Being an Informed Consumer - Question Everything

Today's topic is a little heavier than I usually do on the blog, but it's something I feel passionately about and don't get the chance to write about often.

Let's talk about being an informed healthcare consumer.

So often, we go to the doctor and we enter this role of patient — vulnerable, inexperienced — where we defer to the opinion of someone more knowledgeable. It can be tough to ask questions. I have had instances where I was made to feel as though I was out of line for asking "why."

My doctor visits are no longer a $20 co-pay. I have to ask questions, if only to know whether I will be able to pay the bill. I have an $11,000 family deductible. My monthly premiums are not insignificant either. Anything not considered preventive care, falls under the deductible, meaning I have to pay it out of pocket.

Given these expenses, I feel I am a consumer as well as a patient. I need to shop for services, determine what provider I like, and question the value I get for my money.

Overuse in healthcare

Too often, doctors order unnecessary tests and scans just to be safe. As patients, we feel we need to be sure that everything is clear, even though a test is likely to provide no added value.

When my dad was undergoing treatment for stroke, he received repeated tests and imaging scans, most often showing nothing. While I won't say they were useless — we learned what was not happening — they didn't always add value to his care. Even more concerning, the various specialists recommending all these tests didn't seem to be speaking to one another at all.

In a recent article for The New Yorker, Atul Gawande wrote "Virtually every family in the country, the research indicates, has been subject to overtesting and overtreatment in one form or another. The costs appear to take thousands of dollars out of the paychecks of every household each year."

Question everything

This problem isn't all on the doctor's shoulders. Sometimes the patient asks for unnecessary treatment. That's where I think we need to consider ourselves consumers as well. Healthcare is essential, but it is also a business. As consumers, we deserve maximum value for our money. We need to ask questions, even for simple office visits.

I took my daughter to the doctor one year because she had symptoms of strep. The PA wasn't positive if it was strep and suggested we go to the lab for a culture. I asked whether the results would change her treatment choice. She said no, and we skipped the lab. That's a simple example, and it probably saved more time than money, but I was already spending $75 for the visit, plus the prescription cost. I didn't find value in knowing the result.

Questions to ask

Bigger problems require bigger conversations with your doctor, but for routine visits, there are a few questions you can ask that may save you time and money:

Photo by Jorgejesus4 via Wikimedia Commons

1. What is the test for? What will the results tell me?
2. What does the test/treatment cost? And what does my insurance cover?
3. What is my diagnosis?
4. Will the result of this test change your treatment recommendation?
5. What are the risks vs. benefits, including cost, of this treatment/test?

In this new era of higher cost-sharing, we are more responsible for our care than ever. Unnecessary care can have much more harmful results than overspending, and I encourage you to read the article linked above.

It's important that we become informed consumers to save ourselves unnecessary heartache and expense.

What questions would you add to this list?

An Anniversary Tribute

Today is the one year anniversary of my dad's death. I could write a sentimental post about how I miss him every day, but that goes without saying. And I don't do well with sentimental. Instead, I'd like to dedicate this post to hospice, which was invaluable to my family during my dad's long struggle after stroke.

What is hospice?

Hospice care is too often under-appreciated and underused. It is supportive care given to people nearing the end of life. Hospice focuses on comfort and quality of life -- respecting the patient's final wishes -- not on cure.

For some people, hospice allows them to stay at home, surrounded by family, friends, and pets, rather than in a hospital bed. Hospice can also be provided at hospitals and in freestanding hospice houses.

The medical professionals, counselors, staff and volunteers who work for hospice organizations are amazing people. They make a difficult time far more bearable by their dedication and compassion.

Serving families

After the stroke, my dad was paralyzed on one side, leaving him unable to do many daily activities. He spent time in inpatient rehabilitation and then three months in a rehabilitation center, which was much like a nursing home. Then he came home, and my mom cared for him.

For the first year after stroke, he was in and out of the hospital. Frequent trips to the ER for infections or unknown pains led to scans, tests, and more medications - not to mention huge bills. Being in and out of the hospital also caused my mom to get sick more often as well.

Eventually, my dad said no more hospitals. That's when they sought out hospice and palliative care specialists. The nurses and staff worked with my parents to help minimize medications to only the essentials and gave them tools to help manage pain. They had options other than the ER, and the caregivers helped lessen the fear of my dad's situation, which held a lot of unknowns.

My dad spent up to five days at the Tucker Hospice House on two occasions as part of its respite care program. He received excellent attention and enjoyed the staff while my mom got a break.

My parents had a plan in place with the hospice house to respect my dad's final wishes. In May of last year, my dad had a febrile seizure that put him in a coma.  He was taken to the ER, but soon after moved to the hospice house where he spent the remaining week of his life. At the hospice house, he was surrounded by family and friends.

The atmosphere was much more family oriented and far less stressful than being in a hospital. The staff was wonderful. They took excellent care, not only of my dad but also my mom. They still reach out to my mom and provide bereavement services and grief counseling.

I can't say enough good about hospice and palliative care. I know others who spent their last days at home with family and friends under hospice care. It's always tough to lose someone you love, but having care providers who listen and respect your wishes is invaluable.

Some extra links

Hospice is not always well funded. The Tucker Hospice House that cared for my dad relies heavily on donations. If interested, you can make donations through the website.

This article from The New Yorker is a favorite of mine and gives an excellent view of the role of hospice care.

Why You Should Add Cinnamon to Your Daily Diet

Eating healthy doesn't mean eating bland, boring foods; neither does it mean adding expensive "superfoods" that make your food taste like grass clippings.

Adding spices enhances meals, drinks, and desserts, while giving your body some great benefits. Here's more about my favorite spice.  

Cinnamon

Photo by Simon A. Eugster via Wikimedia Commons 

I love sweets, and I'm terrified of developing diabetes someday. That's why I love cinnamon.

Cinnamon has been proven to help control blood sugar, make insulin work more effectively, and help reduce inflammation caused by high blood sugar. Cinnamon is thought to lower blood sugar, or at least slow the rise in blood sugar from meals, by slowing the breakdown of carbohydrates in your digestive system.

In case giving you some protection from diabetes and helping you reduce your sugar intake isn't enough, here are a few more reasons why cinnamon is amazing:

• Just smelling it boosts your brain power, helping you pay more attention 
• It helps reduce cholesterol, including triglycerides
• It's high in antioxidants
• It contains calcium, mineral manganese, and iron (before being processed)
• It is antimicrobial and anti-inflammatory, helping your body fight off infection
• Recent research is showing that cinnamon may be a powerful tool in helping manage or fight off Alzheimer's Disease, Parkinson's Disease, and other neurodegenerative disorders. 

Tips and Caution

Photo by Chat W via Flickr

Because it's a sweet spice, I can often replace or reduce sugar with cinnamon. I use it in tea, lattes, sweet potatoes, cookies, oatmeal, fruit, spice rubs, smoothies, soups, and so much more.   

You don't need to go overboard adding cinnamon to everything. Just a teaspoon or two a day is enough to reap the benefits. Too much can have harmful effects, particularly for your liver (but you'd have really ingest a lot of cinnamon). Unless your doctor suggests it, there's probably no reason to take a cinnamon supplement.

Splurge and get quality cinnamon, Ceylon and Saigon are two highly recommended types. If you look at the ingredients and see "cinnamon oil," what you're getting is probably stale or highly processed, which is why it needs the oil added. 

Shop at a local spice store or look on Amazon. If you really want to splurge, you can order fresh cinnamon sticks and a grater. When you find good cinnamon, you can see, smell, and taste the difference. 

Do you have any unique uses for cinnamon?

Adventures in Cooking for Kids Part 2

I recently talked about what techniques I've been adopting to get more fruits and veggies in my kids. This time, I want to talk about the reality of how that comes together.

I see other people post on Facebook about their meal prepping and how quickly it was done. I hear these chefs talk about how easy it is. Some days it is quick and easy. But not always.

Prep work is messy!

I decided to get my 2-year-old to help me, which was probably my first mistake. In the morning, I made a purple puree, a white puree, and a flour blend from The Sneaky Chef. I spent about 2 hours.

I started with the flour blend, which was just mixing up two kinds of flour and wheat germ. However, I thought I would shake it in the storage container. I then dropped it, the lid popped off, and I had about 3 cups of flour on the floor.

This resulted in a few four-letter words flying out. Luckily, my 2-year-old only added "crap" to his vocabulary.

After sweeping up flour, running the vacuum over the area, and mopping, I moved on to the purple puree, which was spinach and blueberries. My 2-year-old was decently entertained pushing the Pulse button on the food processor.

After that, it was the white puree, which required steamed cauliflower and raw, peeled zucchini. While I prepped the zucchini and cauliflower, my child unrolled all of my labels and wrapped himself up in them.

The pureeing didn't take long, but somehow both my attempts made much more than what the recipe said. I had to do them in batches because I only have a 4-cup food processor.

But I finally got all the prep work done and stored. Really, the whole process shouldn't have taken more than an hour.

Cooking

I had picked two recipes I wanted to make from the Sneak Chef cookbook, but I was too worn out to make them in the morning. After I picked up my 6-year-old from school, we made breakfast cookies using the flour blend I made that morning.

Other than fighting the kids to let me bake the cookies before they ate all the batter, that went well. I did burn the first batch, but we ate them anyway. My kids really like these cookies, which use a lot of cinnamon and less sugar. Plus they have wheat germ and ricotta cheese in the mix, giving them more protein.

After the cookies, I made a sweet potato and carrot soup because it's my 6-year-old's favorite. It's also super easy. I usually make this with whatever amount of carrots and sweet potatoes I happen to have. Just cook sweet potatoes and carrots in broth until soft, then puree and add milk until creamy. You can skip the milk. I flavor it with ginger, salt, pepper, and sometimes a little nutmeg.

This time, I added in some of the white puree from the morning, nutritional yeast, butter instead of milk, and threw in leftover lentils because I was too lazy to cook chicken to go with the soup. We also had to eat quickly to get to Girl Scouts on time.

Although it's often hectic and messy, the prep work is worth it, especially for the time it saves me later in the week. I tend to spend about one or two days a month doing a lot of cooking. We eat great for about two weeks, then it starts to fall off and we eat out or have frozen pizza. I then get motivated to cook again.

If you're interested, Amazon has used copies of The Sneaky Chef for $0.01.

What are your favorite meal prepping tips?

Adventures in Cooking for Kids

I'm always looking for ways to get my kids to eat healthy. My 6-year-old has always been good about eating fruits and veggies without arguing. My 2-year-old would live off bread products and cheese if I let him. He doesn't really dislike fruits and veggies, but he won't willingly eat them.

What can you do?

I've looked up new ways to get my kids to eat healthy foods. One being to hide veggies inside stuff I know they like. So mac and cheese now has carrots, celery, and onions pureed into the cheese sauce.

I try getting the kids involved in cooking, but that hasn't helped them expand their horizons. They usually just get full from eating off the cutting board. 

Lately, I've looked at other theories. These include The Sneaky Chef and Deceptively Delicious, which are cookbooks with puree blends and recipes for normal kid foods you can mix those in. I think these have some good ideas and are a great start. My one complaint is that they do give in a little bit more than I am willing to and mix in these pureed foods with things like Spaghetti Os.

Another theory I was introduced to this week was by Ellyn Satter. She has some great ideas, I think, although I was at first tempted to say, "Not a chance." For 11- to 36-months old, her recommendations are to sit down and eat with your child for three meals a day, and offer two sit-down snacks in between. Let me get this straight, you want me to prepare food and sit down with a 2-year-old, five times a day? I appreciate the sentiment, but that's not happening.

However, she did have a lot of good advice that I try to follow and some that I need to really get better about.

• Only fix one meal. Don't prepare separate meals for every picky eater. 
• Have foods that you know your kids like along with some new foods.
• Don't force them to eat. They have the option to eat nothing.
• Stick to a schedule. Don't go and feed them snacks when they're hungry because they didn't eat the meal you prepared.

What I've adopted 

I've adopted a mix of these ideas. I hide veggies into things I know they like, not only for their health, but also because it's easier than cooking a bunch of veggies as sides. Although, I almost never manage to sit down for breakfast or lunch with my kids, we do have dinner together, and only one meal is offered. The only time I cook something separate for the kids is when I'm trying a new recipe that I feel sure they won't like.


What do you do to engage your picky eaters? How do you get your kids to branch out and try new foods?

What Fish Should I Get? Farm Raised or Wild Caught?

Seafood can be extremely tricky to shop for in the grocery store. Many of us are trying to eat more fish as current research shows that it’s a key part of a healthy diet.

But, about 86 percent of marine fish stocks are fully exploited or overfished, meaning our supplies of fish are rapidly dwindling. Farmed fish, called aquaculture, has become more prominent, and you’re likely to see more choices of farm-raised fish at the grocery store. But how does it compare to wild caught?

What’s better: farm raised or wild caught?

It depends on the type of fish.

Farmed or wild, you're likely to get similar nutrient content. But, each type of fish carries different environmental effects and health risks based on fishing or farming method.

From an environmental perspective, the basic rule for knowing which to get is the amount of input versus the output. Vegetarian fish are better as farmed fish rather than meat eaters like salmon. It may take as much as three pounds of feed to grow one pound of carnivorous fish.

Coastal net pens. Photo from NOAA via Flickr.

Farm-raised Fish

Auqaculture means breeding aquatic animals and plants in a controlled environment. Methods of raising farmed seafood include raceways, tanks, net-pens, ponds, and lakes. 

China and other Asian countries are the top producers of farm-raised seafood, and much of the fish sold in the United States is imported from China.

Concerns
As with food animals raised in close quarters, disease and waste management are major concerns. Veterinary drugs and antibiotics are used in fish farms and run the risk of spreading to the surrounding waters and contaminating those fish and drinking water supplies. Having so much fish waste concentrated in one area can harm the surrounding waters. Herbicides are also used in fish farms to reduce algae growth.

Raceways and tanks do not breed fish and aquatic plants in inland waterways and may be more environmentally friendly methods.

Better choices
Mollusks and aquatic plants are the best choices for farmed seafood, along with tilapia and other vegetarian fish. Salmon, shrimp, and other crustaceans require large amounts of inputs and have much higher environmental and health costs.

Third-party organizations have also created certification programs to set standards for sustainable aquaculture. Look for labels from the Aquaculture Stewardship Council or the Marine Stewardship Council. The United States does have high quality standards for aquaculture, but U.S. aquaculture makes up a tiny fraction of the supply.

Wild-caught Fish

Our supplies of wild-caught fish are running out, so paying attention to the fishing methods used and avoiding fully exploited fish are what’s key to leaving decent fish stocks for our kids and grandkids.

Concerns

Salmon fishing. Photo by James Brooks via Flickr.

As far as fishing practices, a major environmental concern is by-catch. This is the amount of fish caught that is not part of the target species. These fish are often thrown back dead.

Large amounts of by-catch, which you get with methods like trawling and dredging, harm the seafloor and reduce the organisms living there.
The primary health concern with wild-caught fish is mercury. Those levels are higher in swordfish, king mackerel, tilefish, and others. Salmon, catfish, and trout tend to have low levels of mercury. The general rule is to eat the fish that may be high in mercury less often.

Better choices
When choosing wild-caught fish, look on the package for the fishing method used. Trolling, jigging, and using pots and traps have little to no by-catch and do far less damage to the surrounding ecosystem.

A Note on Interconnectivity

Although aquaculture is looked at as a possible solution to overfishing, it is still heavily dependent on wild-caught fish. Anchovies are the most commonly caught species and are primarily used as fish oil and fish feed.

Sustainability is talked about so often these days it seems to have lost much of its meaning But our food system, environment, and public health are closely related. You can encourage our food producers toward sustainability through your buying choices.

You can find many guides online to help you choose what fish to buy. Most of the ratings for these guides are based on what that organization thinks is most important. This one from the Monterrey Bay Aquarium is a good one.

A Cheap Way to Stay Healthy – Take Care of Your Gut

Photo by Daniela Validimira via Flickr

A happy gut is key to a healthy body. A wealth of research in the past few years has shown how our gut bacteria affect the rest of our bodies.

Your gut bacteria do a lot more than help you digest food and move it through the gastrointestinal system. Your gut bacteria may influence obesity, depression, and diabetes.

 

Function of Gut Microbiota

Your gut is pretty cool and extremely powerful. It even has its own independent nervous system. The gut microbiota is found in the intestine, where there are tens of trillions of microorganisms.

The microbiota start forming as soon as you’re born and evolves throughout your life based on your diet and environment. We each have our own unique composition of around 1,000 species of bacteria.

Here are a few things your gut bacteria do for you:

•  Aids in the production of some vitamins, such as B and K
• Works as an important part of your immune system to fight off illness
• Creates 95% of the body’s serotonin, which helps regulate mood
• Helps you digest food and move it through the GI tract

What the Research Shows

A lot of current research into the gut microbiome has shown its powerful effects and ways in which our diet can alter it — for better or worse.

Here are some highlights:

• A positive balance of good bacteria in the gut could treat depression. This is leading doctors to look more closely at treating mood disorders with probiotics.  
• Gut bacteria may influence anxiety, depression and autism. It could even have an effect on the development of neurodegenerative diseases like Parkinson’s and Alzheimer’s.
•  A high-fat diet may change the gut microbiome, leading to mood disorders and depression. 
• The gut plays a role in the development of diabetes and obesity. Artificial sweeteners may play a role in altering the gut microbiota and inducing glucose intolerance — the first step toward diabetes.

Build Up Good Bacteria

Pre and probiotics are the most common ways to promote good gut health.

Photo by Mike Ortega via Flickr

Probiotics are live microorganisms often in foods like yogurt or offered as supplements. These may have a health benefit in some cases, but the research isn’t definite. There are many strains of probiotics and different strains have different effects.

Prebiotics are nondigestible food components used by gut bacteria for fermentation.

You can get prebiotics and probiotics through diet, and the more diversity you have, the better.

Fermented foods and drinks are usually good sources of probiotics:

• Kefir (yogurt or water)
• Tempeh
• Sauerkraut
• Kimchi
• Yogurt
• Kombucha

Garlic and Jersusalem artichoke

You can get prebiotics from:

• Jerusalem artichoke
• Bananas
• Oatmeal
• Asparagus
• Legumes
• Garlic

Taking care of your gut may be one of the best – and easiest – ways to keep yourself healthy and happy.

Do you try to get prebiotics and probiotics daily? How?