Ageism is Center Stage in Local Show

We were poised for an enjoyable evening of light, live theatre. Prior to the show a couple emerged from the aisle and into a spotlight. They were young actors, costumed to look old and clownish. They proceeded to do a short skit intended to encourage season ticket subscriptions and donations to a building fund. Their characters were hard of hearing (lots of shouting and repetition), forgetful and full-on stereotypes of the elder set. Do I have to tell you that I didn’t find the skit amusing?

Below are excerpts from an email I sent to Buck Busfield, Bill Blake and select members of their board:

 "...  The satirical portrayal of the "old people" ... really has no place in a culture in which more than 10,000 people are turning 65 every day.  I carefully checked out the audience and there were, perhaps, six people under the age of 50. This demographic commands almost 77% of the nation's wealth. It's rich in wisdom, experience and generosity.

 

... I readily admit that most people are accustomed to ageist humor and will laugh, thinking "you have to have a sense of humor." But, like other humor that comes at the expense of an entire class (or race, religion, etc.) of people, it is really not funny. Older people are accustomed to silently accepting derisive humor. However, once someone points out such 'jokes' are really not appropriate and certainly not respectful, they think further and mostly agree. Indeed, older people may be their own worse enemy. But, as baby boomers rise in numbers and prominence I am confident this will change. 

 ... I am also sure the talent at the B Street Theatre is up to the task of creating scenes that are sharp, funny and thoughtful. The piece I saw ...  was none of the aforementioned. I hope you choose to seriously consider this input and think about it. It is one thing for those of us in our age group to laugh about our foibles, but quite something else for young people to make fun of us. ...

 Consider this - there were many decades in which we felt perfectly fine with satirizing Jews, Japanese, Chinese, Blacks, and others - we are still struggling with gay! Once we realize it's not "okay" and not funny, we stop. Really, one of my first thoughts when the skit ended was, "How would we be reacting had this been done in black-face." 

... You've greatly benefited Sacramento and we wish you well. I hope you take this input seriously, in the spirit intended. ...

Darby Patterson"

Two weeks later I receive this from Mr. Busfield (only after I shoot out a second email):

 “Should have given you a one sentence response like, ‘I’ll get to this soon’ but got busy. ... We do take all notes seriously, and frequently make changes as a result.

In short, the skit definitely, without doubt, creates caricatures of the elderly. But in this case, I am okay with it ...   I do apologize, however, that the skit offends your sensibilities...”

 Buck Busfield, Producing Managing Director”

How inadequate and dismissive! Serious consideration of my concern (one shared by the many people I’ve consulted about this) would have led to a far better outcome for the theatre that is in the midst of a capital campaign.

Tolerance for this kind of attitude is what kept us mired in decades of racial, ethnic and gender slurs. It’s my hope that others will let the B Street Theatre (and its sponsors) know that elders should not be the subject of thoughtless humor that ridicules and stereotypes.

For Baby Boomers and those who led the way to healthy and productive longevity, it’s a matter of self respect that we make our disapproval known and withdraw support of entities that choose to insult and demean us.

UCD Doc walks Road Less Traveled

Dr. McCloud talks with a
Mini-Med student

Dr. Michael McCloud is a member of a very exclusive club, a club he wishes was much larger and more diverse. He is one of a small number of board certified geriatricians in Northern California, a medical specialty that’s desperately needed, but nonetheless, a rarity. 

Dr. McCloud is a clinical professor of medicine with the UC Davis Health System, Department of Internal Medicine, and founder of Aging and Medical Science: A Mini Medical School to Prepare for Life's Second Half, the annual community program that features in-depth weekly seminars to educate people about health and the aging process. There is no charge for the program which is taught by a team of eminent physicians and health educators who volunteer their time and expertise. Now in its 10th year, Mini Med School has become so popular that reservations for the 500 seats are filled six months in advance with a waiting list at least as large.

Medical Facts, Peppered with Fun

 

Central to the success of the program is Dr. McCloud whose sharp sense of humor and engaging personality provide a counterpoint to serious medical talks about cardiology, gastroenterology, medications, neurology and other weighty topics. That said, Dr. McCloud makes sure some serious fun is part of the curriculum with an occasional dancing doctor and a very popular session on the bounteous benefits of beer.



Dr. McCloud watches
as 2012 class gets
set to graduate

With the avalanche of baby boomers looking forward to creating healthy and active older years, expertise in geriatric medicine will be in high demand. However, as a medical specialty it has not been a popular choice. For every one geriatrician graduated, there are nine cardiologists entering practice. For every 8,000 people in California, there is one geriatrician. Why then, did Michael McCloud, a graduate of Duke University, choose the road less traveled? It was actually a detour.

 “I had a private general internal medicine practice in San Francisco for 15 years and thoroughly enjoyed it,” he explains. “Because I did a lot of house calls and nursing home calls, my practice base gradually became older than most primary care practices. And, I did enjoy the patient population a great deal.”

Consequently, when he had the opportunity, he completed a geriatric specialty at Duke and Yale universities, planting the seeds for his distinguished career in the Sacramento region. The choice has further enriched Dr. McCloud’s appreciation for the gifts that only come with time.

“The patients are far more interesting and enjoyable than younger patients,” says Dr. McCloud. “There is a saying in geriatrics - ‘If you've seen one 80-year-old, you've seen one 80-year-old.’  They are such textured fabrics. I never, ever have a boring day.”

Healthy Senior is “Work of Art”

In an era characterized by eight-minute, impersonal visits with our family physicians, Dr. McCloud’s approach is a welcome anachronism. Older patients inspire a different approach to health care. “Geriatrics also allows me to practice truly holistic medicine. We are really treating people and not diseases,” he says. “I tell my medical students and residents that geriatrics is the mostly highly remunerated of all medical specialties. It's just not remunerated in money, but something far better.”

It’s an unfortunate reality that aging in America is often seen as a time of physical and mental decline when, in fact, science and medicine prove that both body and mind are capable of robust health into very old age - if we pay attention and follow “doctor’s orders.”

“The positive of aging, to me, is that we have a great deal of control over the outcome, if we only invest the time and interest,” advises Dr. McCloud. “I think of a newborn child as a gift of nature, a healthy young adult as a product of good genes and good parenting. The healthy senior is a work of art.”



Wearing cap and gown, Dr. McCloud
congratulates class of 2012

Prescribing Lifelong Health Education

Mini Medical School is a resource for learning how to control the medical and emotional variables in the aging process. But, since there is but one program a year - and one that’s subject to space limitations, it’s incumbent on today’s baby boomers (and people who want to one day enjoy advanced age) to engage in lifelong learning. Dr. McCloud, naturally, agrees and says “Improve your healthcare literacy, and the rest will fall into line.”

Baby boomers are fortunate to be full members of the digital era - meaning that we have free educational resources at our fingertips. Online information about healthy aging is very accessible from prestigious institutions such as Harvard, Yale, the Mayo Clinic, the National Institute of Heath and scores of credible nonprofits and research hubs.  It’s simply a matter of using our mature judgment in sifting the Internet hype from trustworthy sources.

Of course, we could always hope the Mini Medical School model proliferates and is someday able to serve many more “returning” students, although even Dr. McCloud admits that we need deeper understanding and ownership of our personal aging process. 

“The reality is, of course, that we don't actually teach what individuals need to know to age successfully.  We only give a sampler platter to taste what they need to know, and the enthusiasm to want to learn more,” he says, adding that Mini Med School holds value for people from all walks of life.“ I have now moderated 65 consecutive classes. If I weren't the course director and host, I would probably be sitting in the classroom.”

If he ever does enjoy the role of a student, there’s a good chance he will have contributed even more to our knowledge of what it means to grow older. “I actually keep a diary of some of my patient's reflections, wisdom and humor,” says Dr. McCloud. “A book is on my bucket list, but for now I am selfishly hoarding the wisdom.” 

Whole Body Scan ... or Scam?

He certainly looks trustworthy, but how about the
'breakthrough' technology he's hawking?

Mondays are “Med Days” in our daily paper. Large advertisements devoted to fast, relatively affordable, noninvasive testing of body parts - from heart to whole body - invite us to explore the inner sanctums of physiology in the hope of turning up “nothing” or perhaps finding something early enough to get treatment that avoids disability or death. Who hasn’t wondered and been tempted?

Our final UCDMini-Med School  seminar focused on the technology used in scanning machines, the accuracy of such testing and, importantly, the impact results can have upon the individual tested. Dr. Richard Kravitz  is a professor of Medicine at UC Davis Medical school who is highly published and focuses on the doctor-patient relationship. His advice about jumping into this new arena of discovery? “Maybe not,” he says.

And, here’s why. In general, there are some assumptions made about the publicly available technology that are simply wrong. For example, patients tend to trust technology and most medical personnel in a white coat and, thus, the results of testing. But, studies now show that the accuracy of such scanning tests is questionable. There is a significant percentage of false-positives as well as tagging disease free people incorrectly. “It’s quite common in the real world,” the Doctor said. “No test is perfect.”

 There is also a belief that early detection leads to better outcomes. However, in the case of prostate cancer in which some abnormal cells never become life threatening, the discovery of benign cells can send a patient on a long, painful and costly journey of further medical testing - tests and medications that carry their own set of health risks.

Father of Mini-Med School, Dr. Michael McCloud agrees. “…whole body CT scans can indeed hurt you. That is the very frequent finding of an "incidentaloma" -- a little lump or funny shadow on this or that organ. These very commonly lead to additional, sometimes invasive tests, not to mention angst and expense,” the geriatrician writes in an email. “In most case, they prove to be benign anomalies.”

And, the scans have varying reliability for different parts of the body. Dr. Kravitz reported that whole body CT scans are fairly effective for certain ovarian cancers but don’t have a good record for detecting liver cancers. They are “okay” for lung cancer but not so good at showing coronary artery disease. Those of us checking out the ads in the paper have no way of knowing these variations when slapping down the credit card for a whole body scan.

Then, there is the technology itself. I’d heard some information that CT scans did emit high radiation. But, I thought a momentary zap of radioactivity once in a lifetime was no big deal. After all, the procedure is FDA approved , right? Dr. Kravits set my thinking straight. The radiation delivered during a body scan is “close to the range of exposure” that survivors of the nuclear bomb dropped on Hiroshima received. Whew! Compare that to exposure from an ordinary chest Xray which is equivalent to a couple of days outdoors. A CT scan of the abdomen racks up 400 days of the same exposure to the sun’s radiation.

If that information alone isn’t disincentive enough, there’s something Dr. Kravitz calls “the cascade effect” and Dr. McCLoud referred to earlier as “incidentaloma.”  Seeing potential trouble spots can put a patient on an emotional roller coaster and even bring on a host of new medical problems. Remember, the results could be false-positive or a minor blip that will never turn onto a major disease.

The U.S. spends $8,000 per person on health care, the Doc said. This is much more than any other industrialized country. “It doesn’t show a benefit. It actually produces lower quality care, not higher,” he concluded. Unnecessary testing accounts for a significant chunk of these costs and, with such widely available scanning tests available and being aggressively marketed, that figure is bound to rise as the quality of care falls.

How to proceed when considering tests? Dr. Kravits pointed out the decision

should not be made lightly. He advises talking to our personal doctors first, thinking about what we’d do differently depending on test results and considering what the downstream affects might mean in our lives. Ask “Am I prepared to take on the risks of a false positive”.

To this I will add my own caveat - any time I see a full page ad for a medical miracle - be it a full body scan, a magical back treatment, a weight loss breakthrough or any such quick fix, I hit the “caution” button. I figure the cost of the weekly ad, fly to the Internet and do some serious homework and always apply the old adage “if it sounds too good to be true, it probably is”.

 

Note: We are not done blogging about the important lessons of MMS. More to come next week!

Like Falling in Love - It’s Never Too Late to Exercise

Dr. Calvin Hirsch, a dignified physician of a certain age, started his Mini-Medical School  lecture by dropping to the floor and pumping out a dozen push ups. Appropriately, Dr. Hirsch, professor of Clinical Internal Medicine at UCD medical Health Center, spoke to our class of 500 eager ‘returning’ students about exercise.

Prevent Disease, live longer? Yes!

Charles King and Kim Rhinehelder pay rapt attention at
Mini-Med School. Kim is VP of Philanthropy
with the Eskaton Foundation in Sacramento.

His handout began with the title to a Johns Hopkins article on health after 50 - “Exercise: the universal antidote for Aging.” Indeed, there is a substantial body of evidence that shows exercise is very effective in preventing or ameliorating a host of diseases and conditions that tend to accompany the aging process. On that growing list is heart disease, diabetes, arthritis, cognition and cancers. Nonetheless, so many of us over the age of 50 refuse to become active and take the evidence to heart by making exercise a regular life style practice. According to Dr. Hirsch, the percentage of people in this age range who exercise has fallen in recent years, rather than rising  through increased awareness of the many benefits. Go figure.

Our excuses are many: not interested, no time, exercise is not going to help, it’s too painful, not safe, and embarrassment over going to a gym. I have to admit this last excuse has plagued me - all those spandex-covered young bodies make me want to run for the Senior center! However, there are plenty of alternatives in both the environment for exercising, as well as the style we choose.

An Easy Pill to Swallow

Dr. Hirsch quickly pointed out that exercise does not have to be a formal practice that takes us away from daily life. In addition, all we really need to get health benefits is about one-half hour a day - which can be done in 10 minute segments of vigorous movement. So, think about using the vacuum cleaner for both weight resistance as well as aerobics, or climbing stairs with purpose that exercises the quadriceps (top of the thigh of the leg) - critical to getting up from a chair or climbing stairs. By thinking creatively and taking advantage of opportunities, we can reach that 30-minute daily goal. (One of my practices is to always refuse help with my groceries and, if I am carrying bags, do arm lifts on my way to the car).

 The Doc cited several studies showing that even people with some debilitating conditions that can cause pain and immobility can benefit from the right kinds of exercise. Supervised programs offered in many senior centers can be the ticket to extra added years of life that are not ruled by disability.

The exercise prescription is strongly supported by my friend who recently celebrated her 90th birthday. (She hired a professional ballroom dancer for her party because she still can’t stand to dance with a rookie). Exercise is her mantra - daily stretching, balance and weight resistance. There are many people half her age who cannot keep up with dynamic woman who will remain anonymous because I value my life.

Interestingly, according to Dr. Hirsh, is that the biggest gain for years of life and continued health is in people over the age of 75 who adopt an exercise routine. There’s truth in the adage, “It’s never too late.”

Choose Your Flavor

What kinds of exercise can we do to promote health and longevity? Unless we are training for the Senior Olympics or trying to impress a potential mate who is inappropriately young for us, the choices are simple, accessible and affordable. For great aerobic benefits we can walk - vigorously so that the heart rate rises and there’s a bit of sweat involved. Same for biking, swimming and dancing.  Walking, however, has the added plus of spying on neighbors for garden do’s and don’t’s and decorating faux pas.

 A person doesn’t have to have a history of being a fitness nut to start at any age and get some gains. Being devoted Mimi-Med students we were pleased to learn that Sarcopenia is reversible, even at later age. (Sorry about the jargon - that’s muscle loss for people who missed Mini-Med School).

Balance training is clearly an important element of the after 50 workout. Falls account for 66% of accidental deaths in older adults, according to fall prevention specialists. Try yoga or the gentler forms of Pilates to enhance balance. In addition, dance lessons, Tai Chi and informal opportunities (like standing on one leg) are also helpful practices.

 For simple maintenance that can have significant payoffs in health and longevity, the prescription is not a bitter pill. Dr. Hirsch says walking just 28 blocks a week will positively impact health. In general, about 2.5 hours a week of exercise is a good minimum to shoot for, and remember, it doesn’t have to be performed in hour-long segments or at a gym. For best effect combine aerobic activity with some weight resistance and stretching to keep the body flexible.

I was very pleased to hear Dr. Hirsh validate my personal practice of grabbing opportunities where I find them - the grocery store, climbing stairs, doing household chores and enhancing vapid TV time by stretching muscles and rotating joints while flipping through channels.

The usual caveat - don’t do things without your physician’s advice And, before jumping into my “casual” exercise opportunities learn how to bend, lift and stretch properly from a trained professional (Yes, I did do this).

Here’s a link to lots of exercise opportunities for older adults in the Sacramento Region - there are similar resources in most communities: EXERCISE

 

Exercise for Seniors: Benefits,Risks, and How To Begin

Calvin H. Hirsch, M.D

Heart Felt Class for Heart Health

Dr. Michael McCloud chats with students before
launching Week 4 of Mini Med School

There is no wonder that UC Davis School of Medicine has a world class reputation. Last weekend’s presentations at the 2012 Mini-Medical School clearly demonstrated the university at the cutting edge of medical science and education through communication.  Cardiologist Dr. Jeffrey A. Southard taught in one short hour what many people wait a lifetime to learn – the essentials about heart health and disease, and how to smartly manage our own fate as we age. And, as a real bonus, a prelude of what the UCD Med Center team will deliver in  groundbreaking procedures this week.

Hard Working Heart

Think, for a moment, about the job done by the heart. It beats every second of every day throughout our lives. It doesn’t take time off, or rest up after an injury or heal a broken valve before going back to work.  It just keeps on beating and pumping and making life possible.  Dr. Southard suggested we think about the heart as if it is a house – with plumbing (flow and pipes and valves that open and shut), an electrical system that fires impulses to keep the beat steady and rooms, or chambers, where constant work is happening in concert with the whole-house system.

Considering the vital and continuous demand on the human heart it’s not surprising that it breaks, fails and fibrillates. Think heart attack, coronary disease, atrial fibrillation, congestive heart failure, etc.  But, Dr. Southard says his aim is to keep the heart healthy and avoid acceleration of diseases that can, and often do, land people on a surgeon’s table and, in the extreme, a morgue.  

Some of the common causes of heart disease?  Chief among them are smoking, high blood pressure, high cholesterol, diabetes and genetics.  First line of defense? Exercise, thoughtful eating and drinking, and quitting smoking – very logical preventions but apparently a daunting prescription for Americans. Heart disease is the nation’s number one killer – accounting for more deaths than all cancers combined.

The Aging Heart

The most prevalent heart conditions include Coronary Heart Disease  – a narrowing or blocking in the plumbing that leads to the heart. Plaque, frequently formed because of high cholesterol intake, builds up on the walls of the arteries to the heart. This constricts blood flow and the heart may no longer be pumping adequate blood through the narrowed channels of the arteries.  The preventative or prescription? Diet and exercise. According to Dr. Southard, these two practices are fundamental and necessary. “It is the mainstay of therapy for your entire health,” he told the class.

We don’t want to hear this, but the prevalence of heart disease rises significantly as we age. Therefore, it’s logical that attention to diet and exercise should receive equal increased attention in the second-half of life. Unfortunately, we’ve come to equate “retirement” and later years as a period of well earned inactivity, while people a third of our age are sweating at the gym. Heart disease can and does affect longevity. The Doc reports that most people who make it past the age of 80 or so have not had heart failure along the way.

Remedies and Repairs

Conditions to be aware of include Coronary Artery Disease (mentioned above), Congestive Heart Failure (the heart doesn’t pump enough blood to the body and brain), Atrial Fibrillation (irregular heartbeat that ranges from mild to dangerous) and Valvular Heart Disease (traced to damage of one of the four heart valves). Heart disease, particularly Atrial Fibrillation, can also prompt a stroke.

How we handle any of these conditions varies according to the severity of damage and disease. When a heart ailment has taken hold, repairs can range from the placement of stents – tiny devices that are implanted in heart arteries to keep them open – to open heart surgery. There was an audible groan in the class when Dr. Southard said 60 percent of heart attacks happen in the population over the age of 65. Then, a measure of relief when he added that the best outcomes are also in this same demographic.

New Procedures Hold Promise for Older Patients

In some cases, heart patients are not good candidates for tried and true surgeries. In this arena, UC Davis is a national leader in using the Edwards Sapien TranscatheterHeart Valve to repair damage and increase longevity for qualified candidates. This procedure has been used in more than 60,000 cases worldwide and shown to reduce mortality by half. It is fast, does not require surgery or long recovery. The procedure was only recently approved in the U.S., but fully implemented in Canada and elsewhere. Our lagging behind is due to the political nature of FDA approvals and America’s litigious penchant. Dr. Southard said other countries have eliminated these objections by capping ‘damages’ and cutting political red tape.

Physicians are also leveraging the power of stem cell therapy. Stem cells taken from adult bone marrow (and other parts of the body) can regenerate in targeted organs. Dr. Southard and his colleagues are focused on the potential of such stem cells to treat heart disease without surgery. Patients receiving this cutting edge treatment will be followed for two years and assessed along the way. UC Davis has a state of the art facility at its Institute for Regenerative Cures in Sacramento.

After arming students with information and warnings, Dr. Southard offered his heart healthy rules. “If it tastes good, leave it alone,” he joked (I think). “Eat healthy, exercise, have portion limitation, control your blood pressure, don’t smoke, visit your primary care doctor and avoid seeing me.”

Note: If you want to comment and can’t, EMAIL ME and I’ll post your comment here.

Love Your Liver for Longer Life

Eager Mini-Med students ready for Saturday class

I regret to report that I am not qualified to summarize the recent Mini-Med School  session on the skin. To do that, I’d need at least six years of medical school (rather than my current 18 weeks) and a library of forensic photos of skin lesions (I prefer more nonrepresentational art). The lecture focused on what can happen to the skin as we age, occasionally using our face as a canvas for spots, growths, tags and other unpleasant additions to once-youthful skin. The morphology is far too complex for this blogger’s brain but let me summarize in two succinct points:1. Aways wear sunblock (sun is the major factor in aging skin) 2. Pay attention to anything on your skin that changes with time or worries you and see your doctor about it (skin cancers can and do sneak up without warning).

On to a body part that’s more digestible (sorry) - the liver.  Christopher Bowlus, MD and professor of gastroenterology and hepatology, introduced his lecture by saying he’d talk about “digestive issues after the age of 50 ... which, actually, is most of them.” Ah, yet another portend of the aging process.

A Hernia Where?
The malady of GERD (Gastroesophageal Reflux Disease ) came up first (please notice the paltry pun here) and drew rapt attention as GERD is fairly common - and mostly just annoying, but can grow to be a dangerous condition leading to cancer of the esophagus. GERD develops when acid from the stomach moves up and into the esophagus because the esophageal sphincter no longer prevents this action. A hiatal hernia can be the cause. The sphincter opens and closes to keep acid from traveling up (much like another such muscle keeps other matter from traveling down at will). This acid causes burning, pressure, discomfort and can get bad enough to feel like a heart attack, reports Dr. Bowlus. “I sent my own dad to the emergency with heartburn.”

A hiatal hernia  is not uncommon and can be diagnosed with an endoscopy. Treatments range from taking over-the-counter acid suppressants like Zantac or Prilosec, or simple Tums or Mylanta. However, when such band aids don’t work it’s important to look more closely at what’s happening. If the lining of the esophagus has changed and has the look of the structure of the stomach, this could indicate a precancerous or cancerous condition.

GERD happens to men more than to women and predominantly to white men. There’s a rise in esophageal cancers that’s being traced to this nation’s obesity epidemic. Risk factors include being a white male over the age of 50 and overweight.  (There were lots of sideways glances from women to their male partners during this lecture.)

Baby Boomers Face Increased Risk
Dr. Bowlus also talked about liver health and disease - he says he considers the liver the most fascinating organ in the body. Go figure. Liver disease is the 10th leading cause of death among men and the 12th in women. A scary characteristic about the disease is that symptoms often don’t appear until it is, literally, too late. The risk rises significantly between the ages of 45 and 54. Most common causes are alcohol, chronic hepatitis, the use of certain medications and the growing incidence of fatty liver disease. 

A safe level of alcohol (4 ounce servings) for most women is 1 drink a day and for men, it’s about 2 per day, according to many studies.  The Doc clearly announced that no, you may not save up your drinks and enjoy them all over the weekend.  Studies show about 20% of alcoholics will develop liver disease such as hepatitus, and many other diseases are associated with alcohol consumption.

Hepatitis B is a chronic infection that, in Asia and Africa are transmitted at birth, is the leading cause of death in Asia and greatly impacts immigrants to the U.S. from those countries.

Hepatitis C is more prevalent in the U.S., and traced to sharing needles, getting tattoos and, prior to1992, blood transfusions. Baby boomers beware! According to a recent study our generation is at pretty high risk. Dr. John Ward of the Centers for Disease Control calls it “a silent epidemic.” The recent CDC report predicts that one of every 3 baby boomers “is living with hepatitis C infection.”

The Big, Bad ‘C’

Colon cancer topped off the Doctor’s list of gastroenterological threats. The 3rd most common cause of death in men and 2nd in women, the occurrence dramatically increases after the age of 50. Risk factors include smoking, alcohol use, obesity and family medical history. Stool-based screening tests that we are advised to get annually after the 50th birthday may reveal small amounts of blood. Since cancers bleed, this would be an indication a closer look is needed. Unfortunately, a closer look most often means a colonoscopy or a similarly “uncomfortable” procedure.

Being exceptionally bright mini-medical students we all could extrapolate what “uncomfortable” actually means. I am stunned that, in the digital era, in a time when CERN physicists are dabbling with atoms traveling faster than the speed of light and neuro-imaging scientists are essentially able to ‘read’ a mind, our scientific genius can’t devise a less “uncomfortable” procedure to examine the colon. Nonetheless, very recent studies in the New England Journal of Medicine affirms the procedure is highly effective and critical to saving lives.

Week four of UCD’s Mini Medical School, orchestrated by the Department of Internal medicine and Dr. Michael McCloud, takes a close look at medications (I think we take too many) and the heart (we all need just one in good working order).

COMMENTS
From Mollie:

One of the networks was telling the children of the elderly when they should take away their parents cars.I think that should be up to Motor V. They also were talking  about how many accidents the elderly have. I thought why don't you look at sixteen year olds and how many accidents THEY have... This is one reason we need to fight ageism unless we want

some one else telling us what to do.

> 

Mini Med School Brief #2

Hospital to Home - A Winding Road




Dr. Michael McCloud opens the class

Week 2 of UCD’s Mini-Medical School focused on a topic that most of us would rather ignore until necessity bares its teeth and makes us pay attention. Deborah Bakerjian,PhD, RN concisely outlined the continuum of care that we - or a loved one - may experience during and after a hospital stay. Lacking knowledge of the health care system, any one of us can be drawn into a labyrinth that rivals the London Underground overlaid with a street map of the infamously complicated city. In the case of health care, it’s not only easy to get lost, it’s also dangerous. So, like my fellow undergrads, I Iistened up!

Bakerjian, an assistant adjunct professor at the Betty Irene Moore School of Nursing at UC Davis, advised us: “You are a member of the health care team and you are the center. The more empowered you are, the better the outcomes.” The time to assume that role is now, when we’re well and determined to stay that way!

 
Some Smart Moves

Step one, she says, is to designate a personal advocate - someone familiar with your medical history and your intentions regarding the level of life saving care you expect. After all, when we are admitted to a hospital we may not be in the best mental and physical condition - think stroke, heart attack, unconsciousness. The advocate will have access to your health records, know your wishes and be able to help guide your care when you are not at the top of your game.

 

The California Patients Bill of Rights has an online form that makes it easy to designate an advocate in writing and prepare other documents such as a POLST (Physicians Orders for Life Sustaining Treatment) , a Durable Power of Attorney and an Advanced Directive that specifies the level of care you want and do not want. These documents, when signed by a Notary Public, are legal and enforceable. You can find out more about the benefits of this kind of planning ahead by reading an inspiring story about a Sacramento woman’s advanced planning, by by Sacramento Bee writer Anita Creamer.

 Follow the Roaming Records?

But, it’s not just emergency and end-of-life decisions that call for an advocate. That responsible friend can also help guide your journey back to health. As an expert in the process, Bakerjian admits that, as patients move through the system from hospitalization to after-care, there are ample opportunities for information to go astray.  Consider that a person may have seen more than one team in an ambulance, the emergency room, another in surgery, intensive care, and a hospital recovery room. Each will have sets of records as will an individual’s personal physician; it’s easy to grasp the concept of many moving parts that don’t necessarily fully mesh with each other. In addition, an emergency may have taken a patient to a hospital not in their insurance network - necessitating a transfer. Bakerjian pointed out that although electronic medical records are the ideal solution for such cases, they are not yet reality. Most often, your records and history cannot be immediately shared between all hospitals.

 
“Every time we move we are vulnerable,” Bakerjian  says.
 

Speeding Recovery

Upon release from a hospital, a patient may be sent to a skilled nursing facility (a SNF). The advocate can help select which facility would best suit the patient - and research the quality of facilities www.nuringhomecompare.gov before making that choice. Considerations include staffing level, the results of health inspections, complaints and deficiencies noted in inspections. It’s also important to know that SNF’s are not required to have a physician on site. Most skilled nursing facilities are not like a hospital with doctors, RNs and LVNs readily available. Bakerjian lauds the growing use of Nurse Practitioners in SNFs because their presence shows improved health outcomes for patients. An  advocate can monitor medical visits and intervene if necessary. That said, Bakerjian pointed out that SNFs are the nation’s second-most regulated industry, just behind nuclear power. Nonetheless, caution and research are advised.

 

Learning without Experience often Necessary

Health events requiring hospitalization, rehabilitation and skilled nursing care are, thankfully, not a commonly repeated experience for most people. However, this lack of experience can create ignorance that’s dangerous. Health records with allergies listed, medications taken, past health history and Advance Directives can help mitigate the chance of information getting lost or not communicated from one entity to the next.  Having those documents accessible and available to a health advocate is critical. Understanding these vulnerabilities in the system is important according to Bakerjian. She freely admits that records from hospitals are “often incomplete,” that emergency department treatment can be “missing,” lists of medications “may be inaccurate” and other balls in the healthcare court can go astray.

 The take-away from week 2 of Mini Med School, a free community service created by UCD Department of Internal Medicine geriatrician Dr. Michael McCloud? Just buckle down and take care of business! Complete legal paperwork that can protect you and guide your personal care according to your wishes, and make some trusted person your advocate. Then, relax and do something fun like bungee jumping or sky diving without worrying about those troublesome, what-if details!

 Next week we learn about skin. Stay tuned and perhaps I’ll be able to pass along some miracle cream, eye lift serum, age spot remover or, at least, a better attitude through understanding of the body’s biological concept of “face time”.