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End of Life

As Nelson Mandela receives intensive care at home, what conversations did he have with wife and family about his wishes for end of life in the event he became incapacitated?  Did he want to be on a respirator and breathing tube for prolonged periods of time?  What about feedings in the event he was unable to take food by mouth?  Did he want to be resuscitated if he were to succumb to a disease process?  If he did have those conversations, was any information written down? 

If for some reason your heart should stop or you are unable to breathe on your own, do you want CPR (cardiopulmonary resuscitation) and a breathing tube? Or would you like to die a natural death? 

I ask that question to all patients who are entering the hospital. Oftentimes patients have had experience with the death of a loved one in the hospital after a protracted illness, including many invasive tests and procedures.  Others have had the experience of family members opting to die at home without further intervention. 

The Patient Self-Determination Act of 1990 requires hospitals, nursing homes, and other healthcare facilities to provide information on advance directives to patients.  Patients have the right to determine what is best for their care.  A Living Will delineates healthcare decisions in the event a person is incapacitated or unable to make decisions.  In such a case, a proxy, or stand-in decision maker, acts in the best interest of the person according to their written wishes.

Communicating end of life wishes to family members and physicians, as well as having it officially recorded is extremely important.  What someone decides can be influenced by a myriad of factors – unresolved family issues, fear of death, or financial incentives.    Oftentimes patients ask me to do everything if it will bring them back.  I ask if they mean a return to current level of life, engagement and wellness. If so, there are no guarantees.  In some instances, the medical community can give quantity but not quality.  “Doing everything” does not mean we can prevent your death.  “Doing nothing” does not indicate that the medical community is abandoning the patient and family, nor does it mean do not treat. 

Talk to your primary care doctor about your wishes before you are ill, and include your family in the decision making process.   Speak candidly with your spouse and honor his/her wishes.  Also remember the durable power of attorney for healthcare can always be modified if your life situation changes, such as new marriage, divorce, etc.   Finally, discuss this with your attorney to have documents drawn up for a durable power of attorney for healthcare, including a proxy for your health in the event you are unable to make decisions.   To be clear, it’s not about what the proxy wants; it’s about what the patient would do if he/she were present in the their right mind making the decision.  The goal is to die with dignity.  Be well.

Happiness & Health

How we feel about out health dictates our choices – food, exercise, alcohol, sleep, and sex – as the mind and body are connected.  

Self-love is a large part of good health and facilitates happiness.   Optimistic people live longer, have better health outcomes, and are more resilient if a diagnosis is made.  

Lack of self-love is physically demonstrated unhappiness, which shows up as:

1. Inconsistent exercise.
2. Irregular sleeping patterns.
3. Overindulgence in pleasures of the flesh, such as alcohol, food, illicit drugs, or sex.
4. Ignoring changes in the body – prolonged joint pain, shortness of breath, or chest pain.  
5. Not taking medications as prescribed or neglecting to refill.
6. Denying presence of disease once diagnosed – for example, diabetes or high blood pressure.  

Unhappiness is a disease because it alters mind, body, and/or spirit.  Uneasiness or dis-ease can manifest in all parts of the body and mind with harmful consequence from disruption of normal habits.  Though changes are seemingly small, this furthers the dis-ease causing harm to self and possibly others.  For example, uncontrolled diabetes leads to hemodialysis, blindness, or limb amputation.  I have also seen a number of patients with an early diagnosis of cancer who only seek treatment later when experiencing life threatening symptoms after the cancer has spread.  

Health as a demonstration of happiness can be achieved with a little practice.  Consider the following:

1. Know your medical history.  See your doctor for annual exams.
2. Notice and act upon symptoms; persistent pain or change in bodily fluid is your body’s warning that something is wrong.
3. Communicate honestly with your healthcare provider.  Physicians can only treat correctly if all information is shared candidly.   
4. Take medications as prescribed, which includes completing the prescription, as well as not taking other people’s medications.  
5. Get plenty of rest, which includes 7-9 hours of sleep and, if possible, a quick 15-minute nap or quiet meditation break each day.
6. Exercise daily for at least 30 minutes.  Exercise releases endorphins elevating overall mood.
7. Keep a healthy weight.  Eat 9 fruits & vegetables daily.  Carry an apple or banana for a quick, delicious snack.  Fill your plate with greens, then add a small amount of protein, beans, and other vegetables to keep your waistline in check.
8. Stop smoking to prevent heart attacks, strokes, and emphysema.  
9. Use alcohol in moderation to avoid liver disease, DUI, or death.  
10. Practice safer sex.  Know your HIV status and use condoms to prevent sexually transmitted infections.  
11. Maintain healthy relationships.  Talk at regular intervals, practice forgiveness, and avoid holding grudges.  Anger releases stress hormones that escalate blood pressure and increase risk for heart disease.   
12. Encourage friends and family to know their health history.  Make health an easy part of conversation.  

Altruism and gratitude have been shown to improve quality of life.  Practice self-love by doing small things everyday to improve your health.  Choose optimism and happiness, and share it with your community.  Be well.

Back To School 2013

Back to School time is fast approaching and offers an opportunity to examine family activities, food choices, and health practices to reinforce good habits and develop new behaviors. 

Use Back to School to reassess not only your family’s health, but also your own.   While making your children’s physical exam appointments, make appointments for your annual physical, PAP smear or eye exam.  When was the last time you went to the dentist?  A biannual teeth cleaning reduces cavities and risk of heart disease.  Consider using a smart phone application to store immunization and medication information for all family members.  There are many apps that are free, easy to use and secure. 

Take a look at the first aid kits in your car and home.  Are they prepared for an emergency with Band-Aids, antiseptic, and antibiotic ointment?  Don’t forget about an asthma inhaler and epi-pen. 

When you reach for medications in the car or home, you want to be sure they are current and ready to use.  Check the expiration dates of anti-fever, headache, cold & flu, and anti-diarrheal medications.   Since you finish all antibiotics prescribed, I know you don’t have any in the cabinet.  If you do, pull these or other expired prescriptions, grind pills and mix into coffee grounds before discarding in the trash.    

Assess your pantry.  Do you have staples to create quick nutritious meals?  Have a weekly meal plan to facilitate shopping and reduce food cost.  Buy in bulk, cook once, and eat all week.   Keep brown rice, whole-wheat pasta, and quinoa that combine easily with frozen vegetables without sauce to make a fast, healthy meal.  Frozen berries and fruits combine with ice and banana or kale to make a healthy smoothie for a snack or fast breakfast.  Almonds, walnuts, and pecans travel well and are loaded with protein and vitamins; a small handful stays hunger.  While at the market, read the labels with children to personalize food choices and reaffirm healthy eating habits.  

Even though summer is over for kids, returning to school comes at the warmest months of the year.  Continue to protect against sun and heat.  Wear sunscreen and reapply for afterschool sports or walks.  Have water readily available and continually hydrate while active.  Don’t wait to get thirsty to drink, for then it’s too late.  Stay in the shade when possible.  Wear a hat and mist with water.

Create opportunities to exercise as a family by adding evening walks.  For parents, remember to get in a quick workout while children are at soccer practice or in a tutoring center.  You can take a walk anywhere if you keep athletic shoes and a bottle of water in the car.

Buy a pedometer for each family member and conduct a weekly contest with a prize for the person who walks the most steps.  The goal is to walk 10,000 steps daily.  Use non-food rewards including free time, stickers, new books, song downloads, batting cage time, and others according to the age, appropriateness, and desire of the winner.

Balance outside activities and school with time to reconnect to one another with healthy face time.  Remember eating at the table technology-free builds healthy connection and a lifetime of memories.  And on the weekends, decompress without electronics to allow uninterrupted family time.   

Continue to be a shining example for your children in word, thought, and deed by modeling healthy eating habits, regular exercise, and using medicine appropriately.  Be well. 

BRCA: What you need to know

The Breast Cancer Susceptibility Gene (BRCA) is responsible for approximately 5% of breast cancer cases in America. Though the overwhelming majority of cases diagnosed are not associated with BRCA1 or BRCA2, the risk is still present.  Before you go to your doctor to request a BRCA genetic test, here a few things to know. 

Cancer is disease resulting from a gene that has gotten out of control. Genes tell the cells what to do, specifically what type of protein to create.  The Breast Cancer Susceptibility Genes (BRCA1 & BRCA2) are codes for proteins that help to maintain the stability of DNA (deoxyribonucleic acid).  BRCA1 is associated with increased risk of breast, cervical, uterine, colon, and pancreatic cancers.  BRCA2 is associated with increased risk of ovarian, pancreatic, bile duct, gallbladder, and stomach cancers. 

Men can also be affected with male breast cancer from these genes.  Additionally, BRCA1 in men is associated with increased risk of testicular cancer, and BRCA2 is associated with increased risk of prostate cancer.

Not everyone needs BRCA genetic testing.  Only people who have a strong family history for breast and ovarian cancer should be tested for BRCA.  If you have a sister, mother, or aunt who was diagnosed with breast or ovarian cancer before menopause or a brother, father or uncles who was diagnosed with breast cancer, then discuss this with your physician.  Remember an association is not a definite diagnosis, so speak with your doctor to determine risk factors prior to genetic testing.  If you do not know your family history, then it may be reasonable to have the BRCA test.

Routine breast self-exam and mammography remain the best ways to screen for breast cancer.  Make it your mission to regularly schedule your annual mammogram starting at age 40 or earlier if you have a family history; remind your sisters, friends, and family to do the same.  Though Breast Cancer Awareness Month isn’t until October, health awareness is necessary year round and can be the difference between life and death. 

Be well.

Pollen & Allergy Season

Everything is yellow: cars, sidewalks and windowsills.  The air is filled with pollen as trees, grass and flowers bloom in abundance.  Spring marks nature’s awakening and allergy season is in full force. But  common symptoms can be easily alleviated through a few easy tips. 

Pollen particles are breathed into the nose and mouth causing irritation.  The ears, nose, and throat are all connected, and it is not unusual to have an itch in your ear, tickle in your throat, and a sneeze in your nose.  These can also be accompanied by headache, fatigue, and nasal congestion.

To lessen the impact on your health, try to follow these tips:

—Avoid touching your eyes, for whatever is on your hands could bother your eyes, which can add to nasal issues, too.

—Watch the pollen count just as you keep an eye on the weather report.  When the pollen count is high, avoid outdoor exercise. People who suffer from asthma and chronic obstructive pulmonary disease (COPD/emphysema) can be particularly susceptible to changes in the pollen count.   Save the grass cutting for another day and pray for a good rain to wash away some of the pollen.

—With the switch from furnace to air-conditioner as winter turns to spring, change the filters so when cool air is forced through your home, you are not aerosolizing pollen, dander, mold, and other allergens.

—Keep the windows closed even though spring’s warmth is inviting.  You want to keep as much pollen out of the house as possible, for once it’s in, it’s nearly impossible to get out.  Vacuum your carpets more frequently with a HEPA filter vacuum cleaner to remove as much pollen from your living space. Clean your garage, carport and/or the entrances to your home to further keep pollen outside.

—Keep the top up on the convertible, as well as the sunroof and windows closed to keep from taking pollen into your eyes, nose, and lungs at 65 mph.

—A few drops of eucalyptus oil in the shower can help clear the sinuses.

—A cool cloth over the eyes can calm irritation.

—Acupuncture has been shown to improve allergy symptoms.

Dr. Morris

—If irritation persists, especially during recurring seasons, consider allergy shots.  These inject a tiny amount of offending allergen to familiarize your body so it creates its own antigen.

—Neti Pots are very popular to rinse the sinuses with soothing salt water; however, there have been some cases of serious infection associated with them.  Keep the Neti Pot clean as directed. Do not use tap water for the Neti Pot treatment; instead use distilled water or previously boiled water to prevent amebiasis, which can infect the brain, causing meningitis.   An alternative is to use a squeeze-bulb nasal saline spray purchased from a pharmacy for nasal irrigation.

—The jury is out on the effectiveness of honey for control of seasonal allergies.  Remember, people with food allergies and children under 12 months should not eat honey.  Talk to your doctor prior to beginning any healthcare regime.

With care and a fresh box of tissues, you can breathe easily through allergy season.

Be well.

Red is the Color

February is red – the Chinese Lunar New Year, Valentine’s Day, and Heart Health Month.  Red is the color of luck, valentines, and the heart.  So, February is a perfect time to increase awareness about coronary artery (heart) disease.

Heart disease is the #1 cause of death for both women and men in America.  Every year almost one million Americans have heart attacks.  About 600,000 Americans die from heart disease annually.  In fact, more Southerners die of heart disease compared to those who live in Western states. 

Without blood and breath there is no life, the heart needs a blood supply for nutrients to pump oxygen containing-blood throughout the body. Coronary artery disease occurs when the arteries feeding the heart become clogged.  This condition causes stroke, heart failure, and heart attacks. Risk for heart disease increases as we age. 

Know your risk for heart disease! 

1. Do you smoke?

2. Do you have high blood pressure?

3. Are you overweight?

4. Do you have diabetes?

5. Did your mother or father die of a heart attack before the age of 50?

6. Is your cholesterol high?

7. Are you sedentary?

If you answered yes to anyone to those questions, then you are at increased risk of heart disease and/or having a stroke or hear attack.  Talk to your doctor about reducing your risk.  Stop smoking. Cigarette smoke contains tar and materials, which cause stickiness in blood vessels supplying the heart.  Imagine a sink pipe with loads and loads of grit inside, consequently less and less “stuff” gets through the pipe. 

Oftentimes high blood pressure doesn’t have symptoms, yet it causes life-threatening damage.  By losing as little as 10% of bodyweight can reduce blood pressure and risk of heart disease.  It’s very important not to ignore diabetes if diagnosed, for it can result in blindness and kidney failure in addition to increasing risk of heart attacks. 

I know we all are tired of hearing about eating right and exercising; however it really does work. Have your cholesterol checked annually if female over the age of 45 and if male, over the age 35. Incorporating more grains in your diet can help to lower your cholesterol.  Move more.   

The Million Hearts initiative is a national charge to prevent 1 million deaths from heart attack and stroke in the next 5 years. It’s as easy as ABCS – aspirin therapy when appropriate, blood pressure control, cholesterol control, and smoking cessation.

Honor the contributions of African-American physicians this Black History Month by knowing and reducing your risk for coronary artery disease. Leaders in the field of heart health were: the first African-American cardiologist, Dr. Daniel Hale; the hematologist & developer of modern blood banking techniques,Dr. Charles Drew; and the first African-American woman to perform heart surgery, Dr. Myra Logan.    

Let’s fight heart disease to create a healthier tomorrow!  Be well.