What is Supportive Living?  Find out more here.

Or download this informative summary from the Afforadable Assisted Living Coalition.

I will be joined by Wayne Smallwood, Executive Director of the AALC, and Rick Banas of BMA Management tonight on House Calls.  If you want to learn more about Assisted Living and Supportive Living, this is the show for you!  Tune in and call in live with your questions.

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April 16th is National Health Care Decisions Day.  When a health crisis occurs, many individuals and families are unwillingly thrust into a situation where a difficult decision must be made, and the values or preferences that would guide that decision were never discussed.  Don't let this happen to you.  Take time to choose your power of attorney for health care, the one person you would trust to make decisions about your health care on your behalf if you were ever unable to express those wishes.  Let that person know that you would be honored if they would play that role for you.  Talk with them about what is important to you if you ever encounter a scenario in your own health where you cannot verbalize your wishes.  You don't even have to discuss specifics, but it may help that person if they know what type of approach you would want if you were in that situation and you had very little hope for recovery.  Then, complete the Durable Power of Attorney for Health Care form.  It can be downloaded here.  Make copies for your power of attorney, yourself, and give one to your doctor and anyone else you think should have a copy.  If you need help, make an appointment with your doctor to specifically discuss this issue.

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Today I attended the Million Med March held in cities across the US and here in Chicago.  It was sponsored by Docs 4 Patient Care, a grassroots organization of physicians, healthcare professionals, and concerned citizens who want to reform health care while preserving the integrity of the patient-physician relationships we enjoy in this country.  I didn't know much about the group before today.  There weren't exactly 1 million doctors at Chicago's rally today- maybe 200-300.  Even so, there were some important messages.  Here is a summary of what was said, and my reflections on the event.


1. We are blessed to live in a country where the exchange of ideas is protected by law.
It was a privilege to gather with like-minded people today and express my views on an issue that I care about.  Few nations on earth protect, and even encourage, free and peaceful assembly to promote a cause.  The police who were present were not there to break up our meeting, or even monitor what we were saying, but to protect our right to assemble.  I'm not a big "rally" guy, but I appreciated the chance to participate today with no risk to my personal safety, my job security, or my family's well-being.

2. Doctors are bad protestors/activists.
Today's rally lacked the energy that I have experienced at other public events.  It was not because the doctors present do not believe strongly in sensible health care reform.  I think most physicians, in an effort to provide their patients with the best, evidence-based medical care, get used to just falling in line with the latest recommendations and "standard of care."  Protests do not come naturally.  That, combined with the even-tempered personalities often found in physicians, makes us bad activists.  We are not a "rah-rah" crowd.

Most of the doctors I talk to are not in favor of the current health care bill.  Most of them also feel there is not much they can do to impact the health care reform efforts in Congress.  Part of that is due to the fact that very few doctors were actually invited to participate in the process.  The American Medical Association (AMA) supports the bill, but it represents less than 30% of doctors.  (Many AMA members are newly graduated physicians who have not taken time to cancel the free membership they received as a medical student.)  Another reason doctors don't feel we can have an impact is that, for whatever reason, we tend not to rally together.  Perhaps it is the self-sufficiency we learned in medical school and residency training.  It may be that we are too busy to ask each other to participate in an event seen as an "extra" thing.  The laws prohibiting physicians from forming a union also prevent us from uniting around a cause.  I am proud of those physicians who attended today.  As one physician and speaker put it, "I wasn't going to come today because I have a busy practice, a family, and few minutes to spare, but then I realized, that is why I needed to come today, because health care reform is going to affect all of those things."

3. The introduction of a public option will lead to government-run health care.
Even if this is not the stated intention, offering a government-subsidized health insurance plan to all will eventually destroy private health insurance as we know it.  The argument for the "public option" says that health insurance companies need a competitor to "keep them honest" and the government needs to provide this competition to prevent abuse.  Sounds great, but since when did the US government compete with its own people?  One enters a competition for one reason: to win.  That means that the clandestine goal of the government-run plan is to make private insurance companies into losers.  Since a government plan does not have to remain profitable to stay in existence, it will play by different rules.  Since its inception in the 1960's, Medicare has operated at a $37 trillion loss, yet it is bigger than ever.  No private company can "compete" against a beauracracy that bulletproof.

4. The "opt-out" provision in the Senate bill is a sham.
To create the impression that the public option is not being forced upon us, the Senate included language that will allow individual states to opt out of offering the public option.  What is not publicized is the fact that states who opt out will still pay the same taxes as states who opt in.  They will incur the same costs but no benefits.  It's doubtful that any states will opt out of the plan, since they cannot opt out of the cost.

5. Estimates of the bill's costs are grossly underestimated.
You have probably seen the CBO estimates of a $849 billion price tag for the current health reform bill.  The CBO numbers are based on a ten-year projection.  Since the changes to the health care system are slated to take place in 2013, the estimates only include 6-7 years of costs, but they include 10 years of increased taxes that will start immediately.  In other words, three of those ten years are income-only years for the program, with no costs.  Let's say you move into a house in June and paying six months of mortgage payments of $1000 each.  Would you then assume that, since you paid $6000 for your mortgage this year, that you would pay $6000 again next year, and your payments would only be $500/month?  Of course not, because you failed to take the entire year into account, but that is essentially the way the CBO is projecting the costs of this health care plan.

Plenty more was talked about today, and I encourage you to read as much as you can and get as involved as you can.  To learn more about today's event, visit Docs 4 Patient Care.


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uesday morning on WMBI a caller asked if there was something safe that her daughter could take in her 7th month of pregnancy to help her sleep. In the midst of a busy morning of calls, I gave her a kneejerk response by recommending the antihistamine diphenhydramine, the active ingredient in Benadryl. This approach is safe, as diphenhydramine is a pregnancy category B medication (meaning that studies in humans have proven it to be generally safe for the unborn child). However, I did not take the opportunity to discuss other natural remedies, as well as behavioral strategies for sleep in the later stages of pregnancy.

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The fine people at the Albert Schweitzer Fellowship recently invited me to participate in their "Five Questions for a Fellow" feature on their blog Beyond Boulders.

Read the article here.
Read more about Albert Schweitzer here.

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Here it is: the breakdown you've been looking for on the flu vaccines.
Who should receive them?

First- the regular seasonal flu vaccine, available now.
You should get the flu vaccine this year.
The only people who should not are infants less than 6 months, people with an egg allergy, and people with a previous reaction to the flu vaccine.

Next- the H1N1 vaccine, available in the next few weeks.
The following groups of people should get this vaccine:
Pregnant women
Children age 6 months to 18 years
Caregivers for children this age
Young adults 18-24
Health care workers
People age 25-64 with a chronic medical condition
(Examples include diabetes, asthma, COPD, and autoimmune conditions)

People age 65 and older are at lower risk for H1N1, so they are not recommended for the vaccine until the higher priority groups are inoculated.  Sometime in December or January, people age 65 and older may be recommended to receive the H1N1 vaccine.

The H1N1 vaccine will be available as a nasal spray and as a shot.  Pregnant women cannot receive the nasal spray because it contains a live virus.  It is safe for everyone else except those with a compromised immune system (as in HIV).  Children under 10 will require 2 doses about 4 weeks apart.  Everyone else will need only one dose.

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Today's article by Barbara Brotman in the Chicago Tribune gives an excellent representation of what advance care planning conversations might look like at the end-of-life. Of course, advance care planning can occur at any stage of illness, and does not always have to address things like Do-Not-Resuscitate orders or refusing other invasive measures. It could simply cover what you value when it comes to your health care, and who you want for your Power of Attorney.

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Have you heard the radio advertisements for legal firms that will send you a FREE living will? Have you heard them promise that if you call now, you can save even more money because they will include a FREE Health Care Power of Attorney? Sounds great, doesn't it? What they don't mention is that these documents are already available for free, and you don't even need a lawyer in order to complete them.

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Part of the proposed health care reform bill that I like is the idea to reimburse physicians for having an "advance care planning" discussion with their patients once every 5 years. This is something I do with my patients often, and I have wished many times that Medicare would recognize the value of this skill, and the time it takes to perform it, by offering specific reimbursement for the discussion. Unfortunately, some Republicans are saying that supporting a patient-physician conversation about goals of care and end-of-life options will "start us down a treacherous path toward government-encouraged euthanasia". I disagree.

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A caller to my Tuesday morning appearance on WMBI asked a question about chia seeds, and I had to admit that I did not know much about what they had to offer. If you're like me, the word "chia" conjures up images of pet-shaped terra cotta pottery with green sprouts. It turns out that eating chia seeds can have some positive health benefits.

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