Mary and I are doing the JDRF walk this morning in Gulfport. If you would like to donate to our team, cleverly called "Live-abetes," please click this link and follow the instructions. I will have a blog post about the event next week!
Thank you for the support. God bless!
Saturday, May 18, 2013
Thursday, March 14, 2013
Mississippi Healthcare at a Crossroads
I'm not from Mississippi, but I love Mississippi. A lot. I was brought to the state after college via a service-through-teaching program that placed me on the Mississippi Gulf Coast. I met my wife, who was born and raised in Mississippi, and we plan to live, work, and eventually retire in this state. Next Fall, I will begin medical school at the University of Mississippi Medical Center in Jackson. It is here, in the capital city, where a debate over medicaid expansion and the future of healthcare and medicine in Mississippi is currently being waged.
Mississippi is hardly a picture of perfect health. To the chagrin of most citizens, Mississippi often finds itself in the worst position of most important state rankings. A 2011 analysis of obesity in the United States conducted by The Heart Forum determined the adult obesity rate in Mississippi to be 34.9%, which earned it the distinction of being the fattest state in the union. This rate is expected to grow to 66.7% by 2030. Keep in mind that these statistics only describe the portion of the population that is obese and do not account for people who are merely "overweight." This means that it is quite possible that less than 10% of the population could be persons at a normal weight by 2030, which is absolutely frightening. Along with obesity comes a myriad of expensive health issues - metabolic syndrome, type 2 diabetes, heart disease, and cancer.
According to the Kaiser Family Foundation, an estimated 442,900 of the state's 3 million citizens are uninsured. Many uninsured persons are members of the working poor class. They hold jobs that do not offer health insurance and earn too little money to pay for health insurance on the open market. Moreover, they often do not qualify for medicaid because they make too much money.
To top it off, the Mississippi health delivery system is facing a severe doctor shortage - both primary care and specialties - particularly in rural areas of the state.
The general state of Mississippi healthcare can be easily summed up as follows: we're fat and we lack access to health insurance and healthcare. Unless something changes soon, Mississippi will face an all out health crisis within the next couple decades. The state is truly at a healthcare crossroads.
Fixing the Doctor Shortage
In October 2012, Mississippi Governor Phil Bryant announced a $10 million community block grant from the Mississippi Development Authority in order to expand the school of medicine and add 1,000 physicians to the workforce. These funds will go towards expanding the medical school size (currently 135 students) and the number of residency positions. According to a report commissioned by Bryant and conducted by the Mississippi Economic Council, each doctor in a rural area has a $2 million economic impact on the community. In other words, investing in more physicians pays back dividends.
Plans to increase the number of physicians should be commended. But, should the state also find ways increase access to healthcare?
Medicaid Expansion
On March 23, 2010, President Obama signed into law the Affordable Care Act. Dubbed Obamacare, the law sought the expansion of health insurance coverage for millions of Americans, reform of the health insurance industry, and changes to many aspects of the current fee-for-service reimbursement scheme. Under the law, states have an incentive to expand medicaid coverage because the federal government will pay for 100% of the expansion from 2014-2017, and then 90% of the program costs after that. For every $1 that Mississippi spends on expansion, the federal government will pay $14. On the surface, this appears to be "free" money, but in the words of the late economist Milton Friedman, there is no such thing as a free lunch. The expansion of state medicaid programs will be financed through large increases in federal taxes and fines on individuals who do not purchase health insurance as well as businesses who do not make health insurance available to employees.
Just what are the costs of expanding medicaid? A University Research Center study estimates that the state would spend $159.1 million more on medicaid in 2025 than it spends now. Moreover, the state can reasonably expect to generate $63.3 million in revenue; thus, leading to a loss of $95.8 million.
Some experts believe that the costs are overestimated. Retired state health officer Dr. Alton Cobb believes expanding medicaid will increase visits to primary care physicians and reduce the number of costly visits to ER. Mississippi currently ranks 7th in per-capita ER visits. From my own experience, I tend to agree with Dr. Cobb. Too many people go to the ER for ailments that could have easily been treated by primary care physicians at a considerably lower cost. Most trips to the ER result in a plethora of tests - urine tests, blood tests, CT scans, and x-rays - many unnecessary but performed out of fear of litigation. Expanding medicaid could curb such visits. In addition, retired state economist Phil Pepper believes expansion would create 9,000 new jobs in the health sector. Of course, this would mean that if medicaid expansion were to be undertaken, it would be nearly impossible to reverse for fear of job loss and devastating economic consequences.
Who supports medicaid expansion? Hospital administrators. Currently, hospitals that treat uninsured patients receive money from the federal government to offset costs. Mississippi hospitals will lose millions of federal dollars if the state does not choose to expand medicaid. Moreover, hospital CEOs claim they will be forced to lay off employees and reduce the supply of healthcare due to funding cuts. According to Evan Dillard, CEO of Forrest General Hospital, "It's ludicrous for the poorest state in the country ... not to do expansion." Some Democrat and Republican lawmakers support expansion as well. If the state chooses not to expand, its citizens will be paying to expand medicaid in other states through federal taxes. They claim that they do not support the Affordable Care Act, but must act in accordance with the law of the land.
Who is against medicaid expansion? Primarily Republican politicians who fear the high cost of expansion and political repercussions for appearing to support Obamacare. Governor Phil Bryant has said that he will not support medicaid expansion. His position was bolstered last week when a poll showed that 76% of registered Republicans are against expansion even though only 13% claimed to be knowledgable on the issue. Bryant's two arguments against expansion are 1) the federal government will not actually end up paying as much as it says it will because it cannot afford it and 2) the medicaid system is currently replete with waste and fraud. Both arguments are sound, but does that mean the state should do nothing at all?
The Crossroads
The choice confronting Mississippi lawmakers will have a profound impact on the health, wellness, and economy of the state. If the state chooses not to expand, there will still be individuals who lack health insurance but need healthcare. They are not going away. Expansion could potentially curb overall healthcare costs by providing access to primary health care for thousands of people who need it. Moreover, expansion could be considered an economic investment as healthy people are more productive workers, more likely to work and pay taxes. If supplying a single physician in a rural area has a $2 million economic impact, what economic impact does making healthcare more accessible ultimately have? Even if lawmakers choose not to expand, they should find ways to make the system more efficient so that the dollars can be better spent. Choosing to keep the status quo would be the most devastating outcome. It will be interesting to see which road the state chooses to travel.
Mississippi is hardly a picture of perfect health. To the chagrin of most citizens, Mississippi often finds itself in the worst position of most important state rankings. A 2011 analysis of obesity in the United States conducted by The Heart Forum determined the adult obesity rate in Mississippi to be 34.9%, which earned it the distinction of being the fattest state in the union. This rate is expected to grow to 66.7% by 2030. Keep in mind that these statistics only describe the portion of the population that is obese and do not account for people who are merely "overweight." This means that it is quite possible that less than 10% of the population could be persons at a normal weight by 2030, which is absolutely frightening. Along with obesity comes a myriad of expensive health issues - metabolic syndrome, type 2 diabetes, heart disease, and cancer.
According to the Kaiser Family Foundation, an estimated 442,900 of the state's 3 million citizens are uninsured. Many uninsured persons are members of the working poor class. They hold jobs that do not offer health insurance and earn too little money to pay for health insurance on the open market. Moreover, they often do not qualify for medicaid because they make too much money.
To top it off, the Mississippi health delivery system is facing a severe doctor shortage - both primary care and specialties - particularly in rural areas of the state.
The general state of Mississippi healthcare can be easily summed up as follows: we're fat and we lack access to health insurance and healthcare. Unless something changes soon, Mississippi will face an all out health crisis within the next couple decades. The state is truly at a healthcare crossroads.
Fixing the Doctor Shortage
 |
| Governor Phil Bryant |
Plans to increase the number of physicians should be commended. But, should the state also find ways increase access to healthcare?
Medicaid Expansion
On March 23, 2010, President Obama signed into law the Affordable Care Act. Dubbed Obamacare, the law sought the expansion of health insurance coverage for millions of Americans, reform of the health insurance industry, and changes to many aspects of the current fee-for-service reimbursement scheme. Under the law, states have an incentive to expand medicaid coverage because the federal government will pay for 100% of the expansion from 2014-2017, and then 90% of the program costs after that. For every $1 that Mississippi spends on expansion, the federal government will pay $14. On the surface, this appears to be "free" money, but in the words of the late economist Milton Friedman, there is no such thing as a free lunch. The expansion of state medicaid programs will be financed through large increases in federal taxes and fines on individuals who do not purchase health insurance as well as businesses who do not make health insurance available to employees.
Just what are the costs of expanding medicaid? A University Research Center study estimates that the state would spend $159.1 million more on medicaid in 2025 than it spends now. Moreover, the state can reasonably expect to generate $63.3 million in revenue; thus, leading to a loss of $95.8 million.
Some experts believe that the costs are overestimated. Retired state health officer Dr. Alton Cobb believes expanding medicaid will increase visits to primary care physicians and reduce the number of costly visits to ER. Mississippi currently ranks 7th in per-capita ER visits. From my own experience, I tend to agree with Dr. Cobb. Too many people go to the ER for ailments that could have easily been treated by primary care physicians at a considerably lower cost. Most trips to the ER result in a plethora of tests - urine tests, blood tests, CT scans, and x-rays - many unnecessary but performed out of fear of litigation. Expanding medicaid could curb such visits. In addition, retired state economist Phil Pepper believes expansion would create 9,000 new jobs in the health sector. Of course, this would mean that if medicaid expansion were to be undertaken, it would be nearly impossible to reverse for fear of job loss and devastating economic consequences.
 |
| CEO Evan Dillard |
Who is against medicaid expansion? Primarily Republican politicians who fear the high cost of expansion and political repercussions for appearing to support Obamacare. Governor Phil Bryant has said that he will not support medicaid expansion. His position was bolstered last week when a poll showed that 76% of registered Republicans are against expansion even though only 13% claimed to be knowledgable on the issue. Bryant's two arguments against expansion are 1) the federal government will not actually end up paying as much as it says it will because it cannot afford it and 2) the medicaid system is currently replete with waste and fraud. Both arguments are sound, but does that mean the state should do nothing at all?
The Crossroads
The choice confronting Mississippi lawmakers will have a profound impact on the health, wellness, and economy of the state. If the state chooses not to expand, there will still be individuals who lack health insurance but need healthcare. They are not going away. Expansion could potentially curb overall healthcare costs by providing access to primary health care for thousands of people who need it. Moreover, expansion could be considered an economic investment as healthy people are more productive workers, more likely to work and pay taxes. If supplying a single physician in a rural area has a $2 million economic impact, what economic impact does making healthcare more accessible ultimately have? Even if lawmakers choose not to expand, they should find ways to make the system more efficient so that the dollars can be better spent. Choosing to keep the status quo would be the most devastating outcome. It will be interesting to see which road the state chooses to travel.
Tuesday, March 12, 2013
Exercising with T1D
Exercising is such an integral part of maintaining good blood glucose levels. I consider it to be the second best way (insulin being the first) to keep my sugars under control. In fact, I like to do fairly rigorous 15-minute workouts if my blood glucose levels are a little high in order to bring it down. Even though exercise is so important, it can be difficult for persons with T1D to figure out how to manage blood glucose levels during exercise. For this reason, I decided to make a video that provides some helpful exercise management tips.
A few notes about the video:
- I always get my blood glucose levels into the 140-180 mg/dL range with an upward trend prior to exercising. It's not shown in this video, but my blood glucose was 145 mg/dL when I started working out.
- I use a pump and do not adjust basal rates during the work out.
- Checking blood glucose levels is the key! You have to know what's going on during before, during, and after working out.
- I do bolus entirely for the recovery drink. You might not have to!
- It has taken me a while to figure out the best exercise routine that works. What I do may or may not work best for you. Diabetes is an individual disease after all.
- I am not a doctor. Please consult a licensed physician before beginning an exercise routine!
I hope you enjoy the video!
Thursday, March 7, 2013
Adding Incentives to Your Management Plan
I have been very busy over the last month and half and have neglected my duties as a blogger! In addition to teaching nursing chemistry classes at Spring Hill College, I am currently working on a local mayoral campaign. It's been difficult to find time to write for the blog, but I promise to do better!
Around the holidays, my wife likes to torture me by leaving out fun-size holiday chocolates in a variety of locations in our home. As tasty as these treats can be, eating them can be a poor management decision because, let's be honest, you can't stop with just one! It's not just a momentary elevation in blood glucose levels that a person with diabetes should be worried about, however. Studies have demonstrated that the consumption of foods with sugar and/or high fructose corn syrup can increase LDL (bad) cholesterol. This is a topic that I have previously discussed on this blog.
So, is it ever ok to just indulge and enjoy these delicious chocolates? I say yes, but only if you have earned it through exercise. In his book Not Dead Yet, Phil Southerland explains that he began biking when he was young because he realized that if he biked long enough, he could have a snickers bar and his blood glucose levels would still stay in range. Like Mr. Southerland, I too have found that I can have a piece of chocolate (or two) without much impact on my blood glucose levels if I have engaged in 40+ minutes of cardiovascular exercise. This includes things like walking, jogging, cycling, swimming, playing tennis, shooting hoops, or raking leaves. Hopefully, for your sake, it's not raking leaves because if you're like me, you loathe that activity. More important, you can eat that piece of chocolate or few bites of cheesecake (not a fat, huge piece) because exercise helps raise HDL (good) cholesterol; thus, adding a layer of cardiovascular protection. Incentives can also prevent the occasional (or frequent) sugar binge because you can still eat the sweets you love in moderation. At the end of the day, good management is all about living a life of moderation.
I like having incentives in my management plan because it keeps me accountable. I enjoy having a few pieces of chocolate, and since it's something I want, I'm willing to do the work to earn it. Adding incentives to your management plan is easy. First, come up with a plan. My plan goes as follows: if I exercise for 30 minutes, then I can eat 1 piece of chocolate; If I exercise for 1 hour, then I get 2 pieces, and so on. Second, put your plan in writing and sign it. This makes you psychologically more likely to follow it. As long as you stick to your plan, you can enjoy the sweets you love guilt-free and still maintain good control!
Around the holidays, my wife likes to torture me by leaving out fun-size holiday chocolates in a variety of locations in our home. As tasty as these treats can be, eating them can be a poor management decision because, let's be honest, you can't stop with just one! It's not just a momentary elevation in blood glucose levels that a person with diabetes should be worried about, however. Studies have demonstrated that the consumption of foods with sugar and/or high fructose corn syrup can increase LDL (bad) cholesterol. This is a topic that I have previously discussed on this blog.
 |
The Nutcracker dolls closely
guard fun-size chocolate
pieces in our home.
|
I like having incentives in my management plan because it keeps me accountable. I enjoy having a few pieces of chocolate, and since it's something I want, I'm willing to do the work to earn it. Adding incentives to your management plan is easy. First, come up with a plan. My plan goes as follows: if I exercise for 30 minutes, then I can eat 1 piece of chocolate; If I exercise for 1 hour, then I get 2 pieces, and so on. Second, put your plan in writing and sign it. This makes you psychologically more likely to follow it. As long as you stick to your plan, you can enjoy the sweets you love guilt-free and still maintain good control!
Thursday, January 10, 2013
Bon Appétit: Broccoli and Cauliflower Creole Pasta
The first dish that I want to share with you is broccoli and cauliflower creole pasta. The main spice used in the dish is Tony's creole seasoning, which is very popular along the Gulf Coast where we live. Tony's gives the dish a little kick and makes it very flavorful!
Below are the ingredients and a step-by-step list of how to prepare the dish.
Ingredients
 |
Broccoli and Cauliflower
Creole Paste |
- Whole grain thin spaghetti (1 serving size = 56g of dry pasta)
- Broccoli
- Cauliflower
- Extra Virgin Olive Oil
- Italian cheese
- Tony Chachere's Original Creole Seasoning
Directions
- Chop and wash broccoli and cauliflower. Steam it for approximately 12 minutes on medium heat.
- While steaming the vegetables, measure out the number of servings of pasta you want to cook. Bring water to a boil and cook the pasta for 6-7 minutes until al dente.
- Pour extra virgin olive oil on the cooked pasta and toss. Amount depends on how much pasta was cooked.
- Place pasta and vegetables in serving dishes. Sprinkle Italian cheese and *Tony's on the pasta.
- Serve!
Each serving of the dish has ~41 carbohydrates. I usually measure out 1.5 servings (84g of dry pasta) for myself when we make this dish. Whole grain pastas are higher in fiber and digest slower than white pastas. Therefore, I always use a 30 minute square wave bolus. I have found that I actually need to give a little less insulin for this dish than the number of carbs would suggest likely because of the fiber, but this might not be the case for everyone. My CGM always shows a very small spike over a 30 minute period for this meal and then a gradual decline to normal levels within 1.5-2 hours. Whole grain pasta is low on the glycemic index, which makes it a great choice for people with diabetes.
Bon appétit!
Friday, January 4, 2013
Exercise and BG Now - January 4 @ 6:15pm
 |
Heart-rate monitor (L) and BG
meter (R)
|
Just finished cycling. I was on the saddle for about 1 hour, burned 697 calories, and my blood glucose levels are currently at 157. I checked my blood sugar at 4pm and was sitting at 98. I ate half of a cliff bar and half of a banana and waited about 1 hour before hopping on the bike. 157 is a little higher than usual after an hour of cycling and the CGM shows me sitting steady, so I gave a small bolus (0.7 units) and am getting ready to eat dinner. I love cycling because once it comes back down into range, it'll be solid the rest of the night!
Thursday, January 3, 2013
My 2013 New Year's Resolutions
Well, we survived the Mayan apocalypse and, for the time being, a fiscal cliff has been averted, which can only mean one thing: 2013 is here, y’all! This year is
going to be full of new things as Mary and I move to Jackson, MS and I begin
medical school at the University of Mississippi Medical Center. In addition, we
are taking high school students to Ireland and Scotland in June. Though it may
be a bit cliché, I decided to write a post listing my top 5 New Year's
resolutions for 2013. Some are obviously serious and some are, well, not.
Regardless, here they are (drumroll please):
5. Be a good friend. I have a tendency to get busy with numerous side
projects and forget to call, email, text, etc. good friends from high school
and college. Our relationships with other people define us, and I know that I
need to be a better friend.
4. Determine whether or not there is a cure for Bieber Fever. If there
is, then surely they will teach us about it in medical school, right?
3. Continue to maintain a good HbA1c. This next year is going to be
replete with challenges – moving, traveling, medical school. All of these
events will pose their own unique management challenges for controlling my diabetes along the
way. I intend to use my own knowledge as well as the support of the DOC to
steady the ship and stay healthy.
2. Complete an ADA Ride for the Cure. I recently fell in love with
cycling. I have completed a few organized rides, though none of them have been
for a cause. My brother and I have talked about doing an ADA ride together, and
I want to make this happen!
1. Be the best diabetes advocate I can be. I’m
excited to move to Jackson, MS because the only JDRF and ADA offices in the state are located there. This seems a little outrageous considering the high rate of diabetes (mostly type 2) in the state. Nevertheless, I hope to volunteer at a few events and
connect with other people who are affected by diabetes.
Well,
there you go, my 5 resolutions for 2013. What resolutions do you have for the
new year?
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