Determined to get more sleep? Want a healthy diet that allows you to drop pounds and keep them off? Confused about insurance? Thinking of going to a concierge physician? T&S talks with local experts about these and other topics in our first edition of the new year.
[sleep: are you getting enough?]
Feeling fatigued before you start your day? Lack of sleep, or poor-quality sleep, may be the culprit.
Dr. Oscar Schwartz, Medical Director, Sleep & EEG Center, Barnes-Jewish West County Hospital:
A normal sleep cycle lasts 90 minutes, with a person transitioning from light to deep sleep repeatedly. Some practices recommend 7.5 to 9 hours of sleep; both amounts are divisible by 90 minutes. I recommend a minimum of seven hours for adults. Below that amount, you have problems. Above it, you have fewer problems. Quality of sleep is also important. That’s why some people who get enough sleep aren’t rested.
Many people rush throughout the day and then expect to fall asleep upon contact with their pillow. You have to allocate time for sufficient sleep and you have to prepare for it. TV and other electronic devices may be relaxing at night, but they also stimulate the brain. Don’t use them and keep them out of the bedroom. Decrease activity before sleep. Listen to music. Practice imagery. Stop exercising three hours before you turn in and keep your bedroom slightly cool. Your body temperature needs to drop a bit before you fall asleep.
Loretta Colvin, nurse practitioner, Clayton Sleep Institute:
The amount of sleep one needs changes over the course of his/her life, but usually stabilizes during adulthood. Infants need the most. Children need less than infants. Teenagers tend to shift their sleep cycles for a later start time. Biologically, they become more of a night owl, so a school day that starts before 8 a.m. is really not good for them. And if they’re staying up later to do homework, they can become sleep-deprived, which can lead to safety concerns, especially if they drive. College kids also tend to be sleep-deprived.
A sleep-deprived person gets good quality sleep; they just don’t get enough of it. The typical adult needs seven to eight hours of sleep, but there are exceptions. It’s a bell curve. Some people need more, some less. People who are sleep-deprived sleep through their alarm or have to hit it repeatedly. They’re tired during the day and have to consume a lot of caffeine to maintain a level of alertness.
If you suspect you are sleep-deprived, assess your lifestyle. Go to bed earlier. If you’re still tired, you may have a sleep disorder, which means you aren’t getting good quality of sleep. You need to see a sleep specialist.
[concierge medicine]
Want more TLC from your primary care physician in 2014? Consider concierge medicine, where a physician limits his or her practice size to make more time for each patient. Patients often are seen the same day or within 24 hours, and appointments can last from 15 to 30 minutes. But there’s an access fee that can cost from $1,500 to $2,500 per year.
“I think this is the only way to practice good medicine today,” says Dr. Jeffrey Zohner of Zohner Medical, a West County concierge practice. “There are not enough primary care physicians now, and soon there will be 30 million more patients due to new health care legislation.” Many physicians are leaving insurance networks because of declining reimbursement rates, he adds. And those who have stayed try to see as many patients as they can. “I had a hard time going into an exam room knowing that I had to be out of there in seven minutes,” he says. “At five minutes, I had to stand up and get ready to leave.”
[coping with pain]
Bothered by joint and/or muscle pain? You might want to consider these options.
Dr. Ravi Yadava, owner/operator, Performance Rehabilitation:
Everyone gets a strain, a bump or a twist now and then. Most people get significantly better in three to five days with rest, ice, compression, elevation and maybe some bracing. A little bit of pain and ‘creakiness’ in one’s joints is a natural part of aging. But chronic pain is a different matter. There are many tools to manage pain. What you need depends on its cause.
If pain from a sports injury or fall persists more than five days, see a physician who performs a good physical exam and has additional musculoskeletal or orthopedics training. People with chronic pain can live a functional life but it may require a lifestyle change, like weight reduction. Nutritional supplements have helped some individuals with osteoarthritis.
A new field called regenerative medicine also shows promise in relieving joint pain and restoring function. It involves taking stem cells from the patient’s fat or bone marrow, concentrating it, combining it with growth factors from their blood, and then injecting it into joints for pain relief and regenerative purposes. I’ve used it in my practice and have undergone the procedure myself.
Pain medication doesn’t resolve chronic back problems. It camouflages and chemically decreases the pain signals so people can function. But there are significant side effects and concerns with prescribed pain medications, addiction among them.
There are five interventions I recommend to patients with back and neck pain before they seek relief with meds. They include chiropractic manipulation, acupuncture, massage therapy, exercise (specifically, aerobic exercise and a program for muscular balance), and a healthy diet designed to decrease inflammation. Inflammation produces pain. Aerobic exercise helps reduce pain signals.
Hands-on techniques, including chiropractic, acupuncture and massage therapy, are safe, effective and have no side effects if applied carefully. Patients are often surprised with the relief they achieve in just one session. Additionally, one or more of these interventions can be integrated with pain medications.
[what’s up with insurance?]
“Today’s health insurance is meant for catastrophic care,” says Dr. Teresa Knight of Women’s Health Specialists of St. Louis. “It’s intended to cover medical care for events you couldn’t afford unless you mortgaged your house or sold your car.”
Knight advises patients to read their policies carefully, including the fine print. Each policy is individual, and it’s the patient’s responsibility to talk to their insurer and find out if a service or procedure is covered. “There’s a lot of confusion about what’s covered and what’s considered ‘free,’” she says. “Unfortunately, most people now have high deductibles they’re required to meet before their insurance company has to pay anything.” So even though a procedure may be covered, the initial cost comes out of the patient’s pocket. “Our goal is to provide excellent care, but patients have to be their own advocates.”
Although preventive care is covered, services are limited. For example, if a patient wants to talk about hormones or pelvic pain during her well-woman exam, she’ll need to schedule an additional visit. “If you want to discuss an issue, it’s no longer considered a well-woman exam,” Knight explains. “It would be malpractice for me not to address those issues, and it’s insurance fraud for me to call it anything but a problem visit. It’s frustrating for all of us—physicians included. We’re patients, too.”
[what a body needs: choosing the right diet for you]
I don’t like the word ‘diet.’ I prefer people change their lifestyle by focusing more on what their body needs and less on what they can’t or shouldn’t eat. I want them to consume more nutrient-rich foods: fresh fruits, fresh vegetables and lean proteins. These foods also don’t promote inflammation, as do refined grains, dairy products and heavily processed foods, including some soy products. Keep dairy products and grains to a minimum, and drink lots of water. Dehydration can also cause inflammation.
With some of the more restrictive diets, it’s easy for people to become frustrated and abandon their weightloss goal altogether. And maybe their goal was unrealistic. Maybe they were trying to lose too much weight too quickly. The important thing is to first focus on what your body needs—real foods—and eat more of them. It’s a lot easier to shed weight that way, and to keep it off.
Samantha Strimpel, program director/registered dietitian, Physician’s Choice Wellness:
It’s best to eat a variety of foods and not follow a specific diet. Unless you have a documented medical condition, such as diabetes, diets are traditionally short term. They’re somewhat restrictive and can eliminate food groups. Eat healthfully, eat mindfully and eat right-sized portions. Focus on whole grains, low-fat dairy products, lean proteins, and fruits and vegetables. Eat when you’re hungry. Don’t eat emotionally when you’re mad, sad, tired or bored.
Also important is to avoid processed, packaged and fast foods as much as possible. Prepare your own meals as often as you can. This allows you to take control of what a
meal contains so there’s not a surplus of salt or sugar. You can also modify recipes to make them healthier. Instead of using garlic salt or onion salt, substitute powdered versions and reduce your intake of sodium. Regardless of the type of cooking oil you use, all have similar fat and calorie content. Choose healthier options such as olive or canola oils. Allow for treats in moderation, but not as a daily event.