Diabetes testing can be done at your doctor’s office. All adults should have basic diabetes testing at age 40. Earlier testing is recommended for:
Fasting blood sugar and hemoglobin A1C are two criteria used to diagnose pre-diabetes and diabetes. Normal fasting blood sugar should be less than 100 mg/dl. Readings of 100 to 125 mg/dl indicate pre-diabetes, and readings of more than 125 mg/dl are consistent with diabetes. The hemoglobin A1C test, measuring the average amount of sugar in the blood over 60-90 days, is also used to diagnose diabetes. Hemoglobin A1C results of more than 6.5 percent indicate diabetes, while someone without diabetes will register an A1C of between 4 and 5.6 percent.
People with pre-diabetes are generally encouraged by their doctors to lose between 5 and 7 percent of their body weight and exercise for at least 30 minutes five days a week. This may prevent the condition from progressing to diabetes. Today, doctors take a more patient-centered approach to treating those with diabetes that considers individual needs, preferences and tolerances. In addition to diet and lifestyle modifications, treatment options include oral diabetes medications, insulin injections and sometimes incretin mimetics – medications that signal the body to release insulin after eating. When doctors and patients work together, diabetes can be successfully managed and quality of life maintained.
Fortunately, most women who choose to delay childbirth until after age 35 will have healthy pregnancies and deliver healthy infants. But research shows that risks to both moms and babies increase with advancing age. Women can improve their chances by adopting healthy habits and getting good health care before they conceive and once they’re pregnant.
What’s the Risk?
Chances of having a baby with a genetic disorder also increase with age. Women who are 35 have twice the risk of 30-year-old women. Past 40, a woman’s risk is nearly three times that of a 35 year old. Down syndrome, which results in mental retardation and physical birth defects, is the most common genetic birth defect.
“Although women older than 35 may be considered a higher-risk pregnancy, a noninvasive first trimester ultrasound can help identify women who may be carrying a baby with a genetic disorder. More importantly, women older than 35 or 40 may have chronic illnesses such as hypertension or diabetes that should be addressed before conceiving,” says Brad Weber, MD, IU Health Physicians Women’s Health.
Preconception Care Is Key
Start taking care of yourself before you become pregnant. Because of the increased risks, health experts advise older women planning to become pregnant to see a health care provider first.
Ideally, preconception care should begin at least three months before pregnancy, but some women may need even more time to get their bodies ready. Other steps that can help prevent problems during pregnancy include:
Myth: A concussion is only diagnosed if the person loses consciousness or “blacks out.” Most concussions do not result in loss of consciousness. Concussions are diagnosed based on several symptoms resulting from impact to the head. Common symptoms include headache, dizziness, confusion, irritability and change in personality or mood. Generally, the child will experience these signs immediately or within a few hours of the injury.
Myth: Children recover quickly from concussions. Children usually take longer to heal from concussions than adults, and the younger the child is, the longer the recovery. It may take a 10-year-old up to four weeks to recover, while a concussion in a high school freshman may resolve itself in 10 to 14 days. Adults may recover in just three to five days.
If your child suffers a head injury, seek medical care immediately. If a concussion is diagnosed, your doctor will likely recommend physical and cognitive rest. This means suspending sports and physical activity until the symptoms disappear. Schoolwork may be restricted to allow the brain time to heal. Children with concussions also should refrain from all activities that stimulate the brain – watching TV, using the computer and even texting.
Children are fully recovered from a concussion when they experience no symptoms at rest and exertion, and they are back to their cognitive baseline. Computerized cognitive tests (like the ImPACT test) administered by physicians trained in concussion management can help determine when cognition is back to baseline. Children (age 10 and older) involved in a contact sport should get a baseline cognitive test every two years. Physicians, schools and sports clubs offer these tests. The goal of treating a concussion with rest is to prevent another injury to the brain when it’s vulnerable. The good news is that children do fully recover from concussions. Following your doctor’s recommendations regarding rest and a gradual return to physical activity is the best approach.
Whether or not you have a family history of heart disease, it’s important to understand the risk factors for the condition, which include:
Practicing a healthy lifestyle, which includes good nutrition and exercise, is a good way to help prevent heart disease. Most people should engage in at least 30 minutes of moderate exercise most days of the week. This helps control blood pressure and weight. Talk with your primary care doctor before beginning any exercise program. As for diet and nutrition, choosing the right foods, such as fruits, vegetables and lean proteins, and avoiding excessive amounts of caffeine, sugar and salt also are good ways to prevent heart disease. Additionally, adults should have periodic preventive health exams and testing so that fasting cholesterol and glucose levels, as well as blood pressure, can be checked and treated, if necessary.
While there is no one symptom that signals the onset of heart disease, there are a number of warning signs. Some of the most common include:
Although these symptoms can indicate heart disease, they also may be related to many other conditions. Generally, I recommend contacting your doctor if you have new or unusual symptoms to ensure you are properly evaluated. If your doctor suspects heart disease, he or she will likely refer you for further testing.
Taking medications, especially more than once daily, can be challenging for people of all ages. That’s why good medication management begins by partnering with your primary care doctor and a reliable local pharmacist. These professionals will help oversee your prescriptions and answer any questions you may have. Other tips for managing your prescriptions:
Shifting to Health Management Systems
Success in this new environment requires a shift from our traditional patterns of healthcare delivery. As a volume-based enterprise, the more we do the more we are paid without any reward for quality. Financial risk is with the payer – insurance companies or employers – and the growth strategy for providers focuses on the acute care hospital. Conversely, in a value-based environment, payment rewards value, and partnerships among payers and providers develop to better manage the risk. In today’s new reality, successful systems will begin to define themselves not as hospital systems, but as health management systems.
Focusing on Coordinated Preventative Care
Fundamentally, accountable care requires an emphasis on primary care and preventive care and a strong focus on keeping patients well and managing the health of a population. To support this new delivery model, care coordination and management techniques and tools become increasingly important. A premium is placed on using evidence-based practices to reduce unnecessary clinical variation and improve patient outcomes. To control costs, providers must manage utilization, assuring that unnecessary care is eliminated, while also reducing the cost of a unit of service, an admission, a lab test, an x-ray, or a physician visit. Typically, this will require expanded use of information technology, analytics and decision support tools, and alerts and reminders.
In addition to providing quality care at lower cost, accountable care aims to eliminate fragmentation of care and develop a coordinated healthcare enterprise. Every one of us has a role to play in our successful transition to this new healthcare environment. In the end, it’s not the strongest that will survive, but those that best adapt to the change.
Regarding prevention, women often have questions or concerns about breast health, specifically screening mammograms, and pap smears. The American Congress of Obstetricians and Gynecologists (ACOG) recommends annual mammograms beginning at age 40, along with clinical breast exams. ACOG also recommends breast self-awareness – looking for lumps, swelling, change in size or shape, dimpling, discharge, rash or pain. This also may include monthly breast self-exams. Women should report any changes to their healthcare provider.
Breast cancer, which claims nearly 40,000 lives annually, is the leading cause of cancer-related death in women. That’s why it’s important to talk to your doctor about your personal risk (based largely on family history) to see if you should consider enhanced screening, such as MRI or gene testing.
Each year there are more than 12,000 new cases of invasive cervical cancer, and more than 4,000 women die from this disease. Many women are surprised to learn that half of diagnosed cervical cancers are late stage, correlating with lack of screening, particularly in older women. Historically, it was recommended that women have annual pap smears to screen for cervical cancer; however, ACOG changed its recommendation to every two years beginning at age 21 and every three years starting at age 30. Your doctor will likely recommend more frequent testing if you have certain high-risk conditions, such as human papilloma virus (HPV) infection or a history of abnormal test results. Persistent HPV infection is the condition that causes cervical cancer. Pap smears can include HPV testing; ask your doctor for more details.
For today’s busy women, there are never enough hours in the day. Remember to take some time out to get a well-woman exam. It’s one of the best ways to maintain and improve your health for years to come.
As we head outdoors to enjoy the warm spring weather, now is the perfect time to review the best ways to protect your skin from sun damage.
It’s important to wear a sunscreen with a sun protection factor (spf) of 30 or higher when exposed to the sun for an extended period. Sunscreens with zinc oxide or titanium dioxide provide the best protection and should be applied to your entire body before going outside. It’s best to reapply sunscreen every two hours or sooner if you begin developing sunburn, and remember; doeverything you can to prevent your skin from burning.Sunburn causes DNA damage to skin cells, which can lead to skin cancer, as well as wrinkles and other damaging effects. In addition to good sunscreen, there are hats, beachwear and protective clothing that have ultraviolet (UV) protection; look for UPF (ultraviolet protection factor) on the label.
Even if you are only exposed to the sun for alimitedtime, you should use a daily sunscreen. We are exposed to harmful UV rays while driving a car, sitting by a window or walking from the car to our destination. Routine exposure to harmful UV rays can lead to skin cancer and photoaging (wrinkles and brown spots). This is especially true for tanning beds. With proms and other seasonal special events right around the corner, teenagers and others are strongly discouraged from using tanning beds, which have been proven to cause skin cancer.
If you are already showing signs of photoaging, using a daily sunscreen, as well as topical anti-aging products that include retinoids and Vitamin C, will help prevent and reverse signs of sun damage. Laser treatments may also be considered to help reduce fine lines and brown spots. The Fraxel Dual® laser was recently approved by the U.S. Food and Drug Administration (FDA) for the treatment and prevention of pre-cancerous lesions called actinic keratosis. This laser also helps treat brown spots and fine lines. A dermatologist can discuss such treatment options with you.
Enjoy this wonderful weather – and please make sure to protect your skin!
]]>A medical home focuses on three key areas: disease prevention, including lifestyle modification and safety education; chronic disease management, such as blood pressure control and diabetes management; and transitional care during acute illness that requires specialists, hospitalizations or palliative care.
Why is establishing a medical home a good idea? First, medical homes support accountable care. Compared to conventional care delivery, health systems in which medical homes are the cornerstone of care produce higher levels of quality at lower cost – the guiding principle of accountable care. Medical homes also fulfill an important role in a changing healthcare environment that elevates the importance of preventive care and counseling. An expert recently estimated that to provide all of the recommended preventive care and counseling to an average patient population, a primary care doctor would have to work more than 18 hours a day – and that doesn’t include time needed to manage acute illnesses, injuries or chronic diseases.
This is where the medical home’s team approach fits perfectly. Effective patient care management now requires attention to transitions of care and more oversight outside the physician’s office and by non-physician professionals with specialized expertise. Health educators, social workers, nutrition consultants, nurse specialists and advanced care providers are vital members of the medical home team – and necessary to produce the best patient outcomes. The point person of such coordinated care is the medical home nurse. This designated professional functions as the liaison between team members, specifically between the primary care doctor and other professionals providing care outside the primary office.
While the medical home concept is new to patients and families – especially those patients who have grown accustomed to being treated exclusively by their family physician – there are a number of important benefits. A medical home provides the framework for proactive care that focuses more deliberately on prevention and lifestyle changes that lead to long-term health and well-being. In fact, some would argue that medical homes are essential in managing health through all phases of life. By working with a healthcare team, patients also have more professionals with specialized expertise to call upon for guidance. As we move toward a value-based accountable care environment, the medical home will play an important role in delivering high-quality patient care in more cost-effective ways.
IU Health Neuroscience is the only program in the country that can do just this: 24/7 monitoring, no matter where your loved one is receiving care throughout the hospital. While a few hospitals can provide continuous recorded brain monitoring, and some view it in real-time during parts of the day, only IU Health Neuroscience can provide 24-hour, real-time monitoring by onsite experts who are specially trained and credentialed to spot seizures and other brain-related problems.
What is brain neuromonitoring?
Brain neuromonitoring is the recording of the electrical activity made by brain cells (neurons) as they talk to each other. This recording is made by gluing sensing wires to the head, which are similar to the wires that record the electrical activity of the heartbeat during an EKG. The wires are attached to a machine that looks like the “Johnny 5” robot, complete with a video camera through which specialists can watch patients and match up their brainwaves with everything else that’s going on with them.
Why is brain neuromonitoring so important?
Brain neuromonitoring can act as the voice of the patient when he or she is too ill to speak, letting the doctor know, for example, when the patient is suffering from seizures that don’t cause visible symptoms, yet can have devastating neurological effects.
Brain neuromonitoring can also allow for faster, more accurate diagnosis of other conditions, and provide real-time observation of a medication’s effectiveness. If a patient does not respond to treatment, doctors can immediately adjust the medications or respond in other ways. Neuromonitoring can also help avoid unnecessary use or overuse of medications.
What types of patients benefit from brain neuromonitoring?
People with many different neurological conditions can benefit from brain neuromonitoring, including those who have:
How long has IU Health Neuroscience been providing this service?
IU Health Neuroscience began providing this service at IU Health Methodist Hospital in 2008. And in March 2011, the service was expanded to Riley Hospital for Children at IU Health. The service has also been provided remotely from IU Health Methodist Hospital to IU Health Saxony Hospital since its opening in December 2011, and IU Health North Hospital since February 2012.
Why don’t other hospitals provide this service?
This service is at the cutting-edge of technology, neuroscience and critical care. It takes a significant amount of resources to maintain the continuous flow of brainwave and video data streaming from patients all over the hospital to a control room that feels much like NASA’s Mission Control Center. And the neurodiagnostic specialists manning the control room are hard to come by, with a recognized nationwide shortage of these trained experts. These factors, coupled with the collaboration that’s required with neurologists, results in a complex process that few hospitals are prepared to manage.
For more information
To find out more about brain neuromonitoring visit IU Health Neuroscience. For details on how to become neurodiagnostic technologist, please visit the neuromonitoring health sciences education page.