A small manual of important healthcare information, intended to help patients with their own medical care.

IMPORTANT INFORMATION REGARDING YOUR HEALTH

By Jorge Bordenave

Balboa Press

Copyright © 2011 Jorge Bordenave
All right reserved.
ISBN: 978-1-4525-3580-7

Chapter One

The purpose of this manuscript is to inform you about various issues relating to your current health care.

As you may already know, the population is aging, getting older and living longer. At the same time, we are seeing an increase in rates of obesity and diseases directly related to our lifestyle, including diabetes, cardiovascular disease, cancer and Alzheimer's disease.

Many also are concerned about the current financial states of Medicare, Medicaid and health insurance plans. It feels like there is less coverage and increased out of pocket costs. Some even have to choose between paying for their medicines or other necessities like food or utility bills.

Things will likely not improve and possibly may worsen, simply because costs are increasing, the federal healthcare budget is already maxed out, and demand for services continue to increase each year.

These increases are due to several factors.

1. The numbers of elderly are growing and the population is getting older. In this population are included many who suffer from chronic diseases.

2. This increase is due in part to newer drugs and advanced medical technology, which is costly. Both are responsible for prolonging life and even curing some conditions that just a few years ago had no treatment.

3. In 2011, there will be 7000 people a day turning 65, and receive Medicare benefits, for a total of 2.5 million additional beneficiaries in 2011 alone.

4. We are experiencing and treating a wave of epidemics related to our lifestyle, such as obesity, heart disease, cancers, lung disease and diabetes.

5. There is currently no adequate government policy, aimed at solving the nations healthcare problem. A problem that will take significant time, bi-partisan agreement and some shared hardship.

These are just some of the many factors that contribute to our Nations increasing annual healthcare expenditures.

Medicare is the health insurance assistance program of the U.S. federal government for people over 65 years of age, and those suffering from kidney failure at any age.

There are different forms of Medicare. Part A, covers hospitalization and some nursing homes.

Part B, covers doctor office visits and some tests.

Part C, or Medicare Advantage plan, is healthcare that is managed by provider health plans and HMO's.

And Part D, covers prescription drugs.

Medicaid is a health insurance program, for low income individuals, managed and funded by individual States with additional funding by the Federal Government. Each State sets the income qualifying standards as well as benefits. Both programs were passed into law in 1965.

In 1980, Medicare expenditures totaled $34 billion dollars, or 6% of total Federal spending (TFS) of that year. By 1990, Medicare expenditure was $107 billion (9% TFS), in 2000-$216 billion (12% TFS), in 2002-$257 billion (13% TFS) in 2004-$300 billion (13% TFS), in 2007-$435 billion (16% TFS), and in 2008-$600 billion (20% TFS). Again these are just Medicare expenditures only.

In 2006, the Medicare prescription drug plan took effect to help with the cost of some common medications, which added another $49 billion dollars to the total Medicare expenditures of 2008.

The breakdown of healthcare payments for the U.S. population is as follows: 35% is paid by private insurance, 34% is paid by the Federal Government (mainly in the form of Medicare), 13% is paid by the individual States (mainly in the form of Medicaid), 12% of comes from our own out of pocket payments, and the remainder, from other sources.

Remember that the figures mentioned above, is of Medicare spending only. When you add the all the other payment sources just described that cover and pays for all medical expenses, the total final annual healthcare expenditure is even higher.

For example, in 2002, Medicare expenditure alone was $257 billion dollars. Add the other amounts spent to cover and pay for all healthcare costs that year, and the total expenditure on healthcare in 2002 was $2.1 trillion dollars, or $2,100, 000,000,000.00! No country in the world can continuously sustain these kinds of costs indefinitely. Without some form of compromise, reform and solution, the U.S. will eventually be bankrupt.

We all need to be aware of this reality and work together to try to contain costs and sustain a functioning healthcare system. To believe that you are immune and that none of this can or will affect you and your family is naive. We don't have to fear or get overwhelmed but it is time for all of us, from physicians and other health care providers to patients and their families, to take more responsibility and become pro-active for maintaining our own health.

Just four diseases are responsible for 60% of all the expenses paid by Medicare. Four! These diseases include diabetes, cardiovascular disease, asthma/chronic bronchitis (COPD) and depression. Diseases and conditions that can be modified or controlled by simply changing our lifestyle!

A change in lifestyle consists of improving our diets and nutrition, increasing our level of daily activity or exercise and smoking cessation. Changes that anyone can make and that in the long term is going to save us money by cutting down on medications, doctors visits, and improve chronic health conditions and our quality of life.

A balanced diet and exercise, in addition to taking your prescribed medications, is should be a routine and integral part of your health care.

The importance of our food and the diet in the prevention and treatment of diseases cannot be overstated. Food was used as one of the first medicines. For over 5000 years, food and nutrition has been an important part of ancient Indian medicine known as Ayurveda, as well as in traditional Chinese medicine, both of which continue to be practiced today in parts of the world.

Nutrition and disease.

The quality of food we have been eating as well as the amounts we consume has changed. We eat more processed, refined foods that are loaded with calories, sugar and saturated fats.

"Foods" that are very different from their components in natural form.

Because of these dietary changes, we have gained weight, and become a society suffering from an obesity epidemic as well as obesity related diseases.

It's as if eating, has become our favorite national pastime, while having forgotten the reason for eating in the first place.

Many eat not to satisfy hunger, but rather to fill and satisfy a void. We use food as our lover, friend, drug and entertainment. We even eat at times without being hungry all because we have easy access to cheap comfort foods.

Having recognized this, now is the time to try to change our bad eating habits.

Start by eating fewer processed, high calorie, high fat, sugary foods and snacks and instead, try eating more natural, less processed and fried foods. Eat more fresh vegetables, fruits, grains, beans and use olive oil instead of other fats.

Choose all kinds of healthy, fresh, natural foods including lean meats, fish and free range poultry.

Like changing any bad habit, it may take some getting used to.

Eat slowly.

It takes our brains about 20 minutes to think we full.

Drink plenty of water, as the neuro-signals of thirst, are similar to that of hunger and many times we feed ourselves when what our body really needs is water.

Eat smaller portions, throughout the day if possible. Smaller sized portions are used for energy, the left over's from big meals get stored as fat.

There is no need to go hungry, starve, or restrict any macronutrient.

There are many helpful books and resources available to assist with your nutrition.

Exercise / physical activity.

The definition of exercise is: a strenuous physical or mental effort, especially used to maintain the wellbeing or for the purpose of improving ones health status.

At the same time that we have been changing our dietary habits, we have also reduced the amount of exercise and physical activity we do on a daily basis.

My personal opinion is that many of us are just plain lazy and comfortable with our daily lives. When I advise patients as to the importance daily exercise, and I request they add it to their daily routine, it is amazing to hear the multitude of excuses and reasons they come up with, as to why they simply can't. "I'm too old", "my legs, waist, hip or spine hurts". "I have arthritis", "I have no one that can take me" and my favorite, "I have no time." Favorite, because most of these patients are sedentary and just stay home and watch TV during their day. Some may not recognize the importance of routine daily exercise and physical activity in the management of our health care and the treatment of diseases.

Others may try it once or twice and quit for various reasons. Tired, fatigue, muscle and joint pain, shortness of breath, generalized discomfort, and boredom are some of the most common reasons given for not being able to exercise.

Maybe others can't see immediate change or recognize the health benefits as another possible reason for stopping.

Whatever the case may be, inactivity affects us all.

We each individually need to be more motivated and proactive in caring for our own health.

It is the responsibility of each individual, not your doctor, your health plan, your family or the government, to take care of ourselves. The heart attack you may get, will be your heart attack. The stroke that may get, will be your stroke and your paralysis. The diabetes and its complications, like blindness and renal failure, will be your complications.

No one, not your doctor or your family members will feel the discomfort, anxiety and uncertainty that occurs if and when you happen to suffer from such a life changing event. I sometimes wish patients could see out through my eyes, or through the eyes of your own doctor. You would see patients that did not care or bother to follow medical suggestions.

Patients who continued to eat too many of the wrong foods, continued smoking and chose not to do any physical activity or exercise. Patients who now are trying to re-learn the use of their speech and their limbs in rehabilitation centers or being left debilitated, and paralyzed in a nursing home, bed bound all day long. This is no life, but it is the current reality of many who never imagined this possibility while being given friendly advice.

Most of us have the opportunity to take control of our own health, but we become comfortable, complacent and satisfied with our lives and think that something so tragic can never happen to us.

Twenty minutes of daily exercise can control, improve and may prevent:

High blood pressure / insulin resistance / diabetes / cholesterol / osteoporosis / weak heart muscle / angina / stroke / coronary artery disease / arterial inflammation / obesity / sleep apnea / improves memory / slows dementia / reduce the number of medications needed and many others.

The only people who really cannot exercise are those confined to wheelchairs or with advanced neurological disorders. Everyone else can do a variety of different kinds of exercises but many choose to look for excuses instead.

Prevention

The continued increases in the costs associated with the treatment of diseases, is changing the way medicine is practiced. We are moving away from the treatment of disease, to one that has formed a basic principal of traditional medicine, which is in maintaining health and wellness by preventing disease.

Since its inception in the early '1960s, the federal government and private health insurers companies were established to cover the costs of medical diagnosis and the treatment of disease. A person lived their lives and received medications and treatments when sick or ill. Many developed chronic diseases and some, complications of the disease.

It is in this way, treating chronic diseases and their complications, that we have been using the lion's share of our limited health care resources. Healthcare resources used at a time when it is most expensive and difficult to treat and reverse the disease, because of the damage already done.

Congestive heart failure, bronchitis/emphysema (COPD), pneumonias, and kidney failure are the most common diagnoses that patients are admitted to the hospital with.

All are chronic conditions that can be prevented.

As mentioned at the beginning of this reading, the most common chronic diseases, which uses up the largest portion of our limited healthcare resources, are conditions that are reversible and subject to prevention.

Each patient is an individual.

Another change to the practice of medicine has to do with recognizing each patient as a unique individual.

An understanding that is not new, but that has been clouded and lost during the last decades. I remember that during my medical training, emphasis was made on recognizing that although patients may have the same medical condition, each of them required individualized care. This is due to individual differences such as: age, sex, weight, liver and kidney function as well as genetic, metabolic and physiological make up, all that vary from one person to the next.

We were taught to always take into account each persons individuality, uniqueness and needs, when formulating a medical management plan. Something that has been lost in the U.S., where everyone is treated equally, based on a series of regulations and guidelines.

Academic physicians and researchers formulate these guideline and in essence control how we practice medicine in the U.S. They then complain about the rising medical costs and often blame doctors themselves, while they continue making generalized management guidelines that apply to all, without taking into consideration the importance of individualizing treatment.

An antiquated practice, but one that is being called into questioned today.

Prevention and individualizing care, a simple combination that should improve the quality of health for many.

The development of health care centered around the person and care that takes into account the particular needs of each individual including biological, psychological, spiritual, social and economic, are key factors that are part of well-being, and healing.

As your healthcare provider, this is the commitment we make to you, our patients. We will work together to try to keep you well and healthy, through routine checkups, counseling and education. We will address any and all concerns you have to the best of our ability. We are interested only in your wellbeing.

In return all we ask is that you recognize the importance of your diet, nutrition and daily exercise.

Several additional thoughts

A. Participate in your own care.

Don't wait to have a health scare to then start making healthy lifestyle choices.

As a physician, we often have patients who upon taking their history, have no clue as to why they are being seen by the doctor. No knowledge of their medical conditions, surgeries or medications. Patients that give the impression that they have no desire to even be at their appointment.

This is very sad but is more common than one might think. It also indication of a type of patient who is more likely to not follow medical advice, take their medicines, or be involved or even care about their own health and health care.

It may be indifference, boredom, or due to states of depression, but whatever the reason, it is an attitude that is not beneficial for the patient or anyone who depends on our healthcare system.

Your appointment with your primary care physician, provider or specialist is the time and opportunity to talk with them to discuss any of your health concerns. It should be the opportunity to begin an extended, open dialogue.

Each person will have different concerns or questions about their health or illness. People who are more informed, who study, read about and are familiar with their medical conditions and then use the time with the doctor to ask questions, are those who tend to stay healthier and require less medicines.

Most doctors are happy to explain and help educate our patients. Many patients forget that one of the main roles of the doctor, is to teach the patient, and not just to prescribe medicines.

Ask.

Get comfortable, feel at ease and start that dialogue. Should your doctor not enjoy or have the time to answer your questions, choose another who will. Helpful doctors do exist and are the rule, not the exception.

(Continues...)

Excerpted from IMPORTANT INFORMATION REGARDING YOUR HEALTHby Jorge Bordenave Copyright © 2011 by Jorge Bordenave. Excerpted by permission of Balboa Press. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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