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A Father’s 5-Point Plan for Investing in Your Health

As fathers, one of our most important responsibilities is to be there for our children. Work and travel schedules may make it difficult to be home every night for dinner or to catch every baseball game or music performance, but taking action on a few simple things can help us invest in our health today to ensure we are around to support and guide our children as they grow.

As the survivor of a health scare a few years ago, I have made a personal commitment to a simple, five-point plan for health – and I encourage others to do the same. Here’s the plan I follow that can also help you invest in your future:

1. Know your numbers – Cholesterol, blood pressure, blood sugar. The key to good health is understanding first where you stand, and what you need to improve. For me, I love to cook so it’s about reducing the amount of salt and sugar I use to keep my numbers in check.

2. Know your history – Just as important as the lifestyle you lead is what you’ve inherited from your family. Knowing what you face genetically can go a long way in ensuring your current and future health. Share your family history with your physician who can help develop a customized health care plan that allows you to monitor and track against illnesses for which you might be disproportionately at risk due to what you’ve inherited.

3. Make balanced choices in your diet – Healthy eating isn’t about denying yourself every food you enjoy. As my doctor likes to say, you don’t have to give up everything. You never will be successful. But you do have to discipline yourself, and that’s something I have been working on as I try to manage my own weight. It’s not about going on a diet, which is based on denial, but about making responsible decisions that let you enjoy the foods and drinks you love, but in moderation. It’s tempting to eat steak and burgers – but research continues to caution against eating too much red meat. Instead of reaching for the chips, eat celery or carrot sticks instead. And instead of grabbing that cookie, reach for a peach or an apple to satisfy your sweet tooth.

4. Get moving! Get active – Most of us sit behind desks – or in traffic – for a good part of the day, so I can’t emphasize this point often enough. Physicians usually recommend at least 30 minutes of exercise, five days a week. You don’t have to be an athlete to get active – just walk, walk, walk! As president of a large, national health care organization, I log many miles traveling to our various sites. During my time on the road, I often take a personal walking tour of the many cities I visit. Walking doesn’t take fancy equipment and you don’t need to dress up or drive somewhere to do it. All you need is a sturdy pair of walking shoes, and many hotels provide maps for walking. You can even log miles and track your progress with walking partners at www.everybodywalk.com.

5. Have a good relationship with your physician. I respect – and also really like my doctor. She is more than a physician; she is a great coach. You should have the type of relationship with your physician where you feel he or she is on your team. If you don’t feel comfortable with your physician or don’t think of her or him as a partner in your life plan for health, then it’s time to find a doctor who can support your path to total health.

According to the U.S. Surgeon General, 80 percent of premature deaths in the U.S. are caused by four preventable behaviors: lack of physical activity, poor diet, alcohol use and smoking. The five steps I’m sharing with you are simple behavioral changes that won’t take up a lot of time, and will pay off in dividends in 10, 20, even 30 years down the road. Making time to invest in your health is a commitment well worth making and every effort you contribute starting today, will pay significant dividends for years to come.

Bernard J. Tyson is president and chief operating officer of Kaiser Foundation Hospitals and Health Plan, Inc.


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Richmond, VA – In an effort to simplify inpatient medical billing, one area hospitalist group has determined that “altered mental status” (ICD-9 780.97) is the most efficient code for use in any patient work up.

“When you enter a hospital, you’re bound to have some kind of mental status change,” said Dr. Fishbinder, co-partner of Area Hospitalists, PLLC. “Whether it’s confusion about where your room is located in relationship to the visitor’s parking structure, frustration with being woken up every hour or two to check your vital signs, or just plain old fatigue from being sick, you are not thinking as clearly as before you were admitted. And that’s all the justification we need to order anything from drug and toxin screens, to blood cultures, brain MRIs, tagged red blood cell nuclear scans, or cardiac Holter monitoring. There really is no limit to what we can pursue with our tests.”

Common causes of mental status changes in the elderly include medicine-induced cognitive side effects, disorientation due to disruption in daily routines, age-related memory impairment, and urinary tract infections.

“The urinalysis is not a very exciting medical test,” stated Dr. Fishbinder. “It doesn’t matter that it’s cheap, fast, and most likely to provide an explanation for strange behavior in hospitalized patients. It’s really not as elegant as the testing involved in a chronic anemia or metabolic encephalopathy work up. I keep it in my back pocket in case all other tests are negative, including brain MRIs and PET scans.”

Nursing staff at Richmond Medical Hospital report that efforts to inform hospitalists about foul smelling urine have generally fallen on deaf ears. “I have tried to tell the hospitalists about cloudy or bloody urine that I see in patients who are undergoing extensive work ups for mental status changes,” reports nurse Sandy Anderson. “But they insist that ‘all urine smells bad’ and it’s really more of a red herring.”

Another nurse reports that delay in diagnosing urinary tract infections (while patients are scheduled for brain MRIs, nuclear scans, and biopsies) can lead to worsening symptoms which accelerate and expand testing. “Some of my patients are transferred to the ICU during the altered mental status work up,” states nurse Anita Misra. “The doctors seem to be very excited about the additional technology available to them in the intensive care setting. Between the central line placement, arterial blood gasses, and vast array of IV fluid and medication options, urosepsis is really an excellent entré into a whole new level of care.”

“As far as medicine-induced mental status changes are concerned,” added Dr. Fishbinder, “We’ve never seen a single case in the past 10 years. Today’s patients are incredibly resilient and can tolerate mixes of opioids, anti-depressants, anti-histamines, and benzodiazepines without any difficulty. We know this because most patients have been prescribed these cocktails and have been taking them for years.”

Patient family members have expressed gratitude for Dr. Fishbinder’s diagnostic process, and report that they are very pleased that he is doing everything in his power to “get to the bottom” of why their loved one isn’t as sharp as they used to be.

“I thought my mom was acting strange ever since she started taking stronger pain medicine for her arthritis,” says Nelly Hurtong, the daughter of one of Dr. Fishbinder’s inpatients. “But now I see that there are deeper reasons for her ‘altered mental status’ thanks to the brain MRI that showed some mild generalized atrophy.”

Hospital administrators praise Dr. Fishbinder as one of their top physicians. “He will do whatever it takes to figure out the true cause of patients’ cognitive impairments.” Says CEO, Daniel Griffiths. “And not only is that good medicine, it is great for our Press Ganey scores and our bottom line.”

As for the nursing staff, Griffiths offered a less glowing review. “It’s unfortunate that our nurses seem preoccupied with urine testing and medication reconciliation. I think it might be time for us to mandate further training to help them appreciate more of the medical nuances inherent in quality patient care.”

Dr. Fishbinder is in the process of creating a half-day seminar on ‘altered mental status in the inpatient setting,’ offering CME credits to physicians who enroll. Richmond Medical Hospital intends to sponsor Dr. Fishbinder’s course, and franchise it to other hospitals in the state, and ultimately nationally.

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