Telemedicine is Growing with Advances in Video Conferencing

Fans of the Fox TV drama “House,” now in its final season, may wonder why New Jersey isn’t known as The Mysterious Medical Maladies State — it seems everyone who lives there has one.

Fortunately, they also have the fictional Dr. Gregory House, who makes up in diagnostic acumen what he lacks in charm and bedside manner.

Hugh Laurie’s acting talent isn’t the only reason the 2012 Guinness Book of Records ranks “House” the world’s most popular TV show. It’s as much because the premise is all too real, says Sean Belanger, CEO of CSDVRS, a national video relay services provider for the deaf and hard-of-hearing.

“Many illnesses defy diagnosis and ingenious specialists are few and far between,” he says. “Which is why recent technological advances in video conferencing are so exciting. Telemedicine is not just about more convenient meetings – it’s about saving lives.”

Belanger’s corporation launched Stratus Video (www.stratusvideo.com) last year to focus on honing that technology. He understands the life-changing potential of high-quality, on-demand video conferencing – his company provides video-relayed deaf interpreting services to government agencies and businesses across the country, including the Social Security Administration, Boeing Corp. and Wal-Mart.

“On-demand, high-definition mobile video conferencing solves life-or-death problems, like the hospital patient in Georgia who needs to be seen by the specialist at the Mayo Clinic – fast,” Belanger says. “To that end, we support video technology today for American Sign Language and Spanish, and provide language interpretation access for more than 180 spoken languages, all on a mobile device.”

Telemedicine is also used to bring doctors to far-flung rural communities; save travel time and money on consultations and team problem-solving; and even to have more experienced medical professionals offering guidance and instruction during procedures.

Observation and reliable connections are critical when video conferencing is used in these ways, Belanger notes. So continuing to refine and improve the tools will have far-reaching – and very personal – effects.

“Think about what happens when you go to the doctor. He or she looks down your throat, into your eyes and ears. What they see there gives them information about what’s wrong with you,” he says. “The better the video relay system, the more reliable and trusted telemedicine becomes and, who knows?, that could even lead to lower health insurance premiums.”

At the least, it ensures patients get all the medical whiz genius of a Gregory House – without the snark.

“Hey, with video conferencing,” Belanger says, “just hang up on him.”

Sean Belanger is the chief executive officer of CSDVRS, the parent company of Stratus Video. A graduate of Virginia Technology, he has 30 years’ experience in the technology industry. He previously served as CEO of the Paradyne Networks and general manager of 3Coms’ network service provider division.

Physician Offers Tips for Saving Money, Assuring Quality

More Americans are paying more of their health-care costs out of pocket every year because they lack insurance, have higher deductibles and co-payments, or have chosen a Health Savings Account plan.

There are ways they can save money without jeopardizing their health and there are steps they should take to ensure they’re getting the best value for their dollars, says physician Angel M. Garcia (www.DoNoHarmDrs.com), an internist who has been in practice for more than 25 years.

Garcia, author of Do No Harm: Saving Our Health-Care System, says patients themselves are the first line of defense in an industry where increasing tensions have created new stressors at every level.

“No physician is beyond becoming burnt out,” he says. “Physicians who are working mechanically, who are no longer interested, committed and enjoying practicing medicine can be a danger to their patients.”

“I’ve heard many patients excuse their doctors by saying, ‘Oh, he’s just burnt out.’ While such loyalty is kind, the issue is one the patient should talk about with their doctor. “You could just say, ‘Hey, Doc, you seem tired. Are you OK?’ You may be surprised how much your doctor appreciates your concern.”

Garcia offers these simple ways patients can save money and ensure their money is well spent:

• For minor illnesses, try over-the-counter medications: Some illnesses might be resolved with non-prescription drugs. Caution: If symptoms aren’t resolved in three to five days, or if they go away but keep returning, you must see a doctor. Garcia recommends Zyrtec-D 12 Hour for allergic sinusitis and upper respiratory infections, hydrocortisone cream for rashes and bug bites. Prilosec for heartburn, Imodium AD for diarrhea.

• Talk to your doctor – if you can’t, change doctors: It doesn’t matter whether your physician is nationally renowned or a Harvard graduate; if he or she doesn’t have time to listen to you, or doesn’t seem interested, find a new doctor. A good place to start is references from friends – but be sure to ask whether they’re happy with their doctor’s bedside manner. “Arrogant but good” is not what you want.

• Be prepared so you get the most out of your visit: The doctor will want to know your chief complaint: when the problem began, how it progressed, what makes it better or worse, any associated symptoms, such as fever. He or she will also need to know what medications you take, including the drug name, dosage, how it’s administered, and frequency. If you take more than one or two medicines regularly, you should make a list and keep this information in your wallet.

• Don’t skip the follow-up visit: When a patient sees a doctor for a medical complaint, a follow-up visit usually is scheduled. Some patients skip these because they feel better, but that may mean the medications have temporarily relieved the symptoms. The follow-up is worth the money to ensure the problem is resolved and no abnormalities remain.

About Dr. Angel M. Garcia - Angel M. Garcia is a practicing physician with more than 25 years of clinical experience. His efforts to help reform the health-care industry include creating standardized, electronic medical records for 38 medical and surgical specialties. Maintained in a centralized patient record database, use of these records can prevent complications of many chronic illnesses, including heart attacks and strokes. Dr. Garcia was a five-time guest speaker at the National Medical Records Institute annual scientific meetings. In 2001, Dr. Garcia was selected as a finalist for the Ernst & Young Entrepreneur of the Year Award and was a guest of President George W. Bush at the White House for the High-Tech Leaders Forum and the Economic Leaders Forum.

…And Should! You Probably Know What’s In Your Kids’ Peanut Butter, But Do You Know What’s In Their Toothpaste?

Most parents are careful about learning what’s in the stuff their kids eat and drink. They avoid artificial dyes, preservatives, chemicals, and sweeteners. Yet ask just about any of those same folks if they have ever looked at what is in their toothpaste and you’ll likely get blank stares.

Considering the fact that children – and adults — ingest toothpaste twice a day every day, it’s probably the most frequent thing we put in our mouths other than water or other beverages. And still, most people have never looked at what is in their toothpaste.

Dentist and national oral health care expert Harold Katz, suggests that needs to change. Many ingredients in some commercial toothpastes are of questionable benefit and some are just plain bad for you.

Consumers have become increasingly aware of the hidden toxins in foods, beverages and eating and drinking utensils, he says. They avoid high fat and high sodium foods, sulfates in their personal care products, aerosol sprays, and toxic chemicals in their household cleaners.

“They’re taking no chances, and rightfully so. Remember the rush to replace plastic baby bottles with glass ones after the BPA scare in 2008?” he asked.

However there has been a surprising lack of attention to toothpaste, Katz says. The dentist suggests that all consumers – but especially parents – take the time to read their toothpaste tubes today. Effects of potentially unhealthy toothpaste ingredients are multiplied in the smaller bodies of children.

Here are a few ingredients to stay away from:

• FD&C blue dye No. 2: This commonly used toothpaste dye is one of several on the list of additives to avoid, maintained by the Center for Science in the Public Interest. It’s said to be linked to learning, behavioral and health problems, severe allergic reactions, and headaches, among other problems.

• Sodium lauryl sulfate: The American College of Toxicology reports this ingredient in cosmetics and industrial cleaning agents can cause skin corrosion and irritation. Doses of .8 to 110 grams/kilogram in lab rats caused depression, labored breathing, diarrhea and death in 4 out of 20 animals.

• Triclosan: An anti-microbial ingredient, the federal Environmental Protection Agency lists triclosan as a pesticide and regulates its use in over-the-counter toothpastes and hand soaps. According to the agency’s fact sheet, “Studies on the thyroid and estrogen effects led EPA to determine that more research on the potential health consequences of endocrine effects of triclosan is warranted. … Because of the amount of research being planned and currently in progress, it will undertake another comprehensive review of triclosan beginning in 2013.”

• Saccharin and aspartame: Both of these artificial sweeteners are on the Center for Science in the Public Interest’s list of additives to avoid.

Toothpaste buyers should look for natural ingredients, such as aloe vera juice, which cleans and soothes teeth and gums and helps fight cavities, according to the May/June 2009 issue of General Dentistry, the Academy of General Dentistry’s clinical, peer-reviewed journal. Aloe vera tooth gel is said to kill disease-causing bacteria in the mouth, Katz says.

Also, avoid all toothpastes that contain sodium lauryl sulfate, a harsh detergent that has been linked to canker sores. Toothpastes that are free of sulfates include Weleda’s Salt Toothpaste, TheraBreath and Tom’s of Maine.

Brush your teeth at least twice a day and get children into the habit from a young age, Katz says. You’ll have fresh breath, avoid painful dental problems, and be far more likely to have your teeth in your mouth when you go to sleep at night as you age.

Just be sure to check what’s in your family’s toothpaste and avoid buying anything with problematic ingredients. And when it comes to brushing kids teeth use a pea-sized drop of paste on the brush – no more – and oversee brushing to ensure young children don’t swallow their toothpaste, says Dr Katz.

Dr. Harold Katz received his degree in bacteriology from UCLA and is the founder of The California Breath Clinics and author of The Bad Breath Bible. He has been featured on ABC’s “Good Morning America,” CBS’s “Early Show” and “The View” with Barbara Walters and countless other TV shows. Dr. Katz’s formulated the TheraBreath oral care program in 1994 and has continued to update products in order to make use of the most effective and most natural ingredients. For more information visit: www.therabreath.com

Author Offers Tips for Writing Off Emotional Pain

The unexpected blows experienced by so many Americans during the current economic recession have left many dealing with what psychotherapist Daniela Roher calls “recession stress disorder” – feelings of helplessness, shame and betrayal, headaches, loss of appetite, insomnia, depression.

Add to that the emotional turmoil endured by tens of thousands of families directly affected by the wars in Iraq and Afghanistan, and we are a nation traumatized.

George Molho, author of Scarred, a memoir recounting his kidnapping as a 7-year-old in 1978, knows well the crippling effects of emotional trauma. He also knows what it takes to recover and move your life forward.

“Whether you are a ‘writer’ or not, writing has a cathartic and healing effect,” says Molho, who wrote his memoir as a way to move past the pain inflicted by his father during his year in captivity.

Whether your emotional pain is the result of losing a job or divorcing a spouse, experiencing the trauma of war or a criminal assault, Molho offers several suggestions for beginning the healing process by putting your feelings on paper:

• Keep a journal or jot your thoughts on a Post-It, either way you’re getting them out of your head and putting them into the world. Writing comes from the subconscious, which sucks in all kinds of data that the conscious mind isn’t aware of. Much of writing comes from the subconscious mind, so when you write down your feelings, you release them. It helps cleanse you of the pain, anger and fear lodged in your subconscious.

• If someone has hurt you and you don’t have the opportunity or courage to confront them face to face, write them a letter. You don’t ever have to send it; you can write it and then burn it up. But sit down and write down everything you would say if you could in that letter. This is especially helpful for people struggling with a breakup that had no closure – one person up and left the other. Empty every thought, good, bad, vengeful, whatever, then have a little bonfire. Light it up!

• Buy a $10 mailbox at the hardware store and put it in the backyard. Then write letters to God, or whoever your creator is, and “mail” them. It will help you feel less isolated and alone in dealing with your pain, and more connected with the world. It helps you see a bigger picture, one that involves faith.

• Look back at your victories, no matter how small or insignificant they might seem, and count up all the things you’ve overcome. Whether it was getting through the grief of losing a beloved pet when you were a child or executing a challenging task on the job, when you start adding up these victories, you begin to see you’re much stronger and more capable than you might have realized. Write them down and save them somewhere, so you can pull them out when you need to be reminded that “I can do this.”

• This one doesn’t involve writing but is too valuable to exclude, Molho says. Help yourself by being a shoulder for someone else. By listening to other people share their problems and trying to help them, you actually are healing yourself. When you offer them advice, sympathy and encouragement, you’re talking to yourself at the same time. Connecting with others who are in pain can help you deal with your pain.

George Molho worked as a health-care consultant for 15 years before becoming a writer and public speaker, addressing domestic abuse, child abduction, and recovering from trauma through self-reflection. He lives in Houston, where he has volunteered as a board member for several Texas charities and agencies that assist children and the elderly. For more information, visit:  www.georgemolho.com

For those of you who are already aware that you have seasonal allergies, it may be worthwhile to also ask your allergist for food allergy testing. When you are sensitive or allergic to certain foods, your body similarly reacts with inflammation as it would with environmental allergens…and over long term, this is not beneficial to your health.

Acute inflammation is necessary for our survival. When we are injured, we need to inflame and heal; just like when our cuts get red and heal over. However, chronic inflammation causes more trouble than good for our overall health. Even for heart disease, the more inflamed and unstable artery plaques are the ones that are more concerning for breaking off and causing a heart attack. So, whatever we can do to decrease chronic inflammation in our body, the better.

Therefore, if you are constantly consuming a certain food that you are in actuality allergic or sensitive to, this would be an ongoing trigger in your body for inflammation…and that would not be good for your overall health in the long run.

I’ll share an example of a patient I work with in regards to food allergens and its potential impact on health. I have a patient who I had been seeing for a few months and we had been working on changing her diet around to a healthier, more anti-inflammatory diet. She was feeling slightly better and was losing a few pounds every month since she was eating healthier. But she was still feeling fatigued and her autoimmune disease was still mildly flaring with pain in her joints. We decided to do food allergy testing and found that she had a moderate level of sensitivity to nuts.

She had been snacking on nuts since she thought it was a good anti-inflammatory alternative for snacking when she was hungry. For most people, it would be a good snacking option in controlled portions, however for her food sensitivity, it actually worked against her. After about two to three weeks off of nuts, she felt less fatigued and her joint pains were significantly improved.

This is a good example of how even healthy foods can unbeknownst to us be causing harm if we are not diligent in checking for factors that inflame us on a daily basis. So, for this upcoming spring season, the allergens you should be paying attention to aren’t just in your environment…but might be on your plate as well.

Dr. Julie T. Chen, M.D. an integrative medicine physician who is board-certified in internal medicine and is also fellowship-trained and board-certified in integrative medicine. She has her own medical practice in San Jose, CA, is the medical director of corporation wellness at several Silicon Valley-based corporations, is on several medical expert panels of websites as well as non-profit organizations, is a recurring monthly columnist for several national magazines, and has been featured in radio, TV, newspaper, and magazine interviews. She incorporates many types of healing modalities into her practice including, but is not limited to, medical acupuncture, Chinese scalp acupuncture, clinical hypnotherapy, strain-counterstrain osteopathic manipulations, and biofeedback. To learn more about Dr. Julie, you can check out her website at www.makinghealthyez.com.

Fifteen Tips for Pushing through the Discomfort and Truly Connecting with a Chronically Ill Person

Few of us know how to act around a very sick person. And yet, what we say (and don’t say) makes a huge impact. Here are some practical skills for caregivers, family members, and anyone else who wants to make a meaningful difference in a very difficult time.

Being around a severely ill person—especially one who is facing a long-term recovery or who must live with a chronic condition—is not easy. It makes most of us deeply uncomfortable, even if we’ve known (and loved) the person for years. We struggle to say “the right thing.” We want to cheer the person up, but pasting on a smile feels fake and pointless. In light of his or her emotional and physical suffering, it may be tough to keep our own tears at bay. And frankly, the patient’s plight reminds us of our own mortality, too, which is most troubling of all.

Yes, for most people, the sickbed is uncharted territory. Unless you work in healthcare, you’ve probably spent little time around chronically ill people. But eventually, someone you love will be lying in that bed—and when that happens, knowing how to communicate with him or her will make all the difference.

When someone you love becomes ill, you probably won’t instinctively know how to handle it. Providing solace doesn’t come naturally to most of us. As a result, we either act in a way that makes us feel better, or we withdraw. Neither meets the needs of the patient.

The good news is, you can learn how to relate to chronically ill people. You can learn to listen to the patient’s cues and respond appropriately. You can learn what to say and what not to say. You can create a relationship that brings comfort and peace of mind, even during a difficult time when life-changing issues arise and tough decisions must be made.

Caring for a sick person is, intrinsically, a very stressful experience that can be mentally and physically exhausting. Knowing how to interact with and respond to such a patient in a way that fosters mutual understanding and trust can truly be a game changer for both of you.

If you would like to feel more comfortable and confident around your ill loved one, read on for fifteen communication suggestions:

Don’t try to be a preacher, doctor, or therapist. Just be you. In many ways patients are different from the healthy individuals they once were. But they can still tell when you’re being phony, masking your feelings, or playing a role (especially if they know you well). It’s natural to feel uncomfortable around chronically ill people—at least initially—but the best course of action is to simply be you. If your loved one detects that you’re putting up any sort of façade, he’ll begin to wonder what your true purpose is; for example, whether you might be hiding something important from him.

When you’re around someone who’s ill, you’ll do the most good if you focus on being genuine and real. For example, don’t feel that you have to put on a constant show of cheerfulness if you’re normally a blunt straight-shooter. And don’t feel that you need to suddenly “have all the answers.” Without being insensitive, let your natural mannerisms, feelings, quirks, and words shine through. This is the best way to maintain trust and a relaxed atmosphere.

Don’t squelch uncomfortable conversations. Your chronically ill loved one will probably still want to talk about things like her favorite TV show, her children, and the news you tell her about your own life. But due to her condition, she will also bring up more weighty topics that might make you uncomfortable, such as her fears, the pain she is in, and her worries about the future. Even if you’d rather not touch a particular conversation with a ten-foot pole, try not to respond with, for example: Can’t you ever talk about anything pleasant? Don’t you get tired of complaining about the same stuff all the time? Do we have to talk about your condition so much?

Remember, the patient deserves to talk—even if you don’t want to hear or process what she has to say. In fact, by squelching her concerns, you are sending the message that she doesn’t matter, and you reinforce feelings of isolation and resentment. The best course of action is to listen as objectively as possible, with an open mind and encouraging attitude.

Know how to say, “I don’t know.” Whether the topic is medical, spiritual, or personal in nature, the patient will sometimes ask questions to which you don’t have answers. When this happens, it’s important to avoid giving a definite answer without seeming evasive, lest you jeopardize your credibility with the person. After all, you don’t want your loved one to think that you don’t care or that you’re hiding something, and you definitely don’t want to offer misinformation that might do more harm than good.

The patient will probably ask things like, “How much longer do I need to take this medication?” for example. Don’t feel pressured to say something you don’t want to. Honest yet noncommittal answers to this and other queries might include: “I’m not the right person to answer that, but I’ll help you find out.” “Wow, that’s the $64,000 question, isn’t it?” “I need a little time to digest this.” Just don’t ignore the person entirely unless you have good reason, such as being verbally abused.

Don’t hesitate to call in spiritual reinforcement when it’s needed. Some questions that your loved one might ask are so deeply personal—and so plain overwhelming—that you don’t feel qualified to deal with them. Questions that center on spiritual concerns almost always fall into this category. When someone asks, for instance, “What happens after death?” or, “Will I go to Heaven?” trying to answer him can do more harm than good.

If you attempt to help with these complex issues when you don’t possess the knowledge or skills to do so helpfully, you’ll do more harm than good regardless of how well intentioned you are. You don’t want to inadvertently increase your loved one’s confusion or anxiety. When spiritual needs and questions arise, don’t be afraid to admit that you aren’t qualified to handle them. In this instance, please call in a rabbi, priest, or other spiritual leader. And know that no matter how little spiritual training you may have, you can always be a confidant and source of support.

Understand that sometimes silence really is golden. Many people find extended silences to be uncomfortable. It’s common to break them with idle chatter or statements like, “A penny for your thoughts!” Realize, though, that at times being quiet is most helpful and meaningful. There’s no need to break a comfortable silence—your loved one might feel tired, weak, or contemplative and not want to chat. Your mere presence and availability can often be all she needs.

Just sitting silently, perhaps with an arm around the patient, can communicate compassion that is beyond words. However, be alert for unnatural silence that is characterized by tension and anxiety, as it can alert you to the fact that the patient is worried, angry, or uncomfortable. And don’t use silence as a weapon—giving the cold shoulder to a seriously ill person will not help anyone.

Let the patient cry. When most of us see someone crying, we tend to whip out a tissue and murmur something along the lines of, “It’s okay. Don’t cry,” because we’re uncomfortable with weeping. From now on, continue to pass the tissue when your ill loved one starts to tear up, but don’t pressure her to stop sobbing. Tears are a natural emotional release for emotions ranging from anger to sadness to fear, and they can be very therapeutic.

The best thing you can do for someone who is crying is to simply be present and listen if the person wants to speak. It may go against your nature, but refrain from interrupting with supportive statements—you can make those after the crying spell is over. At this point, your presence is the crucial thing. Don’t be embarrassed to show emotion yourself, either; crying can also be beneficial for you. And after the tears are dried, encourage your loved one to talk about her feelings (unless, of course, she doesn’t want to).

Realize that it’s okay to say “no.” If you’re around someone who’s ill, demands will be made of you. That’s normal. Especially if you’re a caregiver, you’re agreeing to do things the sick person can’t handle himself. It’s crucial to understand, though, that you can’t say yes to everything. While you may be the “healthy one,” you still have physical and mental limits. And when you try to be everything to everyone, you’ll end up stretching yourself too thin, and perhaps even harming yourself or the patient.

It is much better to respond with a responsible no as opposed to an irresponsible yes. The situation could be as simple as the patient asking to eat an off-limits food “just this once,” or as complex as your family asking you to move in with Mom full-time to care for her. Regardless, saying no requires courage and conviction, and does not mean that you are weak or selfish. Just be sure to deliver your response with love. Explain your reasons and re-affirm how much you care for the patient.

Think before you speak. (Choose words carefully.) Words are very powerful. An off-hand comment that you make and never consider again can impact another person’s mood or sense of self-worth for hours, days, or longer. That’s why it’s very important to do your best to say exactly what you mean when you are talking with your ill loved one. Especially when conveying something important, put a little prior thought into choosing your words so that you don’t spark unnecessary tension, anxiety, or anger.

As a caregiver, or even a visitor, your goal should be to choose words that are as clear and unambiguous as possible. Remember that what you say can help heal, or it can make the patient feel even more demoralized and sick. So instead of blurting out the first phrase that pops into your head, take into account nuances like: Am I speaking abstractly or specifically? Is this person capable of understanding complex words and ideas right now? Is he offended by certain words or ideas? Will telling him this make him dread my visits in the future? Using a little prior judgment can save everyone a lot of grief.

Share bad news. Don’t “deliver” it. Say, for instance, that your mother is terminally ill and that your brother—her only son—has decided to end his marriage. If your family is having the Do we tell her? She probably won’t live until the divorce is final conversation, understand that sick people are still entitled to hear the truth and that you have the ethical obligation to deliver it, even when it’s negative. And the manner in which you convey that truth is critical.

Whether the bad news relates to family drama, financial trouble, or the patient’s own illness, try not to present it as an idea that the other person will have to deal with on her own. In other words, don’t “tell and run.” This should ideally be a gut-to-gut, heart-to-heart conversation. Therefore, it’s a good idea to put some prior thought into who the best person and when the best time to share the news might be. Make sure your loved one knows that you are a partner in working through and/or coming to terms with the situation. Offer to help and don’t make everything about you and your own reaction.

Treat the patient like a person, not an illness. When your loved one’s medical condition dictates almost all aspects of his daily life (and perhaps yours as well), it can be easy to focus primarily on his illness when you’re together. Even if you’re just visiting for an hour or so, you’re still acutely aware that the change in circumstances is due to cancer, for instance, or kidney disease. Remember that you aren’t spending time with a disease that is treated by a certain medication and manifests itself through specific symptoms. You’re spending time with a person who is still capable of interacting, understanding, and feeling.

Patients may be sick, but they are still themselves. Unless your loved one’s illness has affected his mental abilities, his personality, preferences, and characteristics are largely unchanged. When you begin to define him by his condition, he will likely begin to resent not being accepted and valued for the person he is. It’s important to always treat the patient with dignity and respect, and allow him to retain as much control over his life as possible.

Pay attention to body language. (It can tell you what’s really being said.) Sometimes chronically ill patients might seem to communicate in a confusing or incomplete manner. (In fact, everyone does this from time to time!) Maybe your loved one is saying one thing but doesn’t seem to mean it, or perhaps her response to a particular set of circumstances doesn’t seem to fit. In these situations, body language can give you valuable clues as to what’s really going on.

For example, fidgeting or looking away might indicate nervousness. Crossed arms are a sign of defensiveness, while nail-biting or lip-chewing are symptoms of insecurity. Leaning toward someone points to cooperation, while leaning away might indicate suspicion or skepticism. When you learn to “speak” this language, you’ll be able to more accurately get to the heart of the matter.

Be (appropriately) hands-on. Similar to a comfortable silence, touch is a powerful way to communicate without words. To a sick person, physical contact can convey support, comfort, reassurance, and more in the midst of a very frightening time. For some patients, a long period of not touching might even increase feelings of separation and isolation. That’s because something as simple as holding your loved one’s hand, kissing his cheek, or patting his arm says, “You are not alone; I am here with you.”

The appropriate way to touch someone depends on how close your relationship is, what sort of contact he is comfortable with, and whether he’s even receptive to touch in the first place. Unless you are already very close and have a history of hugging, for example, it’s good to consider asking, “May I give you a hug?” the first few times. Also, keep in mind that your touching should be a natural, spontaneous gesture of caring, rather than something planned or contrived. This is one of the best ways to create trust, especially during serious conversations about the patient’s feelings, pain, or fears.

If at all possible, honor the patient’s confidences. Everyone needs someone to whom they can talk about their innermost thoughts, feelings, and concerns—especially people who are suffering from an illness. If you’re a caregiver or frequent visitor, you’ll probably fill this role to some extent. It’s important for you to maintain the patient’s respect and trust by not divulging confidential information, “even once,” because “even one” betrayal can be fatal to your relationship. And when you’re listening, remember to maintain a nonjudgmental and nondirective attitude.

There are two types of confidences: those you are explicitly asked to keep private, and those that are obviously very sensitive and private. Even if you haven’t been explicitly asked to keep something confidential, err on the side of caution. Speak up against the patient’s wishes only if you feel that her well-being, or that of other family members, might be in danger. For instance, if your loved one is contemplating suicide due to feelings of futility and fear, or planning to secretly spend a large sum of money on something ill-advised, breaking her confidence might be the right thing to do.

Remember, smiling isn’t taboo! There’s a saying that when you smile and laugh, you’re speaking in a universal language…and it’s even spoken by patients in sickrooms. Yes, when you’re visiting an ill loved one, you probably don’t feel like grinning, and you also want to keep things as peaceful as possible. But when you’re the patient, all of the seriousness and sadness can be wearing. Unless your ill loved one is a humorless person by nature, don’t feel the need to suppress laughter and smiles.

Actually, laughter has numerous healing effects. It can relieve stress and even pain, and it’s also a wonderful way to “equalize” the sick and the well. Remember that before cracking a joke, though, it’s smart to gauge the patient’s mood as well as your own personality. In other words, if you always flub the punch line, stick to spontaneous humor and avoid reciting jokes—and pack the humor away entirely if Uncle John is in an unreceptive mood. Lastly, don’t be afraid to laugh at yourself—it will endear you to your family and friends!

Don’t take anger personally. Do respond constructively to it. Anger is a natural human emotion, and seriously ill people have a lot to potentially feel angry about. After all, they have a prognosis that might not be hopeful, and they have lost some amount of independence and autonomy. Plus, their pain and energy levels might make them less patient or less able to handle stressful situations. Therefore, it’s not unusual for caregivers to be on the receiving end when their loved one’s fuse blows for any reason.

While you can’t control the patient’s anger, you can control your own response. Make every effort to remain cool and collected, even if you have to pause for a few seconds or leave the room to keep your own stack from blowing. And after the episode is over, try to identify what really caused the outburst so that you can avoid similar situations in the future. Anger doesn’t happen in a vacuum—it is triggered by various emotions, perceptions, and events. Refrain from squelching or downplaying your loved one’s anger since she has a right to express it, and since it may even be therapeutic.

Taking time to learn the art of giving solace is absolutely worth it—and not just because it helps the patient.

We learn so much from our interactions with chronically ill loved ones. When you do all you can to make your time with the person productive and meaningful, you may gain great emotional and spiritual growth. And you’ll stave off regret—down the road, when you look back on this experience, you won’t wish you hadn’t squandered what could have been the richest, most real time you ever spent with your loved one.

Dr. Walter St. John is a retired college professor and administrator who lives with his wife in Old Town, Maine. He taught interpersonal communications courses for more than twenty years and has presented communications workshops throughout the United States and Canada. He has hands-on experience with disabled veterans, multi-handicapped youth, and Special Olympics participants, and he has written widely in the field of communications.

Dr. St. John’s observation that there was a need for an accessible and useful resource for caregivers led to the development of this book. The methods in Solace were developed in conjunction with extensive research with caregivers and healthcare professionals.

If your child is overweight, discussing that problem can be one of the most difficult conversations you’ll face as a parent. Sarah Stone lists several reasons why parents are hesitant to have the “weight talk” and presents compelling reasons for

overcoming that reluctance.

If you’re the parent of an overweight child, you probably feel like you’re stuck between a rock and a hard place. On one hand, you know that your child’s health is in jeopardy and that you should take the lead in addressing this problem. But on the other hand, bringing up this touchy topic—not to mention figuring out how to make important lifestyle changes—is difficult, uncomfortable, and potentially embarrassing for all involved. If you’re like most parents in this situation, you probably find yourself putting off the “weight talk” for just a little while longer…and a little longer after that…and a little longer after that.

According to Sarah Stone, though, you’re making a big mistake. It’s time to stop stalling and start talking—for the sake of everyone involved.

“Communication is an essential part of effective parenting—but that doesn’t mean it’s always easy or enjoyable,” says Stone. “It certainly doesn’t help that most parents are never trained in this critical skill—especially when our children and sensitive topics are involved. And children’s weight in particular is too often the elephant in the room.”

The good news is, as the current director of operations at MindStream Academy (www.mindstreamacademy.com), a co-ed health and wellness boarding school for teens who want to get fit, lose weight, build self-esteem, better manage stress, and take control over their health and wellness destinies, Stone can shed some much-needed light on this tough topic.

First, she says, it’s helpful to understand that you’re not alone in feeling reluctant to discuss your child’s weight. In fact, a recent study conducted by FIT, a partnership of WebMD and Sanford Health, showed that about 5 percent of parents struggle when talking to their kids about drugs and alcohol and that 10 percent are uncomfortable talking about sex, but 25 percent are hesitant to discuss their children’s weight issues. In fact, many parents of eight to seventeen year-olds admit to avoiding the weight conversation altogether.

“These statistics are not surprising, but they are tragic,” says Stone. “The developing years are when the brain learns habits that will last a lifetime. So right now is when a lasting change can be made relatively easily. Frighteningly, though, if parents don’t act, the health habits of today’s children will only get worse from every conceivable angle—increased disease risk across the spectrum, poorer quality of life, and massive public and private expenditures that will weigh heavily on the economy and on the lifestyle of almost every citizen.”

No parents want their children to experience any of the problems Stone describes. To help you get over your reluctance to have the weight discussion, here are five reasons she says parents are likely to hold back when it comes to talking about their children’s number one health issue…and why you need to stay the course regardless.

They maintain complete radio silence (on parenting issues, anyway). When your child is small, it goes without saying that you’ll tell her what to do in most areas of her life—or at least make strong suggestions. But as kids grow into their tweens and teens, this autocratic approach often falls by the wayside. Since teens are supposed to start making their own decisions and growing into their independence, some formerly-involved moms and dads believe that they can stop being parents and start being friends. And “friends,” their reasoning goes, would accept one another as-is instead of bringing up sensitive issues like excess weight.

“There’s nothing inherently wrong with wanting to cultivate a fun, positive relationship with your kids, but never forget that being your child’s buddy is not your primary function,” Stone insists. “A parent’s job is to provide guidance, love, support, and effective preparation for life, even if that causes temporary resentment. Good parenting means recognizing that children have issues and then guiding them lovingly to effective solutions. And while good parents listen to their children’s input and take their feelings into account, they also know that raising a child isn’t a democratic process.”

They want to spare their children’s feelings. It’s something of an understatement to say that your child’s wellbeing is important to you. The last thing you want to do is cause him any sort of hurt. For that simple reason—a reluctance to see their children in emotional pain—many parents avoid telling their kids that their weight is unhealthy. They are unwilling to, as the saying goes, be cruel in order to be kind.

“Just as effective parenting isn’t about being a friend, it’s also not about sparing feelings,” asserts Stone. “On some level, parents know that if a child is very sensitive about a subject, that’s exactly why we should be talking to them. Letting children continue to feel shame, humiliation, and embarrassment because they (or you) don’t want to talk is only compounding the problem. In other words, avoidance is a symptom that you don’t want to reinforce. It’s a bit like locking the door on a house that’s on fire and pretending it isn’t burning. Remember, not facing a fire doesn’t put it out.”

They know that food isn’t a clear-cut “bad guy.” Remember those statistics on parents who avoid tough talks? Twenty-five percent are reluctant to discuss weight problems, while 10 percent avoid the sex talk, and only 5 percent struggle with addressing drugs and alcohol. There’s a good reason for the disparity in those numbers: sex, drugs, and alcohol are choices that don’t have to be pursued, whereas everyone has to eat. Talking about food in negative terms is much more dicey.

“It’s a lot easier to talk about drugs rather than weight because there’s a moral structure to the discussion,” points out Stone. “Using illegal drugs is wrong, and therefore the guideline is much more concrete for parents to set forth and enforce. But neither weight nor eating are moral choices; they are a function of everyday decisions. St. Augustine said that ‘Abstinence is easier than perfect moderation,’ and of course, he was right.”

They don’t know how to help. Knowing that your child’s weight is unhealthy is one thing. Knowing how to make positive changes is another. Understandably, many parents are reluctant to broach the subject of their kids being overweight because they simply don’t know what to say to effectively guide their children. After all, with incredibly lucrative industries revolving around health and weight loss, parents (as well as kids) are faced with a massive amount of often-conflicting information about how to best proceed.

“It’s one thing to address the issue, but being unsure of where it’s going and what advice to give can certainly inhibit the discussion,” admits Stone. “It’s important to understand that in reality, weight management is about many aspects of lifestyle ranging from sleep to stress management, not just food and exercise. Meanwhile, the average parent is still stuck in a ‘fat culture’ that revolves around the concept of diet, rather than understanding that this is about more far-reaching behaviors and the whole person. That’s why MindStream Academy rejects the concept of being an extended fat camp for children to drop weight, and instead focuses on teaching a healthy lifestyle. Parents can take a page from MindStream’s book by researching and learning about holistic health.”

They have their own weight issues. In a culture in which 70 percent of people are overweight if not obese, many parents struggle with the problem of carrying extra pounds themselves. If that’s the case in your family, you—the pot—may be (understandably) reluctant to call the kettle black. Plus, you probably know that the “do as I say, not as I do” strategy doesn’t tend to work over the long term. And, toughest of all to admit, you might realize that doing something about your child’s weight will force you to tackle your own as well.

“Parents inevitably bring their own feelings about weight to the table, which can certainly prevent meaningful discussion,” points out Stone. “Often, they too feel helpless and thus not in a position to give advice. Also, raising your own child can elicit emotionally fraught memories from your own childhood. If weight has been a lifelong issue for you, you’ll instinctively try to avoid those resurrected emotions. Remember, though, while you cannot change the past, you do have the power to create a better future for yourself and for your child.”

“Once they realize that it’s dangerous to put off the weight talk, many parents believe that they can safely leave the discussion to the family doctor, pediatrician, or other health professional,” adds Stone. “Getting professional input is a great idea, especially if nothing else is working. But know, though, that research suggests that health professionals also have difficulties raising sensitive issues with their teenage patients.

“Ultimately, while others might talk to your children about weight, the most important discussion they can have is with you. That’s because parents control the health environment at home and establish the wellness culture in the family. They are in a position to actually do something about the obstacles their kids are facing. And given that your children’s lives are quite literally on the line, avoiding the subject is a terrible abrogation of parental responsibility.”

Read Part Two: Eight Tips for Approaching the “Weight Talk”

By Dr. Julie Chen

Are New Year’s resolutions truly meant to be broken or are we supposed to just make more realistic ones? Every year, my patients come into my clinic with summaries of their goals for their health in the upcoming new year…but unfortunately, the same staunch resolution in their voices start to sound like waning interest when discussed again months later. So, how can we possibly get ourselves to stick to our health resolutions for 2012?

The most common reason why we can’t stick to our New Year’s resolutions is typically because they are not specific enough. Another reason is that because they are too vague (and hence too difficult to execute to the point where you are consistently getting positive feedback in the form of tangible improvements), that lack of measurable advancement causes you to lose interest in the initial goal.

For example, if you created a company and your resolution is to “make it be successful and make a lot of money,” you would have a hard time making that happen without more specifics right? Like, how will you make it successful, what will you do for marketing, what is your product, what is your budget for each department, and how will you make money, just to name a few issues.

Health resolutions are the same…you need to clarify the specifics. For example, when you say you’ll “eat less junk food,” you need to change that resolution to something more achievable and less vague. Such as, “I will not buy junk food to keep in the house” or “I will give myself 10 minutes before giving into a craving and drink a cup of water first” or “I will always go for a walk or do jumping jacks or do push-ups for five minutes before I give in to a craving to see if I can bypass that craving with exercise.”

These more specific examples of health resolutions will allow you to actually work towards one goal and be able to achieve that instead of saying “I will eat less” or “workout more.” Because what is “less” or “more”? When the resolution is vague, people are less likely to stick to it. But when it is specific, such as “I will always eat vegetables and drink a glass of water at the beginning of every meal before I eat anything else,” it is easier to make sure you do exactly that…and these little habit changes amount to a lot of health improvement in the long run.

So, when you are surrounded by friends and family or if you are cozy in your pajamas on New Year’s Eve as you ring in the New Year, just remember that your resolution doesn’t have to be a grand gesture of any kind…just a simple specific promise to yourself will be enough.

Ultimately, simple, practical, and most importantly, do-able changes in your life are the changes that will lead you to tremendous health benefits. And as you see tangible health improvements and feel your clothes becoming looser on your more toned and trim body, these measurable benefits will help you to maintain that staunch resolution and excitement you get in January well into the summer months and beyond!

By Dr. Dean Ornish

The holidays are a time for…overeating? It would seem that way, given the latest statistics.

• • Americans gain 1 to 1½ pounds annually during the holiday season

• • Leading health experts believe most midlife weight gain comes from poor holiday eating habits

To help fight holiday weight gain, best-selling author and health expert Dr. Dean Ornish created this list of 16 Steps to Healthy Holiday Eating.

“How to Indulge During the Holidays”

• 1. Eat something beforehand. If you don’t eat all day, you may arrive at holiday meals and parties ravenous and lose control.

• 2. Put 20 percent fewer high-calorie foods and 20 percent more fruits and vegetables on your plate. Studies show that you probably won’t notice the difference.

• 3. Eat the healthier foods first – they will fill you up somewhat, so you’ll be less likely to overeat the more indulgent foods.

• 4. Choose foods that leave evidence – e.g., keep the shrimp tails and chicken wing bones on your plate after you’ve eaten them. Studies show that if you have cues to see how much you’ve eaten, you’ll eat less.

• 5. Try not to put more than two or three items on your plate at one time. We eat more when food is in front of us.

• 6. Eat more slowly. The faster we eat, the more we eat. Sip water between bites. Holiday meals last longer than typical meals. If you wolf down your food, your plate may be clean while others are still eating, which will lead to seconds.

• 7. If you have a choice, use a smaller plate!

• 8. If you’re at someone’s home, try to serve yourself instead of allowing your relative to heap your plate full.

• 9. Arrive a little late and make a grand entrance. More of the indulgent foods will be gone by then.

• 10. If you go to a restaurant, ask your server not to put bread on the table beforehand. If it’s there, you’ll probably eat it. Leave more room for your favorite holiday foods instead.

• 11. Substitute cranberry sauce for gravy, which is usually high in fat and calories. Cranberry sauce is nutritious and loaded with antioxidants.

• 12. If you eat baked potatoes and yams, avoid toppings such as butter, cheese, bacon and sour cream. If possible, substitute low-fat yogurt or nonfat sour cream.

• 13. Watch the alcohol, which is high in calories and slows your metabolism. Also, too much alcohol can impair judgment, so the more you drink, the more you’re likely to eat.

• 14. Close your eyes and savor the food periodically during the meal. You’ll consume fewer calories and experience more pleasure.

• 15. Have just a few bites of dessert. The first and last bites are always the best, anyway.

• 16. Take a walk after dinner. You don’t have to hike five miles. A stroll around the block is a good start. Walking not only burns calories, it also helps relieve bloating and prevent heartburn.

For more information, and additional tips from Dr. Ornish on how to make healthy choices throughout the holiday season, visit www.marshealthyliving.com. I’m reaching out on behalf of Mars.

By Dr. Julie T. Chen, M.D.

Throughout my clinical practice years, I have always said to my patients that I don’t believe in cookie-cutter medicine. Every person and body is different and hence treatment regimens should be individually tailored to every patient. A recent study has made it easier for me to further ingrain that idea into the minds of my patients when they come into my clinic with the idea that if their friend is taking something, then that’s the only thing that would work for them.

In a recent study at Duke University, scientists recently found that how we respond to certain medications, such as the cholesterol-lowering medication called simvastatin, may be determined by our gut bacteria. The results were published in PLos ONE on October 13, 2011 and it demonstrated that gut bacteria can cause differences in how people digest and metabolize different drugs and substances; hence drug effectiveness can differ from person to person based on that.

Within this study, they identified three bile acids produced by gut bacteria that altered medication response such that the effectiveness of the drug differs. What is ground-breaking about this study is the idea that drug effects differ from person to person and is personalized because we are all physiologically somewhat different and a medication effect on any given patient is in fact not going to be cookie-cutter or identical amongst various patients.

This concept is called ‘metabolomics.’ It’s the science of examining the multitude of biochemical components involved in cellular metabolism and its effect on health. It is essentially an examination of personalized medicine and how every person may respond differently to various treatments due to the uniqueness of each of our individual physiological factors. The reason we may respond differently to any given treatment or medicine may be more than our genetics; it may also be due to other physiological factors such as our microflora.

What is interesting about this finding is that we may be looking forward to an era where drugs will target specific sub-populations instead of assuming all of our physiology is cookie-cutter.

We may be seeing a growth in the industry of diagnostic studies that help us to fine-tune our medication regimens toward more personalized physiological factors; as well as pharmaceuticals that derive optimal results from our body’s individualized micro-environments instead of medications that are presumed to function the same in every body.

It’s comforting to finally see medicine take on the obvious assumption that we all know when we interact with other people in our life; that every person we meet is slightly different and hence our relationships are different from person to person.

So, if inherent differences in people are easily recognized in social interactions, isn’t it about time that these obvious inherent differences seen in people are taken into consideration when we choose medications and treatment regimens? I think it’s a long time in waiting to finally see medicine catch up to the concept that our bodies just like our personalities are not cookie-cutter; thus medications and treatments shouldn’t be either.