HealthLink, January 2005

2. LEARNING
Why Don’t Antibiotics Work
Against the Common Cold?
by Peter Alperin, M.D., Medical Director M.D., has shown that antibi-
Brown & Toland Medical Group otics are of no benefit in
fighting this disease.
HealthLink uring the winter season, fighting The bigger issue is that
Winter 2005 D a cold the old-fashioned way — without
the use of antibiotics — can be unappealing.
overuse of antibiotics has
many negative implications.
Overuse has led to rampant
3 Diabetic Care
Why your checkup should But the implications of improper antibiotic use bacterial resistance, so many
be head to toe. of our once powerful anti-
can affect all of us, clinically and financially.
biotics no longer work
4 Childhood Obesity
Healthy habits help prevent Antibiotics are medicines against the other main when we — and at some
serious medical and that kill bacteria. They do cause of infections: viruses. point, you — really need
emotional problems. this in a variety of ways, Viruses are small bits of In addition to his role as them. There is always a risk
7 Effective such as breaking down protein that are not quite medical director of Brown & of an adverse reaction to
Asthma Control bacteria cell walls, shutting “alive” and need to “live” Toland Medical Group, Peter medication, and these reac-
An assertive approach to down protein synthesis and in a host to survive. The E. Alperin, M.D., is in active tions may be very serious.
this chronic disease can interfering with bacterial common cold and flu are The cost to our medical sys-
practice at Mills-Peninsula
make a difference. DNA replication. As we all caused by viruses, as are tem is staggering, resulting
Hospital and teaches as an
8 Top Performance know, when we have a bac- most sore throats and assistant clinical professor of from wasted medications
We scored in the top terial infection, antibiotics many sinus infections. Since and needless doctor visits.
medicine at the University of
10 percent for quality are essential weapons in antibiotics work by killing The main reason we feel
among California California-San Francisco.
medical groups. your doctor’s arsenal. The bacteria, they are ineffective better after we take anti-
widespread use of antibi- against viruses. There are But many studies over the biotics for a viral cold is
10 Healthy Seniors otics after World War II has anti-viral medicines for cer- past decade have shown that we were getting better
A food pyramid just for
you; plus new HMO led to significant improve- tain viral infections, but not that antibiotics are of NO anyway. Most people wait a
options in 2005. ments in our ability to treat for common viral infections. benefit in fighting viral few days to go to the doc-
a wide range of infections. This is where we get into infections. How about in tor. When they finally start
Brown & Toland’s HealthLink editor: Richard
Angeloni, Corporate Director, Communications and Common infections treated trouble — we are a culture bronchitis — better known the medicine, they were
Public Relations, Brown & Toland Medical Group,
415.972.4307. Brown & Toland’s HealthLink is pub- by antibiotics are communi- that relies on pills. We want as a chest cold? Nope. Most already on their way to
lished quarterly and printed in the United States.
Copyright 2005 by Health Ink & Vitality ty-acquired pneumonia, a magic bullet to make our acute bronchitis is viral. recovery.
Communications, 780 Township Line Road, Yardley,
PA 19067, 267.685.2800. Articles in this newsletter skin infections and urinary cold go away yesterday, Bacteria can be cultured Remember what your
are written by professional journalists or physicians
who strive to present reliable, up-to-date health tract infections. Why? when, in fact, this is just not from the lungs, but it isn’t grandmother said: “Here,
information. Our articles are reviewed by medical
professionals for accuracy and appropriateness. No Because these infections possible. I know that many causing the problem. In dear, rest and have some of
magazine, however, can replace the care and advice
of medical professionals, and readers are cautioned are caused by bacteria. of us have had a cold, gone fact, a local University of my chicken soup.” That, and
to seek such help for personal problems. Some
images in this publication were provided by ©2005 On the other hand, to the doctor, taken antibi- California–San Francisco time, is all that works. Until
PhotoDisc, Inc. PhotoDisc models used for illustra-
tive purposes only. (105) antibiotics are useless otics, and then gotten better. researcher, Ralph Gonzales, next time, stay healthy. ■
How to Communicate only if you provide the cor-
rect information.
Better With Your Here are some simple
steps you can follow to
Physician ensure that you and your
by Tammy Fisher, M.P.H. doctor are communicating
Manager of Health and Quality Improvement correctly.
Brown & Toland Medical Group Start the conversation
with your physician by
ommunicating effec- of care you receive. As explaining the reasons for
Cplays an important
cian
tively with your physi- patients, we expect quality
care. Your physician, how-
your visit. Are you visiting
for a regular checkup?
role in the overall quality ever, can deliver that care Do you want to talk about
2 Brown & Toland’s HealthLink, Winter 2005 www.brownandtoland.com

3. DIABETES CARE
Diabetics Must Take
Care from Head to Toe
Get your doctor to check your eyes and feet each year
ost of us could blindness among adults On your feet decrease blood flow and education for the ADA.
M use a head-to-toe
checkup now and then.
ages 20 to 74 years. Loss of
vision can result from a
More than 60 percent
of nontraumatic lower-
damage nerves in the
extremities. Then common
The decrease in blood
flow also impairs the heal-
But for people with dia- condition known as dia- limb amputations occur scrapes and bumps of ing process. This can lead
betes, it is important to get betic retinopathy, in which among people with everyday life can end up to infection and, in the
a head and toe checkup the delicate blood vessels diabetes. According to causing some serious worst cases, amputation.
every year. in the back of the eye the National Diabetes problems. “Our feet are subjected
In 2002, there were an swell and bleed. According Information Clearinghouse, “People can lose sensi- to a tremendous amount
estimated 18.2 million to the National Diabetes in 2000–2001, about 82,000 tivity so that they don’t of pressure and wear,’’
people in this country Information Clearinghouse, nontraumatic lower-limb know if they step on a says Dr. Susman. “Foot
with diabetes. For them, diabetic retinopathy causes amputations were per- needle or get a small stone care should be practiced
eyes and feet can be 12,000 to 24,000 new cases formed annually among imbedded in their foot,’’ each day in addition to
potential trouble spots. of blindness each year. people with diabetes. says Christine Beebe, pres- being part of an annual
The American Diabetes “There may be substantial Why? Diabetes can ident of health care and checkup.” ■
Association (ADA) recom- damage before a person is
mends an eye exam and a aware of visual problems,’’
foot exam by a medical says Jeffrey Susman, M.D., of
Follow These Healthy “Footsteps”
professional each year. the University of Nebraska
Check daily for calluses, cuts or cracks in the skin and
Why? Diabetes can cause Medical Center. “So it is look for signs of infection.
eye problems that can lead important to have regular Use a mirror, if necessary, to look at the bottoms of
to blindness if left untreat- eye exams whether you are your feet.
ed. And when diabetes having problems or not.’’ Keep feet clean. Do not use alcohol or hydrogen
causes poor circulation During the eye exam, an peroxide. They dry out skin.
and nerve problems in the ophthalmologist can look Be careful when soaking feet in hot water. Nerve
feet, sufferers can develop into each eye and check damage decreases sensitivity to temperature.
wounds that are difficult along the inner back wall You could burn yourself.
to heal. for damage. “It is some- Do not go barefoot outdoors. Indoors, wear slippers
or sandals if you don’t want to wear shoes.
thing that, if we can catch
Eye to eye Make sure all footwear fits properly.
it early on, we can do a
Do not cut calluses yourself. See your doctor, who also can
Diabetes is the leading great deal to help,’’ Dr. check for ingrown toenails and other potential problems.
cause of new cases of Susman says.
some medication you’ve especially if your health family member. long way to ensuring that satisfaction with the care
been taking? Be as specific depends on it. Have any changes you are receiving a correct they receive from their
as possible. Make a list of your occurred in your diagnosis and quality care. personal doctor and med-
Also remember to tell concerns and take it health? If so, remember Good communication will ical group. Should you
the doctor if you have with you on your visit. to tell your doctor. keep you better informed, receive a survey from us,
been taking over-the- Take notes! You can Listen to your physician. happier and healthier! we strongly encourage you
counter medications or never remember every- Make sure you know Your medical group, to complete it so that we
herbal remedies, or if you thing your physician the phone numbers Brown & Toland, cares can continue to improve
use alternative therapies. tells you. and emergency contacts about the care we provide the care we provide to you.
Here are some other If you have trouble of your physician’s to you. Each year, we send Having satisfied patients is
helpful hints. communicating with office. satisfaction surveys to most important to us. ■
Ask questions. Every your physician, Remember, effective a group of our patients
question is important, take along a friend or communication can go a to inquire about their
www.brownandtoland.com Brown & Toland’s HealthLink, Winter 2005 3

4. HEALTHY DIET
How to Prevent
Childhood Obesity
aby fat is something children are supposed to out-
B grow, not grow into. According to the American Academy of
Pediatrics, one in five children in the United States is overweight or obese.
That’s twice as many overweight children as 20 years ago. Extra pounds and
too-big waistlines have serious consequences for children, including low
self-esteem, social problems and increased risk for chronic diseases.
Why are so many children too heavy? Experts say there is no single
cause of childhood obesity. Genetics plays a role, but too little physical
activity and poor food choices are more often the culprits.
Too little activity recommended 60 minutes Public Health revealed
Anyone up for a breathless of moderate activity a day, that the risk of being over-
game of tag, kick-the-can, many children spend hours weight is more than four
hopscotch? Childhood a day watching television times greater in children
should be filled with hours or playing video and com- who watch more than five
of energetic play, but chil- puter games. hours of television daily devastating as the medical
dren today are less active compared with those who Why you should problems. They are often
than past generations. Television watch two hours or less. be concerned teased by other children
With more families living in troubles And having a television in Being overweight or obese and as a result suffer poor
cities, fewer children walk Almost half of all 8- to the bedroom is associated places a child at risk for self-image, low self-esteem
to school, and parents 16-year-olds watch three to with being overweight, even many health problems. An and depression.
may keep children indoors five hours of television in very young children. obese child is more likely
more often out of concern daily. Children who watch to develop type 2 diabetes, If you’re
for their safety. Adding to the most television are also Food woes a condition that used to concerned
the problem, many schools the most likely to be obese. Our environment is loaded occur only in adults. If you’re concerned about
have cut back on physical A study published in the with food temptations. According to the National your child’s weight, first
education programs. A medical journal Pediatrics High-calorie foods are avail- Institutes of Health, there talk to your pediatrician or
national survey found that found that the rate of obe- able everywhere a child has been an alarming family doctor. The doctor
20 percent of children ages sity rose 2 percent among turns: in school vending increase in diabetes among can determine whether
8 to 16 in the United States 12- to 17-year-olds for machines, at fast-food obese children and adoles- your child is at a healthy
are vigorously active only every additional hour spent restaurants, at corner con- cents recently. weight by calculating body
twice a week or less. watching television. A study venience stores and even in Obese children often have mass index (BMI). BMI, a
Instead of getting the by the Harvard School of kitchen cupboards at home. high cholesterol and high ratio of weight to height, is
Fruits and vegetables are blood pressure, increasing considered the best
easily ignored in favor of their risk for heart disease. method for evaluating
high-calorie snacks such as Children who are obese weight in children. (To find
potato chips. Hectic sched- are more likely to have an online BMI calculator,
ules mean home-cooked asthma and sleep apnea, you can go to www.cdc.gov/
family meals are often a breathing problem that nccdphp/dnpa/bmi.) Your
skipped and replaced with interrupts sleep, as well as pediatrician will compare
less nutritious grab-and-go bone and joint disorders. this number with a growth
foods eaten on the run. And overweight children chart for children of your
Families eat more often at are more likely to become child’s same age and sex.
restaurants, where portion overweight adults. Your pediatrician can
sizes have ballooned, pro- The psychological stress help you identify appropri-
viding too many calories that overweight children ate weight management
and too much fat. experience can be as goals for your child. Often,
4 Brown & Toland’s HealthLink, Winter 2005 www.brownandtoland.com

5. What You Can Do to Control Obesity
Helping your children to have a healthy body weight
is a family affair. Instead of putting the focus on
the overweight child, the whole family should get
involved in making healthy changes in activity and
eating habits, experts say. As a parent, you are the
most significant role model for your children, so it’s
important that you set an example
with healthy lifestyle habits.
Get up and move
Physical activity is a great way for you to
spend quality time with your children. TECHNOLOGY
Emphasize the fun of an activity, rather than skill.
Build family activity into every day, perhaps tak-
ing an after-dinner walk or bike ride or dancing
to fast music in the living room.
ePocrates
Plan active family outings, such as hikes, Provides Brown & Toland
ice-skating, swimming or Frisbee. Try a family
vacation that emphasizes canoeing, bicycling,
Doctors With On-the-Spot
camping or swimming. Drug Information
On birthdays, give presents that encourage
activity, such as roller skates or a basketball.
Set guidelines for how long your children can
T hanks to new now able to atmake pointdecisions
providers are
technology, Brown & Toland
about prescription medication the
key
of care
watch television or play computer or video games.
the goal isn’t to lose weight, and with the click of a button.
but to change behavior. Brown & Toland is offering physicians free online
Restrictive diets are not rec-
Choose healthy foods access to the ePocrates RxOnline® drug database, a
Use the Food Guide Pyramid as a
ommended for overweight clinical database that compares the co-pay levels of
guide for food choices. Serve fruits,
children. Rather, the goal is prescription drugs and provides the most up-to-
vegetables, whole grains, beans, and lean meats
to help them maintain their and poultry. Use low-fat or nonfat milk products date clinical information, such as dosing and drug
weight as they grow taller. (except for children younger than 2 years old). interactions.
Another approach is to help The technology will help health care profession-
Keep healthy snack foods in the house, such as
a child burn more calories fresh fruit, raisins, pretzels, string cheese and als avoid medication errors and practice more effi-
by being more physically popcorn. ciently. Physicians can access the popular database
active. A registered dietitian online via the medical
Have your children start the day with a good www.brownandtoland.com
can provide guidance on breakfast, such as whole-grain cereal with fruit group’s new Web site,
eating behaviors, meal and low-fat milk, whole-wheat toast with www.brownandtoland.com.
planning and shopping. peanut butter, a fruit smoothie made with Modeled after ePocrates’ widely used hand-held
If your child is at risk for yogurt, or even leftover vegetable pizza. program, RxOnline operates from PC desktops and
medical problems, your Involve kids in shopping for and preparing meals. provides numerous advantages to physicians. These
doctor may recommend a Children like to eat what they’ve helped prepare. include the ability to look up dosing and prescrib-
formal weight management Don’t forbid “bad” foods. Instead, teach your ing information, check for adverse reactions or con-
program staffed by a team children about foods that can be eaten every day traindications, and access drug pricing, clinical tables,
of health professionals, and those that should be eaten only now and then. and guidelines. In addition, RxOnline’s pill checker
such as a pediatrician, allows doctors to identify drugs based on their color,
dietitian and psychologist. Foster self-esteem size and shape. It also features custom patient drug
Most important, let your Children are more likely to make information sheets that physicians may print and give
children know that you healthy changes when they feel to patients. Most importantly, using the “Multi-Check”
love them, regardless of good about themselves. Experts at the Baylor feature allows physicians to check the drug inter-
their weight. Give your College of Medicine suggest that parents help their actions of up to 32 medications simultaneously.
children plenty of support children find things to do that make them feel valu- “Brown & Toland is committed to bringing our
and approval. Helping to able. It might be community volunteer work, visit- physicians the latest in technology to improve
build your children’s self- ing the elderly neighbor down the street, helping patient care,” says Peter Alperin, M.D., Brown &
esteem is a great way to Grandma clean her yard, or pursuing a special interest Toland medical director. “ePocrates is well-known in
help them develop healthy such as art or music. Point out your children’s strengths the industry for its quality drug information, and
and help them develop their own interests and abilities.
new habits. ■ using ePocrates will improve patient safety.” ■
www.brownandtoland.com Brown & Toland’s HealthLink, Winter 2005 5

6. HEALTHY DIET
A Guide to
Eating Through
the Ages
t every stage of life, healthful eating fuels
A fitness. We can benefit from a lifelong eating pattern
that promotes health by adapting food choices and physical
activity to match our personal needs.
Yet statistics show not reasons people’s nutrient children’s needs for com- Get enough folic acid Keep moving. Moderate
everyone is taking the steps needs differ. plex carbohydrates, and before and during preg- physical activity helps keep
necessary to achieve good According to Ms. Fitz, it’s soluble and insoluble fiber. nancy. Eat a variety of folate- blood pressure, cholesterol
health. A 2002 nationwide sound advice for everyone Physical activity, whether rich foods to prevent neural and blood sugar normal,
survey conducted by to enjoy an eating plan in playing hopscotch or bicy- tube birth defects. Foods strengthens muscles and
the American Dietetic accordance with the Food cling, and good nutrition rich in folate include citrus bones, and helps digestion.
Association (ADA) indicates Guide Pyramid. It’s based are key to developing a fruits and juices, dark green, Keep drinking water.
that although 38 percent primarily on grain products, healthful lifestyle. leafy vegetables, whole- Consume lots of fluids to
followed by vegetables grain and fortified breads prevent dehydration.
and fruits, with moderate and cereals, and legumes Enjoy a variety of foods.
“Nutrition is an amounts of dairy products, (beans, peas and peanuts). Perk up the flavor of favor-
important issue for lean meats, fish, poultry and Maintain a healthy body ite foods by using herbs,
legumes, and small amounts weight. “Energy in” must spices and lemon juice
people of all ages.” of fats, oils and sweets. balance “energy out.” Make to compensate for a dimin-
— Polly A. Fitz, R.D., In addition to the Food a commitment to the follow- ished sense of taste or smell.
former president, ADA
Guide Pyramid recommen- ing lifestyle behaviors: Enjoy
dations, ADA offers the fol- a variety of foods in modera- People of all ages
of Americans say they have lowing advice: tion, get regular physical Be realistic. Gradually
made significant changes in activity, and personalize make changes in lifestyle
their eating habits over the efforts to match your and eating habits. And,
last two years, 62 percent schedule, family situation remember, nobody’s per-
say they either know they and personal preferences. fect. Allow for an occasion-
should make changes but Women al slip-up, but get back on
haven’t or simply don’t Choose iron-rich foods, track as soon as possible.
want to be bothered about especially during childbear- Be adventurous. Try new
good nutrition. ing years. Make daily selec- foods. By expanding choices,
“Nutrition is an important tions from lean red meat, people are more likely to
issue for people of all ages,” liver, pinto and kidney get sufficient quantities of
says Polly A. Fitz, R.D., a beans, spinach, enriched the 40 essential nutrients
past president of the ADA. and whole-grain breads, found in foods, which may
“Eating for good health cereals, rice and pasta. increase vitality and reduce
should start at an early age. Select low-fat dairy risk for many diseases.
The sooner you develop Children foods. Build and maintain Be flexible. No need to
healthful eating and physical Kids should get a healthy strong bones throughout worry about just one meal
activity habits, the longer, start to the day. They need life by getting enough cal- or one day. Balance meals
healthier, and perhaps more a good breakfast to get mov- cium. Include three to four and physical activity over
enjoyable your life may be.” ing in the morning and to do daily servings of calcium- Older adults several days.
According to Ms. Fitz, their best in school and play. rich foods such as nonfat Enjoy plenty of calcium- Be sensible. Enjoy all
everybody needs the same Increase daily intake or low-fat milk, yogurt, rich foods. Foods such as foods; just don’t overdo it.
nutrients, just in different of fiber. Eating a variety of cheese, broccoli, sardines milk, cheese and yogurt Be active. Walk the dog,
amounts. Age, gender and grains, fruits and vegetables and collard greens to reduce can slow the progression don’t just watch the dog
body size are among the is the best way to fill the risk for osteoporosis. of bone loss. walk. ■
6 Brown & Toland’s HealthLink, Winter 2005 www.brownandtoland.com

7. ASTHMA CARE
How Effective Is Your
Control of Asthma?
by Charles McDonald, M.D. improvement in breathing. function is to decrease
The second and more inflammation and return Charles McDonald, M.D.,
rin is a 32-year-old who has a history important aspect of asthma the lung to a more normal has been specializing in
E of frequent asthma symptoms. She relied on is inflammation. You can
Primatene mist for relief. Last year, Erin was seen
® think of inflammation as
state. As a result, the airway pulmonary medicine since
becomes healthier and the he graduated from medical
being similar to a burn on tendency for muscle spasm school at the University of
in the emergency room once for uncontrolled your skin. There is swelling, decreases. So a person with Utah in 1976. He practices
asthma. She had stopped regular exercise, and increased secretions and well-controlled asthma can at the California Pacific
irritation, with the skin return to a more normal Medical Center.
had missed work at least once every two months. perhaps sloughing off. A life. If a long-acting beta
She also had trouble sleep- What do you think of similar reaction occurs in agonist (12 hours) is added asthma nurse practitioner
ing several times a month, Erin’s treatment? Does her the lung, and is present in to the inhaled steroid, Vickie Thun, R.N., F.N.P.,
and hesitated to go out improvement mean that asthmatics even when they there is even better control spent time with her in one-
with friends, because laugh- therapy was successful? feel well. Treatment of and stability. This is called on-one teaching sessions.
ing caused her to have As an asthma specialist, I inflammation includes dual therapy. Within a week, Erin was
asthma. She ultimately saw hear stories similar to Erin’s removal of environmental Erin saw an asthma back to bicycling, slept
a doctor who prescribed almost daily. Most asthmat- allergens, and treatment of specialist, who performed better, and in fact had
a steroid inhaler. She was ics believe that some sinus disease or gastro- pulmonary function tests. improved overall energy
also given a new inhaler improvement with therapy esophageal reflux. The hall- Although she felt well that (even mild active asthma
for relief (albuterol). is all they can expect, and mark of treatment, howev- day, her tests showed mod- is fatiguing). She used her
therefore are content. er, is low-dose inhaled erate obstruction. She was albuterol only before exer-
I love seeing patients like steroids. prescribed dual therapy cise and, in fact, forgot to
“I love seeing Erin, because I know that These steroids are not and entered the free do that much of the time
patients like Erin, within a few weeks their the same as those you hear Brown & Toland Asthma because she was having no
because I know that lives can be turned around. about athletes using. Their Education program, where significant symptoms. ■
Appropriate asthma ther-
within a few weeks apy is extremely effective.
their lives can be Most people with asthma TAKING CARE OF YOUR ASTHMA
can have near total resolu-
turned around.” tion, or at least dramatic How about you? Is your asthma really well-controlled?
— Charles McDonald, M.D.
improvement in symptoms.
If you are experiencing asthma symptoms more than twice a week,
As a result, their quality waking up with asthma-like symptoms twice a month, or needing
Subsequently, Erin felt of life also improves. The more than two inhalers a year for relief, you should consider a
better. She had fewer good news is that therapy re-evaluation of your treatment regimen. The same is true if
attacks at night. She could is relatively simple and safe. you hesitate to engage in physical activity because of asthma,
exercise, but frequently There are two primary or miss school, work or social engagements.
had to stop because of components of asthma.
What can you do? First, make sure your doctor knows how
asthma. She used her The first is spasm of the much your asthma affects your life. When your doctor asks,
inhaler one to three times muscles that surround the “How has your asthma been?” don’t downplay your symptoms. Focus on your
a day for symptom relief. airway, resulting in nar- degree of control. If you are not on dual therapy, ask your doctor if this is right
As she felt better, she began rowing of the airways, and for you. If you continue to have active symptoms, consider a specialist evalua-
to decrease the use of her leading to chest tightness, tion. The majority of attacks and emergency room visits can be prevented; if
steroid inhaler. She just wheezing and shortness of you have been to the emergency room for asthma, this usually represents a
didn’t like the idea of tak- breath. Short-term relief is failure of your treatment regimen and you should seek a specialist evaluation.
ing steroids. Overall, Erin accomplished by taking an Be sure your sinus problems or reflux are well-controlled. Pay attention to
was content with her inhaler, usually albuterol. environmental triggers. Is there a smoker in the house? Is there mold?
asthma control. It was, This class of drug, called a Finally, with active asthma, do not be content with your level of control.
after all, much better than short-acting beta agonist, Be sure you are closely monitoring your asthma and changing your regimen
when she was just taking results in relaxation of the accordingly.
the Primatene Mist.
®
bronchial muscles and
www.brownandtoland.com Brown & Toland’s HealthLink, Winter 2005 7

8. CLINICAL CARE MENTAL HEALTH
Brown & Toland
Medical Group Earns
Top Quality Scores
Are You Depressed,
“Pay for Performance”
initiative gives top rating
or Just Blue?
nyone can feel down from time to time. But a lingering
Brown10& percentMedical California medicalthe
top
Toland
among
Group scored in A sense of sadness or depressed mood could indicate a more serious
depression that won’t go away on its own, no matter how long you try to
groups in several categories for clinical care in 2003
in the annual “Pay for Performance” (P4P) initiative. wait it out or pull yourself together.
Brown & Toland scored in the 90th percentile Doctors break clinical called “dysthymia,” is a six months would be called
for providing preventive care, such as breast cancer depression into five cate- milder form of depression. a depressive disorder.
screening, cervical cancer screening, childhood immu- gories of mood disorder: Doctors diagnose chronic A medical condition or
nizations, diabetes care and cholesterol management. major depression, chronic depression when a medication can cause a
Additionally, the group scored in the 85th percentile depression, adjustment depressed mood and at depressive mood disorder.
for providing care for its asthma patients. The results disorder with depressed least two other symptoms Treating the medical condi-
for the 2003 initiative were released in fall 2004. mood, depression caused of depression have been tion or stopping the med-
“We are obviously very pleased with our clinical by a medical condition or present nearly every day ication eases the mood dis-
results,” says Stan Padilla, M.D., vice president of med- medication, and bipolar for two years. order, but psychiatric treat-
ical services and chief medical officer. “We have placed disorder. Adjustment disorder with ment is usually also needed.
an emphasis on providing the correct preventive Major depression is not depressed mood is diag- Bipolar disorder, which
measures at the right time, both to keep our patients caused by a life event, such nosed when a stressful life once was called manic-
healthy and reduce the overall cost of health care.” as the death of a loved one. event such as divorce or the depression, is a severe
P4P measures and rewards physician groups for It carries a high risk for sui- loss of a job affects a per- mental illness.
chronic care management, investment and use of infor- cide. Up to 10 percent of son more than would be
mation technology, and the patient experience. Groups men and up to 20 percent expected. It is diagnosed Getting help
that score well on the initiative are awarded a bonus. of women may develop only within the first six If you have thoughts of
The initiative was first established in California in 2001 major depression at some months after the stressful suicide, get help immedi-
by the Integrated Healthcare Association (IHA) and six point in life. event has occurred. A con- ately.
participating health plans. Chronic depression, also dition that lasts longer than Clinical depression may
Fiona Wilson, M.D., vice president for quality at
Brown & Toland, notes that the medical group has a
number of programs in
P4P rewards physician place to ensure that its vaginal bleeding, such as
patients receive quality STAYING HEALTHY spotting between periods,
groups for chronic care. These include or heavier periods.
care management, use asthma and diabetes Protect Yourself Against Symptoms can be so mild
of technology, and management programs, a that you don’t notice them.
patient experience.
support report program
in which the medical
group sends reports to
Chlamydia Even so, the disease does
not go away without treat-
ment. If you don’t get treat-
primary care physicians to alert them that their
patients are due for certain tests, and a $10 million
information technology investment that will bring
Chlamydia isreported
frequently
the most
bacterial sexually transmit-
Many people with chlamy-
dia don’t have symptoms.
Women especially are
ment, you can have perma-
nent damage, including
pelvic inflammatory disease.
electronic medical record and practice management ted disease (STD) in the unlikely to have symptoms.
tools to select Brown & Toland physician offices. United States, according to If you do, you may notice Consider
“Health care is light years behind other industries the Centers for Disease them as soon as one week these facts:
in the application of technology,” says Dr. Wilson. “At Control and Prevention. Yet after you are exposed to the About one-third of
Brown & Toland, we are making a concerted effort to many people don’t know disease. Symptoms include women who get chla-
close the gap and set the pace by using technology to about it. For public health pain or burning when you mydia also get pelvic
improve the quality of care we provide to our patients, officials, stopping its spread urinate and a discharge inflammatory disease
reduce costs, and give our physicians practice manage- is a priority. Fortunately, from the vagina or penis. (PID). PID is a serious
ment tools that improve quality and efficiency.” ■ you can prevent this disease. Women may have abnormal infection of a woman’s
8 Brown & Toland’s HealthLink, Winter 2005 www.brownandtoland.com

9. a prescription for anti- prevent relapse, don’t stop chemistry, it’s very difficult
depressants,” says Melodie taking your medication to recover with talk therapy
Morgan-Minott, M.D., a without your doctor’s alone, and it can take
psychiatrist in private prac- knowledge. years to see a result,”
tice in Kent, Ohio, and a If you don’t want to take says Dr. Morgan-Minott.
distinguished fellow of the antidepressants, clinical “Meanwhile, the quality
American Psychiatric depression can be treated and productivity of your
Association. with talk therapy only. life can be severely com-
When discussing your “But because depression promised while you’re wait-
treatment plan with your involves changes in brain ing for therapy to kick in.” ■
mental health practitioner,
ask about its risks and bene-
fits, how you’ll know it’s Symptoms of Major Depression
working, how long it should
take for your mood to Major depression is the most severe form of
change and the options and depression. Symptoms may vary from person to
alternatives if your symp- person, but doctors diagnose major depression if
toms persist or worsen. at least five of these symptoms are present for at
least two weeks:
Minding Feeling depressed most of the day, every day
your meds
Loss of interest in daily activities
If you are prescribed
worsen over time if not specialists to whom they medication, be sure to take Weight loss or weight gain when not trying
treated. Still, most people can refer you. You also it as directed. Most people to lose or gain weight; increase or decrease
with depression don’t get should see your primary see an improvement in in appetite
help, even though 80 per- care physician to make sure three to four weeks. Difficulty sleeping or sleeping too much
cent of people who seek no underlying medical con- Don’t take other med-
help do recover. dition or medication side ications, especially over- Acting agitated or at a slowed pace
If your company offers effect is causing your the-counter or herbal Fatigue
an employee assistance depression. medications, without first
Feeling worthless or guilty
program (EAP), you may “If it’s determined you checking with your health
want to go there first for are depressed, your treat- care provider to see if they Difficulty concentrating or making decisions
help. Often, the EAP has a ment plan is likely to will interact with your anti- Recurrent thoughts of death or suicide
network of mental health include talk therapy and/or depressant medication. To
reproductive organs. Having a screening test If you are infected, tell
Each year, PID makes can help prevent the spread your partner. He or she
100,000 women infertile. of chlamydia because it needs a test, too.
Chlamydia can increase allows for prompt treat- Chlamydia is easy to treat.
the risk of tubal ment. The CDC recom- One dose of an antibiotic
(ectopic) pregnancy. mends a chlamydia test for can kill the bacteria.
A baby born to a woman any woman who answers
who has chlamydia may “yes” to one of these Having a screening test
develop pneumonia or questions:
an eye infection. Are you under age 20 can help prevent the
Although it’s rare, men and sexually active? spread of chlamydia
can develop complica- Have you had a new sex
tions. These include partner within the past
because it allows for
swelling in the scrotum 90 days? prompt treatment.
and infertility. Have you had more than
You can get chlamydia by one sex partner within Tell your doctor if there
having sex with someone Your risk is also higher if sex, the best protection is a the past 90 days? is any chance you could be
who has it. You increase you have more than one latex condom. Use a con- Have you not used a pregnant. Only some medi-
your risk if you have sex partner. But you can pro- dom correctly each time condom or diaphragm cines are safe for pregnant
without using a condom. tect yourself. If you have you have sex. each time you had sex? women. ■
www.brownandtoland.com Brown & Toland’s HealthLink, Winter 2005 9

10. HEALTHY SENIORS
Seniors’ Food Pyramid
Stresses Vitamins
T
he food pyramid stands as the foundation of good eating. Designed by
the U.S. Department of Agriculture more than a decade ago, the pyramid
succinctly shows how much of each type of food we should eat to stay healthy
But not everyone’s nutritional needs are identical. As we Seniors should discuss the issue of supplements with
age, our bodies and metabolism change. Although older their doctor. Older adults already purchase more supple-
adults still need plenty of fruits and vegetables, whole ments than other age groups. “They are led to believe that
grains and fiber, they need to add or subtract a few things many of the conditions that come with aging can be fixed
from the food pyramid. [with a supplement],” Ms. Zanecosky says. “That’s not true.”
Older adults, says Althea Zanecosky, R.D., “have But, she adds, recent research has shown that the aging
decreased taste and decreased absorption.” They need process can be slowed with a good diet. “So we have a lot
to make sure they get enough water and nutrients, even to benefit from eating well.”
if they must take supplements to get them.
Researchers at Tufts University developed a modified Other aspects of
version of the food pyramid (nutrition.tufts.edu/pdf/ nutrition for seniors
pyramid.pdf ) for adults 70 and older. One added section The other parts of the modified food pyramid for
of the pyramid for older adults is water. Although we all seniors aren’t that much different from the general food
If money is a problem, should drink eight glasses of water a day, it’s critical for pyramid. Older adults should consume a combined total
here are some sugges- older adults to factor in water because they have of at least five fruits and vegetables a day. (Most Americans
tions from the FDA: decreased kidney function and may not feel thirsty. don’t even eat four servings of fruits and veggies a day.)
Yet they still need the Fruits and vegetables are a real plus for seniors: They
Buy low-cost foods such as same amount of water are lower in calories than other foods, yet high in nutri-
dried beans and peas, rice that they did when they “This pyramid heightens ents, Ms. Zanecosky says. Fruit is much healthier for
and pasta. were younger, Ms. dessert than cookies or cake — yet many older adults
Use coupons to save money Zanecosky says.
people’s awareness to indulge their sweet tooth with sugary treats rather than
on food. Adequate water intake focus more on fluids.” fresh fruit. Because the aging metabolism slows down as
Look for sales and store-brand
helps avoid constipa- — Althea Zanecosky, R.D., the years pass, even a few extra calories can add up at the
tion. Older adults’ nutritionist and spokesperson for the waistline.
foods, which often cost less. American Dietetic Association
digestive tracts don’t The dairy products section recommends that older
Check with your religious work as effectively as adults consume three servings of milk, yogurt or cheese
community for free or low- they once did, making constipation more likely. Also, each day. “Even three is low,” Ms. Zanecosky says, because
cost meals.
many older adults have dental problems that keep them of the risk for osteoporosis.
Call a local senior citizen from eating as much fiber as they need. Fiber also helps
program about meal pro- prevent constipation. When eating is a problem
grams. You may be able to “This pyramid heightens people’s awareness to focus Some older adults have trouble getting adequate nutri-
eat there or have meals more on fluids,” Ms. Zanecosky says. tion because of health problems or financial difficulties. If
brought to your home. Another addition to the pyramid is a flag at the top for these are problems that affect you, there are steps you can
Find out if there is a Meals vitamin and mineral supplements. The flag is a warning take to ease them.
on Wheels program near sign, not a mandate, about supplements. Older adults If you have trouble chewing, you might not be able to
you. (www.mowaa.org) often don’t get enough calcium or vitamin D in their eat fresh fruits and vegetables, or meat. Instead, you might
Get food stamps. The food diets, and a lack of either of those can lead to bone loss try the following ideas, from the Food and Drug Admini-
stamp office is listed under and osteoporosis. Vitamin B12 is another nutrient that’s stration (FDA):
your county government in often found lacking in older adults. As the body ages, it Instead of fresh fruit, try fruit juices or canned fruits
the phone book. becomes less able to absorb B12, so a supplement can such as peaches or pears.
help provide enough of this important nutrient, which is Instead of raw vegetables, try vegetable juices or cooked
critical for nerve function. and mashed vegetables.
10 Brown & Toland’s HealthLink, Winter 2005 www.brownandtoland.com

11. Tufts Food Guide Pyramid for Older Adults
Food Safety Tips
From the FDA
Refrigerate or freeze
all perishable food.
Your refrigerator
should be kept at
40 degrees, and
your freezer at
zero degrees.
Never thaw foods at
room temperature.
Instead, thaw them
in the refrigerator, in
cold water or in the
Instead of a chunk of meat, try ground meat, or protein Fruit juices and canned fruits can take the place of microwave, and cook
them immediately.
alternatives such as eggs, milk, cheese and yogurt. fresh fruit.
Instead of sliced bread, try cooked cereals, rice and If you cannot shop for yourself or cook for yourself, you Wash your hands
bread pudding. can make other arrangements. Some groceries will deliver with soapy water
If certain foods give you gas, making you uncomfortable, food at no charge; others charge a fee. A family member, before preparing
try these alternatives: friend, or church or synagogue group may be able to help food. Wash your
Cream soups, pudding, yogurt and cheese can take the with shopping. A senior citizen program in your area may hands, utensils,
cutting boards and
place of milk. deliver meals. You can use the microwave to cook already-
other work surfaces
Green beans, carrots and potatoes can take the place prepared meals. You might consider moving to a place
after they come in
of broccoli and cabbage. where meals are prepared for you — either with a family contact with raw
member or a senior citizens’ community. Eating with other meat and poultry.
people also is a good way to encourage your appetite; eat-
ing alone can be lonely. Never leave perish-
able food out of the
Food safety refrigerator for more
than two hours. If
No matter what your age, it’s important to treat food the temperature in
carefully to avoid foodborne illness. As you age, your the room is over
sense of taste or smell may not always be able to tell 90 degrees, the food
you when a food is no longer fit to eat — when milk has shouldn’t be left out
soured or meat has spoiled. Your senses may be affected for more than one
by illness or by the medication that you take. hour.
Your stomach also produces less acid. Stomach acid is Thoroughly cook
a natural defense against bacteria you might have eaten. raw meat, poultry
Your immune system also may not be as strong as it once and fish.
was, making it more difficult to fight bacteria. ■
www.brownandtoland.com Brown & Toland’s HealthLink, Winter 2005 11

12. FOR MEDICARE BENEFICIARIES
HMO Options
Increase for Medicare
Beneficiaries in 2005
B rown & Toland members will beneficiaries to access Brown & Toland’s wide network
of physicians,” adds Mr. Fisher. “A beneficiary choosing
have more plans — with lower either Health Net or PacifiCare’s Medicare product will
also enjoy a long list of additional benefits and access
monthly premiums — to choose to a number of San Francisco’s finest hospitals.” ■
from in the Medicare arena in January, as Health Net
rolls out lower premiums and lower co-pays and
PacifiCare Health Systems enters the San Francisco
senior market for the first time since 2001.
Health Net’s filings for 2005, pending approval from
the Centers for Medicare & Medicaid Services (CMS),
Health Net rolls out indicate that the health plan will lower its premium
and lower its specialist co-pay. Primary office co-pays
lower premiums and will remain unchanged.
lower co-pays and “Health Net will be aggressively promoting these
changes with a multi-tiered advertising campaign
PacifiCare Health including newspaper and outdoor ads,” says John
Systems enters the Fisher, Brown & Toland marketing manager. “They are
San Francisco market. working hard to educate the community about the
product and all it has to offer.”
Meanwhile, PacifiCare will re-enter the Medicare
arena in San Francisco in 2005, with a lower monthly
premium for its Secure Horizons product.
“This is yet another product that allows Medicare
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