Kicking Sugar to the Curb – Tips for Healthy Brands and Healthy Lives

Regular readers know that I am committed to doing 50 healthy things in honor of my upcoming 50^th birthday. Here’s number five: eliminating sugar.

I was hesitant to put this one out there for public display, because I wasn’t sure I could do it.  However, I am happy to report that I have eaten no added sugar for more than a month.  I’ve also cut way back on grains, breads, pastas and other processed foods that metabolize as sugar.

Why?  You might ask.  I have been very swayed by recent research that suggests sugar is the biggest health culprit when it comes to heart disease, diabetes, obesity, cancer, dementia, liver failure and many other ailments.

The American Heart Association recommends no more than 5 – 7.5% of daily calories come from sugar.  However, most Americans eat far more than that – sometimes without realizing it.

According to Dr. Mark Hyman, “Most of us don’t know that a serving of tomato sauce has more sugar than a serving of Oreo cookies, or that fruit yogurt has more sugar than a Coke, or that most breakfast cereals — even those made with whole grain — are 75% sugar. That’s not breakfast, it’s dessert!”

For more of Dr. Hyman’s perspective, see his blog post here:

Interesting and scary.   Now here’s the thing.  Do I think it’s realistic to cut out all sugar from my diet indefinitely?  No.  I am planning to continue my sugar “fast” through the end of February.   It has been a great exercise in awareness.   But I’m not into total deprivation. From now on, if I do allow myself an occasional sugary treat, it will be a very mindful decision.  (And it will be something really good that is worth the calories and risk – no more mindless snacking.)

What are your thoughts about sugar?  Do you agree with this research or think it’s hype?  I’d love to hear your thoughts.

Communicating with Spouses: An Opportunity For Cardiovascular Marketers

Providing a step-by-step game plan to patients’ spouses can certainly aid in patient satisfaction.

Take it from me. I am something of an expert in this area, as my husband has had at least 10 cardioversions. He has paroxysmal atrial fibrillation, the remnants of viral-induced cardiomyopathy that hit 14 years ago.

Fortunately, his episodes have become few and far between.  Unfortunately, he went into the “bad rhythm” as we call it last week for the first time in more than three years.  Last week, he underwent a successful cardioversion, and he has rhythm again. (Insert joke here about a middle-aged white guy.)

This episode marked the first time I had played my recurring role of the patient’s spouse in a while. I am certainly not complaining. However, it was an interesting reminder to me about some issues that are important to this key target audience. With constant advances in medication and technology, things can change significantly in three years.

For example, the options for anticoagulation have changed, as Pradaxa seems to have replaced Coumadin as the first-line drug of choice. The rules for how to take it and how it has to be monitored are quite different from what we’ve experienced before.

Additionally, the hospital where he had his procedure has expanded its facilities greatly since we were last there.  That’s good news for many reasons, but it was kind of confusing to me because the location and the order in which we did things were much different from before. For example, prior to his cardioversion, the doctor performed a transesophageal echocardiogram to ensure he had no blood clots, thereby reducing the risk of stroke. This procedure used to be handled in a completely separate room on a completely different floor. Now, the hospital does both procedures in the same room, one right after the other, using the same anesthesiologist. This is a nice improvement in many ways, but it really surprised me at the time.

These are just a couple of examples, but they got me thinking as I sat in the waiting room. Wouldn’t it be great if the spouse received an “agenda” for the day at outpatient registration?  It could have the day’s scheduled events, locations, approximate timeframe and names of key personnel who would be involved – very much like an agenda we prepare for meetings at an office. It really doesn’t seem that hard to do for scheduled procedures, and it would be very valuable in terms of patient peace of mind.

Even for “veterans” like me, uncertainty and confusion about what is supposed to happen next can cause undue stress. I am thankful that everything turned out well, and I don’t want to do it again soon. But in some ways, I’m happy to get an occasional reminder about the important role communication plays in patient satisfaction. What are you doing at your hospital to make spouses feel more informed?

Worst Heart Habits: Great Content for Cardiovascular Marketers

Lifestyle choices may account for more than 90 percent of heart attack risk, according to new research. And even small changes can make a big impact.

I saw a great post from Healthline that identifies six of the worst habits for your heart and looks at how to turn them around.

Too much TV

• People who spend four or more hours per day on screen-based entertainment have double the risk of a cardiac event vs. those who spend two hours or less in front of the tube.
• The risk of dying prematurely is much greater for those who are heavy screen watchers, even if they also exercised.
• Recent research also shows that too much sitting can be just as bad for your heart as smoking. (I hope you’re walking around reading this post on your mobile phone.)  I’m tempted to start scheduling more meetings while walking. Seriously.

Negativity

• A Harvard review of 200 previous studies found that an optimistic outlook might cut heart disease and stroke danger by 50 percent.
• The association between an upbeat attitude and reduced cardiovascular risk held true even when they took the person’s age, weight, smoking status, and other risk factors into account.

Ignoring Snoring

• Frequent loud snoring can trumpet obstructive sleep apnea (OSA), a dangerous disorder that magnifies heart attack and stroke risk, if untreated.
• Ask your doctor about a sleep study if you are waking at night for no apparent reason or have unexplained daytime drowsiness.

Forgoing Fiber

• Research from the National Institutes of Health and American Association of Retired People found that people age 50 and older who ate the most fiber were up to 60 percent less likely to die from cardiovascular disease, infectious diseases and respiratory ailments, compare to those who ate the least.
• Another study showed that eating eight servings of fruits and vegetables a day trims the risk of a fatal heart attack by 22 percent, compared to eating less than three.

Failing to Floss

• One theory is that the same bacteria that trigger gum disease may also spark inflammation inside the body, damaging arteries. I’ve seen other research lately disputing this as a clear link, but still….this link seems to make sense.
• A 17-year-study published in Journal of Aging Research showed those who never flossed were 30 percent more likely to die than were those who flossed daily.

Smoking Even a Little

• Some statistics show that smoking even one cigarette a day increases the threat of heart attack by 63 percent and smoking 20 or more cigarettes a day more than quadruples it.
• Tobacco use also boosts risk for diabetes, chronic obstructive pulmonary disease, and many types of cancer.

These are great reminders.  Sometimes it’s hard to realize how much even small changes matter.

Cardio Exercise Advice For Cardiovascular Marketers

It doesn’t matter when you do your cardio as long as you do it.

Many cardiovascular marketers I know are publishing content about exercise this time of year. I thought these insights from “America’s toughest trainer,” Jillian Michaels of Biggest Loser fame were kind of interesting.

Michaels refutes the oft-espoused theory that cardio is most effective first thing in the morning on an empty stomach. Some people believe that because they haven’t eaten in 8 to 10 hours, there will be less blood sugar available for fuel, which will force your body to draw on and burn more of its stored energy. Not true, says Michaels. In fact, exercising on an empty stomach can hinder performance and make you feel weak. Her advice is to do your cardio workout whenever you have the energy to give it maximum effort. For people who are interested in weight loss, Michaels recommends one day per week devoted strictly to cardio and cardio mixed in with circuit training on other days throughout the week.

How long is long enough?

When it comes to duration, Michaels recommends a minimum of 30 minutes and a maximum of two hours of cardio in any single session. For some people, the number of calories burned in a half hour session may not seem worth it, but obviously, heart patients need to heed the advice of their doctors based on their individual situations. And exercising for too long can release stress hormones into the body, such as cortisol, which inhibit weight loss, causing your body to react by storing fat and retaining water out of self-protection.

What type of exercise is best?

Walking, rowing, spinning, stepping, and climbing can all lead to increased fitness. Michaels recommends that people do whatever they enjoy the most and that they mix it up to avoid plateaus. Here’s a good calculator to figure out how many calories you’re burning during various exercises.

How much is enough?

When it comes to intensity, Michaels recommends using your best judgment. I would add that heart patients should also consult their physicians. In general, if it feels too easy, increase intensity; if it feels too difficult or your form is compromised, decrease intensity. As you get into better shape, your tolerance for intensity will increase. Michaels recommends keeping your heart rate at 85 percent of your maximum while you are doing it. To figure out your target heart rate, here’s a heart rate calculator from Mayo Clinic.

Most experts also strongly recommend that you purchase a heart-rate monitor, which will give you instant feedback on how you’re doing, letting you know if you’re working too hard or not working hard enough.

Still not motivated? Try these tips.

AFib and Stroke: A Hot Topic in Patient Education for Cardiovascular Marketers

Only half of patients with atrial fibrillation know they are at a heightened risk for stroke.

I’m pretty amazed if the results of this study, sponsored by the American Heart Association, are correct.

Both my husband and my father have a history of AFib. And fortunately, I feel like the risks of stroke were one of the first things their doctors discussed. Apparently, others aren’t doing as good a job, which tells me that cardiovascular marketers have a big job to do in terms of education.

The survey examined what AFib patients perceive to be their biggest health risk. It also measured respondents’ knowledge of stroke, warning signs of stroke and stroke prevention strategies.

While nearly all patients claimed to understand the definition of stroke, just more than half defined it in correct terms.

Of those diagnosed with AFib:

• 42 percent said they were most concerned about the potential of heart disease or MI

• 10 percent said they were most concerned about becoming diabetic

• Only 8 percent of respondents said they believed stroke was their greatest health concern

• 25 percent said they believed they were not at a risk for stroke, even despite their condition

• 25 percent said they did not know

Two-thirds of the patients said their healthcare provider spoke with them about their elevated risk of stroke with AFib, yet among these patients, 21 percent said they were told they were not at risk for stroke.  Huh?

“Patients need to be aware of this risk and have serious conversations with their healthcare providers about what they should be doing to prevent stroke,” Mark Estes III, MD, professor of medicine at Tufts University School of Medicine in Boston, said in a statement.

Uh, yes.  I agree.

Twelve Questions Your Cardiovascular Marketing Should Be Able to Answer

Empowered patients are more assertive than ever when it comes to selecting physicians.

This trend is pretty close to home for me right now, as I am trying to help my husband select an orthopedic surgeon for a major knee procedure. Having worked in health care marketing for a long time now, I can certainly recite all of the standard things to look for: board certification, education and fellowships, years in practice, hospital affiliation, etc. I also know that I tell my clients to pay attention to online satisfaction scores and reviews.

But somehow, these standard measures seem to be falling short for me. And it seems I’m not alone. I recently found a great post from Steve Wilkins, who says, “empowered patients today are being taught to be less patient, more critical and more assertive.”

He has authored a list of 12 evidence-based questions every patient should ask prospective physicians:

1.  How would you describe your communication style?

2.  How do you inform patients of lab test results?

3.  How long after you get your lab results before I can expect to be notified?

4.  What percent of your patients have had their recommended screenings?

5.  Will you take the time to understand and respect my beliefs and opinions about my health and communications preferences?

6.  What percent of your patients are non-compliant with respect to taking their medications or otherwise following treatment recommendations?

7.  If I need to be hospitalized, who would my doctor be? You or some hospitalist?

8.  What safeguards do you have in place to prevent communication hand-off errors should I be hospitalized or seen in the ER?

9.  How do you feel about my bringing a friend or my spouse to my visit?

10.  Do you encourage patients to ask you about health information they have found on the Internet?

11.  For patients needing additional information, do you have a list of recommended websites you can give me?

12.  Will I get a written post-visit report summarizing what occurred at each visit, including medication and self-care instructions?

Very interesting. How many of the physicians you represent would have great answers to these questions?  I am going to recommend that our clients circulate these questions to their physicians (right after I jot them down to take to the next orthopedic surgeon appointment for my husband.)

Should You Add A Chief Experience Officer to Your Cardiovascular Marketing Mix?

 Making the patient experience a top priority is more critical than ever.

As marketers, we spend a lot of time and resources developing our brand promises.  But how many of our organizations are as deliberate as they should be in making sure the patient experience delivers on the brand promise we tout in marketing?

Current research indicates that patience experience is at the top of CEOs’ priority lists.  But, how is it working?

I came across an excellent post from consultant Anthony Cirillo, who recently spoke at Cleveland Clinic’s Patient Experience Summit.

His main point is that only with a Chief Experience Officer (CXO) at the top of an organization can you assure the patient experience is consistent and integrated with marketing efforts, especially as delivery mechanisms continue to change.

He recognizes there is a financial implication, particularly in the context of value-based purchasing.

Here’s an example from Cirillo:

The average hospital has $180 million in revenue. Say 50 percent is Medicare. That is $90 million. By 2017 you will have to hold back two percent of your Medicare revenue for a bonus pool. So you are starting almost two million in the hole. And what would you have to charge to net two? And what happens when other payers follow suit? Do you really want to leave patient experience to chance?

Given these circumstances, Cirillo asserts there are three roles the CXO should assume to enhance patient experience:

1.   Chief Promise Keeper

The CXO must ensure patient experiences are consistent across the organization and consistent with the promise set forth by marketing.  Cirillo points out the importance of storytelling in making sure the patient experience matches the expectation.

2.   Chief Healing Officer

Cirillo asserts that healthcare workers often take the emotions of work home with them, which can have consequences that lead to quality issues.  As Chief Healing Officer, the CXO is an advocate for employee assistance programs that include benefits such as pastoral care.

3.   Chief Context Setter

The CXO should serve as a organizational leader who “infuses the patient experience into the culture” through employee orientation, training and other areas as appropriate, helping employees understand their ultimate role as healers.

I think this is great stuff.  One of my favorite parts of working with clients is to help them articulate their brand promises.  It’s even better when the promise is consistently delivered through the patient experience.

Improving the Cardiovascular Patient Experience with Electronic Medical Records

The mandate to transition hospital and clinic records to a digital format by 2015 could dramatically impact the patient experience.

Much to my chagrin, I had to visit my doctor’s office yesterday.  Fortunately, I do not get sick very often, and when I do, I am not a very “patient” patient.

However, I was kind of excited about one part of yesterday’s experience.  I was offered a chance to sign up for a new program called MyChart, “ a free, easy and secure way to view my health information and communicate with my healthcare team.”   Providers around the country are using this and similar products.

When I got home, I promptly logged in and spent a few minutes reviewing past test results and looking at other features like prescription renewals and appointment setting.  I realize I’m probably more of a geek than most people, but I love the fact that I can now quickly view historical cholesterol readings, etc. any time I please.

Apparently, some providers are dragging their feet a little bit when it comes to embracing electronic medical record (EMR) technology.  However, I found a great blog post from Dr. Eric Van De Graaf, a cardiologist at Alegent Health.

He says he is now “favorably inclined” toward EMR after using it for about seven months.

He also gives a great list of pros and cons.

Advantages of EMR:

• Ability to access it from virtually anywhere  – from an emergency room, a home computer and potentially a portable device. No more waiting until the office opens on Monday to get a hold of a chart.
• Legibility – Dr. Van De Graaf says, “doctors’ handwriting is the stuff of legend.”
• More thorough notes – the system addresses issues that could be skipped, e.g., family history, previous procedures and drug intolerances.
• More streamlined billing – better documentation means better reimbursement
• Fast and accurate prescription refills – most EMR systems send orders directly to pharmacies, saving time for both patients and providers
• Better communication between primary care doctors and specialists – notes can be electronically transmitted within minutes after a patient visit

While all of these features seem to potentially enhance the patient experience, Dr. Van De Graaf offers a few words of warning about EMRs that could potentially detract from the experience.

Disadvantages of EMR:

• Temptation to focus on the computer instead of the patient “This is the complaint I hear more than any other when it comes to patients’ experiences with our new system: My doctor spent the whole visit staring at the computer screen. The method that works best for me is to build my note before and after I see the patient and to never access the computer in the exam room, an approach that allows me to devote my entire attention to the patient during their visit,” says Dr. Van De Graaf.
• Stilted, mechanical language that is sometimes difficult to interpret – nuances of patient documentation could get lost in a chart where most of the information comes from pick-lists and check-boxes.
• Takes too much time – voice recognition systems can be fraught with errors, and Dr. Van De Graaf says the current generation of EMR software is nowhere as quick as a Dictaphone.
• Information overload – when all medical information is distilled to a database it can be difficult to discern what is truly important from what is trivial. In order to bill for the visit the doctor has to select a diagnosis from a list of approved terms, rather than simply describing a symptom. Thus, simple aches and pains mentioned in passing become diagnoses that stick with the patient (a stiff knee becomes degenerative joint disease, a cough becomes bronchitis, constipation becomes irritable bowel syndrome).
• A great deal of emphasis on using the computer as the intermediary in the course of clinical communication – Before EMR, if a patient called with a question, a nurse would take down the details and call the doctor for a response.  Now, the patient’s question gets sent to a “tasking in-box” where it will languish along with dozens of lab and x-ray results until the doctor logs on to a computer to address them, which can be tough in the course of a busy day.

Dr. Van De Graaf also refutes early government claims that global adoption of EMR would decrease errors and thereby save the US healthcare system $80 billion. “My personal opinion is that this is nothing more than wishful thinking as I have yet to come across a situation where my computer has saved me from committing an error in the course of patient care.”

Despite its pitfalls, in the end, Dr. Van De Graaf’s overall opinion of EMR is positive.  “I like being able to provide my patient a note as they walk out the door; I appreciate having full access to their history when I see them in the ER in the middle of the night; I love having a list of all their prior procedures and surgeries at my fingertips; and, most of all, I value the legibility of Times New Roman over Doctor Scrawl Italic.”

As a patient, the move to EMR seems great.  I appreciate Dr. Van De Graaf’s inside look and balanced opinion as a physician who has been using the system. How is EMR working in your organization?

Cardiovascular Update: Exercise is the Fountain of Youth

If exercise can keep mice from becoming prematurely gray, imagine what it can do for heart patients.

It’s no secret that physical activity is beneficial in countless ways, but new research published last week in The Proceedings of the National Academy of Sciences, says exercise reduced or eliminated almost every detrimental effect of aging in mice that had been genetically programmed to grow old at an accelerated pace.

In the experiment, lab rodents that carry a genetic mutation affecting how well their bodies repair malfunctioning mitochondria were studied.  Mitochondria are tiny organelles within cells that combine oxygen and nutrients to create fuel for the cells.

Many scientists consider the loss of healthy mitochondria to be an important underlying cause of aging in mammals.

The mice in the study lacked the primary mitochondrial repair mechanism, so they became extremely frail and decrepit early in their lives.  All were dead before reaching a year of age.

Except the mice that exercised.

Half of the mice were allowed to run on a wheel for 45 minutes three times a week, beginning at three months. At eight months, when their sedentary lab mates were bald, frail and dying, the running rats remained youthful.

• They had full pelts of dark fur, no salt-and-pepper shadings.
• They also maintained almost all of their muscle mass and brain volume.
• Their hearts were normal. They could balance on narrow rods, the showoffs.
• Most remarkable, even though they still had the mutation that should have affected mitochondrial repair, they had more mitochondria over all and far fewer with mutations than the sedentary mice.

The researchers said they were surprised by the magnitude of the impact that exercise had on the animals’ aging process.  Intuitively, one would expect that exercise would affect mitochondrial health in muscles, including the heart, since past research had shown a connection. However, they had not expected that it would affect every tissue and bodily system studied.

Very interesting and certainly more incentive to practice what we preach to patients.

Heart-Healthy Muffins for Cardiovascular Marketers

Here’s more proof that healthy food can still taste good.

Heart patients say it’s an ongoing challenge to find healthy recipes that satisfy cravings.  Most moms I know say the same thing.

I’m home with a sick kid today, so it’s a subject that’s top of mind for me.  I thought I’d share a recipe I found that will be part of the healing regimen.

Click here to find out how to make yummy steel-cut oatmeal and blueberry muffins.   I love it – they’re loaded with whole grains and antioxidants, but my son will think he’s eating a cupcake.