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Thursday, May 12, 2011

Taking Care of Your Health in Hard Economic Times

The View from the Office

Taking Care of Your Health in Hard Economic Times

Sad to say, in America it is commonplace not to have any health insurance. Yet as we all age we gradually accrue more health conditions needing chronic attention and more acute health problems. For citizens without health insurance taking care of yourself is very challenging since health care has become so expensive. But there are things you can do to stay healthy and minimize the impact on your budget. Remember—taking care of things now saves you a lot of money over the long-term.

Step 1: Work on developing a healthy lifestyle.

            If you smoke, start cutting down immediately. This is the fastest and healthiest way to save money. If you need help, call 1-800-NO-BUTTS.  Help there is free, and, if you complete the telephone program for smoking cessation, they will pay for your medication, if you need it to quit smoking. The first and most important step for any health program is to stop smoking—and then to help those you love stop smoking and help your kids never to start.
            Eat right. The simplest way to do this is to focus on eating 5 servings of fruits or vegetables a day. This is a healthy source of vitamins, fiber, and just good general eating habits. The more fruits and vegetables you eat, the less junk you eat. If you reduce your red meat intake to no more than 4 ounces (a portion size about the size of a deck of cards), you save money, which will help pay for the fruits and vegetables. Studies have shown that when you make these kinds of changes in your diet at the same time, the net effect on your pocketbook is a wash.
            Focus on ways to relax and be religious about attending to whatever relaxes you. Many people feel guilty if they focus on doing things to relax when economic times are tough or they are out of work, but, in fact, it is during these times that it makes the most sense. Being out of work or otherwise on a tight budget or having health problems without health insurance are sources of extreme stress. These are usually the worst of times. It is exactly during times like these that you benefit the most by taking some time out of the day to just relax, unwind, let it all go. Your body needs this. And it has a very helpful effect on chronic diseases like hypertension, diabetes, and depression.
            When things are tight is also an ideal time to work on your weight. Step one is to know your BMI (body mass index). To calculate this you just need to know your height and weight. If you have a computer, there are lots of free BMI calculators on the Internet. If you don’t have a computer, stop by the library, and they can help you do this calculation. For your weight and BMI there is a magic number30. If you’re below that, you are at a perfectly healthy weight for your height. If you are above that, you have some work to do. Tough economic times are a good time to work on weight—both because you have more time and because the money you save from eating less will really make a difference.  For most of us, BMIs over 30 are due to snacking or junk food on a long-term basis. This is a great time to stop this. You will appreciate the health benefits (more energy, less fatigue, more exercise tolerance) right away if you make a change. All chronic diseases will be improved by losing weight—particularly hypertension, diabetes, and depression.
            Finally, such times are a great time to get back to exercise. Usually these periods are periods where you have more time to spare. Your exercise program does not need to be more vigorous than brisk walks once or twice a day. Your goal is to get 150 minutes of exercise in each week. The more the better. Exercise has been shown to have an equivalent effect to treatment with standard anti-depressant medications for people with depression. You can’t afford not to be exercising.
            A healthy lifestyle is your first line of defense against having health problems at all times of life.

Step 2: But what if you have some chronic conditions already, how do you take care of those during tight times?

Let’s take a look at some of the most common chronic medical problems—hypertension, high cholesterol (hyperlipidemia), and diabetes. For these conditions you need to be able to track certain basic numbers (lab tests) and to take certain medications.

Hypertension: You can have your blood pressure checked for free at the drugstore or many supermarkets. There are no regular blood tests that you absolutely need to have done, but, if you can, it is good to check your cholesterol and your kidney function once a year. You can get all of the most common blood pressure medications (generics) for just $10 for a 3-month supply at Wal-Mart or Target or other stores with this special drug pricing program.

Hyperlipidemia: For this you want to check your cholesterol tests at least once a year. The cheapest way to adequately measure cholesterol levels is to have a total cholesterol level done and an HDL (good) cholesterol level done. You don’t even have to be fasting for these tests. You can make all important treatment decisions, just based on these numbers. The most cost-effective way to have your cholesterol checked is to wait for the nearest health fair in your community. They often offer bargain basement prices in order to provide you with access to this important testing. We have our health fair for Portola coming upon September 10th. In addition the hospital offers specials on testing for cholesterol at various times during the year.
            During really tight economic times, you don’t necessarily need to have your cholesterol checked. If you know, for example, that several members of your family have had heart problems at an early age, then you would be better off on a cholesterol medication regardless of the test results. The same is true if you know you have multiple risk factors for heart disease, like smoking, overweight, high blood pressure, diabetes, lack of regular exercise, chronic high stress. In cases like these it is easier, cheaper, and more effective just to go to Wal-Mart (or Target, or similar programs) where they have $4 a month, $10 for 3 months prescription discounts for the most common medications. For cholesterol what you want is a statin medication like lovastatin, which these programs cover.

Diabetes: This is the most serious common disease that you might have to manage during tough economic times. It’s a challenge because there is a lot to do to take care of diabetes, and a lot of it is expensive. It is very important to take care of it well during such times in order to prevent much worse problems later. There are simpler approaches, however.
            One is to follow my ABCDEF approach:

A-Get yourself an A1c test at your local health fair or through a special with your hospital. Eastern Plumas District Hospital offers a special program to allow patients to get their A1c tests done regularly at a discounted price.

B-Check your blood pressure at your local pharmacy for free and keep it under 140/90 mm Hg.

C-Check your cholesterol through your local health fair or hospital program and keep taking your cholesterol medication through a Wal-Mart discount program for $10 for each 3 month period.

D-Check your kidney function once a year. The basic panel you can get at a health fair will do this for you.

E-Have an eye check once a year or every other year. Often, after the first check, your doctor will tell you they don’t need to see you again for 2-3 years.

F-Check your feet. You can do this yourself. Check for any areas of numbness or tingling. Check for any breaks in the skin or severe fungus infection of the skin or nails. If you have bad fungus, use the over-the-counter Lamisil 1% cream twice a day for the skin (it won’t help with the nails).

This simple approach will keep your diabetes in very good control until you get your health insurance back and can have the full check-up.

To keep up with your medications, the Wal-Mart program has most of the common diabetes medicines (except insulin) on their $10 for a 3-month supply list. If you are currently on a fancy, brand name diabetes medicine, change to a $10 per 3-month generic. Your results will be about the same with really substantial cost savings.

Here is a link to the full list of drugs that Wal-Mart and Target cover at these reduced prices:  [link]    Other plans:

Some other conditions:

Depression:  This is a very important condition to take care of during tough economic times, which are likely to make depression worse. Of course, the place to start is with the 5-steps for a healthy lifestyle as described above. Exercise is particularly important for people with depression; it is as effective as most depression medications. If you need medications, Wal-Mart covers the full range of generics for the treatment of depression for just $10 for 90 days. Some of the Wal-Mart antidepressant medications can also be used to treat insomnia, if that is a problem.

Arthritis:  A healthy lifestyle is going to help this a lot. Wal-Mart has most of the common generic anti-inflammatories for discount prices, but since these are available over-the-counter, places like Costco often offer the cheapest source of medication over the long-term.

Common Infections: If you get an acute cold or skin infection or other common infection (sinuses, ear infections, bronchitis, etc.) while you are without adequate health insurance, your doctor can work with you to find low cost ways to manage them. If you have had a general check-in with your doctor recently and have explained your situation [See below.], it should be no problem just to call your doctor, explain your symptoms, and get reasonable treatment for the most common and probable conditions. If any special evaluation is required, your doctor will let you know, but usually ear infections, sinus infections, bronchitis, simple skin infections, and bladder infections can all be managed over the phone with a prescription for common antibiotics. If the initial round of antibiotics doesn’t work, however, then it will be necessary to come in for a visit. Most doctors will work with you in this way, but you have to have had a check in visit to explain the situation, review your overall health status, and make a general plan. Often this “check-in” visit as described below, will be the best investment you can make.

Other conditions unique to you and your situation: Don’t forget your doctor. Your doctor will often not be aware of your financial situation or lack of insurance unless you tell him/her. If you do tell, most of us are very willing to work with you to see that you get the care you need when you can’t afford regular visits or testing. What I would suggest, if you are just entering a period of economic uncertainty, is to make an appointment with your doctor to discuss the situation and share your concerns. Together you can make a cost-effective plan for how to manage your conditions with less frequent check-ups or testing. I know that, if I have such an initial meeting with a patient, I am very willing to manage most chronic conditions with just telephone consultations for extended follow-up with no charge and refills of medication by phone. If you stay in touch with your doctor, then s/he can tell you when it is important that you actually come in for a visit or for testing.
            You should also be aware that if you need any special medications that are not on the Wal-Mart or Target discount list, there are ways of getting help with the cost of these prescriptions for most drugs. Sarah in the Eastern Plumas District Hospital business office can provide you with more information about these programs.

            The bottom line is that it is very possible to take care of yourself when you don’t have the benefit of a full health insurance program. Let’s talk about it and see what we can do for you.