Reducing Triglyceride Levels

The American Heart Association along with Michael Miller, M.D., director for the Center for Preventive Cardiology at the University of Maryland – School of Medicine in Baltimore, just released data and recommendations that diet and lifestyle changes alone should be sufficient to reduce elevated triglyceride levels.

The researchers analyzed more than 500 international studies conducted over the last 30 years for the purpose of updating doctors on the role of triglycerides in the evaluation and management of cardiovascular disease risks. The study confirmed that triglycerides are not directly atherogenic but are instead a marker of cardiovascular disease risk.  High triglycerides are commonly seen in diabetes mellitus, chronic kidney disease and certain disorders associated with HIV disease. Alcohol and obesity plus inactivity all contribute to elevated levels with TG levels rising markedly in this country since the mid 1970’s in concert with the obesity epidemic we are now seeing.

Triglycerides are checked on a fasting blood test of optimally 12 hours with the upper limit of normal set at 150mg/dl. Newer recommendations will reduce the level to 100 mg/dl.  If your triglycerides are elevated the study made the following suggestions to lower them to appropriate levels:

  1. Limit your sugar intake to less than 5% of calories consumed with no more than 100 calories per day from sugar for women and no more than 150 calories per day from sugar for men.
  2. Limit Fructose from naturally occurring foods and processed foods to less than 50 -100 grams per day
  3. Limit saturated fats to less than 7% of total calories
  4. Limit trans-fat to less than 1% of total calories.

Elevated triglycerides, especially above 500 mg/dl, are associated with an increased risk of pancreatitis. For individuals with TG levels this high we recommend complete abstinence from alcohol.

Exercise is necessary to lose weight and lower triglyceride levels as well. Physical activity of a moderate level such as brisk walking for at least 150 minutes per week (2.5 hours) can lower your triglycerides another 20-30%.

If lifestyle changes including diet modifications and aggressive exercise do not bring you to target levels we suggest the addition of marine based omega 3 products. Also, eat fleshy cold water fish!

A combination of dietary changes, moderate regular exercise and weight reduction is all that is needed to control most problems with triglycerides.  Referrals to registered dietitians can be very helpful in assisting you with the dietary changes required to be successful.

I Work For T-Shirts

Every April my colleague and friend Joe Forstot calls to ask if I will do volunteer physicals for Boca Hoops and I always say “yes”.   Dr Forstot is a rheumatologist by trade, but to me he has been a senior resident and teacher when I was an intern, a mentor and now, the preceptor and teacher for my niece, a second year medical student. Most of all he is my good friend.   I am always intrigued by physicians who find a way to help others outside their normal professional role.  Dr Forstot is one of those individuals.

Twenty four years ago, his younger son, a wonderful basketball player and fan was cut from the school basketball roster on the final day of tryouts.  There were no alternatives. Boca Raton, Florida was a sleepy college town with one indoor basketball court inside the city’s oldest elementary school. The local universities and colleges still did not have an indoor facility and there were certainly few, if any, youth leagues.  Out of necessity, Dr Forstot and his friend Mike Doyle, a Broward County public school teacher, started Boca Hoops.

Everything about Boca Hoops was done correctly for all of the right reasons. Teams were formed by random selection after open tryouts were used to rank the childrens’ abilities. Teams were constructed for parity purposes.  Every child had to play the same amount of time in a rotation system for the first thirty minutes of a 32 minute running time game. Since there were not enough girls to start a girl’s league immediately, most teams were co-ed.  Sportsmanship, having fun and learning the game were the goals of the program.

To finance the costs, the organizers sought sponsors for teams and advertising banners. They came up with the idea of requiring a pre-participation physical exam and charging a fee for it. The fee from the physicals went to offset league expenses. Community physicians were asked to volunteer their time and perform the benchmarking physicals on participants.  In the first few years I was a sponsor of a team, a coach of a team and a volunteer physician.

The physicals were fairly basic discussing vaccinations and immunizations, age appropriate growth landmarks and some screening for cardiovascular diseases and congenital orthopedic problems. Inflation over the last 23 years has driven the cost of the physical from the original $5 to this year’s cost of $25.

From a physician’s viewpoint, we have moved from an elementary school cafeteria where we sat in little chairs and worked at little desks, to a high school teacher’s lounge where the chairs are kinder and gentler to our aching backs. The patients are still young and enthusiastic. The parents are still warm and appreciative. It’s a great opportunity to meet the young parents and children of the community and learn about what is going on in their schools and lives.

The league has grown over the last 23 years. It now encompasses almost a thousand players with separate boys and girls leagues.  There is a travelling competitive program for boys and girls plus three modestly priced summer instructional day camps. They play at indoor facilities at the local public and private schools as well as universities and city parks.  The shining jewel of the program is probably the High Five Division created for special needs children to learn the game and have a chance to play and have fun.

I have continued to sponsor a team each year since my children moved on to college and adult life. Many of the coaches in the pictures on the plaques I receive of my team either played for me as children or on opposing teams. Their children are now old enough to play in Boca Hoops.

I am running out of room on my office walls to hang all the team photos from my many years of sponsorship. The true prize of participation however is my Boca Hoops “Doc” T- shirt presented annually to each physician who volunteers. Over the years, the shirts have evolved from a plain blue t-shirt to a collared golf type shirt with a unique logo for Boca Hoops. The name “Doc” is printed on the front pocket.

I work for T shirts.

Dealing with the issue of Aging Parents – by Andy Berger of Senior Wellness Specialists

I am writing this in response to an article published in the Mercury News titled “Savvy Senior: Elder mediation can help adult families resolve conflicts”

How you deal with the issue of aging parents has a lot to do with the way you were raised. As kids do you remember having dinner with grandparents? Visiting with them at their home? Watching your parents interact with them? Was there respect shown the grandparents? Many cultures revere their elders and gain tremendous insight into many wonderful things through them. But when respect and reverence are absent resentment and anger tend to show their ugly face. Solutions exist before the first salvo is fired, making mediation the choice of last resort.

Money matters among other things, as we have read, bring out the worst in people. The expenses associated with maintaining an independent and dignified lifestyle are enormous.. Insurance and medical costs have gone through the roof. Parents and adult children find themselves in a very stressful situation, as each worries about how they will manage in retirement.

Mom and Dad are living longer and are going through their savings fast, Most Boomers want to be able to help in some way. But they worry about their own retirement. They fret and fight amongst themselves over whether they can or should help out their parents if the need arises, as in the case of a parent having to enter an assisted living facility or a nursing home. Sadly, there have been instances reported where their kids have had to sell off jewelry and other possessions to pay for more time in a facility. From here the frustration and resentment continue to mount.

Boomers who were fortunate enough to have had positive family role models in their youth usually show a strong willingness and a certain calmness when faced with being put in the role of caregiver. Not so much for those whose memories of family time in their childhood were less positive … love, compassion, and tolerance are learned. We all have the capacity to acquire them. We just need better role models.

  • How willing are you to give of your time if your parents need you?
  • Sibling rivalry in adulthood can be as intense in this scenario as it was in your youth?
  • Who’s going to take charge of your parents’ finances to make sure their needs are met?
  • Which of you is nearest Mom and Dad to check up on them if they’re still living on their own? Chances are one of you is going to feel put out.
  • On whom does the responsibility fall to be the primary caregiver in old age?

The need for greater involvement of one’s family in the care of loved ones in later years has never been presented with this much clarity. The government wants you to participate more; heck they’re willing to pay you to stay home with Mom/Dad instead of Medicare and Medicaid picking up the tab at a much higher cost. Unless you have a plan to implement to get you through some of these tough times, expect chaos, apathy and total resentment from your siblings.

The last thing any parent wants to see is their kids miserable. Even if you weren’t lucky enough to have great role models growing up, there are things you can do to make the transition to caregiver an enjoyable one. Start by meeting with an attorney to map out how your parents will be cared for as they age; he/she will help determine who among you is best equipped (emotionally and financially) to act on behalf of the parents; as well as who gets what when the parents pass. Long-term life-care insurance should be purchased in your 30s, 40s and 50s; any later and it is cost prohibitive. Insurance companies are also looking into insurance policies that let you age-in-place at home by paying for modifications to your house. And there are communities in suburban areas popping up where neighbors share various expenses, making aging-in-place more affordable. Concierge programs and services exist that can help you plan and assist with all your health and wellness needs.

This guest post was authored by Andy Berger of Senior Wellness Specialists.

Financial Hurdles of Aging – Guest Post by Andy Berger of Senior Wellness Specialists

There’s no getting around it, aging is very expensive! Hard fact: Tens of millions of Boomers are stressing out over caring for their parents while at the same time trying to map out a course for themselves for the day they lose their independence. We have officially entered a Tsunami of Seniors. But there is hope.

We’re living longer and paying for increased medical procedures. We also have to place parents in assisted living facilities for special care, where they go through their life’s savings quickly. The fastest growing segment of the aging population is the 85 group. As was pointed out by many of you in your comments, Medicare and Medicaid may not be able to handle the demand placed on them. Signs of problems manifested over a decade ago when Florida and Tennessee put a moratorium on the construction of nursing homes; they had simply begun to run out of money to pay for the care of the elderly. Somehow the rapid growth of the senior population fell under their radar. Further cuts to both programs will take shape by 2012, as Congress tries to balance the national budget.

Suffice it to say a greater burden will be placed on families to take care of their own.  So much for parents not wanting to be a burden to their kids or to be an inconvenience to friends.

It’s been reported in the various media time and again that compared with their parents’ generation, Boomers have amassed significantly greater wealth. It’s fair to say, in light of current economic hardships placed on them, they will now have to strike a balance between the dream of a fun, relaxed lifestyle and the changing realities that aging has brought to the landscape.

The government has incentives for families that decide to take in loved ones who would otherwise be placed in a nursing home. It is significantly less expensive to write a monthly check to the family than to pay for the 24/7 care provided at a nursing home.

Other new concepts in senior living are also emerging. In the planning stages in Florida is a village where seniors live on their own in lushly landscaped suburban communities and are able bundle all expenses at discounted rates with their neighbors. This would include doctor visits, transportation, entertainment, etc. Homes are universally designed and technologically enhanced so residents can age safely, worry-free in a 21st Century approach to senior living.

Less costly alternatives to assisted living and nursing homes exist. Concierge programs and services allow you to live independently in your own home through technological innovations that make it possible to stay connected to loved ones and friends.

Long-term care insurance providers are also taking a fresh new look at selling policies that will help pay for expenses related to aging. If purchased by people in their 30s and 40s the costs would be very reasonable. Let’s all try to be better prepared for the second half of our lives.

This guest post was authored by Andy Berger of Senior Wellness Specialists.

Evaluating a Patient’s Ability to Live Independently

As a geriatrician in a locale with many elderly retirees, I am frequently asked how long mom or dad (or both) can stay in their home and live safely and successfully.  It is clearly a complicated issue even if the individuals involved are cognitively and mentally intact, physically capable and financially able to pay for support and help.

There is much to consider. Are the patients physically able to maneuver within their household safely?  If sleep is being interrupted constantly by the night time urge to urinate, can the patient safely navigate the trip to the bathroom without suffering a fall? If they get to the bathroom can they easily manipulate a standard toilet?   If they need to clean themselves and bathe can they get in and out of the shower or bath without falling and injuring themselves?

Fortunately there are elderly home experts who will travel to the home and evaluate it for safety.  They make an assessment and provide a written report to the patient and the ordering physician. Many of these safety personnel are specially trained home health company nurses sent into the home by the patient’s physician. In many cases, Medicare or the patients’ insurance will cover the cost of the evaluation. Once the evaluation is complete, they will suggest certified and responsible contractors to do the home safety alterations.

While our goal is always to keep the patient in their home if possible there are many issues other than the safety of the physical plant to consider. One needs to consider how much supervision and assistance the patient needs to perform their normal activities of daily living?  Can they dress and groom themselves independently?  Can they prepare meals for themselves and clean up after them?  Can they get to the store to shop for food and supplies?  Can they get to their doctors’ appointments? What happens if they become injured or ill?  Do they wear a device which allows them to call for help if they are immobile and cannot get to the phone?

The option of paying someone to care for your elderly loved one is quite expensive. It will cost a minimum of $15 per hour to supply inexpensive help. You may need more than one person so that the staff has time off for their personal needs.  Some families choose to hire a companion who in exchange for room and board supplies help and supervision. This is always risky especially if you don’t/cannot check the background of the individual you are inviting into the home.

If you can afford to pay for help and to alter the home for safety there is always the issue of socialization. Many of my patients who have lost their mates have also lost their friends. They no longer have someone or a group to pal around with.

One particularly spry 93 year old patient was still playing golf, going to the gym and aerobics class three days a week and playing cards regularly. Her golf foursome and card game participants all had passed away or moved closer to their children for support.  Although she had the finances to hire a wonderful aide around the clock she was lonely for companionship despite living in a large country club on a golf course.   She became a wonderful candidate for the correct assisted living facility with a broad range of social activities and residents of a similar age looking for companionship as well.

These are complex issues which require the assistance of the individual’s physician in most cases. It is important for the individual to choose and retain a physician who will take the time to talk to family and professionals involved in the enrichment of their lives.

Senior Care – Evaluating a Person’s Ability to “Safely Drive”

Many of my elderly patients seem to take comfort in the fact that they “no longer drive at night,” or “only drive in the community.”  I am not certain that these self-imposed restrictions actually provide any major reduced risk or protective benefits. In Florida, with a lack of public access transportation, giving up your car is giving up your ability to get around.   It’s also perceived by most elderly as giving up their independence.

As part of a routine office visit, I’ll ask my elderly infirm patients “How did you get to the office today”? A common response is that they are still driving independently.  This same patient, who needs assistance getting up the building’s ramp and a 60 minute appointment just to get out of their clothes and into a gown for an examination, is guiding a 5,000 pound vehicle on the roads.

Unfortunately, there’s very little data available that provides guidelines as to when an elderly infirm person should stop driving.  There is even less data supplied by the State of Florida’s Department of Motor Vehicles.

It is clear that after a neurologic event such as a seizure or loss of consciousness there is a state mandated cooling off period before you are permitted back behind the wheel. It is less clear in an individual with diminished hearing, diminished  eyesight  and diminished flexibility whether they should be driving and how much?

Thus, I was pleased to learn that the Florida Department of Motor Vehicles and a local rehabilitation facility run a State supported Senior Adaptive Driving Program. Pine Crest Rehabilitation Hospital in Delray Beach runs a comprehensive driver evaluation and instruction program. It is far more individualized and comprehensive than the programs run for seniors by their auto insurance companies.

In the Program, trained professionals thoroughly evaluate the person’s abilities to safely drive and help adapt the vehicle to assist the senior. If the professionals say you are good to go then you are qualified and capable. If you are not qualified to drive, they begin the process of rescinding your license.

When patients’ children contact me with their concerns about their parents’ driving abilities I refer them for this evaluation all the time. I highly recommend it for those of you questioning your driving abilities or those of your elderly loved ones.