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It doesn’t matter if I am training collegiate athletes, the geriatric population, or any one in between, movement quality is one of the first areas I assess; along with posture and breathing mechanics. Unfortunately quality of movement is often an afterthought for personal trainers and for everyone else who doesn’t use a trainer. Our days are busy and it’s hard enough to squeeze in time at the gym, let alone work on increasing movement quality on top of that. However, I would argue increasing movement quality is even more important than increasing your fitness level. Why? Because, as Gray Cook, the founder of the Functional Movement Screen, often states, we shouldn’t be adding strength to dysfunction (3).
So what does this mean? Simply put, if we are moving incorrectly than we shouldn’t be getting stronger on top of that poor movement pattern. Now, some people will argue that the only bad movement is no movement at all, which I agree with to an extent, and I am not saying we should stop exercising until we become perfect movers. What I am saying is that we should work on improving our movement quality along with increasing our fitness.
Everyone is different, but in general most people with have mobility issues at the ankles, hips, and mid-back (thoracic spine).
Everyone is different, but in general most people with have mobility issues at the ankles, hips, and mid-back (thoracic spine). This is due in part to the excessive amount of sitting many of us do (either at work or home), how we sit and stand, and the types of shoes we wear (many shoes have a huge heel which decreases the ankles ability move the toes towards the shin, among other factors. Having mobility issues at these locations can often lead to pain in the knee and low back because these two areas are supposed to be relatively stable, but if the ankles, hips, and mid-back lack mobility than the body will be forced to find mobility elsewhere during exercise (4) which often ends up being the knee and lower back.
This can result in several issues, but one typical issue is knee valgus (knees collapsing together) during squats, jumps, etc. Another common issue is the lower back taking a brunt of the movement, which is not good, especially since low back pain causes more global disability than any other condition (1,2). It is important to note that this is for educational purposes only, and if you do experience any pain you should consult your physician prior to trying to implement anything new to your routine.
During exercise we should be bulletproofing our bodies from injury, not causing it. Listed below are three simple exercises that you can perform right from the comfort of your home while watching TV, or at your local gym. You can also visit my YouTube channel (just search “Daniel Flahie”) to see several more movement drills and variations.
Thoracic Spine Mobility Drill
Start with your knee on the foam roller and arms placed on top of one another.
Take a deep inhale, and as you exhale rotate your arm across your body as far as you can go. Pay careful attention to your knee, do not allow it to come off of the foam roller. As soon as it does that is your end range of motion- do not continue to go any farther. Perform 3 sets of 3 to 5 reps on each side.
Hip Internal & External Drill
For this drill it is important to have shoes off and keep your heel on the ground. Keep a neutral spine and go down as far as you can while keeping your heel on the ground. Gently push on the inside of your leg with your elbow.
Dorsiflexion Ankle Rocker Drill
Again, the heel must remain on the ground at all times. Make sure the band is over the talus bone, and not too high up the leg. Place a dowel next to your pinky toe and push your knee out past the dowel as far as possible while maintaining heel contact with the ground.
This drill can also be performed without a band.
Hoy, D, March, L, Brooks, P, Blyth, F, Woolf, A, Bain, C, et al. The global burden of low back pain: Estimates from the global burden of disease 2010 study. Annals of the Rheumatic Diseases 73(6): 968-974, 2014.
Price Transparency In Healthcare Now Mandated
Written by John A. Anderson
A very important step towards truly transforming the healthcare quagmire goes into effect January 1, 2019. Every hospital in the nation is required to make all charges available online to the public. Every item and service a hospital provides will now be available for review and comparison, allowing the public to make more informed decisions about their healthcare purchases.
The average premium in America has increased by 69 percent in the past decade, according to the Kaiser Family Foundation. With premiums increasing, families have to make more educated purchasing decisions in the health marketplace to save money, especially those families with higher deductibles. But accurate price information is hard to come by.
Price transparency in healthcare has been bandied about for decades, and has existed in various forms, but never to the point that it is now required. This is monumental in changing healthcare towards a more commoditized purchase, subject to market forces and demand. It should do a lot towards controlling the costs of healthcare. Critical access hospitals, psychiatric hospitals, and rehabilitation facilities will be required to list the prices of the procedures, surgeries, and medical supplies they offer, including drugs and anesthesia. Most people in American want greater price transparency and would compare health care prices if given the option, according to Public Agenda.
Vagueness In Healthcare
Americans have questioned, but generally accepted the vagueness of healthcare pricing. Why? Well, if you request a procedure’s price, you are generally met with a shrug and a verbal, “it depends.” Ask after a procedure and you are generally advised to wait until the bills arrive. When they do, they might as well be written in Sanskrit where “costs” minus “discounts” with “insurance” deducted, followed by an abstruse “patient may owe” amount that may or may not be what the patient owes. Today’s pricing obscurity deprives patients of the usual benefits of competitive markets — including pressure for providers to push prices down.
What will be meaningful is to now compare prices of everything from medications to medical procedures. What will be motivating is observing the price evolution from same procedures performed at different types of facilities. Currently, the same doctor can perform the same procedure in a different hospital/health system facility and the prices can swing wildly between those facilities. Similarly, what will be revealed is how differently insurance companies reimburse the same procedures based on affiliated facilities.
The Affordable Care Act of 2010 originally introduced the concept of posted prices. The Trump Administration has now activated that policy, and the new federal rule goes a step further, requiring that this information to be available online. Seema Verma, head of the Centers for Medicare and Medicaid Services, highlighted the mandate and suggested the move reflects the Trump administration’s ongoing efforts to encourage patients to become better-educated decision makers in their own care.
“We are just beginning on price transparency,” said Verma. “We know that hospitals have this information and we’re asking them to post what they have online.”
Making public a master price list, or chargemaster has been requested before. Yet insurance companies and hospitals have generally skirted the issue, citing proprietary information that might confuse patients. Ironically, when it comes to understanding the pricing and paying for healthcare services, that is exactly what we have today. There is not a more obfuscated, confusing GDP entity than healthcare, as most have absolutely no idea before a procedure what they can expect to pay, and then only find out after weeks and months of insurance dialogue what their expected payment will be.
To be fair, there have been hospitals and healthcare systems who have willingly published basic pricing information online, or they’ve shared that information with healthcare associations to offer some light to potential patients and physicians. But it has been general practice for a healthcare facility to refer price seeking patients to their insurance providers or to a billing department to try and obtain that information via a very involved process that keeps most uninformed until their EOB (explanation of benefits) arrives.
According to the U.S. Department of Health and Human Services (HHS), the federal rule requires hospitals to post the information in a “machine-readable” format, allowing consumers to download it into a spreadsheet. Hospitals are required to update these price lists at least annually.
While the move towards more public healthcare pricing sounds promising, there is good reason to believe that published prices and actual prices will vary widely. To be sure, healthcare is complex by its very nature, and there can be and should be variations based on actual, in-real-time procedures. But a lot of this variation hinges on the negotiations between insurance companies, provider panels, and healthcare facilities. To this end, HHS is encouraging hospitals to provide more information to consumers to put prices in context in an effort to inform patients what they are predicted to pay.
Not Everybody Agrees
And, while price transparency in its purest form is a big part of transforming the healthcare landscape, not everyone agrees it is good for Americans. Robert Graboyes, a health care scholar at George Mason University, gave three reasons we need to be wary of the move towards a more public chargemaster.
“First, it’s beneficial to let brokers negotiate better, exclusive pricing for certain groups. There are reasons why the car market has dealers whose obscure prices are subject to haggling and others, like CarMax, where the price you see is the price you get. Some customers are better off haggling or meticulously researching costs, while others benefit more from certainty.
“Second, as antitrust law recognizes, public pricing can sometimes lead to collusion — another way for providers to resist downward pressure.
“Third, the transparency mandate itself can serve to exclude competitors. A large, politically connected hospital chain might lobby the government to mandate transparency in a way that upstarts find excessively expensive or impossible to meet. Some good things are best left to the willing.”
However, price transparency does not only serve an educational purpose—it actually lowers the cost of health care. According to an article in Health Affairs, both price transparency and reference pricing—the cost consumers can anticipate paying for a given procedure or health service—have helped reduce costs in the long run. “The historical opacity of health care prices is widely believed to be a major factor inhibiting the more efficient functioning of the delivery system,” according to the Robert Wood Johnson Foundation. “Health economists and other experts are convinced that significant cost containment cannot occur without widespread and sustained transparency in provider prices.”
The goal is an informed public, a simplified healthcare system, and an overall, more cost-effective transaction based on knowledge and good-will. The idea is to facilitate and streamline a ridiculously complex industry. Imagine not making 20+ phone calls to determine the out-of-pocket costs for an MRI or emergency visit. Shopping for an appropriate facility for an important procedure has often required exhaustive calls to multiple medical facilities plus one’s healthcare provider—not to mention the patience needed to weather all the transfers and time spent on hold.
Health care spending will total nearly 20 percent of the country’s gross domestic product (GDP) in the next five years. Price transparency does not only serve an educational purpose—it actually lowers the cost of health care. Ultimately, the new federal rule aspires to make healthcare information easier to find so we can make better, more informed, more cost-effective healthcare decisions. It may take some time and iteration to get this into a truly informative, comparable format, but this new transparency when it comes to health care costs is a welcome change.
by Jeffrey Albaugh, PhD, APRN, CUCNS, Director of Sexual Health, NorthShore University HealthSystem
It’s probably no surprise that most men highly value sex and intimacy, and that includes men with prostate cancer. The prostate is a gland that’s about the size and shape of a walnut. Located below the bladder and in front of the rectum, it produces a fluid that mixes with sperm. Prostate cancer treatment side effects can include erectile dysfunction and urinary incontinence, which can have a negative impact on sexual health, intimacy and overall quality of life.
Sex and intimacy are a vital part of the human journey. We are hardwired for an intimate connection with other human beings. If you are in a close, loving relationship, sex may be an important part of the lives of you and your partner. As men grow older, health issues can impact sexual function. Some of the more common health issues that impact sex are diabetes, high cholesterol, high blood pressure, heart disease, and/or side effects related to the treatment of prostate cancer. According to the American Cancer Society, prostate cancer is the most common non-skin cancer in men affecting about 1 out of 9 men in their lifetime. Prostate cancer has no symptoms in the initial stages but can be detected early through screening with a combination of the digital rectal exam and the prostate specific antigen (PSA) blood test. Annual screening for prostate cancer should begin by age 50 or 40 if a man has a family history of prostate cancer or if he is African American. An elevated PSA level can indicate common issues associated with aging, including benign enlargement of the prostate, prostate cancer or potentially both.
If you have been treated for prostate cancer, the most common long-term negative impact of treatment is sexual dysfunction. This can greatly impact life satisfaction for some men, specifically in regards to capability for penile erections. The penis is full of blood vessels, which fill to capacity during an erection, making the penis hard. Healthy men achieve multiple erections every day, mostly during deep sleep and sexual arousal. Erectile dysfunction is defined as the inability to get and keep an erection sufficient for penetration. The majority of men who undergo prostate cancer treatment will struggle with erectile dysfunction. Some of these men may have had erectile dysfunction prior to treatment and some may have not. The effects of prostate surgery on erectile function are immediate and can improve over time as the nerves recover. This can take an average of 2 years and up to 5 years. On the other hand, the effects from radiation are delayed and erectile dysfunction occurs 6-12 months after treatment.
The good news is that there are treatment options for erectile dysfunction and you don’t need an erection for you and your partner to climax. Contrary to popular misconceptions, women climax primarily from clitoral stimulation and therefore do not need a hard penis or intercourse to climax. In fact, men can also climax without an erection. Erectile dysfunction treatments include non-invasive vacuum devices, oral medications, a tiny suppository inserted in the urethra, penile injections and/or penile implant surgery. Since each treatment has pros and cons, it’s important to understand these factors in order to make an informed decision about treatment that is right for you.
Even after a prostatectomy, the majority of men are able to enjoy the climax feeling even though no semen is ejaculated, although the sensation of an orgasm, like erectile function, may take time to recover. The orgasm itself may feel diminished or different and could potentially impact the sexual experience and distract from pleasure. I recommend being fully present and engaged in intercourse with your partner to attain a more pleasurable experience. As many patients and partners have shared with me over the years, it is possible to still enjoy sex and intimacy after prostate cancer treatment. If you are willing to be open to exploring various ways of enjoying sex including oral stimulation, manual stimulation, and vibratory stimulation, an orgasm can occur without intercourse or a fully erect penis. According to the thousands of patients I have cared for over the years, sex can again be fulfilling and wonderful after prostate cancer treatment. It will be different, but it can bring you closer to your partner, increasing intimacy. Some couples have rediscovered and strengthened their relationships via these new and exciting expressions of sexual satisfaction and pleasure.
For education and support related to prostate cancer, visit Us TOO International Prostate Cancer Education and Support Network at www.ustoo.org.
*The views presented are those of the author and do not necessarily represent the views of the United States Department of Defense or the United States Navy.
During this holiday season, let’s take a moment to think about the value of sharing love to those in need and showing gratitude to those who have helped us. The most valuable act of sharing love is the act of helping others. While such feelings of love and gratitude are ubiquitous during holiday seasons, it is important to maintain such feelings in our daily life – after all, they are what creates meaning for our lives.
I once heard a story about a wise old man on his deathbed. A young child asked him, “What is the meaning of life?” The old man paused to think for a long while before answering:
“Looking back on my life, I believe that I am here on earth to help other people make their lives better. What I have not yet figured out is why the other people are here.”
I hope this holiday season helps you to reaffirm or come to the conclusion that the meaning of life is to help others. In case you are not too sure of who you can help, I would advise you to think about the people around you and ask yourself how you can bring more value to their lives. If you believe your small help may not be enough to make a difference, please think again because your “limited resources” may be someone else’s treasure.
Here’s something to put into practice to ensure you’re sharing love and gratitude: How about writing a daily thank-you email, text or a social media message to someone you’re thankful for that day? It’s a great routine to cultivate gratitude, and you’d be surprised how far making others happy goes toward helping you to be happy as well.
If you are still skeptical, I encourage you to take a trip to some of the poorest countries in the world or watch a few YouTube videos about them. No matter how you look at it, somewhere in the world, some people are going through the worst time of their lives. In this holiday spirit, may the sense of your gratitude for being alive and living in a peaceful country guide you to find a way to help other people. You can run a race in a country like Haiti to help raise funds for an organization like DALH or others that help raise awareness of issues like children’s literacy. In places like Haiti, some kids are not able to go to school because their parents cannot afford the $30 needed for a year of tuition.
Who knows? By helping to improve the lives of these kids in Haiti or somewhere else in the world, you might help them find their own life’s meaning. From there, their new sense of purpose in life may also one day lead them to realize that they are here in this world to help others, and this new meaning may be their impetus to seek to create more value for those around them. Collectively, we may end up making the world a little better in the process – not just for this holiday season, but daily for years to come.
This time of year is known for a time when people open their hearts both at work and home. This season often brings out the best in people (or worst). There are many benefits to helping others, but in are 7 reminders why givers also get:
#1 – Giving makes you happy
A 2008 study by Harvard Business School professor Michael Norton and colleagues found that giving money to someone else lifted participants’ happiness more that spending it on themselves [despite participants’ prediction that spending on themselves would make them happier]. When people give, it activates regions of the brain associated with pleasure, social connection, and trust, creating a ‘warm glow’-effect. Altruistic behavior also releases endorphins in the brain, producing the positive feeling known as the ‘helper’s high’. And like other highs, this one is addictive, too.
#2 – Giving keeps you healthy
Giving helps others, but studies show that giving is also good for the giver. Giving boosts physical and mental health. It lowers blood pressure, you experience an increased self-esteem, less depression and lower stress levels. It seems that, contrary to popular belief, we don’t feel good by what we get, we feel good because of what we give. In the end givers live a longer life!
#3 – Giving promotes social connection
When you give, you’re more likely to get back. When you give to others, your generosity is likely to be rewarded by others down the line. Sometimes by the person you gave to, sometimes by someone else. It’s all about karma-points! When we give to others, we don’t only make them feel closer to us; we also feel closer to them. Giving promotes a sense of trust and cooperation that strengthens our ties to others.
#4 – Giving enhances life’s satisfaction
People who give to others are generally more satisfied with their own situation and life than those who don’t. Givers seem better able to cope with problems and difficulties in their own lives, maybe because they have a good understanding of how many people are worse off than they are. Helping others gives meaning to your life and helps to make life worthwhile. While you are thinking about another person, you aren’t dwelling on your own problems.
#5 – Giving spreads joy
When you give, you will spread joy to others in ways you may not even realize. And by giving joy to others, it’s hard not to experience some joy yourself. You create a connection that you may not have had otherwise. You make the world a happier place, one act of kindness and generosity at a time.
#6 – Giving alleviates chronic pain
Physical giving, as in volunteering may help you feel better physically. You are getting out, moving around more than you normally might and spending time with others. If you feel like other people are counting on you, you may be more likely to keep moving even when you are experiencing pain. And helping others may take your mind off of your pain.
#7 – Giving is contagious
When we give, we don’t only help the immediate recipient of our gift. We also spur a ripple effect of generosity. When someone behaves generously, it inspires observers to behave generously later, toward different people. In fact, researchers found that altruism spreads by three degrees. From person to person to person to person. As a result studies say, ‘each person in a network can influence dozens or even hundreds of people, some of whom he or she does not know and has not met.’
Whether at work or home make a point to open your heart a help others.
Who doesn’t love the holiday season and all the occasions to dress up, hang out with family and friends and sip on eggnog or mulled wine? The problem is, that with a filled glass in one hand and endless trays of finger foods circling the room, it’s easy to lose track of how much you’re eating and drinking. Research shows that weight gained during the holidays will likely be cumulative, staying with you through next year and into next holiday season.
Written by Jo Bartell, RD
1. Pregame: If you skip meals or snacks during the day to “save up” for a holiday party, you will arrive starving and much more likely to inhale every tray of passed apps that walks by. To prevent this, plan for a small yet satisfying pre-party snack about an hour before you head to out the door. Your goal is to show up ready to focus on conversations with friends rather than ready to pounce on the buffet table. The key ingredients to an effective pre-event snack always include protein and fiber together. How about a string cheese, a handful of shelled pistachios and a few 100% whole-grain crackers? Or try an apple sliced and topped with a tablespoon of peanut butter and a sprinkle of cinnamon
2. Dress the part: Steer clear of baggy holiday sweaters, comfy shift dresses and anything elastic-waist (or even worse, yoga pants). Loose clothing allows you to eat with abandon, making you less likely to pay attention to your brain and stomach when they are sending out, “I’m getting full” messages. You want to be able to feel when you’ve had enough to eat and drink, and a tight fitting pair of jeans or belted dress should do the trick.
3. Eat more: yes, you read that right– one of the keys to enjoying the holidays without feeling deprived is to focus on foods you can have more of, not less. Whether you’re at a holiday party or between big events, go crazy with anything vegetable! Veggies are not only rich in vitamins and minerals, but they are also high in both fiber and water which will help fill you up and keep you munching while crowding out extra cake, cookies and mashed potatoes. For snacks, try pairing fruit with shelled pistachios. Pistachios contribute protein, fiber, potassium, vitamin B-6, and more while also being the least caloric nut of all the nut varieties. For the same 100-calorie serving, you can enjoy 30 whole pistachios but only between 5 and 15 with other snack nuts. Setton Farms has a super convenient 100-calorie pack of pistachios with makes snacking easy.
4. Be picky: Most people tend to overeat when faced with a wide variety of options. Your best bet is to limit your choices by first doing a onceover of everything offered before taking a minute to decide what looks the absolute best and most worth-it. Then, bulk up as much of your plate as you can (about 1Ž2) with crudités or any other veggie-based sides you see. Next, fill up 1Ž4 of your plate (in a single layer) with a combo of lean protein, like chicken skewers, shrimp cocktail, or smoked salmon. For the last section of your plate, add the homemade pie, holiday cookies, casserole, or any other goodie you’ve selected as your must-have favorite of the options. Try to save the smallest part of your plate for that and savor every bite!
5. Work the room: Make the party about much more than the food and the drinks. Instead, remember that this is the time of year where you get to socialize, and maybe even reconnect with friends and family you rarely see during the year. So, instead of parking yourself at the buffet or bar, mingle at the other end of the room. This way, when you go grab your plate or drink, you’re feeling completely conscious of what you’re choosing to nibble and sip.
6. Help the host: clear plates; wash dishes; fill up champagne flutes for other guests. These tasks will not make you friend of the year, but they will also keep your hands busy and away from the snacks or desserts after you know you’ve enjoyed enough. Another great way to help your host while helping yourself is to bring your own veggie-based side dish or appetizer that everyone can enjoy. Other guests will thank you for contributing, and you’ll have a foolproof, on-track option to add to your plate. Everyone wins!
7. Drink up: A few simple tricks will keep you from packing in the empty calories that live in most holiday drinks and from getting out of control at the dessert table after a few too many cocktails. Just like you’re planning to be picky with entrée choices, be selective with the festive cocktail you choose. Decide what sounds best to you — a mug of buttered rum, a glass of eggnog, or another equally as delicious drink, and then choose to have just the one. You can sip that treat slowly, and then move onto something lighter for the rest of the evening, like a white wine spritzer, a vodka soda, or glass of champagne. Between each cocktail, plan to drink one full glass of water to help keep the drinks from piling up and to help you stay hydrated which will make the morning after that much more pleasant.
About Jo Bartell
Jo Bartell is a registered dietitian nutritionist with a mater’s degree and has extensive training and experience guiding individuals with various health conditions in achieving nutrition-related goals. She graduated Summa Cum Laude with a BA in Psychology and Sociology from Skidmore College, and earned an MS in Clinical Nutrition and Dietetics from New York University (NYU). At NYU, she also completed her dietetic internship. She currently lives in San Francisco with her own private practice nutrition counseling and consulting business. She is an active member of the Academy of Nutrition and Dietetics (AND), the California Academy of Nutrition and Dietetics, and the Bay Area Dietetics Association, along with several Dietetics Practice Groups of AND including Women’s Health, Weight Management, Sports, Cardiovascular and Wellness Nutrition, and Nutrition Entrepreneurs. When she’s not working, she loves food shopping, cooking, traveling, riding horses, and long walks around the city with her dogs, Winston and Nikki.
With winter creeping up on us, it means shorter daylight time and colder temperatures. For many people, it will also be a time of the year when their physical activity efforts dip. People often reduce the amount of time they spend being physically active over the winter, usually due in part to it being so cold outside. Add to that the lack of motivation that people have during the darker, colder months, and it’s a recipe for disaster. The good news is that there are things people can do to help stay motivated to keep moving all winter long.
“Although we may want to behave like it sometimes, we are not bears and cannot get away with hibernating all winter,” explains Coach Sarah Walls, personal trainer and owner of SAPT Strength & Performance Training, Inc., who is also the strength and conditioning coach for the WNBA’s Washington Mystics. “We must continue being physically active during the winter. It’s the only way that we can continue being healthy, and to help avoid seasonal weight gain.”
Many people tend to gain weight over the holiday and winter season. Not only have their physical activity efforts decreased, but their calorie consumption has usually risen. Rather than curl up on the couch with a blanket and the television remote, there are many good health benefits to staying active all season long. According to the Centers for Disease Control and Prevention, physical activity can improve health, and can help people live longer. Being physically active also helps to lower risks of stroke, heart disease, type 2 diabetes, depression, and some types of cancer.
Here are 6 winter workout tips to help keep you motivated:
Enlist a workout partner. Who no-shows on their workout partner? Not many people, and if they do, a good partner won’t let them hear the end of it. If you’re worried about missing an appointment with yourself, get a workout partner and set up a schedule – it’s likely you will show up for many more sessions with a friend to hold you accountable.
Stay focused on healthy eating. It’s easy for one holiday to flow right into the next. There are parties with alcohol and calorie-dense foods, and it may seem never-ending. When you are having fun, it can have a dramatic effect on how you are feeling. The alcohol and unhealthy party foods will wreak havoc with your energy levels immediately, so one of the best ways to stay motivated to get your workouts in is to start with what you are (or rather are not) eating. If you feel good, you’ll probably want to keep that going with a workout. If you don’t feel good because of all the unhealthy foods, it’s likely you’ll spiral out of control a bit when it comes to keeping up your exercise routine.
Try something new. The winter is a great time to try out a new class. Gyms are always coming up with something new and different, and this might be just the right time to add in something you’ve never tried. Trying new activities will help you find ones that you love, and help keep things interesting.
Define (and track) small goals. Whether it is learning to do a certain exercise, getting stronger, or improving your endurance, it’s a great idea to write down and track goals. Start with the biggest one and then break it down into weekly and daily tasks that will get you there. Hold yourself accountable, track where you are at with reaching the goal, and give yourself some non-food rewards when you reach milestones.
Have a fallback plan. What is your plan B for when you walk out of your office at the end of the day and it is unforgivably cold and dark? Do you need to call a friend to remind you how much you love working out? Do you have a secondary workout to do in front of the TV at home? Having a plan B is a good idea, because you will automatically revert to it, rather than coming up with an excuse.
Try a virtual coach. A virtual coach will help you reaching your fitness goals all winter long, all from the comfort of your home or office. You won’t have to go out in the cold air, rather you can get the motivation and guidance you need in a setting that is comfortable for you, and during a time frame that works best for you.
“There is nothing to gain from not adhering to a workout plan all winter long, except for weight,” added Coach Walls. “When you hold yourself accountable and actively look for ways to keep yourself motivated and pushing on, you will be more successful at it, and you will emerge next spring feeling amazing.”
Sarah Walls has over 15 years experience in coaching and personal training. She is the strength and conditioning coach for the WNBA’s Washington Mystics, and has over eight years of experience working as an NCAA D1 strength and conditioning coach and personal trainer. To learn more, visit the site: www.saptstrength.com.
Winter workouts can be miserable if your extremities are cold. Invest in quality socks and gloves to avoid the misery that comes from being cold while working out.
Physicians have been trying to drug the brain into submission since the 1950s. The outcomes have been poor because doctors too often ignore the necessity of first putting the brain into a healing environment by addressing issues such as sleep, toxins, diet, exercise, and supplementation. Dr. Thomas Insel, former director of the National Institute of Mental Health, wrote, “The unfortunate reality is that current medications help too few people to get better and very few people to get well.”
In contrast with antibiotics, which can cure infections, none of the medications for the mind cure anything. They only provide a temporary bandage that comes off when the psychotropic medications are stopped, causing symptoms to recur. In addition, many of these medications are insidious; once you start on them, they change your brain chemistry so you need them in order to feel normal.
Honestly, I undervalued brain health for nearly a decade as a young psychiatrist until our group at Amen Clinics found a practical way to look at the brain. Before we started our brain imaging work in 1991, I had been trained and board-certified as a child-and-adolescent psychiatrist and general psychiatrist and was busy seeing children, teens, adults, and older adults with a wide variety of issues connected with mental health, including depression, bipolar disorder, autism, violence, marital conflict, school failure, and ADHD. During that time, I was flying blind and not thinking much about the actual physical functioning of my patients’ brains. Researchers at academic centers told us that brain imaging tools were not ready for clinical practice—maybe someday in the future.
I loved being a psychiatrist, but I knew we were missing important puzzle pieces. Psychiatry was, and unfortunately remains, a soft, ambiguous science, with many competing theories about what causes the troubles our patients experience. In medical school and during my psychiatric residency and child- and-adolescent psychiatry fellowship, I was taught that while we really didn’t know what caused psychiatric illnesses, they were likely the result of a combination of factors, including genetics, abnormal brain chemistry, toxic parenting or painful childhood experiences, and negative thinking patterns.
“The unfortunate reality is that current medications help too few people to get better and very few people to get well.”
-Dr. Thomas Insel, former director of the National Institute of Mental Health
IMAGING CHANGED EVERYTHING
My lack of respect for the brain vanished almost instantly when I started looking at the brains of my patients with a nuclear medicine study called Single-Photon Emission Computed Tomography (SPECT). It is different from CT or MRI scans, which look at the brain’s anatomy or structure. SPECT looks at brain function, which is helpful because functional problems almost always precede structural problems. SPECT is a leading indicator of trouble, pointing to issues years before they manifest, while CT and MRI are lagging indicators of trouble that reveal abnormalities later in illnesses. SPECT answers a key question about each area of the brain: Is it healthy, underactive, or overactive? Based on what we see, we can stimulate the underactive areas or calm the overactive ones with supplements, medicines, electrical therapies, or other treatments, all of which optimize the brain. We can also help patients ensure that the healthy areas of their brains stay healthy.
Almost immediately after starting to look at scans, I became excited about the possibilities of SPECT to help my patients, my family, and myself. The scans helped me be a better doctor, as I could observe the brain function of my patients. I could see if their brains were healthy, which meant the issues they were facing were more likely to be psychological, social, or spiritual rather than biological in nature. I could see if there was physical trauma from concussions or head injuries, causing trouble to specific areas of the brain, or if there was evidence of toxic exposure from drug or alcohol abuse or other toxins, such as mercury, lead, or mold. I also could see if my patients’ brains worked too hard, which is associated with anxiety disorders and obsessive-compulsive tendencies.
SPECT is a leading indicator of trouble, pointing to issues years before they manifest, while CT and MRI are lagging indicators of trouble that reveal abnormalities later in illnesses.
Now, close to 30 years after we started to look at the brain at Amen Clinics, we have built the world’s largest database of nearly 150,000 brain SPECT scans on patients from 120 countries.
Here is list of things we’ll buy without bothering to look at the price: a pack of gum, a coffee, and… knee surgery?
There are several reasons why people don’t “shop around” for healthcare prices. Underlying this phenomenon is the fact that we’ve been shielded from the true cost of healthcare for so long, we’ve been conditioned to not care about knowing costs.
As healthcare reaches reaches a crisis state, however, more people do care about costs, from executives to legislators to consumers. But there still reasons why the average consumer won’t compare prices. First, if a person is on employer-sponsored health insurance, they might assume they’ll pay the same thing regardless of which hospital or surgeon they choose. “Premiums, deductibles, out-of-pocket, blah, blah, I just need this hernia repaired, not a math test.” Second, a person might just assume prices don’t vary that much (wrong, they vary to an absurd degree). Third, people don’t know where they’d look to find pricing.
Let’s break down these barriers to better healthcare consumerism.
“I Don’t Price Shop Because I Have Good Insurance. They’ll Cover It.”
This is an unwise attitude to have, and it will come back to haunt you, even if you don’t feel the consequences directly.
Say you chose to have a hernia repaired for $10,000, when the same repair could have been done elsewhere by a higher quality provider for $2,000. If your deductible is $2,000, you’ll pay $2,000 for either place. Okay, no difference, right?
Well, many plans only cover 80 percent after the deductible. If you’ve opted for the more expensive procedure, 20 percent of $8,000 is $1,600. That comes from your bank account.
But say your insurance is awesome, and covers 100 percent after your deductible. Lucky you. The more expensive procedure doesn’t take more of your money. But you’ve tipped a domino. The insurance took that $8,000 gut punch. “Good,” you’re thinking, “they probably deserve it.” Regardless of who deserves what, that unnecessary financial burden is simply placed back on consumers in the form of premium and deductible hikes in the future. That means companies won’t be able to offer as good of health plans to employees, and healthcare coverage will become more expensive in general.
So by not price shopping, you are contributing to the ruin of the healthcare system.
“Healthcare Prices Don’t Vary That Much.”
Let’s look at average knee replacement surgery prices across the country:
New York: $36,584
Are we saying that if you live in Dallas, flying to Arizona to have surgery could save you $10,000? Yes it could.
Similar variation is seen in everything from MRIs to colonoscopies to C-section deliveries. In a word, prices vary wildly, not just from state to state, but from city to city, and especially from hospital to hospital, and doctor to doctor, even within your network.
The savvy reader may wonder, doesn’t higher price mean better quality?
Research suggests that price is not a good predictor of outcome. In fact, many hospitals aren’t aware of how much a procedure actually costs them. They are simply setting the best price they can. It’s a business run on profit, after all. The disconnect between price and costs is the heart of the problem.
“I Don’t Know How to Find Out the Price of Procedures.”
Imagine grocery shopping with all the price tags removed. One loaf of bread will cost you $2, and another $50, but you won’t know which until paying.
That’s what it’s like for healthcare consumers. While most states require hospitals to report price information, many simply don’t give that information to patients, even when asked. In a recent study by from the University of Toronto and Boston University School of Medicine, researchers canvassed hospitals and surgeons to get price quotes for a full hip replacement surgery. They got a complete or partial price about half the time. Compared to a previous study conducted by the same researchers, the number of hospitals that could provide any price information actually dropped. In other words, prices might actually be becoming less transparent.
Currently, there is little incentive for doctors and hospitals to lower costs, because patient’s can’t factor price into their decisions when there is no price tag to be found. Price transparency would provide incentive to lower costs, according to Anna Sinaiko of the Harvard T. H. Chan School of Public Health in Boston. After all, nobody is going to pay for $50 loaf of bread.
“Increasing transparency could also benefit the health care system broadly because it would be increasingly difficult for clinicians to charge significantly higher prices than others without commensurate differences in quality,” she wrote, commenting on the study. “These high prices are a key contributor to higher health care spending in the US relative to other countries.”
Wouldn’t it be great if doctors and hospitals had to compete for your business? That’s how an economy is supposed to work, and why prices go lower.
Price transparency isn’t a new issue. In 2014, the Centers for Medicare and Medicaid Services were asked to make pricing information available. But as this recent research shows, transparency still isn’t where it needs to be. Even if prices are available, a patient has to put forth a lot of effort to find them.
Part of the problem is that prices aren’t always easy to calculate. In many cases, it is hard to determine, in advance the health services a patient will need. For example, if an unexpected complication comes up in surgery, that’s added cost. Additionally, charges often originate from many providers, so costs are hard to nail down and appropriately aggregate.
But for something common like hernia repair or appendix removal, shouldn’t a price estimate be easy to acquire? Yes. For this reason, some insurance companies and third parties are starting to offer price transparency tools. Remember, insurance companies are happy if they can pay less to cover your procedure.
A white paper from Thomson Reuters found that the United States could save $36 billion in healthcare spending with price transparency. For this reason, governments, anxious to lower healthcare costs, also see a benefit to price transparency. Some states, like New Hampshire and Massachusetts, passed price transparency laws, with the hopes that it will drive a more competitive marketplace and lower prices. Most states, however, are terrible with medical care price transparency.
Pushing to know prices is one way consumers can help to correct a flawed healthcare system. One tool consumers can use to know fair prices is the Healthcare Bluebook (www.healthcarebluebook.com). Another is clearhealthcosts.com, which actually lets consumers contribute data about what they’ve paid for medical care, so others can see pricing.
Consumers can also turn to alternative health plans. Some companies offer high deductible health insurance plans attached to a health savings account (HSA), as an option to increase member awareness and encourage them to compare costs. An HSA is essentially a tax-advantaged savings account that can be used for certain qualified medical expenses. Unlike health insurance premiums, contributions are made tax free and anything contributed to an HSA rolls over from year to year, allowing funds to aggregate. Healthcare consumers can therefore take ownership over their healthcare decision making rather than pay dues to the system for a dubious return.
HSA Healthplan in Utah is one such company that combines high deductible health insurance with an HSA. They’ve built a database of pricing for a variety of medical procedures, and push members to compare pricing before receiving medical care/treatment. When members choose more affordable, high value providers and facilities, the company rewards them by putting some of the savings towards the members out-of-pocket costs for the procedure or back in the members’ individual health savings accounts. These funds can be used to pay for current medical needs or future medical, dental, vision and prescription expenses.
As demand for price transparency increases, price will begin to more closely coincide with actual costs. When the two are disconnected, we don’t have a competitive market. When they are connected, costs go down, and the healthcare economy becomes healthier.
Jennifer Christman, RDN, LDN, CPT, Clinical Nutrition Manager at Medifast, Inc.
The holiday season can be a time of excess, both in eating and in celebration. It’s easy to overindulge in large portions of high calorie foods; tis the nature of holidays for many people. Fortunately, it doesn’t have to be. If you’re looking to maintain your healthy habits and your waist line, consider the following tips:
1. Don’t change your eating pattern.
Have you ever planned on “saving” your calories by dodging food all day for a party later that evening? Many people do, but what they don’t realize is that the body will naturally try to compensate for the lack of calories and nutrients later in the day. By skipping meals and starving yourself prior to the event, you’re more likely to overindulge and eat more than you would normally would have had you maintained your normal eating pattern! So, stick to eating every few hours to help with metabolism, normal blood sugar levels, and preventing those binges later on.
2. Eat breakfast.
Start off the day with a balanced breakfast. Include at least three of the following for a nutrient dense and energy-packed meal: low-fat dairy, fruit, whole-grains, lean protein and vegetables. This will give you the nutrition you need to plan holiday activities, run errands, shop, or wrap gifts. Try a veggie omelet made with egg whites, peppers, mushrooms, tomatoes, and low-fat cheese. Include a glass of unsweetened almond milk or skim milk and a cup of berries to round out the meal. A balanced breakfast will help jump start your metabolism and give you the energy you need to stay focused throughout the day.
3. Avoid grazing.
Prior to arriving at a holiday party, make a plan to avoid grazing. How many times have you stood by the buffet table and mindlessly ate whatever was being served while catching up with family and friends? By the end of the night, the number of calories you consumed is a complete and utter mystery. High-calorie foods, such as sweets and high-fat dips, are often a part of the holiday menu and can cause unwanted calories to add up fast. To prevent yourself from overeating, make a plan to create distance between you and the buffet table. Talk with friends in a different room other than the one with food in it to avoid grazing.
4. Be picky!
Let’s face it; there are bound to be several tempting treats that you cannot completely avoid because making and serving them are truly a part of your family’s holiday tradition. If you were completely honest with yourself, it wouldn’t be the holiday season without a taste, right? So, be picky when it comes to indulgences. Have a plan and carefully choose which higher calorie foods are truly worth it. Does your mom make the most amazing chocolate chip cookies? Is your aunt’s double chocolate cake a tradition? Choose wisely and watch your portion size to keep overall calories down.
5. Water, water, water!!!!
Staying hydrated is one of the habits to help you sustain your energy level and keep you feeling your best. Keep a reusable water bottle with you at all times throughout the holiday season. When you go out shopping, refill it at a water fountain for free. When attending a party, try adding a little fizz and/or flavor to your hydration regimen with options like seltzer or sparkling water with a lemon or lime wedge.
6. Keep the drinks skinny or avoid them all together.
Free flowing alcohol tends to be a staple during the holiday season and can be a trigger for many people. A few drinks add extra, non-nutrient calories while lowering inhibitions, which leads to overeating. Avoiding alcoholic beverages when possible will help keep your calorie intake down. If you do choose to imbibe, stick with zero calorie mixers and light beers. Fill your glass with ice to add water and reduce the volume of the alcoholic beverage. While enjoying spirits, drink a glass of water in between each alcoholic beverage to ensure you stay hydrated.
7. Fill up with color.
Fill your plate with low calorie, nutrient dense fruits and vegetables. Enjoy vegetables like; peppers, carrots, sugar snap peas, celery, cauliflower, and broccoli. Seasonal fruits like pomegranate, pears, oranges, and clementine make a sweet addition to any buffet. Filling half your plate with fruits and vegetables can ensure you keep your overall calorie intake low and get the fiber you need to stay full and satisfied.
Try incorporating these tips during the holiday season to avoid over indulging and maintain your healthy lifestyle.
Jennifer Christman, RDN, LDN, CPT, Clinical Nutrition Manager at Medifast, Inc.