DC and Drunk

We just might be seeing double but there are two (2) count them two (2) stories about the "drunkest" places in the United States and in our area - no where is as drunk as Washington DC. Actually the two articles aren't exactly the same. The first which uses data from 2007 comes from the National Institute on Alcohol Abuse and Alcoholism (NIAAA) which rated Washington DC as the third (3rd) "drunkest" state in the nation. North Carolina ranked seventh (7th) in the state rating. None of the other local jurisdictions ranked in the NIAAA top ten (10) highlighted states. The second story or the one on the left (depending on if were seeing double or not) is a city ranking being published by Men's Health magazine but previewed by USA Today. The most recent listing includes both a number and a grade.

According to the USA Today article, here is the listing that shows how our area fared when compared to the rest of the nation:

NUMBER UNITED STATES CITY RANK 37.) 43.) 60.) 63.) 70.) 78.) 94.) Washington, DC Greensboro, NC Baltimore, MD Raleigh, NC Virginia Beach, VA Richmond, VA Durham, NC D+ C- C C C+ B- A

For our area the District of Columbia is the "drunkest" city in our jurisdiction. Thank you USA Today though we like to think of the District of Columbia as a political powerhouse, the seat of government, the home of the "three martini" lunch where our national representatives historically drank heavily and sought the favors of "painted women." Men's Health shows that while we're not the country's "drunkest" we're the "drunkest" with power and alcohol in the region. Add cigarettes and salted meat to the area mix - and you're talking all kinds of bad news. The next political movement should be, now that we've got a smokefree DC, is drink free DC.

Abstinence now but, of course, most of us don't drink and that slogan hasn't been applied to alcohol. While adults promote sexual abstinence for their teenage children we certainly wouldn't want any one to promote anything curtailing our current lifestyle decisions bad as they might be for us. At the very least we suggest taking the advice of Michael VanRooyen, an emergency medicine specialist at Harvard-affiliated Brigham and Women's Hospital and an associate professor at both Harvard Medical School and the Harvard School of Public Health:

“Don’t drink and drive is the first 10 things I would remind people of,” VanRooyen said. “While everybody is worried about eating poinsettia leaves [over the holidays], the way to stay out of the Emergency Department is to not drink too much, and certainly don’t drink and drive.”

It's also a way to get all of our jurisdictions to the bottom of the top one hundred (100) "drunkest" cities in America list. That title is certainly not something that the governors, mayors or the "chambers of commerce" hope to promote to the tourists and visitors to our fair cities. They generally are the ones to suffer as a result of that title either. That's something that largely occurs to we the citizens.

Salted to Death...

...but at least you didn't get cancer when you died!

The men among us here are big salt users. Calls us "salters" because we reach for the shaker before our lips ever touch the food. There is not a woman among us that doesn't warn us against the dangers of our salty ways. We get the same grief when we sweeten our drinks. The warnings always include the ominous you're going to get cancer (or diabetes as the case may be) and die! Maybe you've heard it or maybe you're a carrier of "the ominous warnings of death!" (TOWOD)

Now comes The American Journal of Clinical Nutrition (AJCN) and the Japan Public Health Center–based Prospective Study which says we (the men) were right and they (the women) were wrong. Well kind of wrong.

"Sodium intake as a whole salt equivalent may not increase the risk of cancer but may increase that of cardiovascular disease (CVD). In contrast, salted food intake may increase the risk of cancer. [Their] findings support the notion that sodium and salted foods have differential influences on the development of cancer and CVD." (AJCN)

So to all the other Tarzans out there - "Salters" not dying but greasy pre-salted bad! That includes all the processed meats and salty processed foods which can still kill you. Science keeps verifying it this bit of news over and over again. In this case science, since 1995 and eliminating family history for over ten (10) years and over seventy-seven thousand (77,500 men and women aged 45–74 y. During up to 598,763 person-years of follow-up until the end of 2004, 4476 cases of cancer and 2066 cases of CVD were identified.) individuals helped confirm the results.

It's not direct research it's what's called "a meta-analysis" of twenty-one (21) studies but the bottom line is (according to these  reviewers) "there is no significant evidence for concluding that dietary saturated fat is associated with an increased risk of CHD or CVD." (AJCN) That's good enough for us and we'll hang on to every thread of countermanding evidence.

We don't need new lab research to show us the benefits of fruits and vegetables. We need research that emphasizes real-world solutions. - Janet King, PhD

Here Here Dr. King! We giveth the bad news and we taketh away the bad news - there is some new cancer hope from some fairly unconventional sources.

Children's Hospital Oakland Research Institute (CHORI) scientist Julie Saba, MD, PhD, and her colleagues have just published a groundbreaking study in Cancer Research that identifies a new class of therapeutic agents that could hold the key to the prevention and treatment of colon cancer. Sphingadienes (SDs) are sphingolipid metabolites found naturally in soy that Dr. Saba’s group has found to be protective against colon cancer. (CHORI)

Soy and fruit flies, all things we turn our noses up from the very mention or even seeing. Now showing us the way that going to get cancers and kill it!

"Although cell death does not sound like a good thing and can indeed contribute to pathology, it is also part of the normal process the body uses to remove unhealthy or mutant cells, providing what Dr. Saba refers to as a "cancer surveillance" function. Preventative colon cancer strategies often focus on the same process – ways to get rid of those cells that might be damaged – and thus more prone to turning into cancer – as quickly as possible, which was why Dr. Saba’s team was particularly interested in SDs." (CHORI)

Now we've got some additional ammunition in our growing arsenal to fight the "big C" (cancer) and we won't have to make major life changes to take advantage of its benefits. That's what we call a good day and a great end to a great week.

Suicide By Cancer

Pearlie Mae Frierson Leach, for whom we are named, was suffering with cancer prior to her death. Breast cancer had reached her back and was in her bones. Our experience is that the diagnosis created what the editor's at the Journal of the National Cancer Institute (JNCI) would say:

Receiving a cancer diagnosis is a stressful event and may increase risks of suicide and cardiovascular death, especially soon after diagnosis.(JNCI)

That was our experience but we have earlier memories of women whom hide their breast cancers from their families until the disease so ravaged their bodies that they could no longer disguise either the smell or the effects until hospitalized. Death soon followed. In our opinions both situations should be considered "cancer-assisted suicide" when patients refuse or avoid treatment. You've heard of "suicide-by-cop" this is a similar condition we believe.

The authors from the best hospitals in the US, Sweden and Iceland reached this conclusion:

"A diagnosis of prostate cancer may increase the immediate risks of suicide and cardiovascular death." (JNCI)

Emotional counseling and support should be provided for patients with newly diagnosed cancer. These results add to the complex debate of pros and cons of extensive prostate-specific antigen testing and the many nonlethal prostate cancers thus detected. (JNCI)

We support their conclusions though our support comes from our own anecdotal experiences. While offering counseling we hope the facilities will look beyond their own staffs and into the communities they serve for diversity in counseling and support. Even in the best of circumstances professionals might not be able to override cultural biases and fears fed by their own anecdotal history. Pearlie Mae was prayed over, friend supported by best friend cancer survivors and still choose "cancer-assisted suicide" rather than receive chemotherapy.

Although the Center for Disease Control and Prevention (CDC) doesn't separate their 2006 data by state in reference to race the numbers for suicide especially among African-American women is not considered very high (about twenty-fifth according to Center for Disease Control (CDC Table 14 by Race)25th, the figures for African-American men is substantially higher (about fourteenth) 14th. By jurisdiction the leader in suicides for 2006 was North Carolina, Virginia, Maryland followed by the District of Columbia according to the CDC (Table 29). The four (4) or five (5) leading causes of death in our jurisdiction and the nation are preventable. This isn't secret information. Yet we do not take the steps that should be taken to prevent the preventable.

Other suicidal considerations could be financial. Especially among the aged and the elderly.

"New Avalere research suggests that the cost of providing infusion services in community oncology practices may be higher than the associated payments from Medicare. This study – the most comprehensive to date on infusion-related services performed by community oncology practices and associated costs – suggests that many oncology offices in community settings are losing money on some key services." (Avalere Health, DC)

Patients live with cancer until they die. There is no cure to living - obviously we live to die. Whether or not that contributes to the person's depression (which obviously leads to a decision to either commit suicide or to choose "cancer-assisted suicide") when one chooses to not seek treatment is not known.

Typically, malignant mesothelioma will respond to chemotherapy and radiation therapy, but these treatments are not able to fully cure the cancer. (Asbestos)

We speak of treatment (chemotherapy) as though its a pill to take or needle to receive. We acknowledge that it is non-invasive yet an immensely strong and debilitating procedure. Indeed knowledge of the intensity of the procedure may be another factor in such ultimate decisions.

"(C)hemobrain or, less catchily, "cancer treatment-related change in cognitive function" - a widespread problem for cancer patients which, until recently, has been largely ignored by clinicians. For many, it's the last straw after months of treatment. You might struggle to find the right word for an object or be unable to follow a fast-paced conversation. Or you might have trouble multitasking. You might even forget your own phone number. More than just irritating, these occurrences can shake your confidence, damage your career, upset your social and family lives and, in extremis, even put you in danger." (Guardian News)

The hope, which is where we live and what we have, is that although patients "complain that doctors dismiss these symptoms, "or put them down to stress, depression, fatigue or the menopause." When they hear that there may be concrete physical causes, and that the condition usually abates a year or two after the chemo finishes, their relief is palpable."

That's the hope. Yes, it's hard. Yes, it's uncomfortable. Yes, it's difficult but there is light at the end of the tunnel. We support the call for counseling but not just for patients but for physicians as well. Yes, we know the above information comes from across the pond nonetheless, we believe the circumstances remain the same there as here. It's a pervasive problem that affects the medical community whether American or British, patients speak but doctor's don't listen until it's too late.

Suddenly Dying Babies

It could happen in their sleep. Don't fall asleep cause Freddy will get you. After Friday the 13th there was A Nightmare on Elm Street. Any first time parent doesn't have to be familiar with the films to worry when their child is sleeping if they are really sleeping or are in jeopardy. A quiet sleeping infant can cause anxiety in any and probably every new parent. There is much to fear if you wish to live in fear. Fear for the young is understandable and concern commendable. Unreasonable fear is just unreasonable and parents luck or blessed enough to suffer pregnancy twice learn, eventually that lesson.

NBC News, WUSA the local CBS affiliate and other local stations featured the current research on Sudden Infant Death Syndrome (SIDS) a problem that doesn't really affect the newborns in the nation.  The numbers one, two, three and four causes of death for newborns in the US are (according to the Center for Disease Control and Prevention):

1. Unintentional accidents, 27.8%, 
2. Heart disease, 8.4%, 
3. Homicide 8.1%,  
4. Septicemia 6.5%; 

From 2006, these are "pre-flu" death numbers. These are the more substantial numbers of dead babies, unless your child is the child not reflected in the group and has succumb to Sudden Infant Death Syndrome.

In the Journal of the American Medical Association (JAMA) autopsy study on forty-one (41) dying infants offers a possible answer to what makes sleeping infants die: "Brainstem Serotonergic Deficiency." Is it the final answer - we don't think so. But it is an answer when there was no clear answer prior and possible the solution to a prevailing new parent fear.

The 10 leading causes of infant mortality for 2007,  for the US according to the Center for Disease Control and Prevention (CDC), were:

1. Congenital malformations, deformations and chromosomal abnormalities
   
2. Disorders related to short gestation and low birth weight, not elsewhere classified
   
3. Sudden infant death syndrome
   
4. Newborn affected by maternal complications of pregnancy
   
5. Accidents (unintentional injuries)
   
6. Newborn affected by complications of placenta, cord and membranes
   
7. Bacterial sepsis of newborn
   
8. Respiratory distress of newborn
   
9. Neonatal hemorrhage
   
10. Diseases of the circulatory system
The only difference between the leading causes for 2006 and those for 2007 is that Bacterial sepsis of newborn and Respiratory distress of newborn exchanged rank. (CDC p6)

So goes the nation but the national numbers are not substantially reflected in our region. The numbers don't reflect SIDS deaths in numbers equaling alarm status. (CDC Table 9)

And you thought we only wrote about the aged and aging! The only reason this story was worth our attention is because such stories divert attention from the more serious and deadly causes of death of all ages. If the news was a magic show this would be a simple case of misdirection. We think it's not news worthy unless of course you're the parent suffering the loss. Our question is why in this environment is their suffering superior to all others?

Natural Heart Care

The Mayo Clinic is known for quality health care and being in the forefront of research however when it comes to research review they're results not so forefront(y)! While the major publications (CNN,Reuters, US News and World Report, WebMD) find the review (based on a search of PubMed and MEDLINE databases, for literature on herbal supplements published between 1966 and 2008. Search terms included cardiovascular agents, complementary therapies, herb–drug interactions, and cardiovascular disease interactions) news worthy. We think their conclusions are very unnews worthy:

The authors encourage physicians to ask patients about concomitant use of herbal therapies, in particular among patients who are taking cardiovascular medications with narrow therapeutic windows such as digoxin and warfarin. Increases in research, which provides controlled clinical evaluations of herbal therapies and improvements in regulation and oversight of such therapies, are warranted. (Use of Herbal Products)

That reads more like a sticker on your drugstore medication than a careful well reasoned progressive scientific analysis.

Mayo's "Lean Enterprise Institute" which speaks of being "at the pinnacle of patient care, leadership keeps looking for ways to improve — and now they’re looking to lean." (PDF) We're all working with leaner resources and as patients will be making choices based on less income. What we don't need is for the best to do leaner research.

St. John's Wort is used to treat depression as a natural substitute to prescription drugs. As more and more people lose their jobs and health insurance natural and lower costs remedies seem more likely to be sought out.

"The "focus of cardiovascular research at Mayo is congestive heart failure. One of the questions that we've been dealing with is: What does the most dangerous snake in South America have to do with human heart failure? The answer is that the green mamba snake of South America and the human heart both produce very potent peptides that regulate heart and kidney function." Robert Simari, and I'm the chair of the cardiovascular research division at the Mayo Clinic in Rochester, Minnesota." (ABC News)

Natural remedies aren't unfounded in their claims for healthy results. The argument has to be what's best and affordable for those with and without the financial wherewithal to pay for the best treatment for the money. That's what real lean leadership should, in our opinion (though that should go without saying), be. What are the medical costs for such short cuts.

"Mayo Study Shows Stroke Incidence Related to Angioplasty Remains Steady over Past 15 Years - Research results 'somewhat surprising' because patients are older, have more complicated disease "Eighty-four patients, or three or four in 1,000 patients, had a stroke or a TIA, and 23 percent of those were mini-strokes, according to senior author Rajiv Gulati, M.D., Ph.D."

While such results for eighty-four patients is very good. We applaud this type of research from MAYO but for the suffering settling is not an option and any, especially natural or low cost, alternative would be desired. Scientific research is wonderful and we support it but it's not the be all and end all in every case or there would never be any side effects.

We do agree with MAYO's review conclusions. Before starting or ending any natural medicines or treatments please, please, please speak to your physician. More importantly try to find a physician who is knowledgeable enough about such treatments who can adequately address your condition and concerns. In our area there are plenty to choose from.

Flu Week 3 2010

The supplies are available and though you might not be able to get the shot on demand and you may have to stand in line. The shots are everywhere - now is the time to use Google's flu shot finder. Just don't forget to call to find the time as well as the dates at the location nearest you. That's a little piece of information missing from the Google application. This information is received from the Center for Disease Control and Prevention (CDC).

The proportion of deaths attributed to pneumonia and influenza (P&I) based on the 122 Cities Report increased over the previous week and is higher than expected for this time of year. This increase in P&I is thought to result from an increase in reports of pneumonia-associated deaths in older people. These deaths are not necessarily related to flu illness. In addition, another five flu-related pediatric deaths  were reported this week: four of these deaths were associated with laboratory confirmed 2009 H1N1, and one death was associated with an influenza A virus for which the subtype was undetermined. Since April 2009, CDC has received reports of 312 laboratory-confirmed pediatric deaths: 262 due to 2009 H1N1, 47 pediatric deaths that were laboratory confirmed as influenza, but the flu virus subtype was not determined, and two pediatric deaths that were associated with seasonal influenza viruses. (Flu Update) 

It's still considered to be 2009 by the Center for Disease Control and Prevention (CDC) in terms of the flu season. There is still the possibility of more unnecessary deaths that the shot can prevent. The choice is whether or not to get shot - that a decision we've made but we consider the choice live or die. However that's just us we're kind of fond of this living and breathing thing we've got going on.

2010 FLU DEATHS This Last 2010 2009 2008 2007 District of Columbia Baltimore, MD Charlotte, NC Richmond / Norfolk, VA 3 14 11 6 1 26 17 4 6 48 37 18 1 11 6 19 U 21 14 6 1 15 14 7 TOTALS (Week 3) 34 48 109 37 41 37

• No states reported widespread influenza activity. Five states reported regional influenza activity. They are: Alabama, Georgia, New Jersey, South Caroline and Virginia.
• Almost all of the influenza viruses identified so far continue to be 2009 H1N1 influenza A viruses. These viruses remain similar to the virus chosen for the 2009 H1N1 vaccine, and remain susceptible to the antiviral drugs oseltamivir and zanamivir with rare exception.

False charges are easy to make but difficult to refute unless you go directly to the source of the charges and ask specifically what was the error made. The World Health Organization (WH0) has spoken to the Council of Europe (CE) and denied the charges though it's hard to disprove an unfounded accusation. (VIEW) The results are World Health Organization needs to be more transparent in its operation.

Best Area Nursing Homes?

Though pronounced dead at the hospital which provided her care Pearlie Mae actually died at the nursing home where she for hospice care. The facility did not receive a favorable rating during her "residency." We certainly felt the home was unacceptable for animal care let along the care of a human being. We don't have a high opinion of nursing homes in general. However the ones we do have neutral feelings toward actually didn't score very highly either.

One in five of the nation's 15,700 nursing homes have consistently received poor ratings for overall quality, a USA TODAY analysis of new government data finds. More than a quarter-million patients live in homes given another set of low scores within the past year, according to data released today by Medicare, which first released the star ratings of the nation's nursing homes in late 2008. The ratings are derived from inspections, complaint investigations and other data collected mostly in 2008 and 2009. (USA Today)

It's only because we have experience with many of these local facilities at the time of the ratings that we can support the findings of Medicare. We have from the Medicare site the list for our jurisdictions of the ONLY facilities that you should even consider for housing your recovering or discarded family members. Sorry! That was unnecessarily harsh and we apologize but the subject is still a sensitive one.

Former Frazier co-star David Hyde Pierce had a different opinion and take on the issue when interviewed for the for PBS Series Life (Part 2) stating:

"...[T]hey found a great assisted living place 7 miles from their house, moved him there. It turned out to be the best thing in the world. We usually think of that as a bad second choice. In this case, it was a wonderful choice because instead of being in a house where there were very few people around, 'cause people had to work or be in school, he was constantly surrounded by people. He flourished in a social environment. He was always a very social person. Because of the demographics, he was one of the few men among many women, so that was lovely. And he continued to decline. He never went as far as my grandfather did. My grandfather went the whole route of the disease. My dad was, as we think, mercifully, stricken with the flu and got very sick, and my brother called us all. We were all able to come up there and we were all with him and he still knew us when he passed away." (Science of Happiness, Episode 10)

It took us a few days to analysis the data and find the best of the "poor." These should be the only facilities that you'd even consider for care, however, knowing how a facility fails can help you in either your choice or your lawsuit. The choice to know the devil the government knows or to know what you need to watch out for can also be a great boon to their care.

The Five-Star Quality Rating System was created to help consumers, their families, and caregivers compare nursing homes more easily and help identify areas about which you may want to ask questions. This rating system is based on continued efforts as a result of the Omnibus Reconciliation Act of 1987 (OBRA '87), a nursing home reform law, and more recent quality improvement campaigns such as the Advancing Excellence in America’s Nursing Homes, a coalition of consumers, health care providers, and nursing home professionals. Nursing home ratings are taken from the following three sources of data: Health Inspections, Staffing and Quality Measures. We provide a star rating for each of these three sources, in case some areas are more important to you than others. Then, these three ratings are combined to calculate an overall rating. (MEDICARE)

DC 3 choices (though we only found two (2) worthy of use and our choices are below):

1.  Jeanne Jugan Residence, NE  Stars 5/5/5/2 Medicaid, Non Profit, (40)
2.  The Methodist Home, NW   Stars 5/5/4/4 Medicare and Medicaid, Non Profit, (50)

MD 36 choices (though we only found seven (7) worthy of use and our choices are below):

1. Maria Health Care Center, Baltimore  Stars 5/5/5/5 M and M, Non profit, (60)
2. Crawford Retreat, Baltimore  Stars 5/5/4/5 Medicaid, For Profit, (20)
3. Sacred Heart Home, Hyattsville, Stars 5/5/4/5 Medicaid, Non profit, (102)
4. St. Vincent Care Center, Emmitsburg, Stars 5/5/5/4 M and M, Non profit (46)
5. Garrett County Subacute Unit, Oakland, Stars 5/5/5/3 M and M, Government (10)
6. Hartley Hall Nursing Home, Pocomoke City, Stars 5/5/3/5 M and M, Non profit (70)
7. St. Joseph's Nursing Home, Catonsville, Stars 5/5/3/5 Medicaid, Non profit (44)

NC 47 choices (though we only found four (4) worthy of use and our choices are below):

1.  Chowan Hosp-Snf, Edenton, Stars 5/5/5/5 M and M, Non Profit (40)
2.  Mayview Convalescent Center, Raleigh, Stars 5/5/5/5 M and M, For Profit (51)
3.  Pungo District Hosp Ventilator Unit, Belhaven, Stars 5/5/5/U M and M, For Profit (10)
4.  Wakemed Fuquay Varina Outpatient & Snf, Fuquay Varina, Stars 5/5/5/3 M and M, Non Profit (36)

VA 35 choices (though we only found seven (7) worthy of use and our choices are below):

1. Central Virginia Training Cent, Lynchburg, Stars 5/5/5/5 M and M, Government (104)
2. Little Sisters Of The Poor, Richmond, Stars 5/5/5/5 Medicaid, Non Profit (22)
3. Shenandoah Vly Westminster-Canterbury, Stars 5/5/5/5 M and M, Non Profit (40) 
4. Snyder Nursing Home, Salem, Stars 5/5/5/4 Medicaid, Non Profit (45)
5. Summit Square, Waynesboro, Stars 5/5/5/4 Medicaid, Non Profit (18)
6. Lake Prince Woods, Sufflok, Stars 5/4/5/5 Medicare, Non Profit (40) 
7. Southside Regional Medical Ctr, Petersburg, Stars 5/4/5/5 M and M, For Profit (20) 

• Stars (Overall / Inspections / Staff / Quality Measures) (# of Beds in the facility)

The best nursing home in the District of Columbia can't equal the best Maryland, North Carolina or Virginia facilities according to the Medicare government data. In choosing a better nursing home in the area size matters and the smaller the better - however smaller means fewer available beds. When your loved ones are in need the need from a hospital is immediate. Like David Hyde Pierce whose family interred their Grandfather and then their father in a nursing home while proclaiming the sites good for their relatives. You know if you're a nursing home person.

For us the question is would we want this for ourselves. We certainly wouldn't want to be burden on our families nor bankrupt them financially either. But to quote Mr. Pierce, speaking about his grandfather, on the PBS Series Life (Part 2) episode 10 entitled "Seeking Happiness:"

"The last time I saw him he was in a nursing home in New York State. He was in a wheelchair with his arms tied with straps to the arms of the wheelchair looking at cutout pictures in a construction paper book that some helpful volunteer had put together of flowers. Just sort of happily staring kind of blankly at this thing." (VIEW)

That's not the kind of life or death we'd like for ourselves but that's just us! We say live the kind of life you'd like to die living. For us it's not something we'd like to do alone with strangers but that's how we were raised. If you're raised differently stay in contact with the best places which can transport your loved ones to a facility for specialized care and then return them to the home to convalesce. Beds are few are far between - people are dying to get in.