Health Care and Pregnancy Massage

Your Best Health Care: Health Care and Pregnancy Massage

Health Care and Pregnancy Massage

A growing trend in pre-natal
care is pregnancy massage.
therapy during pregnancy is a wonderful complementary choice for prenatal care,
according to Massage Envy. It is a healthy way to reduce stress and
promote overall wellness. Massage relieves many of the normal discomforts
experienced during pregnancy, such as backaches, stiff neck, leg
cramps, headaches and edema (or swelling).
addition, massage for pregnant women reduces stress on weight-bearing joints, encourages blood
and lymph circulation, helps to relax nervous tension — which aids in better
sleep — and can help relieve depression or anxiety caused by hormonal changes.
More information is available at this site: .
If you’re
visiting or living in the UK, here’s a website that can direct you to a local
massage therapist for this type of care:
to Massage Envy,
massage therapy during pregnancy is a wonderful
complementary choice for prenatal care. It is a healthy way to reduce
stress and promote overall wellness. Massage relieves many of the normal
discomforts experienced during pregnancy, such as backaches, stiff
neck, leg cramps, headaches and edema (or swelling). In addition, it can
help relieve depression or anxiety caused by hormonal changes.
While a massage can’t promise that your newborn will
sleep through the night, it can provide you with a better night’s sleep both
during pregnancy and afterwards. Regular massage therapy not only helps
diminish anxiety and discomfort but boosts relaxation as well. This ultimately
can lead to improved sleep patterns. In addition, the serotonin, endorphins and
dopamine released by your body in response to massage provide an extra helping
of those natural chemicals. More details on this subject are located at this
According to the American Pregnancy Association,  massage
therapy addresses the inflamed nerves by helping to release the tension on
nearby muscles. Many women have experienced a significant reduction in sciatic
nerve pain during pregnancy through massage. Although most massage training
institutions teach massage therapy for women who are pregnant, it is best
to find a massage therapist who is certified in prenatal massage. The APA
works with some massage therapists who are trained to work with pregnant
women, but it is still important to ask about qualifications.
As with
any therapeutic approach to pregnancy wellness, women should
discuss massage with their prenatal care provider. The best way to address
the risks of prenatal massage is to be informed and to work together with
knowledgeable professionals, as noted by the APA.

Many professionals
consider the best position for a pregnant woman during massage is
that provide a hole in which the uterus can fit may not be reliable and
can still apply pressure to the abdomen, or allow the abdomen to dangle,
causing uncomfortable stretching of the uterine ligaments. Consult your
massage therapist before your first appointment to verify what position
they place their clients in during the massage. Additional info on
pregnancy massage is available at this website:
pregnancy, there are several physiological and endocrinological changes that
occur in preparation for creating the environment for the developing baby,
according to chiropractors who specialize in this type of therapy. The following
changes could result in a misaligned spine or joint:
abdomen and increased back curve
adaptations, including ligament relaxation due to the increased production of relaxin
(a hormone produced during pregnancy which causes the pregnant woman’s body to
increase its elasticity preparatory for birth)
pelvic balance and alignment is another reason to obtain chiropractic care
during pregnancy. When the pelvis is misaligned it may reduce the amount of
room available for the developing baby. This restriction is called intrauterine
constraint. A misaligned pelvis may also make it difficult for the baby to get
into the best possible position for delivery. The nervous system is the master
communication system to all the body systems including the reproductive system.
Keeping the spine aligned helps the entire body work more effectively. More information
is located at this site:—prenatal-care.html
trained prenatal massage therapist knows where a pregnant woman’s sore spots
are likely to be and may be able to provide some relief. (She’ll also know
which areas and techniques to avoid.) Still, it’s important to communicate with
her and tell her where you need attention. Let her know right away if anything
during the massage – including your positioning – is causing you any
discomfort.  More material on pregnancy
massage can be found at this site:
According to this site by What to Expect,
,  massage is a generally benign
treatment. Still, some massage therapists are leery about giving therapeutic
massages during the critical first trimester. In addition, there are pregnancy
complications that can make massage somewhat risky. Check with your
practitioner before receiving a prenatal massage if you have diabetes, have
morning sickness or are vomiting regularly, have been diagnosed with
preeclampsia or high blood pressure, have a fever or a contagious virus, or
have abdominal pain or bleeding.
If you are in the second half of your pregnancy, don’t
lie on your back during your massage; the weight of your baby and uterus can
reduce circulation to your placenta and create more problems than any massage
can cure. The good news is that prenatal massage has become so popular that
many therapists and spas provide specialized services just for moms-to-be (always tell your therapist
you’re pregnant). Plus, there are prenatal massage tables and pillows that can
make the experience safer and more comfortable.

Although there aren’t any unusual physical demands for working with pregnant
women, working with women during the labor process can be very physically
demanding, according to the American Massage Therapy Association. This website
is primarily geared toward information for the practitioner who may be considering
or is already offering pre-natal massage therapy to pregnant women:
If you are
pregnant and thinking about getting massage to help with some of the physical
and emotional demands you have during your pregnancy, this therapy may be for
you. Always consult your doctor or medical professional before proceeding with
massage therapy, and always let your therapist know about your situation in
every aspect of your health. In cases where the risk may be greater, it is always
best to err on the side of caution. Seek medical attention immediately if any
problems occur. Safety for you and your baby is always the best course of

Do Your Employees Like Your Patients or Customers?

I may seem like I am asking a
silly question, but truth be told, beyond the customer or patient
satisfaction numbers, chances are, your employees may not like your customers
or patients all that much.  I am not
saying that your employees are treating customers and patients with open
disdain or contempt. They may be exhibiting behaviors and using language in
internal meetings that demonstrate a lack of respect in a “we know better than you attitude.”  
The lack of employee concern and caring, communicated verbally and non-verbally
in the workplace, with average to mediocre employee satisfaction surveys, may
be a pretty good indication that leadership behavior is sending a powerful unspoken
When little differentiation exists (a service, is a service, is a service)
to tell vendors, hospitals, doctors, and other providers apart, employees are liking their customers, can set
you apart from your competition. And with little opportunity existing now, and
in the future, to differentiate yourself in your competitive healthcare
vertical, success and growth beyond a simplistic single strategy of the acquisition will only come when attitudes
towards prospects and customers change.
Besides, employees in the office and the field are your front-line
brand ambassadors. The visual and emotional representation of your brand.  And if they behind closed doors speak with contempt
and disdain, then what does that say about your brand, your leadership, and strategy?
Leadership and employees are the best brand ambassadors that exist.
They can do more to create customer evangelists than you may even imagine. But,
if internal attitudes and actions are arrogant, condescending and pejorative, then
growth just got a lot harder. And marketing with all the creativity and tactics
in the world, can’t fix that.

Can’t have one without the other. 

Michael is a healthcare
business, marketing, communications strategist and thought-leader.  As an
internationally followed healthcare strategy blogger, his blog, Healthcare
Marketing Matters is read in  52 countries and listed on the 
Top Healthcare Marketing Blogs, and Websites
 ranked at No. 3 on the list by Michael is a
Life Fellow, American College of Healthcare Executives, and a Professional
Certified Marketer, American Marketing Association. An expert in healthcare marketing strategy, digital
marketing & social media, Michael is in the top 10 percent of social media
experts nationwide and is considered an established influencer. For inquiries
regarding strategic consulting engagements, call Michael
at 815-351-0671. Opinions expressed are my own.

Trump Administration Shoots Foot While In Mouth

How the Trump Administration Shot Itself In the Foot
According to national demographics, white voters vote at a
higher rate than other groups, but the proportion of white votes is diminishing
based on the age of dinosaurs like evangelical minister, Pat Roberts. I am
still shaking my head in disbelief that this nonagenarian preacher was trotted
out as some foreign policy expert on Fox News to make excuses for the Saudi
murder of journalist and House of Saud critic, Jamal Khashoggi. Evangelical
Christians, who are apparently behind the Kavanaugh appointment and many other
Trump era efforts, make up only 25.4% of the nation or about half of all protestants
and yet are dictating futures to us all. The second largest demographic group
for religion are those who are unaffiliated, agnostic, or atheist representing
29.9% of the nation. Those reporting Catholic as their religion accounted for
23%. The fastest growing religion in the US is Islam.
A quick analysis reveals that the diminishing white
Christian majority will not be the majority for much longer. Experts predict
that by 2045 the US Caucasian or white population will be the minority, and it
could happen before then. I for one, expect to be alive at that point, and
welcome the diversity. The religious right-wing minority dictates to the Trump
Administration and represent a last gasp to reverse this inevitability.
Unfortunately, rising temperatures and sea levels are also edging toward the 2
degrees mark in global warming. I can just hear the eschatologically inclined
orgasmicly describing their day of revelation. Unfortunately for the more sentient,
this is no comfort for the rest of the nation or the planet for that matter.
Short of putting a finger in the proverbial dike, what can
the rest of us do to stop the march to the end of environmental live-ability?
It comes down to the math, the Republicans cannot afford to lose the white suburban
female vote and hold on to their majority. More than twice as many voters with university
degrees voted for Clinton than Trump, both male and female representing 30% of the
electorate. Among whites with less than a four-year-degree, 64% voted for Trump,
representing 44% of all voters. However, the proportion of those women who
voted for Trump was a lot smaller than male voters, with 54% voting for
Clinton, based on Pew Research.  
 Thanks to Orin Hatch,
Lindsey Graham, and President Trump’s performance before and after the
Kavanaugh/Dr. Ford hearing, they may have already lost those votes. Women, no
matter how conservative, do not consider sexual assault a laughing matter,
taunting the victim of a sexual assault is considered an offense of the highest
order, and calling women dogs and other animal euphemisms doesn’t play well
either. I think its clear this charmless Republican bunch has already shot itself
in one of their club feet. Expecting the rest of us to just “lay back and enjoy
it” is asking a bit much. We’ll see how it blows up on November 6th.

The Demise of the Trump Foundation, an Extreme Example of Elite "Do-Gooding" to Prop Up the "Broken System" that Benefits Them

Big foundations often claim that they are out to improve society.  For example, the Robert Wood Johnson Foundation claims to be

the nation’s largest philanthropy dedicated solely to health.

Its goal is to improve health care for all, that is,

help raise the health of everyone in the United States to the level that a great nation deserves, by placing well-being at the center of every aspect of life.

Yet, as we discussed here, large foundations with an interest in health rarely address the sorts of issues we discuss on Health Care Renewal, particularly problems with health care organizational leadership and governance, most particularly leadership that is ill-informed, incompetent, self-interested, conflicted, or even corrupt.  One explanation was provided by Anand Giridharadas, author of  Winner Take All: Elite Charade of Changing the World, as summarized in an August, 2018, op-ed ine New York Times.

His thesis was that society has handed over the responsibility
for reform to those who benefit most from the status quo. Thus,charitable foundations, one vehicle for reform, are now largely run by people with business management background, and financial ties to big corporations.  The foundations thus largely propose minimal, if not fake reforms, representing change “the powerful can tolerate.” So, 

American elites generally seek to maintain the system that causes
many of the problems they try to fix — and their helpfulness is part of
how they pull it off.
Thus their do-gooding is an accomplice to greater, if more invisible, harm.

What their ‘change’ leaves undisturbed is our winners-take-all economy, which siphons the gains from progress upward.

In a recent interview with the Guardian, Giridharadas explained how his concerns evolved while he was a fellow of the Aspen Institute,

a thinktank that organizes exclusive ideas conferences for the wealthy and powerful, as part of a program designed to raise up a ‘new breed of leaders’ and solve ‘the world’s most intractable problems’.

Aftr being selected as a fellow, along with a bunch of corporate leaders, he realized that the Institute was carrying out its view that

the people best-equipped to protect the interests of the poor are the rich and rich adjacent.

In a 2015 talk to an Institute audience, he

delivered an electrifying critique, arguing the ‘change makers’ and ‘thought leaders’ in America’s winners-take-all economy – once again, the very people he was speaking to – are less helping the world through their various philanthropic efforts than propping up the broken system that made them.

The 2015 audience was apparently “aghast,” but it is not clear whether Giridharadas’ insight led them to change their ways.   Instead, foundations continue to prop up the “broken system,” but in often subtle ways.   It is likely that those that benefit from the current status quo
continue to promote little reforms around the edges, while failing to
face the real issues, because doing so could “could implicate powerful people, or perhaps even themselves.”

Foundations may continue to fund projects that promote small incremental changes, while
avoiding those that could lead to questions about aspects of the system
that benefit its current top leaders, or suggest changes in the policies
that allow this.  For example, as we wrote here,
the Bill and Melinda Gates Foundation’s is currently led by a former top
pharmaceutical executive who had defended extremely high drug
prices which presumably helped fuel her extravagant compensation.  
Meanwhile, the Foundation has been accused of “ideological commitment to promote neoliberal economic policies and corporate globalisation.”

Example: the Demise of the Trump Foundation

Now in 2018, three years after Giridharadas confronted the Aspen
Institute with little effect, we witness a truly extreme example of a
non-profit foundation supposedly set up to do good for society, instead
propping up the system, and specifically the supposedly generous
philanthropists who founded it.  However, rather than funding marginal reforms, this example demonstrates much more direct, crude efforts to prop up the system which supported the founders of the “charity” in question, that being the Trump Foundation, the creature of our current US dear leader.

Major questions were first raised about the Foundation in 2016, when the Washington Post published an article by David Farenthold entitled, “Trump Boasts About His Philanthropy.  But his Giving Falls Short of his Words.”  The Post continued its investigation of the topic, leading to an investigation by the New York Attorney General.  This week, that investigation resulted in an agreement to shut down the Trump Foundation, as again reported Farenthold in the Washington Post.  In announcing this agreement, Barbara Underwood, the New York AG, said the investigation found

a shocking pattern of illegality involving the Trump Foundation — including unlawful coordination with the Trump presidential campaign, repeated and willful self-dealing, and much more.

Transactions Benefiting Trump and Family

Basically, the Foundation was alleged to have made transactions that resulted in direct personal benefit to Donald Trump and his family.  For example,

The largest donation in the charity’s history — a $264,231 gift to the Central Park Conservancy in 1989 — appeared to benefit Trump’s business: It paid to restore a fountain outside Trump’s Plaza Hotel. The smallest, a $7 foundation gift to the Boy Scouts that same year, appeared to benefit Trump’s family. It matched the amount required to enroll a boy in the Scouts the year that his son Donald Trump Jr. was 11.

One suspicious transaction could be construed as a bribe meant to forestall investigation of another shady Trump venture, Trump University.  Per an opinion piece in USAToday, the Foundation made a “donation” to

Florida Attorney General Pam Bondi’s re-election campaign in September 2013, years before Trump decided to run for office. According to Florida campaign finance records, the Trump Foundation contributed $25,000 to And Justice for All, a section 527 political organization associated with Bondi.

Charitable foundations like the Trump Foundation, however, are prohibited from political activity. On its tax forms, the Trump Foundation claimed it did not transfer any money to a 527 organization or engage in any political activity, and did not report any contribution to And Justice for All. Instead, it reported a contribution to a similarly named nonprofit organization. The foundation cited ‘coincidences and errors,’ but it looked like a ham-handed attempt to hide the illegal political contribution.

In fact, something more sinister than improper political activity may have been going on. The Trump Foundation made its contribution three days after it was widely reported that Bondi’s office was reviewing joining the New York attorney general’s lawsuit against Trump University. Following the donation, Bondi’s office decided not to join the suit or open an investigation. It is possible the contribution was meant to influence Bondi’s decision, and it is possible that it worked. Whatever the intent, the payment was illegal, and the IRS ultimately sanctioned the foundation, levying a fine for the violation.

After the shut down of the Foundation was announced, Trump boasted on Twitter that at least his charity had not paid him directly, as reported by Politico,

The Trump Foundation has done great work and given away lots of money, both mine and others, to great charities over the years – with me taking NO fees, rent, salaries etc.

It seems like a distinction without a difference  

The Foundation Functioned as an Arm of the Trump Campaign

In recent years, the Foundation mainly worked to benefit Trump’s presidential campaign. Per the Washington Post,

In 2016, state investigators allege, Trump effectively ‘ceded control’ of his charity to his political campaign. He raised more than $2 million at a fundraiser in Iowa that flowed into the foundation. Then, the state said, Trump campaign manager Corey Lewandowski determined when and where it would be given away.

‘Is there any way we can make some disbursements . . . this week while in Iowa?’ Lewandowski wrote in an email cited in Underwood’s lawsuit.

Trump gave away oversize checks from the foundation at campaign events in the key early-voting states of Iowa and New Hampshire, pausing his campaign rallies to donate to local veterans’ groups.

Federal law prohibits charities from participating in political campaigns. As president, Trump has called repeatedly for that law to be repealed.

Again, the Foundation was acting directly to promote Donald Trump’s interests.

The Foundation Had No Meaningful Governance Structure Beyond Trump’s Whims

Finally, the Foundation seemed to have no meaningful governance structure that could counter its use as a family “piggy bank”

The attorney general’s investigation turned up evidence that Donald Trump Jr., Eric Trump and Ivanka Trump — all listed as officers of the charity — had never held a board meeting. The board hadn’t met since 1999. The charity’s official treasurer, Trump Organization executive Allen Weisselberg, told investigators that he wasn’t aware that he was on the board.

State investigators asked him what the foundation’s policies were to determine whether its payments were proper.

There’s no policy, just so you understand,’ Weisselberg said.

So, thanks to the investigations that have swirled around Donald Trump and company since he began his campaign for the presidency, we have seen an amazingly blatant example of a non-profit charitable foundation used not to improve society, but to support the “broken system,” and particularly the advantageous position of the charity’s founder within the system.

Further Discussion

This example may be extreme, but it may not be unique.  Vox just published an opinion piece entitled,”The Trump Foundation shows just how preposterously light our oversight of charity is.” It noted,

As the political theorist Rob Reich explains in his new book Just Giving, we really don’t expect much from foundations as a matter of public policy.

They don’t have to have a website or some other way for interested charities to contact them about funding. They don’t have to make their giving strategy publicly available or accessible in any way. They do have to fill out 990-F tax forms, which are public and provide some information on their assets, spending, and grant recipients. But those take the form of long, difficult-to-parse tax documents, and crafty philanthropists can get around these requirements by starting up offshore foundations. And there are basically no requirements to speak of beyond filing a 990-F and spending at least 5 percent of assets every year.

Foundations are often black boxes, stewarding and distributing private assets for public purposes, as identified and defined by the donor, about which the public knows very little and can find out very little,’ Reich writes.

Maybe the revelations about the Trump Foundation will inspire a more skeptical look at “do-gooder” foundations.  We need to know the extent to which they are devoted to the interests of rich insiders rather than of society at large.  Per Giridharadas, shining more light on their obscure operations might inspire them to start

listening to more of society’s losers, and fewer winners. ‘The powerful are very good at disseminating their own bullshit,” he says. ‘They don’t need the intellectual reputation laundering of ideas festivals to make their heavily marketed bullshit smell even sweeter.’

‘I sincerely believe,’ he says, ‘that had more of the institutions of this country – and particularly those involved in thinking and ideas, not just conferences but all kinds of things – been more skeptical of elite fantasies and more mindful of what was actually going on in other people’s lives in this country, I think it’s very possible we wouldn’t have orange Mussolini in the White House.

We also could have had real health care reform.

Nutrition – One of The 7 Keys to Healthy Aging

“If We Could Give Every Individual The Right Amount Of Nourishment And
Exercise – Not Too Much And Not Too Little – We Would Have Found The Safest Way
To Health,”


 Two thousand four hundred years ago and it is still
the best advice.

Your agenda is health and
longevity. This means most of us have to modify our lifestyles. That is the
goal. If lifestyles are changed to include appropriate eating patterns and
appropriate food intake along with exercise, better sleep, no tobacco and less stress, then
health and wellness will follow and persist. This means many fewer chronic
illnesses and a longer lifespan. But it is very important to modify lifestyles
for the long term, not just a few weeks or months.

A good place to begin is with nutrition and for that a good starting point is to
understand and follow the Mediterranean Diet.
It consists of extensive
fresh vegetables and fruit each day plus regular servings of nuts, seeds and
beans along with whole grains such as whole wheat, oats and brown rice, olive
oil and fish with a topping of wine but limited meat and very little added
sugar. This is widely considered to be a sound, healthy diet. As a general rule
it is food prepared “from scratch” in the kitchen, not processed food from the
manufacturers nor prepared foods from the corner deli or fast food place.

There are some specifics that
should be noted.

Cover your plate with two thirds
vegetables and only one third with meat or fish. Make the veggies the major
part of the meal. Fresh and local when possible and organic whenever available.
Fix them simply such as steaming, stir frying or baking. Fresh vegetables need
little seasonings although some herbs are both flavorful and healthy additions.
Dark greens should be a frequent part of the meal – spinach, kale, collards, dandelion
greens, arugula and Swiss chard are good examples. Spinach, arugula and
dandelion make a wonderful salad; toss it with olive oil and balsamic vinegar
and perhaps top it with a few slivers of carrot plus some cucumber slices and
cherry tomatoes. Consider steaming or stir frying the others.

Fruits are important. Eat a wide
variety of types and colors, preferably local and fresh although frozen is
fine. Avoid canned fruits as they invariably have added sugar. Berries like
strawberries, blueberries, blackberries, raspberries and cherries are high in
polyphenols that are valuable for many metabolic processes and especially good
for the brain.

Whole grains means just that and
not refined white flour as found in most breads, packaged foods such as most
cereals, pasta, cakes, pies, cookies, and yes even pizza. Refined white flour
has essentially no nutritional value so it is essential to avoid all of these,
with perhaps a rare treat or two. It follows that trips to the fast food outlet
are verboten. Fats are fine in moderation and indeed are essential. Get them
from olive oil, avocados, nuts and seeds and from fin fish. Avoid trans fats. Keep
omega 6 fatty acids to a minimum; they are found in many commercially baked

It is critical to avoid sugar.
This is difficult since we have been trained to desire sweet tastes and sugar
of various types is added to many packaged foods, sodas, yogurts and of course
ice cream. The limit per day is 25 grams for women and 37 grams for men. To put
this in perspective, a can of soda has the full complement of sugar for a man
and is well over that for a woman. One more reason to avoid fast foods. When
you buy cheese avoid ones with food colors; real cheese has natural color.
Yogurt is very healthy but most brands add fruit, flavoring and a lot of sugar.
Look to also see that the cultures are “live;” many are not and essentially all
flavored yogurts and those with sugar added have no live cultures.

Fish are high in omega 3 fatty
acids – the good fats. You need them and can’t create them in your body so it
must come from your foods. Most beef comes from animals that have been placed
in small pens for months and fed a diet of grains like corn and soybeans so as
to fatten them up. But this fat is mostly omega 6 fatty acids which is pro
inflammatory. Unfortunately, the USDA labels the fattest beef as “prime.” Beef
from cattle that have been grazed their entire life have minimal omega 6s and
do have omega 3 fatty acids but the amount pales compared that found in salmon,
mackerel or sardines. Another important point – find meats that do not have
additives, either on the range, the feed lots or added after butchering.
Antibiotics, growth hormone, nitrites and other additives are likely adverse to
your gut health.

Chickens are usually raised in
buildings so that they never see the light of day before slaughter but do have
antibiotics in their feed and may be stimulated with hormones to grow larger.
Look instead for poultry from farms that use no additives and let the chickens fun
free. And with all meats avoid these that have added liquid “to retain
moisture.” Get real chicken and real beef, lamb or pork, additive free and
pasture grazed.

Buying organic vegetables and
fruits and grass-fed meats are more expensive for sure. But the health benefits
outweigh the costs.

Is there anything that you can
eat? Yes, dark chocolate, preferably 85% cocoa or more. It is inherently
healthy. So is coffee. It is not only OK but healthy to have alcohol in

You are eating not just for
yourself but also for the bacteria in your intestines – the gut microbiota
(microbiome.) The 100 trillion of them need nourishment so that they can help
maintain your immune system, your intestinal lining cells and so that they can
produce various nutrients that your cells in various organs use for energy. Their
“food” is the fiber that your intestinal enzymes cannot digest but which the
bacteria love. The best sources are in vegetables and fruits. Consume
inadequate fiber and the “good” bacteria are starved. If meanwhile, you eat
sugar, refined white flour or too much alcohol, you will be feeding the “bad”
bacteria with detrimental results. That, of course, is a common combination in
the standard American diet but it leads to increased intestinal permeability
(“leaky gut”), local and systemic inflammation, passage of toxins into the
bloodstream and the induction of a variety of complex chronic illnesses. So,
treat those bacteria well. The foods like veggies with their high fiber content
that benefit the gut microbiota are called prebiotics. Foods that include bacteria
and yeasts that are known to be healthy are called probiotics and are found in
many foods like live culture yogurts, live culture Kefir, non-pasteurized
sauerkraut, kim chi and other fermented foods. Have some regularly.

To recapitulate – aggressively
avoid added sugars; eat lots of veggies of a wide range of colors including
dark green leafies; include only whole grains and not too much. You need good
fats as found in olive oil, nuts and seed, and lots of fish. Dairy, eggs and
poultry are best if it comes from grass fed animals. Same for beef, pork and
lamb in limited quantities. Include some wine and plenty of water. Be sure to
include plenty of fiber foods and probiotic foods as well. Local, fresh and
organic are preferable.

This combination will keep you
healthy and keep your intestinal bacteria happy as well. When they are happy,
you will be healthier

A final word comes again from Hippocrates; “All disease begins in the gut.” 

Still the best advice only now we begin to understand just
why he was correct.

Next post – Keep moving!

Ensuring Clinical Safety – HL7 Implementation

The one thing that is missed quite often during deployment and rollout of HL7 (read HL7V2.x) is the “clinical safety” factor. It is not often considered if introducing the messaging is any way compromising the information quality of patient’s data or if it’s introducing any major business changes to the existing clinical workflow in the organisation. Organisations need to stress to the system providers as well as to the system integrators that they ought to consider clinical safety as a major factor in all stages of the rollout including development, deployment and testing.
There are ways to ensure that the introduction of HL7 does not compromise clinical safety. This post discusses a approach for this
Conformance Accreditor: The organisation needs to employ a system integrator or act itself as one (in case it has a internal tech team) to define conformance standards
Conformance Guidelines: The defining of conformance standards need to be based on the following principles

1. Define the message set that is required to be used within the organisation and publish it. The definitive message needs to be based on the requirements to automate and provide seamless data access, subject to access controls.

2. Avoiding optionality and being more specific when defining the messages

3. Identify the use cases and build story boards using every day scenarios of the organisation. Involve the organisations clinical and administrative team in this.

4. Publication of defined code set to be used in the messages

5. Define mapping guidelines to enable system providers to identify the correct data attributes

6. Provide sufficient guidance on message interactions for the messages that need to be sent and received by the systems for different events.

7. Define the expected systems behaviour while processing the message.

The publication of proper definition of code sets and values, message specifications and mapping guidelines ensures that data is not manipulated in a clinically unsafe fashion or mapped to the wrong code compromising patient safety.
(See this for a better understanding of conformance :
Conformance Tools: Provide simple test harness tools adhering to the proposed conformance standards, for the system providers to check the correctness of their implementation- e.g. message structures, data types, expected code values. Provide ability to view data in the message in a GUI so that they do not have to traverse the message. These tools are expected to be provided by the system integrator
Conformance Testing: The clinical safety testing process involves exhaustive end to end testing to see if the data sent by the sending systems has not hindered the work flow in the receiving system. The testing to defined work flows in system where the data is received and used ensures that safety of the patients is not compromised
Defining Transition: The changes that are brought about by implementing HL7 in an organisation needs to be formally documented. The capabilities and workflows in the organisation that are impacted by the implementation needs to be compared and ensure that the users are aware of the changes through training.

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Home Care Advisory Committee Meeting – 2018 Sunset Review Report

The Home Care Advisory Committee has scheduled an additional meeting for Tuesday, January 22, 2019, 11:00 A.M. – 1:00 P.M. This meeting is specifically to review the 2018 Sunset Review Report and gather committee comments and questions.

The meeting will be held at CDPHE, 4300 Cherry Creek Drive South, Denver, 80246, Building C, Room C1D and via teleconference.

Conference number: 712-770-8066
Participant code: 727084

Is the Iron Triangle of Health Care a Law or an Observation?

A recent commentary in the Journal of the American Medical Association titled, “The Iron Triangle of Health Care: Access, Cost, and Quality” reflected that any health care system can only optimize two of the three elements – quality, access, cost.  A health care system which provides the finest quality and best access cannot do so without raising costs to unaffordable levels. An inexpensive health care system available to all cannot do so without sacrificing quality. The iron triangle of health care was introduced to me during my medical school training in the 1990s. Like many others, I simply assumed it was a fact. An immutable law. A fixed certainty that could not be altered any more than gravity.

What if this iron triangle isn’t a fundamental truth or law? Why don’t other industries have their own iron triangle? Is health care really different than aviation or computing?  Asking this simple yet basic question is something medical students and doctors don’t ask. Fortunately, this was not the case for Harvard Business School Professor Clayton Christensen, author of the Innovator’s Prescription. His
book not only details the theory of distruptive technologies, but also
how companies who do “disrupt” the incumbent companies and the status
quo are the ones that ultimately provide goods and services which are more affordable, more accessible, and of higher quality. Might there be analogies for health care? Professor Christensen highlights aviation and computing as two examples.

Commercial flight for the masses was not a realistic possibility over a century ago when the Wright Brothers navigated their winged contraption in Kitty Hawk. Even decades later, as epitomized by Pan-Am in the 1960s, air travel was for the affluent and a special event. At that point, air travel was not accessible or affordable for the general public. Yet, in the 1970s, a Texas start-up known as Southwest Airlines provided discounted travel to the general public by offering low fares, no amenities, and a point to point service rather than hub and spoke system.

And traveling by air was never the same again.

Now, more people travel by air than anytime in history with unparalleled safety. More accessible. More affordable. Higher quality.

Computers had a similar beginning evolving from a product where only available to a few due to cost and complexity of the systems to now where computers are affordable, ubiquitous, easy to use and of even better quality than the past. One of the first computers in the 1940s, was Eniac, a huge and expensive mainframe computer which was not reliable, extremely complicated, and accessible only to academics. Years later, the general public typically accessed these mainframe computers at work via technicians. Access was limited. It wasn’t until the late 1970s that desktop computers appeared. Hobbyists and others, like Steve Jobs, built computers which were less expensive and underpowered compared to the mainframe computers, but they were more accessible to the general public. It wasn’t until many years later that subsequent computers became more affordable, more powerful, and more accessible in the form of laptops, netbooks, and now smartphones and tablets. More people had access to computing because the products were more affordable and of even higher quality.

And computing was never the same again.

Based on Christensen’s model, we can predict that health care will indeed break the iron triangle and demonstrate it is not a law but an observation. The question is who will lead these changes? Insurers? Doctors? Patients? Entrepreneurs?

Our next generation of doctors must be trained in other disciplines outside of health care. We must collaborate and accept other ways of looking at the same challenges through the lens of other disciplines including business school. Yet, there is a loathing for this. There is the belief that health care is different. Yes, we can continue to talk about the iron triangle of health care and accept that as a reality.

We can also say no. The iron triangle is not a law but an observation. We choose a different path.

The truth is that this is the most exciting time in health care with the intersection of better medical understanding, the availability of technology, and the best and brightest minds working on the issues of better quality, better access, and lower costs. As doctors and educators, it is our job to make sure the next generation is equipped with the right mindset to team with others. If not, others will define the future of health care.

This is what worries me the most.

Two Drugs Safe for Rare Forms of Kidney Cancer

(HealthDay News) — Using a combination of the drugs temsirolimus (Torisel) and Bryostatin appears to be safe in patients with metastatic kidney cancer, according to early data from 25 patients in a phase 1 trial.

The researchers said a pathway known as mTOR signaling promotes tumor cell proliferation and tumor blood vessel development. The temsirolimus-bryostatin combination blocks two portions of the mTOR signaling pathway, and the early data suggests the drugs may be active in patients with rare forms of renal cell cancer that are less likely to respond to other therapies.

“We have certainly seen sustained responses with this combination, which are encouraging,” Dr. Elizabeth Plimack, a medical oncologist and attending physician at Fox Chase Cancer Center in Philadelphia, said in a news release from the center. Read more…

Ayurtox for Body Detoxification

Ways To Boost Your Immune Systems

Posted on | Thursday, January 24, 2013 |

Many people don’t recognize how important a healthy immune process is and the way it can affect our every day life. The immune systems helps to the body to defend against bacteria that may cause infection, viruses, diseases and then some. When your immune process is low and/or not functioning properly you can be more susceptible to these common everyday issues. Also if your immune process is low you may feel low on energy, irritable, and sluggish. On the other hand when your immune process is functioning properly you may have energy, be in a better mood, and have better focus. Down below are ten ways that can help to boost your immune process.

Exercise- try to exercise on a regular basis this will help to boost circulation and boost your immune process. This will also help you to get better in shape.

Proper rest- 8 hours of sleep is a nice amount of time to sleep. Try your best to get your proper rest. Are body needs to rest in order to re-cooperate for the next day. When you do not get the proper rest that can have a great effect on your immune process.

Drink lots of water- this tip is important are body needs the proper amount of water to be able to function properly. Water also flushes toxins and impurities that are in our body.

Eating right- eating the right foods can provide great benefits to your immune process. Try to incorporate fresh fruits and vegetables in to your diet. vitamin c this is excellent for your health. Try you best to stay away from unhealthy foods that contain lots of grease, overweight, preservatives and toxins. These food can have a negative effect on your overall health.

Tidy hands- washing your hand more often can help to cut down to bacteria and germs. You ought to make definite your hands are clan before you eat or are touching anything that may be entering your body. If feasible try to keep hand sanitizer on hand the are lots of germs an surfaces all over the place in are every day life.

Watch toxins- toxins such as smoking cigarettes and/or drug abuse is harmful to your body as well as your overall health. Try to stay away from these or environments that may contain these toxins. Even new smoke can have a effect on the well being of your body.

Stress- stress will have a great effect on your health. Try so stay stress free the best that you can. Try to stay out of stressful situations or try out different stress relievers like taking a walk, listening to music, laughing and/or taking up a hobby.

Harsh weather- in case you do must deal with the harsh elements take the proper precautions. In case you are dealing with extreme weather like in the coursework of the chilled months in the winter bundle up and be definite that your are properly covered and warm. Also definite that your chest is properly covered if not that is the best way to catch a chilled. In case you are dealing with the harsh heat in the summertime be definite to stay hydrated and that you have plenty fluids in your body to help to eliminate the risk of dehydration.