the same advocate as the one I spoke to today.)]

The Patient Advocate gave me the contact information for the DoD’s Interactive Customer Evaluation (ICE).  I am going to contact ICE and provide “customer evaluation” on the negligent care I have been receiving, such as waiting 27 months for an MRI/Arthrogram of my wrist, even after I specifically told my soon-to-be-former PCM that my shoulder orthopedic surgeon suspected that I could have a torn ligament in my wrist, and then requested that my PCM submit a referral for an MRI and Arthrogram, which he did not do.

I will tell them that I gave up on ever receiving the care I needed from Tricare, and instead requested an MRI/Arthrogram from the VA, which I received within 6 weeks and which confirmed that I have *two* torn ligaments in my hand/wrist.

There are a few other things I will discuss with ICE about the inadequate care I received from this PCM…

But, next, after speaking to the Patient Advocate and confirming that my PCM did submit a request for referral to a wrist orthopedic surgeon after I confronted him with the results of my (VA) MRI/Arthrogram, I went home to aggressively manage my referral.

I called my Tricare region’s customer service number.  I never reached a human being. (ALL of the People. ALL of the Jobs. ALL of the Computers?)  I chased menu options long enough (15-20 minutes) to figure out that I would not get the level of information I needed from a machine.

So I bit the bullet and created an account on my region’s Tricare website.  I had been avoiding creating an online Tricare account, given the government’s track record on protecting personal information.  I don’t want my health information compromised.

But I needed access to the information, which I got after I created my account.  I was able to see the referral letter and, most importantly, the authorization number.

There are several useful pieces of information on Tricare referral letters.  If you keep reading past the name and contact information of the healthcare specialist to whom you have been referred, you will see this sentence: “This authorization is valid for the dates and service codes that follow on the back page.”  Keep reading until you reach the dates and service codes.  Make sure that your treatment takes place with the date range, and that you do not receive any treatments that were not authorized, or you will have billing problems with Tricare (as in, they may refuse to pay).

If you keep reading past that section, you will see a section titled “If You Would Like to Choose a Different Provider.”

Did you know that if you are not referred to an MTF, but are instead deferred to network, you can choose to see *any* in-network provider of the same specialty?

Also, as per the referral letter, “if your authorization number begins with a 7, you do not need to notify us of a change in provider.”

[Authorization numbers can also begin with a 4, in which case, you *do* have to get prior authorization to switch providers.]

***CAUTION: “You may not switch providers if you have already begun seeing a provider for the service authorized in this letter.”

Armed with that information, and all of the research I had done on orthopedic wrist and hand surgeons since my (very-belated) diagnosis, I called the office of the in-network surgeon I had selected, and scheduled an appointment for later this week.

This probably shaved several weeks off my wait-time, instead of waiting for the referral letter to come in the mail and then trying to figure out how to change providers.

The Patient Advocate also gave me advice on how to switch to a different PCM, given the current constraints of the system (patients being forced to use PCMs at MTFs only; no network PCMs; MTFs not accepting new patients due to being over-capacity).  We decided it would be best to remain with my soon-to-be-former PCM until the wrist/hand surgery is complete, so as not to cause hiccups in the system.  But I will be switching to a different PCM and a different MTF as soon as that is complete.

Meanwhile, I continue to receive excellent care for my other health issues from the local VA facility.

As far as resolving my issues with Tricare, I followed the chain-of-command, as well as rules of common decency.  I tried resolving my inadequate healthcare issues first with my PCM, who got defensive and hostile.  Then I went to the Patient Advocate.  Next I will file an evaluation with ICE.  I will also be completing an Army Provider Level Satisfaction Survey (APLSS).  If I still don’t receive a satisfactory resolution, I will continue to pursue the matter (on the days my health permits me to battle).

I have no illusions that my PCM will change his methods as a result of these actions.  He is impervious to feedback, and I’ve seen much worse healthcare providers remain in the military healthcare system, sadly.

The best I can hope for is:

  1.  To insist I get the care I need for my health conditions and injuries
  2. To insist the providers of this care are highly competent
  3. To hold this PCM accountable for his negligent care by reporting it
  4. To provide helpful information to others who are dealing with similar situations

I suspect by the time I am done, my soon-to-be-former PCM will regret having ever told a pissed-off veteran to be more aggressive about their healthcare.  Mischief, I mean Healthcare, Managed!

Guest Post: Starting the Right Diet for Me

[Dave Banko continues his guest post series on healthy diet and lifestyle.]

The host of this blog, Crew Dog, wrote an excellent article posted on 9 February 2016 about the ‘What’s the Right Diet for You?’ program put together by doctors, nutritionists and dietitians from Oxford and Cambridge Universities in England. As mentioned in my first post, I watched this program just as I was starting my latest ‘diet’ and the comprehensiveness of the program along with the science behind their recommendations impressed me.

Of the 3 over-eating categories, Constant Craver, Emotional Eater, and Feaster, I was clearly a Feaster. I love food, and once I start, I don’t stop until I am literally stuffed. I no longer know what it feels like to be full.

A number of things could have led to this. Everyone in my family is overweight, so there may be a biological predisposition. I also learned to eat very fast growing up, and in the military, which bypasses the response time for your stomach.  I wanted to get my money’s worth at ‘all you can eat’ buffets. And it’s just common courtesy when you are a guest and you enjoy the host’s food to have seconds (or thirds). I suspect all of these thing got me to this place, but now how do I get out of it?

The plan for the ‘Feaster’ is have a ‘high protein low glycemic index (GI)’ diet.

‘High protein’ doesn’t mean I should have an all meat or protein-based diet, but rather a higher ratio of protein than a general diet.

‘Low GI‘, doesn’t mean low carb. It means the carbohydrates I eat should have a low glycemic index.

The glycemic index is how quickly the carbohydrates are metabolized. A lower GI (below 55) metabolizes more slowly, prolonging the release of glucose and insulin into the blood stream.

High GI foods shock your system with a rush of glucose into the blood stream requiring a spike in insulin levels to accommodate. Too many spikes over a prolonged period of time reduces your body’s ability to respond and results in diabetes.

Low GI Foods High GI Foods
Hummus Cornflakes
Beans/Legumes Sugar
Whole Grains White (Processed or Refined) Grains
Whole Grain Breads White Bread
Pasta White Potatoes

So I cut sugar and eliminated processed/refined grains except on my cheat days on the weekend, but then still keeping them to small portions. I also made sure I added some form of protein to every meal.

The protein combined with the low GI foods helps me feel satisfied for longer.

I no longer could depend on my body to tell me when I was full, but by adjusting the foods I ate and the ratio, I would feel satisfied with less and it would sustain me for longer periods before I’d feel hungry again.

I didn’t stop there though. Just because I was a ‘Feaster’ didn’t mean I couldn’t learn something from the ‘Constant Cravers’ and the ‘Emotional Eaters’ too.

Constant Cravers were recommended to implement the 5 and 2 diet, so I skipped dinner 2 nights a week. Emotional Eaters were recommended to join a support group, so I joined the online Facebook Group my friend started to encourage each other in our weight loss and fitness goals.

I put the whole program together and the results were over 130 lbs lost in 13 months.

My routine looked like this:

  • Sunday to Thursday, strict adherence to the eating program using food I like to eat.
  • Tuesdays and Thursdays as my ‘fast’ days skipping dinner.
  • Friday and Saturdays are my cheat days. (after our virtual weigh-in for our Facebook Group on Friday mornings)

On my cheat days I would enjoy some of the higher GI foods I avoided during the week, as well as wine and ice cream, but I still would not go crazy on portion sizes.

During the week, my plate would look like this:

½ fruit and veg, ¼ complex carbs, and ¼ meat or other protein source

At this stage you may ask, “What about exercise?”

One of the points stressed in the program is that exercise is beneficial to overall health and fitness but, to lose weight, the #1 factor is diet.

I can bear witness to this, as numerous times I started weight loss programs with exercise. In 6 to 9 months I might lose 10-15 lbs, but I didn’t control my diet. Then something would happen and I’d have to stop exercising. Because I didn’t control my diet, as soon as the activity ceased, I put on the weight plus some as I was eating more because I was hungrier from the physical exercise.

I did add exercise into my routine, but I followed the program’s advice and kept my primary focus on my diet.

I will expand on the details of my routine and how it evolved over time, as well as tips and food tidbits I picked up along the way, in subsequent posts.

For now, I have one final piece of advice to include in this post – Start Small!

You can’t sustain a crash diet, nor is it healthy for you. Also, if you would have told me before I started that I’d be satisfied eating as little as I do today (now I aim to consume 1800-2000 calories per day in a healthy balance) when at the time I must have been consuming 4000-5000 calories per day, I would have thought you were crazy. And I would not have been able to sustain that big of a drop.

Small changes will have an affect! If you reduce the foods that aren’t helpful and increase the ratio of the good foods while starting to decrease the overall portions, you will lose weight!

After a while, your body will adjust to the reduction and your weight will stabilize – the dreaded plateau! That’s the time to make another round of adjustments.

Let me give you an example. I was working in a city and because I was being reimbursed for lunch, I would go out to buy something every day. I found a great little shop that used whole grain breads and natural ingredients in their sandwiches and fantastic soups.

When I started, I would order a large soup, a large sandwich, a dessert and a diet coke. The first thing was to cut dessert and the diet coke (more on that coming later as well). After a while, I then reduced my sandwich from a whole to a half, later eliminating the sandwich altogether. My lunch calories started around 1500 and ended up being 300-400 (with the piece of whole fruit the office provided). The transition from 1500 to 400 calories for lunch took 6-9 months.

Remember Rule #1 – This is a healthy eating lifestyle, not a diet!

Habits take time to break and to form new ones.

Good luck and feel free to contact me at daveb.uk@hotmail.com if this has helped you or if you have specific questions not yet addressed.

 

Medical Procedures: What It’s Like to Have an Echocardiogram (with “Bubble Study”)

Some things are scary.  Like when your healthcare provider refers you for a procedure that involves bubbles injected into your veins and flowing through your heart.

I told my PCM the thought of it kind of freaked me out.  She said it was perfectly safe.  Just a routine procedure.  No big deal.

So I went home and researched the procedure.  I found an article from a reliable source that explained the procedure simply and thoroughly and assured patients that “The bubble study is extremely safe.”

And the rational part of my mind believed them.  But some other, irrational, part of my mind kept thinking of all the TV shows in which the villain kills someone by injecting an air bubble into their IV.  (Medical personnel hate Hollywood for this, by the way.)

I’m not the type to worry about things and get anxious, so I didn’t spend the days between the doctor’s visit and the bubble study obsessing about it.  But I didn’t sleep very well the night before, and I was pretty anxious on the ride to the hospital.  I did breathing exercises to try to relax, and, of course, cracked dark jokes about things Spousal Unit needed to know in case I didn’t survive.  (Not sure Spousal Unit appreciated that.)

What ultimately helped me relax was talking to the tech who performed the bubble injection part of the procedure.  She told me three reasons not to worry:

1) The saline solution is being injected into a vein, not an artery, and therefore there is less risk;

2) The bubbles are very small, and could not block a vein;

3) The bubbles go through your heart to your lungs, and your lungs handle them just like they handle every other gaseous fluid (bubble).  That’s what lungs are made for.

In other words, your body knows what to do with the bubbles, and it’s no big deal.

That’s when the rational part of my mind won, the irrational part of my mind stopped freaking out, and I relaxed.  More breathing exercises helped me release the tension as well.

So, what exactly *is* an echocardiogram?  It’s basically just an ultrasound of your heart.

Most of us have seen an obstetric ultrasound on TV, where the technician looks at a pregnant woman’s fetus in the womb.  The technique for an echocardiogram is pretty much the same – sound waves are used to get images of your heart.

But unlike an obstetric ultrasound, where the woman lies on her back, for a cardiac ultrasound you lie on your left side.  This helps the technician get a better image of your heart.

My technician explained to me that the ultrasound cannot get images through your bones, so they have to manipulate the wand around all the bones in your chest, like your sternum (breastbone) and ribs.  The ultrasound also cannot get images through air, so they have to avoid your lungs as well.

Since your heart is already off-set to the left of your chest, lying on your left side allows the heart to fall a bit further left, away from your sternum.

So, you take off your shirt and put on a hospital gown (open to the front), and the technician attaches some electrodes to your chest with sticky patches so they can monitor the electrical currents of your heart.  (For a good overview of the entire procedure, see this Mayo Clinic article.)  Then you lie down on your left side, and move your left arm up near your head.

The technician lubes up the wand (a.k.a. probe or transducer) and moves it around on your skin until they can get clear images of your heart.  (The gel helps improve the conduction of the sound waves, and makes sure there’s no air between the wand and your skin.)

Since they are dodging your bones and your lungs, the wand can wind up feeling like it’s trying to dig under your ribs as the technician attempts to get the clearest image, which can be a bit uncomfortable.  It’s not really painful, just a bit…insistent.  This is another time when the breathing exercises can come in handy.  Although it was rather uncomfortable a few times, I didn’t have any bruising afterward.

The technician takes a series of images from multiple angles, so they move the wand around and dig it in to new uncomfortable places to get the various images.  This may cause them to re-apply more gel as well.  My technician also asked me to take a deep breath, hold it, and exhale at various points in the procedure.  (She only forgot to tell me to resume breathing once.)

I appreciated that the technician explained to me what she was doing as she was doing it, and didn’t mind me watching the monitor as she was working.  An echocardiogram allows you to see the heart beating, and the heart valves opening and closing, and it’s fascinating to watch.

I particularly enjoyed watching the Doppler portion of the procedure:

The first part of the procedure took about 20-25 minutes, and then it was time for the Bubble Study (a.k.a. saline contrast study).  My PCM ordered a bubble study because she wanted to determine if there was a hole in my heart.

In a normal heart, the bubbles that are injected for the test enter the right side of the heart through the vein and then go through to the lungs and are removed from the bloodstream before the blood circulates to the left side of the heart.  If there is a hole between the right and left sides of the heart, the technician can see the bubbles flow through the hole to the left side, where they don’t belong.

Don’t Panic!  The bubble study is less freaky than it sounds.  Nothing is injected directly into your heart.  (Also, if you do have a hole in your heart, and the bubbles leak though to the left side, it’s ok.  Your body will still process the bubbles safely.)

A second technician came into the room, we had the conversation about bubbles and why they aren’t dangerous, and she inserted an IV line into my right arm (since I still needed to lie on my left side for the procedure). The IV line had a valve, so that the tech could start and stop the flow of the saline contrast solution.

The second tech told me that at several points during the bubble study, I would need to do a valsalva maneuver, but she described it as “the way you would bear down during a bowel movement”.  Well, that’s not the way I learned to do a valsalva maneuver during aerospace physiology, so we had a conversation until I figured out that what they *really* wanted was an anti-G straining maneuver (except they wanted me to hold my breath during the maneuver, and not exhale in a big gust when they told me I could exhale).

With that cleared up, we proceeded with the bubble study.  The first technician would signal that she was ready, the second technician would release a stream of bubbles into the vein near my elbow, and they would tell me when they wanted me to do the straining maneuver.

Then we would watch the stream of bubbles rush into my heart.  The bubbles appear white on the monitor, and they are very obvious.  Sometimes the second tech would massage my arm a bit to help the bubbles flow faster or something.

The saline bubble solution felt a little bit weird when it first went into my arm, but then I didn’t feel it anymore.  The first batch of bubbles felt weird when it entered my heart – my heart seemed to flutter a little bit.  But it didn’t hurt, and I didn’t feel it with the subsequent bubble batches.

We repeated the sequence four or five times, until there was no more saline solution, and the first tech was satisfied that she had all the images she needed.  They were both very impressed with my straining technique. 🙂

Then the second tech removed the IV line, the first tech removed the electrode sticky pads, and they left me to wipe the gel off my chest and get dressed.

The whole procedure took about an hour, and I had no residual effects.  Turns out, the bubble study really *was* no big deal.

Also, since having a hole between the two sides is congenital (something you’re born with), I’ll never have to have this procedure again.  Once they’ve determined whether the hole is there or not, that doesn’t change and you never need to check again.

TL;DR:

Tired to the Bone

Tired Dog

I try to be optimistic and proactive about my health.  But some days I’m just tired to the bone.

Last week I had three medical procedures.  One was a new treatment, and two were diagnostic.  It may take days, weeks, or months before we know if the new treatment is having an effect.  So I wait…

Meanwhile,

The diagnostic procedures revealed that I have been correct for the past 2+ years that there is something wrong with my wrist.

More than two years ago I fell violently on a wet ceramic tile floor.  Ever since, I have been telling doctors and therapists that I have pain and malfunction in four areas: my scapula, my shoulder, my elbow, and my wrist.

Although my doctor ordered x-rays immediately after the fall, once those came back negative for broken bones she refused to send me for additional imaging (MRI/arthrogram).  Nearly one year later, after I had “failed to progress” in physical therapy, my doctor finally sent me for a shoulder MRI/arthrogram, which revealed that my labrum was severely torn and would not heal without surgery.

By that point, nearly one full year after the injury, I was in severe pain and could barely do my job.  Some days I left work early due to the pain, and I wasn’t getting much sleep either.  I could sleep in one position on the couch, surrounded by pillows that held my shoulder in the least-painful position, but if I shifted in my sleep the pain would wake me up.

I was taking a strong NSAID and a narcotic, but that wasn’t enough to control the pain.  I was getting pretty desperate for relief.  For months I requested that my doctor refer me for pain management, but she refused.

Fortunately, once I received the diagnosis of the torn labrum (a.k.a. SLAP tear/SLAP lesion) things happened a little more quickly.

The story of how I selected my orthopedic shoulder surgeon is a saga for another post.  But once I had authorization to receive care from him, I was able to see him a few days later (one month after the MRI).

At this point, I was desperate for relief, and I didn’t care if it cost me my job.  I told the nurse I would take the first available surgery slot, and asked her to look for cancellations.  She found a cancellation for the following week, which gave me just enough time to stop taking all medications, vitamins, and supplements and get them out of my system so they didn’t interfere with the surgery or the recovery.

I told my boss that I was having surgery the next week, and would probably be out for at least 6 weeks since I couldn’t drive with my arm in a sling.  Although I was an hourly worker, and would not get paid while I wasn’t working, they didn’t fire me.  They told me to get the help I needed and come back when I was better.

I had the surgery, and it was successful.  The surgeon discovered that my labrum was completely severed, and he had to trim it, re-attach it, and anchor it to the bone.  However, the biceps tendon was not torn, and the rotator cuff was not damaged either.

Even immediately post-surgery, the pain level was so much lower than before the surgery.  I was able to stop taking narcotics after about two days.

I started physical therapy seven weeks after surgery.  My surgeon wanted to give the labrum plenty of time to reattach to the bone and form a strong connection.

We noticed in physical therapy that I was still having pain and malfunction in the scapula, elbow, and wrist.  My doctor and physical therapist wanted to give it some time, to see whether this would shake out as physical therapy re-trained the muscles to function as they had before the fall.

My surgeon said that if the pain and swelling in my hand and wrist had not gone down in three months, I should probably see an orthopedic wrist surgeon, as I might have a tear in my triangular fibrocartilage complex (TFCC).

Then a whole lot of life happened.  Moved twice.  Different states. New PCM.  New PCM refused to refer me for MRI/arthrogram of wrist, which was still discolored, swollen, weak, and painful, but did refer me to a new physical therapist.  Physical therapist wanted to try treatment first, but after I “failed to progress” with elbow and wrist function, PT agreed it was time to get diagnostics and see an orthopedic specialist.

Meanwhile, I had finally gotten my VA disability claim processed, and after a seven month wait for an appointment had finally seen a VA PCM.  Since I had not been able to get my Tricare PCM to follow-up on the wrist, I asked my VA PCM to treat it.  She sent me for x-rays immediately following our appointment.  The x-rays showed my ulna was mis-aligned.

Less than two weeks after I saw my VA PCM for the first time, I had EMG and CNS procedures to determine if there was permanent nerve damage in my left arm/hand, and to determine whether the problem was due to a pinched nerve in my neck.

A few days later, I had an appointment at the VA hand clinic.  The x-rays had indicated a problem in my wrist, and the examination at the hand clinic confirmed it, so the hand clinic referred me for a wrist MRI/arthrogram.  FINALLY!

Three weeks later I had the MRI and arthrogram (post pending).  It was more than two years since I had been injured, and more than a year since the shoulder surgery.

The arthrogram revealed not only that I have a TFCC tear, but also that I have a scapholunate (S-L) tear – two torn ligaments in my wrist.

Initially, I was happy to finally have diagnostic evidence to support the injury claims I have been making for the last two-plus years.  And I was excited by the possibility that I could get the ligaments repaired and finally begin to heal.

But today I am just tired to the bone.  I have to find a new orthopedic surgeon in the state where I now live.  Someone I can trust to work on my wrist – a very delicate and complex part of the human body.  Someone in either the Tricare or the VA system.  And I have to get authorization 1) to consult with them and 2) to have surgery, if necessary.

Plus, I still don’t know whether I have a torn ligament or ligaments in my elbow.  My physical therapist thinks that I do.  But I haven’t been able to get Tricare or the VA to send me for diagnostics of my elbow yet.

On a better day, I will conduct more research on orthopedic wrist surgeons, and I will fight to get the referrals and the treatment that I need.  On a better day, I will take positive action to resolve this injury.

But today I am tired.  Today I will rest and regroup, so that I can resume battle recharged and equipped with knowledge.

Bottom Line:  It’s ok to be tired.  We all need rest.  We all need self-care.  Resting does not mean we are weak.

Lessons Learned:

  1. Keep fighting until you get the care you need.  There will be good days and there will be bad days, but you deserve to be heard and to be treated.
  2. You don’t have to go it alone.  Get a Patient Advocate, Case Manager, or lawyer to assist you.
  3. “If you haven’t got your health, you haven’t got anything.”  I delayed my first round of physical therapy because I was busy with work and school.  If I had “failed” PT sooner, I probably would have gotten my shoulder MRI sooner and my shoulder surgery sooner.  I wish I had made my health more of a priority sooner.  Problems don’t go away when you ignore them.
  4. Learn the administrative procedures.  HMOs typically have set procedures for dealing with illness, injury, etc.  PCMs have to follow the sequence when treating patients.  Even though I knew I needed shoulder surgery, I had to “fail” PT first.  It will do you no good to try to pre-empt procedures – you won’t get authorization to do things out of sequence.  So find out the sequence and get it done so you can get to the end-state you need.
  5. Trust your gut.  Various healthcare providers gave me various ideas on what might be causing my symptoms – only one of them was (partially) correct.  I knew from the beginning that something was wrong with my wrist and that I needed imaging to find out what it was.  You know your body better than anyone else.  If you know something is wrong, keep demanding treatment until it’s fixed to your satisfaction.
  6. Watch out for wet freaking ceramic tile floors!  Or any other slip, trip, or fall hazard – you don’t want to jack yourself up like I did.

Indoor Air Quality – How I Made the Air I Breathe Healthier By Using NASA Research

Some of you may be wondering why I said in my first post that I’d rather have house plants than an air purifier.  I chose house plants because they do not use any energy other than sunlight, and because my research did not convince me that air purifiers were significantly better than houseplants.  Thus, I preferred the cheaper, more natural option.

What I said in the previous post:

To me, [naturopathic self-healing] means utilizing evidence-based natural solutions when possible, such as using house plants to improve the quality of the air in my house, rather than buying an air purifier.

The Spousal Unit and I had talked for years about getting an air purifier.  We thought that putting an air purifier in the bedroom would help us get better sleep.  I had read blogs and websites written by asthmatics and allergy sufferers who highly recommended air purifiers with HEPA filters, and they were pretty persuasive.  The only thing holding me back was the price – $500+ for a one-room HEPA filter air purifier.

“Maybe I could start with something less expensive,” I thought.  “What about those Himalayan salt lamps?”  According to the advertisements, a Himalayan salt lamp “works as an air purifier by emitting negative ions into the air.”  And they retail for $25-$30 for a smaller lamp.  So I did some research.  Unfortunately, I found that Himalayan salt lamps do not emit negative ions in a large enough quantity to have an actual effect on your indoor environment.  For a thorough examination of Himalayan salt lamps, I recommend this post over at A Breath of Reason blog.  Bottom line: they don’t improve air quality.

Ok, what about beeswax candles?  They are also touted as being good for air quality because they release negative ions.  Nope, Skepticcystic over at A Breath of Reason debunked beeswax candles too.  (See this post.)  According to her research, not only do beeswax candles not release stable negative ions, but there is no scientific evidence that beeswax is healthier to burn than other types of wax.  So, although some would argue that you should avoid the phthalates in artificially scented candles, the type of wax  a candle is made of doesn’t appear to make a difference to indoor air quality.  Bottom line: Regardless of what they are made of, burning candles does not improve indoor air quality.

So back to air purifying machines…

For a practical overview of air purifiers, check out this article from ConsumerReports.  For example, ConsumerReports suggests:

“Before you buy an air purifier, try some simple, common-sense steps to reduce indoor air pollution. Begin by vacuuming often, banning smoking indoors, minimizing use of candles and wood fires, and using exhaust fans in kitchen, bath, and laundry areas.”

As the article continues, various claims made by air purifier companies are tested.  ConsumerReports cautions that ozone-producing air purifiers are actually harmful to your health and should be avoided, particularly if you have allergies or breathing problems.  This is confirmed by the American Academy of Asthma Allergy & Immunology:

“There is no debate about the negative effect of ozone…with the FDA concluding there is no place for ozone in medical treatment.” (See article here.)

For more information on the pros and cons of air purifiers, read this article from the New York Times, in which Steven Kurutz, an allergy sufferer, tested six popular air purifiers.  Here are a few excerpts from his article:

“For all their high-tech wizardry (some claim to be able to eliminate particles 0.3 microns in size and smaller), air purifiers occupy the same category as faith-based wellness products like nutritional supplements.”

And,

“Over the years, the Federal Trade Commission has taken action against several makers of air purifiers, including brands like Honeywell and Oreck, for unsubstantiated allergy-relief claims or for advertising that their devices removed virtually all impurities from the indoor air people breathed.”

According to ConsumerReports’ deputy home editor, Celia Kuperszmid Lehrman, whom Kurutz interviewed for the article,

“The first thing you need to know about an air purifier is that most people don’t need one.”

However, some doctors do recommend air purifiers for their patients, particularly children who suffer from asthma.  So, if you have asthma or allergies (or both), talk to your doctor about whether an air purifier would be beneficial for you.

According to the American Academy of Allergy Asthma & Immunology:

“There is no definite evidence of filtration clinically benefiting patients with allergic disease, but this may be the result of the studies being of insufficient durations to prove benefit.   The best review of the topic is by Sublett et al in 2010, a report of the Indoor Allergen Committee of the American Academy of Allergy Asthma and Immunology.” (See AAAAI article here.)

The Bottom Line for Air Purifiers: The different things you may be allergic to (dog allergens, cat allergens, mite allergens, mold, pollen, etc.) have different-sized particles.  You will see the most benefit if you select an air purifier that is designed to filter the particle size of the allergen that most affects you.

Conclusion from the Sublett et al report:

“As far as optimal choice of cleaning devices, initial cost and ease of regular maintenance should be considered. Portable room air cleaners with HEPA filters, especially those that filter the breathing zone during sleep, appear to be beneficial.

For the millions of households with forced air HVAC systems, regular maintenance schedules and the use of high-efficiency disposable filters appear to be the best choices.

However, further studies and research in this area are desirable to make more definitive recommendations in the role of air filtration on improving disease outcomes.”

Ok, so I could buy an expensive HEPA filter air purifier for my bedroom, which might help us sleep a bit better.  Are there any other options?

That’s when I remembered that house plants help improve indoor air quality.

Most of us learned in school that plants breathe in carbon dioxide and breathe out oxygen (roughly speaking), which is great for humans because we breathe in oxygen and breathe out carbon dioxide.  So having plants in the house helps increase the oxygen level in the air and decrease the carbon dioxide level.  But indoor plants can do more than just produce oxygen.

NASA published research in 1989 which demonstrated that house plants help reduce indoor air pollution.  Due to the energy crunch in the 70’s, buildings became more air-tight to reduce energy costs associated with escaping heated or cooled air.  But then occupants began developing health problems, and researchers determined that decreased air flow in buildings led to higher concentrations of carbon dioxide and volatile organic compounds (VOCs) in the indoor air.

Three of the VOCs NASA focused upon in its research were benzene, tricloroethylene, and formaldehyde.  These chemicals pose various health hazards that range from skin and eye irritation to headaches, asthma, and cancer (pp. 3-5).  Assuming we’d like to avoid these health hazards, what can we do to reduce the levels of these chemicals in our homes?

As NASA points out, “The first and most obvious step in reducing indoor air pollution is to reduce off-gassing from building materials and furnishings before they are allowed to be installed.” (p.2)

The best way to reduce chemical indoor air pollution is to choose lower-VOC or zero-VOC options for furnishings, floorings, and other elements inside your home (wall paint, flooring glues, shower curtains, etc).  That way, you’re bringing less VOCs into your house to begin with.  (There are lots of good articles about this on the web; I encourage you to Google-Fu them.)

In addition to reducing VOCs by using less-toxic cleaning supplies, lower-VOC paint, etc., we figured “If it’s good enough for NASA, it’s good enough for us,” and bought houseplants – lots of houseplants.

Before I bought the plants, I did an online search and found many helpful articles.  This article at Lifehacker.com has a graphic of various houseplants and the chemicals they filter best.  And since houseplants have not fared well at my house in the past, I also read articles, including this one, on low-maintenance, hardy houseplants.  See this article for a good overview of the benefits of houseplants, including how many you need per room/ per square foot.

In the end, I decided to buy plants that didn’t have runners that would wind up all over the house (I’m looking at you, golden pothos).  I found a local nursery and selected plants for various rooms based on the available sunlight in those rooms, the amount of available space, and what looked good to me.  Be sure to check how big each plant typically grows, so you don’t buy ones that will outgrow the space you bought them for.

For the bedroom, I selected a snake plant (a.k.a. mother-in-law’s-tongue; see picture at top of post) because they are one of the only plants that continue to take in carbon dioxide and give out oxygen at night.

So far, it’s been about six months and none of the houseplants has died.  In fact, nearly all of them are thriving.  It’s hard to say whether our indoor air quality has improved, since we don’t have a way to test it.  But at least we know that science is on our side, and we didn’t waste our money on air purification myths like beeswax candles or salt crystal lamps.

CAUTION: Many low-maintenance houseplants are toxic to dogs, cats, and sometimes children if they chew on the plants.  If this is likely to happen in your home, make sure you know which plants are toxic, and put them where pets or children cannot reach them.

 

 

Guest Post: A Diet for Everyone

 

[Here’s another in the series of healthy eating and lifestyle posts from Dave Banko.]

Shortly after I started eating more healthily, another TV program aired called, “50 of the World’s Best and Worst Diets.” Countries were ranked by average lifespans, rates of obesity, and other health issues, then related to their diet and lifestyle. The results are fascinating!

Worst Countries

#50 – Marshall Islands

  • Health – Highest death rate from diabetes
  • Diet – White (refined) rice, tinned [canned] vegetables, and high-fat processed meats

#49 – Russia

  • Health – ¼ of men die before age 55, high rates of liver disease, alcohol poisoning and car accidents
  • Diet – High consumption of Vodka

#44 – Mexico

  • Health – 1/3 of the population is obese
  • Diet – Lots of soft drinks and processed calories, lack of fresh and natural foods

#43 – USA

  • Health – High diabetes and obesity
  • Diet – Super-sized portions with processed food and cheap sweeteners like corn syrup (fructose)

#38 – Australia

  • Health – Fastest growing rate of obesity
  • Diet – Plenty of Meat and Beer!

Best Countries

#13 – South Korea

  • Health – Lowest obesity rate
  • Diet – Lots of fresh fish and lots of vegetables and fermented foods

#10 – Netherlands

  • Health – Tallest people in the world
  • Diet – Lots of milk and milk products!

#8 – France

  • Health – Low levels of cholesterol and heart disease
  • Diet – Red wine, cheese, high saturated fat dishes!

#7 – Kuna Indians

  • Health – Lowest levels of cardiovascular disease and blood pressure
  • Diet – Lots of chocolate (up to 5 cups a day) in combination with plantains, coconuts and fish

#5 – Japan

  • Health – longest life expectancy for women
  • Diet – Rich in vegetables and fish

#3 & 2 – (Greece & Italy)

  • Health – Long life span
  • Diet – Rich in legumes, fruit, vegetables, fish, olive oil, wine, dairy, pasta, whole grain rice, and red meat

#1 – Iceland

  • Health – Longest overall average life span
  • Diet – fish, red meat and dairy from grass-fed animals, and few fruits and vegetables

Why is this important? Diet information is about as confusing as it gets, fat or no fat, all meat or vegetarian, carbs or no carbs. If you look at these best diets in the world, it seems to only add to the confusion.

  • How can the best diet in the world include few fruits & vegetables?
  • How can the French have such low levels of cholesterol and heart disease with a diet loaded with high saturated fat?
  • Who got excited when they saw #7 was high in chocolate?!

The facts are:

  • Icelanders eat the fresh produce from the land and sea with little processing.
  • The French consume rich food, but in small portions and take their time – enjoying life.
  • The Italians eat pasta with every meal, (made from complex carb flour) even when dieting, with lots of fresh, simple ingredients and small portions.

Most of the diet plans out there were put together as something that worked for someone else. But it wasn’t mine, or what I like to eat.

Recipes are helpful, but need to be adapted to what you like to become a healthy eating lifestyle you can sustain.

There are general principles to follow:

  • Avoid or minimize: sugar & sugary products, processed foods, foods with lots of chemicals, and refined foods
  • Reduce portion sizes – This goes without saying as the curse of our own abundance in a super-sized or ‘all you can eat’ culture.

The countries with the worst diets overindulge in less-healthy food and empty calories.

  • Balance & variety – our bodies need lots of different nutrients for health. I’d be wary of any program that eliminates or focuses on any one food group.
  • 80/20 rule – ‘I adhere to the 80/20 rule. I eat healthily 80 per cent of the time, and that leaves me free to eat what I want for the remaining 20 per cent. And those cheat meals taste so much better when they are a treat rather than the norm,’ Bear Grylls. I follow this myself, relaxing my program on the weekends to have some ice cream, mashed potatoes, or other treats which I avoid during the week.

I’ll share more about the principles and specific techniques in future posts.

For now, pick a balanced program closest to the type of food you generally like to eat, and use it as your starting point. But don’t be afraid to experiment and adapt it to what you like and what works for you.

Until next time!

Dave Banko

P.S. – In case you were interested, here’s the link to the countries in the middle.

[Note from Crew Dog: Looking for a diet starting point, but don’t have time to read all of the “What’s the Right Diet for You?” information?  Start with the guidelines in this article.]

 

Guest Post: The Journey to Healthy Eating Habits and Weight Loss

Triple_Old_100_1Year

[Today we have a guest post from Dave Banko.  Thanks for sharing your inspiring story, Dave!]

My friend, Crew Dog, asked if I’d be a guest blogger, sharing my experience losing over 100 lbs in a year. I was thrilled by the offer and happy to share my experience!

As this is a complex subject, I will be doing a series of posts about various aspects of my journey and specific topics related to healthy eating and weight loss.

Let me preface by saying I’m not a doctor, nutritionist, or health professional of any kind.  I am a veteran, and I have struggled with my weight all my life.

I’m not a person who sits on the couch eating chips or ice cream.   Diabetes runs in my family, so I’ve been careful to avoid sugary food. I have been very active, but injuries over the years have slowed me down.

To put it frankly, I love life and good food!

But my love of food has gradually put on the pounds. On a fairly regular basis, I started another diet to try to lose weight. I tried pills, special recipes, cleansing purges, fiber, meal plans and countless hours in the gym – costing lots of time and money! I’d be good for a little while, maybe lose a few pounds, then something would happen, I’d have to stop and the weight came back plus more.

I even contemplated gastric bypass (and associated) surgeries.

However, when I went for the consultation and heard how strict a diet I would need to follow for the rest of my life, I felt “What’s the point” as it is really the diet I’d have to maintain to lose the weight without surgery.

I reached in excess of 360 lbs.

I felt old. I couldn’t walk far or up stairs. I sweated profusely in a heated room or in a crowd. I developed sleep apnea and needed a CPAP to sleep properly.

Then I was at a Christmas party in December 2014, my feet tangled on some coats, and I fell on my shoulder. I was in severe pain for weeks from such a simple fall.

I know I’m getting older (approaching 50), and the body doesn’t heal as quickly as it did, but I also know I landed with a lot of force and, if I were lighter, it wouldn’t have been so extreme. I determined I was ready to try again after the holidays, but didn’t know what I was going to do differently.

At the beginning of 2015, the stars aligned!

I was in the right frame of mind to start, a friend of mine started a Facebook group of friends to encourage each other to lose weight and adapt a healthier lifestyle, and a program was aired on TV called, ‘What’s the Right Diet for You?’ (referenced in the 9 February post Food, Glorious Food!).

What’s the Right Diet for You? was a 3 part series put together by doctors, nutritionists, and dietitians from Cambridge and Oxford Universities. Rather than prescribing a formula to follow to lose weight, they first addressed why people are overweight, then provided strategies to address the root causes.

This is the first time any program really addressed the root causes, physiologically and mentally, of why we overeat, and put together a comprehensive strategy for a lifestyle of healthy eating, not just a short-term diet. They then supported the strategy with experiments demonstrating the science behind the advice.

I recorded the programs and watched them over and over, adapting the strategies for me, and the pounds starting melting off. I was stunned by the results!

So far, I’ve lost 132 lbs in a little over a year, and have 9 more lbs to go. My target is to reach my military weight.

Unfortunately, I was too embarrassed by the way I looked and had so little confidence of real success that I didn’t take a proper “before” picture. The one in the side-by-side photo above was the best I can find from when I was generally around 350-360 lbs. In the middle is when I reached 100 lbs lost, and the right is 130 lbs lost.

I wish I could provide links for you to watch the programs yourself, but they are no longer available on YouTube. I will try to do justice to the information imparted over a series of blog posts.  If you are where I was in December 2014, get ready.

Rule #1 – This is a healthy eating lifestyle, not a diet!

Accept this now. What I will be sharing is not a short-term diet, but a plan for a long-term healthy eating lifestyle.

[Note from Crew Dog: I hope you will follow along as Dave shares his techniques and experiences with us in a series of guest posts on healthy eating and weight loss. For links and downloads on “What is the Right Diet for You?”, see the previous post Food, Glorious Food.]

 

 

Health Hack: Morning Checklist

The military loves checklists.  For some career fields, it feels like there’s a checklist for every action except going to the can/head/toilet. (Number 1 – check.  Number 2 – check.)

For many of us veterans, using checklists has become a deeply ingrained habit pattern.  So why not harness the checklist habit pattern and utilize the checklist tool to create a healthier lifestyle?

Particularly if you have a health condition that affects your memory, thought-process, or motivation, a checklist can be a very helpful aid.  Why not use  checklists as a health life hack? (“Life hacking refers to any trick, shortcut, skill, or novelty method that increases productivity and efficiency, in all walks of life.”)

Research indicates that it is often beneficial to take positive actions whether or not we “feel like it”.  Since I frequently wake up feeling crappy and either forget to accomplish some or most of my morning routine or just don’t feel like doing it – but I know that my morning routine is good for my health & wellbeing – I have decided to implement a morning checklist.  While it’s easy to destroy my morning routine by gradually skipping more and more days, it’s much more difficult for me to intentionally not accomplish the checklist.  So, for me, routine checklists are an effective life hack.

This is my Morning Checklist:

Morning Health Checklist – One Sick Vet

(Feel free to print it out and use it, or create your own.)

You could also use a daily health journal, a spread sheet, or a chart (like a kid’s chore chart) on the wall or refrigerator or bathroom mirror.  Whatever works for you.  (Anyone know of an app for that?)  The key is to find a way to get yourself to consistently make healthy choices and take healthy actions whether or not you feel like it, or to find a method that helps you remember when you are having difficulty remembering.

What will you do to hack your health today?

Medical Procedures: What It’s Like To Get An EMG (Electromyography)

Raise your hand if you’ve got a bad shoulder (badum ching!).  Yup, me too.  Although I had surgery to repair it a year ago, I’ve had some lingering problems.

Since physical therapy (PT) hasn’t resolved the functionality problems with that arm, my primary care manager (PCM) ordered some diagnostic medical procedures to try to determine what’s causing the problems.  One of the procedures that was ordered was an electromyography.

Electromyography (EMG) is a diagnostic procedure that assesses the health of muscles and the nerve cells that control them (motor neurons).  According to the Mayo Clinic,

“Motor neurons transmit electrical signals that cause muscles to contract. An EMG translates these signals into graphs, sounds or numerical values that a specialist interprets…EMG results can reveal nerve dysfunction, muscle dysfunction or problems with nerve-to-muscle signal transmission.”

In my case, they were trying to determine whether a pinched nerve in my neck was causing the problems with my arm.

Electromyography is an outpatient procedure that typically takes about an hour.  EMG is often done in conjunction with a nerve conduction study (NCS), which I also had.  NCS is the measurement of “the speed of conduction of an electrical impulse through a nerve. NCS can determine nerve damage and destruction” (Johns Hopkins).

According to WebMD,

“Nerve conduction studies are done before an EMG if both tests are being done. Nerve conduction tests may take from 15 minutes to 1 hour or more, depending on how many nerves and muscles are studied.”

Since they were going to need access to my arm and shoulder (and trapezius, as it turned out), I wore a track suit with a tank top underneath. They asked me to take off the track suit jacket and lie down on an examining table.

To prepare for the NCS, the person administering the torture procedure asked me to move my fingers, hand, and arm in several different directions so she could determine her targets.  These she marked on my arm with a marking pen.  She fastened several electrodes to my hand and fingers with tape (see picture below), and proceeded to zap me with a machine that looked like a taser (but used less voltage, obviously).

 

This is not a pleasant sensation.  It typically wasn’t too painful, except when she applied multiple shocks in the same location.  The second or third consecutive shock in the same spot became more and more painful.  For the most part, she told me what she was going to do before she did it, which helped me prepare.  When she told me she needed to do 10 shocks in the same place, I knew two things: 1) It was going to hurt like hell, and 2) I’d better do the stress management/relaxation breathing techniques I learned at the base Wellness Center.

Breathing techniques, whether learned through biofeedback training or as part of yoga or meditation can be very helpful for managing pain or stress.  I use them whenever I am having an uncomfortable/painful/stressful medical procedure.  Of course, in this case, relaxing was a bit more challenging, since my body was also jerking from the shocks.  For some of the shocks, only my hand/wrist twitched.  But for some of them, my opposite leg jumped.  Several times I got a cramp in my arm muscles, and toward the end, I got a cramp in the muscles in my lower back.

That was part one.  Part two was the EMG.  “During a needle EMG, a needle electrode inserted directly into a muscle records the electrical activity in that muscle” (Mayo Clinic).

The needle is inserted into various muscles.  It didn’t hurt most of the times it was inserted, since it is a very fine needle.  It did hurt when it was inserted into the trapezius muscle.  Once it is inserted, the doctor taps on the needle, and sometimes moves it around inside the muscle as she listens to the signal.  As you can imagine, this doesn’t feel very good.  Then she asks you to engage the muscle.  You can hear an increase in signal noise while you are engaging the muscle.  This also doesn’t feel very good, as the needle feels like it is stabbing you more.

These tests may be done only on one side of your body (one arm, one leg, etc.), or they may be done on both sides of your body in order to compare results.  In this case, they only tested the problematic arm, not both, and the doctors were able to give me my results at the end of the procedures.

The good news is they didn’t see any evidence that I have a pinched nerve in my neck.  The bad news is that these diagnostic procedures didn’t help determine the cause of the problems with my arm.

After the tests: I had one righteous bruise, and I was tired for the rest of the day.

According to WebMD:

“After the [EMG], you may be sore and have a tingling feeling in your muscles for up to 2 days. If your pain gets worse or you have swelling, tenderness, or pus at any of the needle sites, call your doctor.”

“If you still have pain after the [NCS]:

  • Put ice or a cold pack on the sore area for 10 to 20 minutes at a time. Put a thin cloth between the ice and your skin.
  • Take an over-the-counter pain medicine, such as acetaminophen (Tylenol), ibuprofen (Advil, Motrin), or naproxen (Aleve). Be safe with medicines. Read and follow all instructions on the label.”

How NOT to Do It: Applying for VA Disability Years After Military Separation

Something slightly different today: I had the opportunity to write a guest post for The Military Guide.  Started by a Navy veteran who transitioned to an early retirement lifestyle after 20 years of military service, The Military Guide covers subjects such as financial independence and early retirement from a military perspective.  If you’re interested in ways to parlay military pay and benefits into savings, investments, and possibly a side hustle or two so that you, too, can avoid working or can work on your own terms after you separate from the military, head on over there and check it out.  Doug Nordman, the founder of The Military Guide, retired in his early forties and now surfs and supports veterans causes.  With some hard work and careful planning, that could be you!

The post I wrote for The Military Guide covers my experience of filing for VA disability well *after* I separated from the military.  Hopefully it will be a cautionary tale of what NOT to do, if you are still on active duty. Or, perhaps, it will give you the motivation to go ahead and apply for VA disability benefits, even if it’s been *years* since you separated from the military.  Check it out and let me know what you think.