April 2016 - Parker Life

How to Be a Writer at Any Age

10 rules to live by from the author of 'The War of the Roses'

By Warren Adler for Next Avenue

Credit: Thinkstock

I always wanted to be a writer. Ever since I was conscious, I felt that inexplicable pull to tell a story, to create a scene, to leave a reader wanting to know what would happen next. When life’s responsibilities came knocking, i.e. I had a family to support, my career as a published author was put on hold. However, I knew that nothing would block the path to my dream: to be a full-time writer in control of my career and destiny.

I had a late start as a published writer, at 46, and since then I’ve published more than 50 works, including The War of the Roses, which became the nomenclature of divorce worldwide and turned into a box-office hit. Having been in the creative ballgame for nearly half a century, I have seen the various reincarnations of the publishing industry.

Self-publishing was my way of taking back control of my own destiny. Folks often tell me that I’m the oldest working writer they know. The truth is: I don’t know how to stop. I work on novels, articles, blog posts and maintain contact with fans from around the world every single day. I hope my insights below and my optimism inspire you to persevere through struggle and continue on your writer’s journey.

1. Do not overanalyze.

You can think something to death and never get anything done. Keep moving and don’t look back too often. I find it boring to be constantly looking back. The future is much more exciting.

2. Never take rejection of your work to heart.

Rejection is an inevitable part of any dream you pursue. I’ve been told “no” many times and never took it seriously. It may be impractical, unwise, foolish, pure madness, but if you truly believe in yourself, your talent, your ideas, your calling, your personal mission, why not, as Lewis Carroll wrote, “go on until the end, and then stop”?

My first novel wasn’t published until I was 46 years old. Ignore insults and negative, unproductive feedback. In today’s age, where everything is gone with the flicker of a screen, be happy that your work is garnering attention. Make sure your name is spelled right.

3. Mind your morning rituals and stay informed.

I wake up every day at 5 a.m. and write until 10 a.m., after which I read the various news outlets.

Read the news and the world’s happenings around you. Inspiration and enlightenment come from current events. Gaining a new perspective never hurt anyone. The truth is, most times, stranger than fiction.

4. Write at least 100 pages before you decide to scrap a novel.

Don’t be so quick to toss work to the trash heap. Get to know your characters and story, but also know when to start anew.

5. Don’t be afraid of change.

Embrace change while staying true to yourself. When digital publishing was in its infancy, few people believed in its power to revolutionize the way people read. I was thought of as crazy, but I was determined to achieve independence as an author and I made it happen.

6. Seize opportunity whenever you can.

I would never have predicted that my first novel would be published the way it was. I was running a PR agency at the time, when a client walked through my door, asking if I could promote his book. I decided to take a risk and said that I would promote his book for free if he published my manuscript. To my utter delight, he agreed and the rest is, as they say, history.

7. Think of yourself as an entrepreneur as well.

People who join the fray as individual authors in self-publishing will have to think of themselves as being in business on their own and pursue strategies as with any business venture.

8. Never let anyone else control your destiny.

Keeping my authorial name alive involves some pretty heavy lifting, investment and optimism, but it’s 100 percent worth it.

9. Stand up for your beliefs and take action.

Don’t be afraid to be the first one. I fought to keep a library open in Wyoming that I knew would benefit generations to come and I got my way. I was also a pioneer of the short story contest, launching the Jackson Hole Writers Conference.

10. Don’t be afraid to color outside the lines.

I write what I want and I never repeat myself. Writing the same book over and over would bore me. Each novel I’ve written is a different story, a different tone and genre.

I hope that my insights inspire you or reinvigorate your zest for this strange and phenomenal path that we’ve chosen, or more accurately, that has chosen us.

April 29, 2016

Uncategorized

How to Organize Your Finances for Your Loved Ones

3 real-life stories show why doing this is so important

By John Seber for Next Avenue

Young man and older man looking at a padfolio

Credit: Thinkstock

If someone will need to settle your estate or care for you because you’re seriously ill, that could mean needing to amass critical financial information about you in a hurry. But this kind of scavenger hunt — finding legal documents, bank accounts, insurance policies, credit cards, online accounts and the like — is very hard when that person is grieving or dealing with a multitude of caregiving issues.

That’s why you should take the necessary steps now, before a potential crisis arrives, to get your records together.

I call this focusing on three dimensions: What you want to document, Where it is located and Who should know about it. This way, your loved ones will easily be able to find what they need when the time comes.

3 Personal Stories

Let me give you three examples from my life that will show you why I feel so passionately about this. In each case, well-organized data was — or would have been — helpful:

My responsible aunt She lived independently her entire life and had superb control over her affairs. She was well-organized and kept diligent records. Totally in control, everything was in order. Then, at 83, she had a debilitating stroke.

As a result, she was first confined to a hospital and then admitted to a skilled nursing home, where she lived until passing away at 87.

With great vision, my aunt had made proper preparations in designating both a Power of Attorney and an executor — me. I was blessed that she had kept outstanding records. She had a book that listed her stocks, bank accounts and other financial information and a small safe containing her legal documents and the deed to her house, stock certificates and other important papers.

All of this planning allowed me to efficiently manage her affairs. And because she could still communicate when I became Power of Attorney, she was able to clarify details and answer other questions. This aunt was a role model on all three dimensions. What, Where and Who.

My less-responsible aunt I had another aunt who also lived independently, but she wasn’t as organized and was reluctant to share information with other family members, even though she had appointed a Power of Attorney and an executor — me again.

Then she developed dementia, which led me off on a wild goose chase to locate her financial records. I’ll never forget the day I was cleaning out one of her old dressers and discovered three forgotten bankbooks with a total value of $150,000. They had not been presented for interest at the bank for almost three years, and were about to be treated as abandoned property. Sadly, this aunt failed on the What and Where dimensions of organization.

Family friends I also had close family friends who lived on our street. The father had an unexpected massive heart attack in his early 50s and suddenly died. He hadn’t made any advanced preparations and when the tragedy occurred, those left behind had no awareness of their financial condition, nor the location of his records.

I volunteered to help supervise getting his affairs in order to settle the estate. But where were the funds to pay the bills? Was there savings? Insurance? No one knew where to start. That began a tedious task of searching through each room in the house and through every file and pile of papers.

Also, no one knew how to access his computer to see if he had vital information online or in email messages and no one knew his passwords or anything about his online accounts.

Regrettably, history repeated itself a few years later, when the mother also passed away unexpectedly. Although I had set up a process for her for better record keeping, she didn’t follow it to maintain updated information. This created an enormous burden for their children.

How to Get Organized

Please learn from these true events. Here’s how to get organized using the three dimensions I’ve mentioned:

WHAT We can’t expect our loved ones to remember key information about our financial lives without a roadmap of documentation. Think about your insurance, bank accounts, investments, wills, Powers of Attorney, living wills, trusts, custodial accounts and guardianship documents. In addition, in this digital age, there are also your online accounts and passwords.

WHERE Think about where your critical information is stored. Can it be found easily?

WHO This is about proactively designating someone or some people to manage your affairs as your Power of Attorney or executor allowing them to legally act on your behalf. Once you’ve chosen these people, be sure to tell them. If you find the topic too uncomfortable to discuss, at least tell them where to find an envelope you’ve created or the place in your home that has all the key information.

Lists to Prepare

If you do nothing else, at least prepare basic lists manually and let your family know their location. It’s actually a simple process to quickly organize your data.

First, develop your categories: Bank accounts, insurance policies, investments, online accounts/passwords, credit cards, etc. Next, for each category, think of the specific information you want to collect. This can be managed in spreadsheets or in a Word document, but you don’t need to use a website or even a computer. You can manually write it all out, and develop a binder.

One more thing: Remember that this is not a one-time effort. You need to review things periodically to keep your financial information up to date.

If you decide to use any online solution to organize your financial life, be sure it’s a secure site. And even if it is, do not store complete details there which could facilitate a theft! For example, I ask my clients not to list their full credit card numbers or passwords and PINs online. Rather, storing only the last digits and the 800-number of the financial institution’s customer service will be adequate information to get to your specifics quickly.

April 28, 2016

Uncategorized

Whom Have You Impacted Today?

By Roberto Muñiz

I love Wednesdays and Thursdays! After a full day at Parker Home discussing strategy, meeting with staff, and reviewing operational data, I start preparing for one of the highlights of my week – my evening classes as an Instructor at Rutgers University.

For the past five years, I have taught Long-Term Care Management, Health Care Systems and Intro to Health Administration at Rutgers University's Bloustein School of Planning and Public Policy. It has been one of the most rewarding experiences of my career.

The students I teach range from sophomores to seniors and come from a variety of backgrounds. These individuals are considering career paths in Public Health and Healthcare Administration, whether community health, long-term care or hospital-based administration or other health-related opportunities. What they all have in common is their interest, enthusiasm and fresh perspective on how we, as healthcare professionals, are serving the healthcare needs of New Jersey consumers and beyond.

These young adults are a part of my professional life not just as students, but as interns, administrators in practice, protégés, social media connections and future colleagues. I view teaching them as a privilege and hope that I have had a positive impact by sharing my knowledge, experience, and insights.

Never underestimate your own power in influencing and impacting others. Whether teaching at a community college or university, sharing your knowledge through career days, or partnering as a mentor to someone in the field, you have a direct impact on the individual and their ability to accomplish their personal and professional goals. I encourage you to seek out opportunities within your own organization and the broader community where you work and live.

We all have the chance to impact those around us and we must consider ourselves role models to our employees, our professional colleagues, and our social network outside of work. This should not be considered something "extra" we do; it should be considered a necessary and important part of our job descriptions as Administrators, CEO's and leaders in the healthcare field.

I am sure we all have checklists for operations, business strategy, programs and processes – but what about a checklist for how we demonstrate and share our passion, energy, enthusiasm and knowledge with others? I'm starting mine today!

April 28, 2016

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How to Care for Your Pet Without Going Broke

A vet's 6 tips on managing costs wisely and lovingly

By Joanne Intile for Next Avenue

Credit: Thinkstock

As I look over my appointment schedule for the day, I mentally note that I’m set up for two patients to be dropped off for CT scans, one of whom will hopefully be immediately transported to an operating room, so surgery can be done to remove a large tumor pressing against the ribs.

There are five patients scheduled to receive chemotherapy, so I I’ll need to stop to meet with the oncology technicians and update them on the plan for the day. There’s one coming in for acupuncture with our rehabilitation service, and I quickly note the time of the appointment so I can be sure to stop in and say hello. There are two patients coming in the afternoon for a recheck of lab work, and one for a superficial skin biopsy.

You might assume I am a high-profile doctor for humans who spends my day treating the most unusual diseases in people with ease, expertise and confidence. In truth, I’m a veterinarian, who spends my day treating animals with cancer. It’s an exciting field to be a part of, but I do spend an excessive amount of time explaining to people that yes, it’s possible to treat cancer in animals, and yes, people will pay to do so.

The High Cost of Providing Quality Vet Care

Though the work I do could be considered inspiring and remarkable, it comes with a hefty price tag.

The cost of maintaining the advanced equipment I require daily to diagnose cancer in my patients, the laboratory contracts I rely on to offer my reliable results and the state-of-the-art treatments I need to have on hand to offer my patients can be extraordinary.

As such, I’m required to be cognizant of the need to offer owners options within their financial means, while simultaneously keeping their pet’s best interests in mind.

Superficially, pet ownership is rather simple. Humans provide for their pets’ basic needs (food, water, shelter, activity and health care) and pets offer up unconditional love, companionship and, for many, a sense of family. Advances in veterinary medicine afford pet owners the opportunity to treat diseases previously considered incurable.

But there are many real issues to consider when we take a look at the cost associated with these options.

6 Financial Tips for Pet Owners

What can owners do to ensure they are providing their pets with quality veterinary care without burdening themselves financially to the point of creating debt or guilt? I have six pieces of advice.

1. Practice prevention. Veterinary medicine centers much on preventive options such as vaccination; heartworm, flea, and tick prophylaxis and deworming. These events generally occur during annual exams, which are recommended for all pets regardless of age, breed or gender.

Owners sometimes find it difficult to recognize the importance of these measures when it comes to the benefit for their pet’s health.

2. Consider habitat. Certain infectious diseases are more prevalent in certain geographical areas (Lyme disease and the Northeast, for example), or within certain demographic populations (e.g., outdoor cats are more at risk for contracting feline leukemia). Therefore, having a candid discussion with your veterinarian about your pet’s specific risks could help tailor these annual exams to the needs of that particular patient.

3. Look into pet insurance. Pet insurance is one option that can help lessen the financial burden of health care. Plans can be purchased and tailored to the specific needs of a particular pet (or owner), and this can significantly reduce the financial burden placed on owners, especially when considering emergency situations or chronic diseases.

Plans may not cover pre-existing conditions, so many owners find they get the most benefit buying plans when their pets are young and healthy.

4. Get prescription drugs elsewhere. Prescription medications can often be purchased outside of the veterinary office either from “human” retail pharmacies or online ones. Just as with people , generic versions of medications for pets are cheaper than brand name.

Ask your vet if he or she knows of a less expensive source for prescribed drugs. You may need to call several pharmacies and explore options, but it could be well worth your time.

5. Find financial help. Several organizations offer financial assistance for owners demonstrating need. Owners may be eligible for grants or loans to help pay for care related to specific illnesses or even routine care.

Some veterinarians also offer discounts for senior citizens, owners who have multiple pets or those who have served in the military or emergency services (police, firefighters, EMTs, etc.).

It’s possible, too, that your veterinarian might offer a payment plan. It never hurts to ask!

6. Choose your pet’s medical care carefully. There are certainly veterinarians who offer low-cost services, but I would urge owners to be cautious when selecting aspects of their pet’s health care based on cost alone. As with many things in life, the mantra of “you get what you pay for” is often true.

For example, the price of a surgery may be significantly cheaper at one hospital versus another, but is that because no pain medications are dispensed? Or because there is no monitoring of the patient while under anesthesia or when an IV catheter is in place during surgery? In those cases, skimping corners may alleviate cost, but puts the animal at more risk from complications or even death.

The best advice I can offer is to be honest with your veterinarian about your concerns and make a plan together that prioritizes recommendations for your pet’s health alongside your personal and financial considerations.

April 20, 2016

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Do You Really Need to Get an Annual Checkup?

Physicians disagree on the need for one when you're not sick

By Rita Rubin for Next Avenue

Credit: Thinkstock

Kind of like the old saw “if it ain’t broke, don’t fix it,” some doctors have been questioning the need for adults who aren’t sick to get a checkup.

In 2012, the most recent year for which data are available, “general medical examination” ranked as the fifth most common type of primary-care doctor visit in the United States (“routine infant or child health check” was No. 1). Out of about 929 million visits, roughly 26 million were the so-called general medical examination, according to the 2012 National Ambulatory Medical Care Survey.

Questions Raised

That same year, the authors of a Cochrane review of published studies on the subject concluded that “general health checks” didn’t keep people healthier or save lives. (Cochrane, a not-for-profit, international organization based in London, produces reviews on a wide range of health-care topics based on the available scientific evidence.)

“One possible harm from health checks is the diagnosis and treatment of conditions that were not destined to cause symptoms or death,” the Cochrane review said. “Their diagnosis will, therefore, be superfluous and carry the risk of unnecessary treatment.”

On the ‘Don’t Do’ List

Citing the Cochrane review, the Society of General Internal Medicine (SGIM) in 2013 included “routine general health checks for asymptomatic adults” as No. 2 on a list of five “don’ts” for physicians and patients. The SGIM defines such appointments as “office visits between a health professional and a patient exclusively for preventive counseling and screening tests.”

The organization issued the list as part of the “Choosing Wisely” campaign, launched in 2012 by the ABIM (American Board of Internal Medicine) Foundation “to help patients choose care that is supported by evidence, not duplicative of other tests or procedures already received, free from harm (and) truly necessary.”

Currently, the SGIM is reviewing all five of its 2013 “Choosing Wisely” recommendations, which it had been planning to do all along, says Dr. Zackary Berger, chair-elect of the SGIM’s Evidence-Based Medicine Task Force.

As far as the organization’s stand against routine general health checks, “we have not yet completed the review, so I cannot say whether our recommendation will reaffirm our recommendation from 2013,” says Berger, a general internist at Johns Hopkins and the author of Talking to Your Doctor: A Patient’s Guide to Communication in the Exam Room and Beyond.

Evidence Weak – and Not Relevant?

The problem, says general internist Dr. David Himmelstein, is that the evidence the Cochrane review and the SGIM have used to argue against checkups isn’t very good, especially as far as its relevancy to 21st-century Americans.

In January 2016, Himmelstein, a professor of public health at the City University of New York and a visiting professor of medicine at Harvard Medical School, coauthored an opinion piece on the subject in the Annals of Internal Medicine. The piece noted that of the 14 studies considered by the Cochrane review, nine dated back to the 1960s or 1970s. While many of the studies were old, the patients on which they focused were not, because old people were excluded from all of them. Plus, 11 of the studies were conducted in European countries where patients faced few out-of-pocket costs, unlike in the United States, so most everyone got regular checkups, making comparisons between a checkup group and a non-checkup group difficult.

Key to the Doctor-Patient Relationship

But perhaps most important is what the data don’t get into — the doctor-patient relationship, says Himmelstein and his coauthor, Dr. Russell Phillips, a general internist who directs the Center for Primary Care at Harvard Medical School.

The two described well-patient visits as a “mainstay” of the physician-patient relationship and said they worried that abandoning it “risks undermining proven benefits of primary care.” They noted they’ve ended up diagnosing melanoma, colon and breast cancer, alcohol abuse, opiate addiction and depression in patients who’d come in for a routine checkup.

Older Patients, Different Needs

Seeing a primary care doctor regularly becomes even more important as you get older, Himmelstein said in an interview. Even if you already go to a doctor routinely for, say, high blood pressure, “scheduling a specific visit when there’s not a problem might be an important thing,” he says. At such a visit, the doctor can make sure you’re up-to-date on immunizations and discuss other aspects of preventive care, such as weight loss, that specialists generally aren’t set up to deal with.

“I think you want a doctor whom you know before you get sick,” Himmelstein said. “There’s someone to call to help you navigate the health-care system when you do get sick.”

Dr. Ateev Mehrotra, a Harvard colleague of Himmelstein’s and Phillips’, stands on the opposite side of the debate over the need for checkups when you’re feeling fine.

In The New England Journal of Medicine last October, Mehrotra coauthored a “perspective” piece against the annual physical.

A Time-Waster?

Before he became a hospital-based doctor, or hospitalist, at Beth Israel Deaconess Medical Center in Boston, Mehrotra says, he had a primary-care practice for many years. When patients came in for a checkup, he says, he used to wonder, “Am I wasting my time?”

And yet, he noted in his article, Medicare began reimbursing for annual wellness exams in 2011 and many private health plans have created a financial incentive for physicians to provide checkups by paying higher rates for them than for other office visits.

“I recognize that if you haven’t seen a doctor for three, four years, there could be a role for a visit,” Mehrotra, who is also an associate professor of health-care policy at Harvard, said in an interview. “What I’m arguing against is the idea that there should be some visit on an annual basis with the focus on picking up some asymptomatic illness for all adults in the United States.”

On that point, Mehrotra and Himmelstein and Phillips might not be that far apart. While well-patient visits play an important role, Himmelstein and Phillips wrote, they don’t necessarily need to be annual.

April 14, 2016

Uncategorized

What to Do When Your Green Thumb Has Arthritis

These 11 professional tips will help you enjoy gardening (relatively) pain-free

By Leslie Land for Next Avenue

Credit: Getty Images

I am mostly unbothered by the signs of my advancing age: Finding a wrinkle here or a gray hair there disturbs me not a jot. But last spring the osteoarthritis that I've had in my hands for more than a decade stopped being a minor annoyance and became quite literally a major pain, especially when I’m in the garden.

Simple tasks like weeding and deadheading had always been meditations that freed and quieted my mind. Then suddenly they were the opposite. My mind was pretty much tied up to the noise of my thumbs hurting.

Knowing I wasn’t alone didn’t help; the majority of women over 50 have this kind of arthritis. And the longer you live, the more likely it is that you’re in for it. (Men are somewhat less likely to be cripplingly afflicted, but plenty of them suffer nevertheless.)

Arthritis in the hips and knees is usually more debilitating, so it’s not surprising those joints get a lot more notice from the medical community and the media. But speaking as a gardener with only the one variety, I am here to tell you that is bad enough.

There are orthopedists who specialize in hand conditions, therapists without number and no shortage of soothing drugs, both prescription and OTC, but for me the biggest relief came through behavior modification. By the end of last summer, I was able to care for the garden almost as well as I had done before, and although my doctor and therapist both deserve some credit, I’m convinced more of it goes to me, because I (mostly) followed this simple, at-home program.

A Behavior Modification Guide to Hand Preservation

Drugs can help ease some of the pain of arthritis, but doctors, therapists and sufferers all agree that the best “treatment” is less of the kind of use that aggravates the condition. Since no use isn’t possible for avid gardeners, I’ve come up with a number of solutions and work-arounds that I’m listing below.

1. Think of your pain-free hands as money in the bank. Then realize that everything you do with them has a “use cost.” Even things that normally don’t hurt, like petting the cat or smoothing a planting bed, are putting at least a small strain on your joints, thus subtracting from your account.

2. Give yourself a daily allowance. If you spend a bunch of hand use making a pie, you'll have less for picking peas. When I'm planning to do a lot of cooking for an evening party, I harvest the food and herbs and cut and arrange the flowers on the previous day. On party day, I ignore the garden, upping the chances I can cook all day and still hold my fork without wincing when dinnertime comes around.

3. Sort tasks between "must be done" and "must be done by me." Only I can make the artistic decisions called for in hydrangea pruning. And my delicate touch is essential for successful transfer of sweet pea seedlings from starter pot to waiting trench. But just about anybody can dig the trench the seedlings will go into, just as almost anyone can deadhead the daffodils, turn the compost and carry seedlings to the garden from the car.

4. Delegate as much as possible. This brings us to the unpleasant realization that there is not always a delegatee just waiting around to be used. Keep a list of non-urgent tasks ready to whip out whenever some unsuspecting friend offers to lend a hand. And if those kinds of friends are in short supply at critical times …

5. Hire help. Paying somebody to do garden tasks is very difficult. Even if finding the dollars is easy, finding the right helper is not. The local teenager looking for pocket money is a myth, but craigslist.org, taskrabbit.com and Work Wanted sections of local papers are likely places to find affordable part-timers. (Most newspaper classified sections are more extensive online than in print, so don't forget to check the Internet.) Bulletin boards at supermarkets are another place to look for signs or post your own. As usual when hiring strangers, check references and be wary.

6. “Preheat” your hands. Don’t leap right into the cold garden without doing this. Warm joints move more smoothly than cold ones, and joints that start out at body temperature chill quickly outdoors, especially in early spring and late fall. This step can be as simple as a five-minute soak in hot water (wear thin rubber gloves) or as elaborate as using a hot wax machine. There are dozens of models available through online beauty outlets, on Amazon, and both new and used on eBay.

7. Ration hand use by kitchen timer, not specific task. Work in the garden is open-ended almost by definition. I can be weeding the bed by the driveway, firmly committed to cleaning up just that one bed for today. But then if I turn my head to the side, there are some very untidy zinnias that really should be deadheaded. Next thing I know it's 3:30, and my hands are killing me. Remember, this method works only if you stop working when the bell goes off. It may seem too obvious to mention, but I can testify that time limits are very easy to ignore if your hands don’t hurt yet.

8. Use your whole hand (or both hands) to pick things up. We tend to grab for things with just our fingers, but doing that requires a pinching motion, which stresses the joints. Then you have to press tightly to keep your grip on whatever, stressing them even more. Once I started paying attention, I was amazed at how often I did just that, moving empty flowerpots without putting a supporting hand underneath, using my fingertips to carry one last planting stake, grabbing a trowel that was just out of reach instead moving toward it and picking it up with my whole hand. Although breaking this habit is difficult because it’s so useful, it does get easier over time and even partial success is worthwhile. I’d give my current efforts about a C minus. But even that is making a big difference.

9. Keep your tools sharp. This also helps mega in the kitchen. Well-honed cutting edges take far less hand pressure to do their work. There are also many garden implements designed to be easier for arthritic hands to use. Actual helpfulness varies considerably; my hands are small, for instance, while many “ergonomic” handles are larger than usual.

10. Use a voice recorder, not pencil and paper. If you (like me) are a person most comfortable with the written word, get a recording device that transcribes words to text and can store photographs as well. I use my iPhone, and I’ll bet other smartphones can do this, too.

11. Sit still and bathe your hands in the sunshine. Find a spot to just enjoy the place without worrying about work to be done. Emotional stress-reduction is also part of the program. And what’s the point of all your hard work if you forget to just sit in the garden and bask in its beauty?

April 11, 2016

Uncategorized

The Risks of Taking Statins

Lifestyle changes may be better for some with high cholesterol, an expert says

By Suzanne Robotti for Next Avenue

Credit: Getty Images

Is your cholesterol high? Has your doctor suggested you might be at risk for heart disease? If so, you have some decisions to make.

You need to know that you can likely improve your health and lower your cholesterol by simple lifestyle changes like exercise and changing your diet. You also will likely have the option of taking a statin.

The fact that people have choices in their health care is very important and something we explore at MedShadow, an online nonprofit I founded to inform the public about the side effects, risks and benefits of medicine, both prescription and over-the-counter.

Which is why I’m concerned about the USPSTF’s (U.S. Preventative Services Task Force) impending action to approve a broadening of the group of adults for whom statins are recommended — without including a recommendation to try lifestyle changes to lower cholesterol first. The mission of the USPSTF, as a government agency, is to create guidelines for doctors. Their recommendations strongly influence the care and options that doctors discuss with patients.

New Proposal

The USPSTF is proposing that any healthy adult between the ages of 40 and 75 with no history of cardiovascular disease, but whose 10-year risk of stroke or heart disease is 10 percent or greater, and who has at least one risk factor, take statins.

Although it’s not yet approved, the draft recommendation closely follows the guidelines put out jointly in the fall of 2013 by American College of Cardiologists/American Heart Association. At that time, it was projected that the guidelines would literally double the number of people on statins, from 25 million to more than 50 million people.

That’s a lot of people to put on a medicine that has been shown in some studies to increase the risk of diabetes and/or cause muscle damage and cognitive impairment but hasn’t proven its effectiveness in this group. Is that really necessary?

Possible Drawbacks

In looking at the risks and benefits of statins, we know that they are highly effective in preventing heart attack or stroke in someone who already has cardiac disease. However, in a study published in 2015 of statin drugs given for five years for heart-disease prevention to healthy adults, no lives were saved, but 1 percent developed diabetes and 10 percent suffered muscle damage. The benefits were that 6 percent avoided a nonlethal heart attack, and just over 9 percent avoided a nonlethal stroke. A 2013 study in BMJ showed a 9 percent increased risk of diabetes when using statins.

That said, the risks might well be different with each type of statin, a good point to discuss if your doctor is recommending this class of drug.

Factors to Consider

It’s possible that some might look at preventing a heart attack or stroke as “better” than getting diabetes. That’s a personal decision best made between the patient and doctor. However, diabetes, a chronic and serious disease that can lead to heart disease, stroke, vision loss, kidney failure, amputation of toes, feet or legs and premature death, should not be considered lightly.

Further, statins have also been linked to liver damage and cognitive impairment, although there is conflicting research on the subject. An article in Monthly Prescribing Reference (MPR) explores the link between statins and depression and explains why this would make sense.

Since the USTPF’s recommendations are for all adults 40 to 75 and clinical trial results were focused primarily on white males, it is shortsighted to assume that statin use should be recommended across such a wide range of the population. The Patient, Consumer, and Public Health Coalition, an informal group of nonprofits of which Medshadow is a member, recently sent a joint letter to the USPSTF about our collective concerns. Those included the lack of women, seniors, racial and ethnic minorities in statin clinical trials.

‘You Have Choices’

Talk to your health care provider about all your options. If you do not have heart disease but do have a risk factor (such as smoking, being overweight or having a family history of heart disease), you have choices. Statins can be a good choice and so can lifestyle changes.

Importantly, consider how your medical choices will affect your entire life — changing your diet and taking a walk every day can have beneficial side effects for every aspect of your life.

Taking statins may appear easy, but comes with a cost.

April 6, 2016

Uncategorized

Dedicated LPN and Parker Enjoy Long and Strong Relationship

By Harry Glazer

Ann Burgess, long serving LPN at the Parker Home senior residence in Piscataway, has set a remarkable record of rarely missing a day of work in her 30 plus years at Parker.

What inspires such incredible dedication?

If you ask Ann, she will tell you that a lot has to do with the company’s strong compassion not just for the elders and the participants it serves but for the staff as well.

Ann recalls, in particular, the gracious understanding her managers and coworkers gave her when her husband James, a former baker for the Wonder Bread bakery in East Brunswick, was on dialysis in the early 2000’s. Ann had to assist him with doctors’ appointments and treatments, sometimes in the middle of her work day, and Parker was always supportive.

Ann is also grateful that Parker accommodated her desire to shift to part-time work after her husband died in 2013. Though she was considering retirement, she wanted to stay active and to continue providing superb care for the nursing home residents. Recognizing her superior skills as a nurse and a role model to new nurses, Parker made a place for her by shifting its staffing in the senior residence.

Ann, in turn, is a very valuable part of Parker’s staff so it’s no mystery why managers have worked to accommodate her.

She is well known for her dedication to her work, her easy-going nature, and her consistently pleasant manner. Her motto is simple and straightforward: “You do what you have to do to help the elders. Because that is the goal of a nursing home – to bring happiness and care into the lives of those we serve.”

When Ann received a 30-year service award at Parker’s annual service award dinner on March 22nd, she was celebrated as one of four people who reached that major milestone in 2016.

Ann has another distinction at Parker, as one of a handful of people whose child has also joined the staff at Parker. In 2004, her daughter Tamara became a concierge working part-time at Parker’s homes in New Brunswick and Piscataway. Tamara has become a valued member of the team at Parker and is now a full-time concierge in the Pavilion who also works to support the Adult Day Program.

In her 30+ years at Parker, Ann has witnessed a lot of changes.

When she started, in 1985, paper medical records were the norm and computers were not seen in the homes. Now, most records are electronic and computers have become commonplace.

In her early years at Parker, nurses’ caps and white uniforms were the rule. Shortly after Parker’s CEO Roberto Muniz arrived in 1998, he decided to do away with the caps and allow the nurses to choose from a variety of colors for their scrubs, two decisions that were widely celebrated.

Even the language used to refer to those whom Parker serves has changed, moving from ‘patients’ to the more dignified and person-centered term of Elders.

Throughout all the changes, Ann’s upbeat approach has stayed constant. You can see this in the way she advises new nursing staff members: “To be successful in this business, you have to like people and be positive. So even if one day is difficult, be hopeful. Because tomorrow will be a better day.”

Parker is grateful beyond words to have a role model like Ann on its staff. We hope to continue to benefit from her positive spirit and skilled efforts for a long time to come.

April 4, 2016