Archive for April, 2010

Get the most out of your dollar…without the Dollar Menu

by Leah Frankel, MS, RD | frankel@myhousecallmd.com

With increasing numbers of Americans now unemployed or taking salary cuts, it’s not surprising that people are trying to save money any way possible. Cutting back could mean only one double chocolate espresso ventichino per week instead of your normal five or carpooling to work instead of driving.  Many people worry that cutting back in terms of food costs may mean more trips to fast food joints and less fruits and vegetables.  In fact, there has been a boom in fast food consumption recently due to our current economic status.  We’re here to discuss tips for maintaining a healthy diet even in these hard economic times, compare a typical fast food meal to one prepared at home (looking at both price and nutritional value) and prove to you that you can continue eating healthy even if the economy has let you down!

Getting in your 5-a-Day

When cutting the cost of your grocery trips there is a concern that fruits and veggies will be the first to go, however there are a variety of ways to continue to eat fruits and vegetables without breaking the bank. In general, fresh fruits and vegetables are least expensive when they’re in season; for instance, it is best to buy asparagus and grapefruit in the spring and grapes and eggplant in the fall. Not only are foods fresher and more flavorful when they’re in season, they’re cheaper.

While fresh fruits and veggies are great, you can still get essential nutrients from frozen or canned items.  Canned and frozen items last longer than fresh items and prices won’t fluctuate seasonally as with fresh foods. When choosing frozen or canned foods, make sure there are few additives, such as sugar, salt or sauces, since these additions make the foods less healthy. For example, when buying canned fruit, choose fruit canned in its natural juice instead of in heavy syrup or frozen vegetables without added salt or sauce.

There’s no question that people are more likely to eat fruits and vegetables when they’re easily accessibly which is why many people turn to the freshly cut versions in the grocery store. Next time, instead of buying their pre-cut fruits and veggies, cut your own when you come home from the grocery store to save money.

Finally, you can always grow your own small garden with fresh herbs, veggies or fruit (depending how much space you have) and enjoy inexpensive produce right in your own backyard.  It always tastes better when you’ve grown it yourself!

How to decide what to buy

With grocery stores carrying many options, it can be overwhelming choosing healthy and cost-effective foods, but there are some easy ways to make better choices.

Shopping at warehouse stores such as Costco and Sam’s Club can save you money but only if you know what to buy there.  Depending on the size of your household, you might not benefit from buying fresh fruits or vegetables at these stores since they’ll go bad before you can eat them. However, items that can be frozen, such as meat or fish, or foods that are prepackaged in “normal” sized containers, such as pasta or cereal, may help you save money since they can be purchased at a discounted price and won’t spoil before you have a chance to eat them.

Almost every grocery store chain has its own brand of generic food items. The store’s brand is frequently less expensive than the other brands and is usually nutritionally equivalent.  We’ve found that in some instances, as with yogurt, the generic brands are higher in protein and lower in calories (and cost!) than their brand name equivalent.

Have you ever looked at a 4 lb bag of rice and tried to compare it to a 15 lb bag of rice in terms of cost?  Not an easy task without some serious arithmetic.  Next to the price of each item in the store, there is a cost per unit that helps you determine which product gives you the most bang for your buck!  Let’s look at an example, the 4 lb bag of rice may cost $0.50/ounce and the 15 lb bag of rice may cost $0.40/ounce, therefore the 15 lb bag is a better value assuming you can eat 15 lb of rice!


Lastly, and potentially most obviously, use coupons and stock up when foods are on sale. It seems like such a simple task but cutting out a piece of paper and bringing it to the store with you can save you thousands of dollars a year!  As with buying foods at Costco, the money you save by stocking up when items are on sale at your local grocery can really add up.  Remember to only buy as much as you can eat before it spoils or you’ll find yourself throwing your money straight into the trash.

Meal Time!

While all of these tips sound great, they’re really not much use if we can’t use them to create healthy meals.  Unless you’re cooking for a football team, it’s likely that your recipe will provide more than enough food for you and your family. While some people are ok eating spaghetti and meatballs all week, most of us aren’t so we need to be creative when it comes to leftovers. Depending on what you’re cooking for dinner, your leftovers can either be frozen, like a chili or meatballs, or transformed into a different meal, for instance turning baked chicken into chicken tacos or chicken salad.

Planning your meals and snacks in advance means you’ll be less likely to eat out since your kitchen will be stocked with plenty of food. Spend some time during the weekend planning out your meals for the upcoming week.  If you have kids, involve them in the planning process. Once you’ve planned your week, bring a grocery list to the store to prevent multiple trips to pick up forgotten items.  Keeping snacks readily available at home and at work will prevent snacking at the vending machine or an afternoon trip to the drive through or coffee shop.

Aside from saving money, there are many health advantages to preparing food at home.  Since you’re cooking the food yourself you can control the amount of butter or oil that’s added to your food, eliminating excess fat and calories from your diet.  You can also control the ingredients that are in each dish which is especially helpful if you or someone you are cooking for has an allergy to certain foods.  Finally, cooking at home allows you to control the portion sizes; in case you hadn’t noticed, the portion sizes at most restaurants are 2 (sometimes up to 4) times as large as they should be which can lead to overeating.

The Facts

For those of you that still don’t believe us, we’re going to prove that you can get a more nutritious meal and cost effective meal by cooking at home.  What follows is a comparison of a day of eating at fast food restaurants to a day of eating meals prepared at home.

Meals/Snacks from the grocery store:

Item Cost
Breakfast
¾ cup shredded wheat $0.27
1 cup non-fat milk $0.19
1 small apple $0.50
6 oz non-fat yogurt $0.48
¾ cup cranberry juice $0.18
TOTAL: $1.62
Item Cost
Lunch
2 slices whole wheat bread $0.25
3 oz turkey $1.86
3 slices tomato $0.30
½ cup baby carrots $0.17
1 small banana $0.40
¾ cup non-fat milk $0.14
TOTAL: $3.12
Item Cost
Dinner
4 oz salmon $2.49
1 cup wild rice $1.00
1 cup broccoli $0.52
1 cup garden mix salad $0.08
½ cup fruit salad $1.00
TOTAL: $5.09
Item Cost
Snacks (2 per day)
1 oz mixed nuts $0.35
1/2 cup grapes $0.50
6 crackers $0.07
2 tbsp peanut butter $0.13
TOTAL: $1.05

Grocery store grand total: $10.88

Meals/snacks from fast food:

Item Cost
Breakfast: McDonalds
1 Sausage McMuffin $1.00
1 serving hash browns $1.00
1 medium orange juice $1.99
TOTAL: $3.99
Item Cost
Lunch: In-N-Out
1 Hamburger Combo meal
1 order fries Combo meal
1  medium coke Combo meal
TOTAL: $4.75
Item Cost
Dinner: KFC
3 Crispy chicken strips $3.99
1 biscuit $0.50
1 small corn on the cob $0.38
1 side mac and cheese $1.49
TOTAL: $6.36
Item Cost
Snacks (2 per day)
1.69 oz bag M & M’s $0.65
2 oz bag Doritos $0.99
TOTAL: $1.64

Fast food grand total: $16.74

Nutrition Facts:

Calories Protein Fat Carbs Fiber
Grocery store 2,064 calories 120 grams 67 grams 272 grams 36 grams
Fast food 3,038 calories 90 grams 133 grams 374 grams 19 grams

We know what you’re thinking, “I only eat off the dollar menu” or “I only eat healthy fast food items.”  Let’s assume that you really do choose less expensive fast food items that also happen to be the restaurant’s healthier choices (unlikely but we’re pretending).  The problem is that many people would have ordered two 99¢ hamburgers instead of one or a large shake instead of a medium soda.  It’s hard to make consistent healthy and economic choices when eating at fast food restaurants.  When we compare breakfast we see that even items off the dollar menu are more expensive than a well-balanced meal at home.  It is possible to make healthy choices when eating out, but we’ll save those tips for another day.

Questions? E-mail Leah: frankel@myhousecallmd.com

References:

1. Nutrition facts obtained for fast food restaurants obtained from: http://www.mcdonalds.com/, http://www.in-n-out.com/, http://www.in-n-out.com/

2. Price of groceries obtained from: http://www.safeway.com/IFL/Grocery/Home

3. Nutrition assessment of grocery foods completed via: http://www.mypyramidtracker.gov/

12

04 2010

The Achilles’: Your Weakest Link

by G. John Mullen, DPT 2011 | mullen@myhousecallmd.com

Achilles’ tendon injuries have been present since the time of the Greek Gods and Goddesses, (remember Achilles from Greek Mythology?).  Achilles’ is the burly, handsome warrior from the Trojan War legends who could only be harmed by a lethal blow to his Achilles tendon…and the name was born.  Contrary to popular belief, this warrior’s surname was not Pitt.  What we really want to know, however, is how does the Achilles tendon affect us today?

We all witnessed the devastating loss Michigan State suffered to underdog, Butler University, in the men’s NCAA basketball tournament. The Spartans put in a valiant effort despite the season-ending loss of Kalin Lucas, a pivotal player averaging 12.3 points per game.  Lucas tore his Achilles’ tendon during the game against Maryland (tragic, we know). Achilles’ tendon tears are not unique to the collegiate super-athlete; weekend warriors are just as susceptible to Achilles’ tendon tears as the pros.  An Achilles’ tear is debilitating, requiring surgery and extensive rehabilitation in most cases.  Successful surgery and rehabilitation of a torn Achilles’ tendon requires a thorough understanding of the anatomy, cause of the injury, patient’s unique health condition & lifestyle and patient’s athletic activities.  These factors are essential to preventing a re-repture of the tendon.

Stat Fact: Most Achilles’ tears occur 2-6 cm above the Achilles’ insertion into the calcaneus, the heel bone in the foot (3).

Anatomy

The Achilles’ is a complex tendon whose rarity is secondary to the fact that the tendon crosses two joints.  Multi-joint crossing places increased stress on the Achilles’, resulting in the tendon’s high injury rate.  Everyday activities like walking place repeated stress on the tendon.  The tendon is the composite of two muscles in the calf: the gastrocnemius (the medial and lateral heads which cross the back of the knee) and the soleus (the bulk of the calf). The tendon is surrounded by two sheaths (which are called “paratendon” and “mesotenon”).  The mesotenon is responsible for the nourishing blood flow to the tendon.  Diminished blood flow is seen at the bottom of the Achilles’ tendon and is responsible for the high rate of tears in this region. The majority of the tendon is made of Type 1 collagen (4).

Stat Fact: The Achilles’ tendon twists in a spiral motion as it wraps around the foot and inserts into the calcaneous.

Types of Achilles’ Tears and Risk Factors

Athletic Achilles’ tears are typically acute injuries caused by a “high rate of loading” associated with specific movements which include landing, pivoting or sweet juke moves on the field…talk about all-time backfires! Acute injuries commonly occur at the distal portion (i.e. the point farthest towards your heel) of the tendon where blood flow is diminished. Out-of-shape athletes returning to high-impact sports make up the largest portion of these injuries.  Trauma from a foreign object is another common cause of an acute Achilles’ tear (i.e. Tonya Harding action to the back of your ankle).  These injuries are not pretty, but if you’ve seen the movie, Saw, you may remember one of the hostages having their Achilles’ sliced to prevent escape.  Uncommon but horrific to say the least.  Tears during motor vehicle crashes are more typical and can be equally debilitating.  Chronic Achilles’ tendon injuries can also eventually lead to tears. Nagging Achilles’ tendonosis (chronic inflammation of the Achilles’ tendon) transforms the molecular properties of the tendinous collagen making the tendon soft and pliable.  Pliability is the Achilles’ kryptonite (not arrows as Hollywood would have you believe)!  As we age, we are more prone to tendon tears.  Two factors lead to increased Achilles’ tears as we age: 1) the transformation that takes place in your tendon’s cartilage and 2) hypovascularity (impaired blood flow) making previously injured, older athletes more prone to Achilles’ tears.

Stat Fact: The Achilles’ tendon is the strongest tendon in the body, absorbing up to 8x our body weight in force during athletic movements (2).

Surgery and Rehabilitation

Surgery is always the last option.  Debate surrounds the efficacy of surgery and rehabilitation in Achilles’ tears.  Studies show conflicting evidence in terms of recovery speed and re-rupture rates for individuals with and without surgery (5). There is further debate on the first phase of rehabilitation for both groups. One theory of rehabilitation promotes 6-8 weeks of immobilization via casting.  Casting is typically done in plantar-flexion (with your foot bent at 90 degrees to your calf) or in the neutral position (imagine your foot’s position as your leg hangs over the edge of the bed).  Immobilization is thought to allow collagen repair following surgery increasing stiffness and strength of the tendon. The other accepted method of rehabilitation is the exact opposite of immobilization: early mobilization. Early mobilization is believed to promote revascularization of the injured tendon. Revascularization is believed to enhance strength (4).  More importantly early mobilization is associated with similar functional gains and a low re-rupture rate (5).  These positive attributes make early mobilization an important variable for surgical and non-surgical treatment of Achilles’ tendon tears.

Rehabilitation regimens vary depending on the surgeon’s approach (early mobility vs. early immobilization).  Early mobilization seems to be gaining momentum with recent publications.  A typical early mobility rehabilitation protocol is listed below:

Postoperative Exercise Program (1)

Group 1 (early mobilization)

Time: 0-3 wk

  1. Flexion and extension of the toes in a supine position; 25 × 3 series

  2. Plantar flexion of the ankle and dorsiflexion to neutral in supine position

  3. Extension of the knee in a sitting position (hold 2 s); 10 × 3 series

  4. Flexion of the knee in a prone position; 10 × 3 series, 3 times daily

  5. Extension of the hip in a prone position (hold 2 s); 10 × 3 series

Time: 3-6 wk


Same as week 0-3

Time: 6-9 wk

1. Ankle flexion and extension exercises with manual help

2. Rotation of the ankles in both directions; 30 × 3 series, 3 times daily

3. Standing on the toes and heels alternately; 30 × 3 series, 3 times daily

4. Ankle extension exercises against a rubber strip; 20 × 3 series, 3 times daily

5. Ankle stretching exercises to flexion with the help of a rubber strip; 30 s × 5 series, 3 times daily

6. Stretching of the calf muscle by standing with the leg to be stretched straight behind and the other leg bent in front and leaning the body forward, with support from a wall or chair; 30 s × 5 series, 3 times daily

7. Stretching exercises for the toes and ankle against the hand in a sitting position; 30 s × 5 series, 3 times daily

Time: 9 wk

1. Raising and lowering of the heel, first with both feet at the same time and later with 1 foot; 20 × 5 series, 3 times daily

Exercises against a rubber strip for

Ankle extension 20 × 5 series, 3 times daily

Ankle flexion 20 × 5 series, 3 times daily

Ankle abduction 20 × 5 series, 3 times daily

Ankle adduction 20 × 5 series, 3 times daily

Stretching of the calf muscle against the wall; 30 × 5 series, 3 times daily

Standing with the knee somewhat flexed; 30 × 5 series, 3 times daily

With any surgery, you must take note of the potential complications. At the same time, the re-rupture rates in Achilles’ tendon tears are significant in the conservative non-surgical group.  A notable complication with Achilles’ Tendon surgical repair is sural nerve dissection.  The sural nerve is damaged in approximately 6% of Achilles’ tendon repairs.  Sural nerve damage can lead to impaired sensation to the dorsal (back) aspect of the heel (2).

Stat Fact: Non-surgical Achilles’ Tendon treatment has a re-rupture rate of 12.6%, nearly 4x the 3.5% re-rupture rate seen in the surgical repair group (2).

Prevention

While many people believe that stretching is the key to preventing Achilles’ tendon rupture, this may not actually be the case.  Stretching may reduce the number of tendon injuries, but a more thorough approach is needed to further minimize your risk of injury.  Most Achilles’ tendon tears are caused by high force movements.  As your coach always said, “Practice like your play!”  It only makes sense to practice these high force movements via plyometrics to train your body to adapt to these high levels of strain. Therefore a stretching regimen in combination with a light plyometric routine makes perfect sense.  A simple plyometric routine (for example, ankle hops progressing to higher impact squat jumps and then repeated hops) can be utilized before exercise to minimize your risk of injury.  Who doesn’t want strong enough Achilles’ tendons to dunk like Dwight Howard?

Questions? E-mail G. John Mullen: mullen@myhousecallmd.com

References:

1. Kangas J, Pajala A, Ohtonen P, Leppilahti J. Achilles tendon elongation after rupture repair: a randomized comparison of 2 postoperative regimens. Am J Sports Med. Jan 2007;35(1):59-64.

2. Molloy A, Wood E. Complications of the treatment of Achilles tendon ruptures. Foot Ankle Clin. Dec 2009;14(4):745-759.

3. Park D, Chou L. Stretching for prevention of Achilles tendon injuries: a review of the literature. Foot Ankle Int. Dec 2006;27(12):1086-1095.

4. Strom A, Casillas M. Achilles tendon rehabilitation. Foot Ankle Clin. Dec 2009;14(4):773-782.

5. Twaddle B, Poon P. Early motion for Achilles tendon ruptures: is surgery important? A randomized, prospective study. Am J Sports Med. Dec 2007;35(12):2033-2038.

11

04 2010

Managing your Doctor: Make the most of your visit

by Joshua Goldman, MD/MBA 2010

Managing your life is a lot like managing a company.  You sit in the corner office as CEO and manage your team of employees who may include (but are by no means limited to) your accountant, personal trainer, lawyer, hair stylist, and, most relevantly, your physician.  We often forget this relationship due to the dynamics of our interactions with these “employees” but at the end of the day, they really do work for you.  That being said, you have an obligation to “manage” these individuals, informing them of your needs and expectations, so that they can do the best work possible on your behalf and subsequently allowing you to enjoy the fruits of their labor.  The question then becomes, “How do you manage your doctor?”

Step 1: Hire the Right One

The first and most critical step is to find the right doctor for you.  You want a physician that is personable and who you feel comfortable trusting with your health.  You also want to make sure that your physician can provide you with the face time you deserve and need.  Many doctors now have to rely on a larger volume of patients to compensate for the decreasing reimbursements they receive from insurers (i.e. they crank through 40+ patients per day and look a lot like this guy flying from exam room to exam room).  So make sure that your doctor is willing to spend enough time with you each visit to address all of your medical needs.  Another key is to make sure you’re seeing the right type of doctor.  Primary care doctors come in many forms (internists, family physicians, geriatricians, etc.) so make sure that the doctor you hire is the right one for you.  How do you know what’s right for you?  Ask them about the types of patients in their practice.  If 90% of their patients are 65+ and you’re 24 years old, you may want to find another doctor with more experience with a younger population.  If you’re a female and don’t feel comfortable with a male physician, you should probably find a female (females, by the way, have now surpassed men and become the majority in medical schools in America).  The takeaway: Find someone that you can relate to and that you feel comfortable with.

Step 2: Schedule Your Meeting

Just as in business, there are good times and bad times to schedule appointments with your physician to maximize the attention you receive and prevent yourself from waiting for hours in a crowded waiting room (like the one we are all too familiar with seen here).  Imagine the energy and enthusiasm you would bring to a board meeting at 4:30pm on a Friday afternoon.  It would be a sad showing to say the least.  A Monday morning seems like a more logical choice.  So let’s begin with when NOT to schedule an appointment:

  • Right Before Lunch: Doctors often have lunch meetings that they have to attend.  If the doctor is running behind (which they almost always are) you may be bumped to the first appointment of the afternoon meaning an extra hour in the waiting room.  Those magazines can only keep you entertained for so long.

  • At the End of the Day:  We would bet a small fortune that the doctor will be behind by the time the 4:00pm appointments start to arrive.  The few minutes behind that he has been with each patient will have snowballed into at least 30 minutes by now translating into more waiting for you.  In addition, it’s hard to keep everything straight in your head by the end of the day.  With 30+ patients already floating around in your doctor’s mind, you will certainly not be getting the attention you need at this time in the day.

With all this in mind, the first or second appointment in the morning seems to be the best time to see your doctor.  They will be on time (we hope) and with a clear mind that can be entirely focused on your needs.

Scheduling your appointment is the next step.  Behind every famous Senator has a wonderful assistant who holds the key to face time with that elected official.  The same goes for doctors.  Schedulers are the gatekeepers of the doctor’s office.  Find out who your doctor’s scheduler is and shower that individual with love and kindness.  If you do, they can make miracles happen.  If you are rude to the, they can make your life miserable.  Once you’re on their good side they can squeeze you in at the last minute, give you a call if someone cancels and help you secure that perfect time first thing in the morning.  You may have a longer wait time if you try to get an appointment the same day but the scheduler is the only one that can get you on the books.  They’re like wizards.

Step 3: Lead the Meeting

The most important part of this step is to BE ON TIME.  How would it look if you showed up 15 minutes late to a board meeting you were running?  Think of your appointment the same way.  Your physician, unfortunately, may not be on time but if you’re late and the doctor is on schedule, you run the risk of losing your appointment and having to start the process all over again.  Also, you will undeniably have to do paperwork when you get there.  We’re not entirely sure where all this paperwork comes from or what it is used for (we doctors don’t see the majority of those forms) but you will, without a doubt, have to fill out some new form and sign a document or two before the doctor sees you.  It’s as predictable as the weather in Seattle, so plan for it.  Also, bring a book or a magazine to keep you entertained for the few minutes until your appointment but make sure you’re there on time.

In addition, be prepared.  Bring your personal medical records with you including any imaging and lab studies you’ve had performed (we’ll cover what to include in your record in a minute).  Many physicians will request to see these studied before they make any treatment decisions so save yourself an extra visit by having these tests performed in a timely manner and bringing the results with you.  You only need to bring your full medical record to your first visit with a new doctor but always bring your most recent labs and imaging for the doctor’s reference.

Now it’s time to run the meeting.  The key to any successful meeting is a clear agenda.  As soon as the doctor walks in, set this agenda with him, outlining all of the issues you’d like to address as well as the questions you would like answered before you leave (remember that, on average, the doctor only has 15 minutes to spend with you each visit).  It’s amazing how many times patients, when asked why they have come to the doctor, reply, “I don’t know. I thought you would know.” Our advice: Know why.  You’ve called the meeting for a reason and we can’t help you unless we understand what you need so be sure to let us know why you have made the appointment as well as all of your specific questions and concerns. Many people also forget the questions they wanted to ask (we call it “White Coat Anxiety”) so the best strategy is to write them down and bring them with you to your appointment.

The next key step is to recap and plan your treatment.  Physicians are required to complete the note they write in your chart with an “Assessment & Plan.”  Your job is to make sure you understand both of these inside and out.  It sounds simple but you’d be amazed how many people don’t leave with this understanding.  The number of patients who don’t know why they’re taking a certain medicine is astounding.  Before you begin any treatment plan, you should ask these questions:

  1. What is my diagnosis and how did you confirm it?

  2. What treatment am I being given and why?

  3. How does that treatment work?

  4. Are there any alternative treatments?  If so, why is this treatment the best choice?

With this knowledge, you’ll be able to make better decisions about your treatment and will understand why the treatment is necessary.  Your health care is a team effort and there’s no “I” in “team.”  You are the CEO of the company called “You” and are as accountable for your care (the doctor is your hired consultant, remember?).  While we’re talking about accountability, let’s discuss your medical records.

Step 4: Manage your Records

Until the government and private industry resolve the battle over the ultimate solution to electronic medical records in America, you are responsible for keeping your thorough medical record.  It is scary how many patients can’t remember the name of their medications.  The most common response to “What medications are you taking?” is “A little white pill for my blood pressure.”  Not a good answer (and a scary one at that) given the ridiculous number of blood pressure medications on the market and the catastrophic effects of medication interactions.  Have we convinced you to keep your personal medical record yet?  If not, we’re happy to fill you in on all the gory details of medical mishaps from poor record-keeping.

What should you keep track of?

The medical profession is highly regimented.  We are trained to follow a very specific (and thorough) format when recording a medical history.  Below, is an outline of all the medical information your physician will need to know to provide you with the best care possible.

History of the Present Illness: This is the full story of your current medical problem.  Write it all down so you don’t forget any important details when you finally get face time with your doctor.

Past Medical History:

  • Hospitalizations: Have you ever been admitted to the hospital?  If so, keep copies of your “Discharge Summary” from each admission.  These are not routinely given to patients so be sure to specifically ask for a copy or track one down via medical records.

  • Surgeries: Have you ever had surgery?  If so, keep copies of your “Operative Reports” so the doctor knows exactly what was done and when.

  • Medical Conditions: The doctor will want to know about all of your medical problems.  This includes any history of cancer, heart disease, hypertension, diabetes, STD’s, etc.  If you’ve had something, keep track of it.

  • Medications: Do you take any prescription medications?  It is very important to keep detailed records about the medications you take, how often you take them and what dosage you take.  Also, keep track of any side effects you’ve had with medications in the past.  Many classes of drugs are related and tracking your side effects may be helpful in finding the right medication for you in the future.

  • Allergies: Do you have any allergies to food, medications or things in the environment?  Allergic reactions are horrifying and are often more severe each time you are exposed to the allergen.  Definitely worth keeping track of!

  • Trauma: Have you even been in a major accident?  A history of trauma of any sort is very important for a physician to know.

  • Vaccinations: The government currently gives you a small card to keep track of your vaccinations…not the easiest thing to keep track of.  Add your vaccination history to your medical record so you can be sure to stay up to date with any boosters you may need.

Family History: Many of the diseases that plague our society have a genetic component passed down from one generation to the next.  Keep a detailed history of any major medical problems that have affected your parents, aunts & uncles, siblings, and children.

Imaging: X-Rays, CT Scans, Ultrasounds and MRI’s are extremely expensive.  These test are repeated too often because physicians cannot track down copies of the most recent imaging studies performed (the cost of which comes back to you as a patient).  If they can’t find it, they’ll just do it again.  Request a copy of every imaging study you have performed as well as the report from the radiologist who examined the study.  This is a huge time and cost saver for you.

Lab Results: Same idea as the imaging studies.  Keep a copy of all lab studies you’ve had including blood work and biopsies.  For biopsies, you will want to keep a copy of the “Pathology Report” which contains a description of what the specialist saw when they examined the biopsied tissue.  Nobody wants to have two biopsies done if they don’t have to (they are not as much fun as they sound)!

How do you keep track of your personal medical record?

There are a number of ways you can manage your personal medical record depending on your personal preference and predilection for technology.  There are thousands of additional options, but these should get you started.

  1. Google Health: Google Health, a free record keeping system, allows you to manually input your medical record or import it from a number of medical provider networks’ electronic record systems.  They also have partnerships with a number of record-keeping companies that will track down and upload your personal records for a fee.  Google Health is an efficient paperless way to track your records. At the same time, many people fear the repercussions of inputting their health record into an online database.  We feel you.  If you are more of a Microsoft fan, Microsoft has created a similar program called HealthVault with similar functionality.

  2. Word Document:  If you’re worried about the hackers of the world finding out about your vaccine history, a password-protected Word Document may be the solution for you.  This method requires the same amount of manual data entry as Google but requires you to format the record yourself.  Luckily, you have our nifty outline above to follow…your doctor will be seriously impressed.  Be sure to back up the file on a CD or external hard drive in case your computer crashes.  You don’t want to have to start all over again if you spill coffee on your hard drive.

  3. A Good Old Fashioned Folder: If technology isn’t your thing or you don’t want to have to retype everything into a document, keep copies of all of your doctor’s notes, operative reports, imaging, lab reports, etc. in a big folder.  Oh yeah, and put the folder somewhere safe (ideally fireproof) that you will remember.  We know how hard it is to keep track of paperwork…don’t lose this stuff!

Now that you’ve compiled your extensive medical record, take a copy with you each time you see a new physician.  This document will save you a ton of time in the office with them (which you can use for your personal questions) and ensure that you receive the best care possible.

Armed with these strategies, you’ll be able to make the most out of each meeting you have with your doctor.  Remember, the most crucial step is finding the right doctor for you; someone you can trust, who spends time listening to your concerns and who leaves you feeling well cared for.  Your health is a team effort and you are the team captain.  Assume the helm and lead “You” to a happier, healthier life, beginning with more meaningful visits with your doctor.

07

04 2010

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