Medical Use Of IPod To Detect Heart Problems

Recent research has shown doctors can use iPods to greatly improve their stethoscope skills and their ability to diagnose heart problems.

Previous research has shown the average rate of correct heart sound identification by physicians is 40 percent.

In a new study, 149 general internists listened 400 times to five common heart murmurs during a 90-minute session with iPods. After the session, the average score improved to 80 percent.

Stethoscope proficiency -- and the ability to recognize abnormal heart sounds -- is a crucial skill for identifying dangerous heart conditions and minimizing dependence on expensive medical tests, said lead researcher Dr. Michael Barrett, clinical associate professor of medicine and cardiologist at Temple University School of Medicine and Hospital.

"It's important to know when to order a costly echocardiogram or stress test," Barrett said.

Barrett believes the best way of learning to identify heart problems is through intensive drilling and repetition, not by traditional methods, usually a classroom lecture or demonstration in medical school and then on the job.

"You don't build this proficiency by osmosis," Barrett said.

He presented the findings Monday at the American College of Cardiology's annual meeting.

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Women - Take Some Aspirin To Stay Alive

Women who take low to moderate doses of aspirin have a reduced risk of death from any cause, especially heart disease-related deaths, according to a new study published on Monday.

Researchers at the Massachusetts General Hospital and Harvard Medical School in Boston examined the association between aspirin use and death in 79,439 women enrolled in the study.

Beginning in 1980 and again every two years through 2004, the women were asked if they used aspirin regularly, and if so, how many tablets they typically took per week. At the beginning of the study, the women had no history of cardiovascular disease or cancer.

The study reported that a total of 45,305 women did not use aspirin; 29,132 took low to moderate doses (one to 14 standard 325-milligram tablets of aspirin per week); and 5,002 took more than 14 tablets per week.

By June 1, 2004, 9,477 of the women had died, 1,991 of heart disease and 4,469 of cancer. Women who reported using aspirin currently had a 25 percent lower risk of death from any cause than women who never used aspirin regularly.

The association was stronger for death from cardiovascular disease (women who used aspirin had a 38 percent lower risk) than for death from cancer (women who used aspirin had a 12 percent lower risk), according to the study published in the March 26 issue of Archives of Internal Medicine.

"Use of aspirin for one to five years was associated with significant reductions in cardiovascular mortality," said the study.

"In contrast, a significant reduction in risk of cancer deaths was not observed until after 10 years of aspirin use. The benefit associated with aspirin was confined to low and moderate doses and was significantly greater in older participants and those with more cardiac risk factors."

There are several mechanisms by which aspirin could reduce the risk of death, the authors note. "Aspirin therapy may influence cardiovascular disease and cancer through its effect on common pathogenic pathways such as inflammation, insulin resistance, oxidative stress [damage to the cells caused by oxygen exposure] and cyclo-oxygenase (COX) enzyme activity," also linked to inflammation, according to the study.

Because the study looked at women who made the decision themselves whether or not to take aspirin, as opposed to a clinical trial where women are randomly assigned to aspirin or a placebo, the results do not suggest that all women should take aspirin.

"Nevertheless, these data support a need for continued investigation of the use of aspirin for chronic disease prevention," the study concluded.

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6 Importance Of Exercising During Pregnancy

While exercises are good for your health, exercising during pregnancy can brings added benefits. Generally, exercise should be light, especially during the first few weeks of pregnancy while your body adjusts to the changes. Heavy exercise can divert blood flow from crucial areas and most women that exercise regularly should tone down their workouts during pregnancy.

Walking, swimming, and yoga are two popular exercise activities suitable for pregnant women. Other forms of exercise like weight lifting are okay too as long as it is not too strenuous. Most experts recommend exercising 3-4 times a week, unless a medical condition prevents it. If in doubt, always consult a physician first. Listed below are some of the top reasons for exercising during pregnancy.

1. Exercise can reduce the length of labor and reduce recovery times. The right exercise routines will increase stamina needed for delivery.

2. Improve emotional health - exercise lowers stress and improves emotional health and can make it easier for the new mother to get through the experience of pregnancy.

3. Exercise can help with weight management after the child is born. A common concern with most mothers is losing weight after pregnancy. Exercising during pregnancy can make postpartum weight loss easier.

4. Exercise is good for your unborn baby. By keeping your body healthy, you are also helping out your baby.

5. Reduced pregnancy side effects - Symptoms like headaches, fatigue, swelling, and constipation are common in pregnant women. Exercising has been shown to reduce the occurence of these symptoms.

6. Decrease risk of premature birth - exercise has been shown in studies to decrease the risk of premature birth by about 50%.

Make sure to drink plenty of fluids before exercising, have a nutritious diet, and avoid over exertion. Also, listen to your body - if you start feeling sick or nauseous, then you should stop and rest.

Some have tried "The Look Good, Feel Great" Pregnancy Kit and have had some very positive experiences.

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7 Foods That Boost Your Immune System

Lisa Mosing,
MS, RD, FADA, LifeScript Director of Nutrition

To make it through cold and flu season unscathed, your immune system needs to be strong enough to fight off germs and viruses lurking, well, everywhere. Eating nutrient-rich foods is a great way to keep your family healthy. But with tight schedules, many of us eat on the run and sacrifice good nutrition, which can undermine the health boost that a normally nutritious diet offers…

Even at the edge of springtime, colds and flu can sneak up on you and your loved ones. More than 200 viruses can cause cold symptoms. That’s a lot of bugs to fend off. Luckily, eating healthfully may be just the immune-system booster you need to ward off illness.

A healthy immune system is a defense against pathogens, such as viruses, bacteria, and carcinogens that can make you ill. Immune cells are found throughout your body – in your tonsils, lymph nodes, spleen, thymus gland, and bone marrow. By focusing on nutrient-rich foods instead of high-calorie foods like cookies and ice cream, you and your family can ward off illness.

1. Go Fishing
For a stronger immune system, nutritionists suggest consuming at least two servings a week of fatty seafood, such as sardines, salmon, herring, and mackerel. The omega-3 fatty acids in these fish and in other foods such as walnuts, flaxseed, and canola oil are known to boost the immune system and reduce inflammation in the body by increasing the activity of while blood cells called macrophages, which engulf troublesome bacteria. Monounsaturated fats in foods such as olive oil and wheat germ also protect our bodies from microorganisms, bacteria and viruses. In fact, researchers have found that diets low in fat weaken the immune system and increase depression.

2. Pick Protein
Zinc, a mineral abundant in meats like calf’s liver, beef and lamb, works with protein found in meat to help to strengthen the immune system. (Vegetarians can get their zinc from whole grains and fortified breakfast cereals.) In fact, certain types of immune cells, including white blood cells, cannot function without zinc. Other proteins that can help reinforce your body’s defense system include chicken, fish, tofu, eggs and dairy foods.

3. Reach for Plant Foods
By serving your family a variety of fruits and vegetables at meals and for snacks, you ensure that their bodies get plenty of phytonutrients. These compounds help boost your immune system, strengthen your heart and blood vessels, and even fight some cancers. In the winter months, most markets offer a wonderful array of fresh choices, from winter squashes, greens and root vegetables to cranberries. And you can always reach for canned and frozen fruits and vegetables. Processed just after harvest, canned and frozen produce can actually sometimes have more nutrients than produce that has spent days in transit.

4. Don’t Skimp on Citrus
Go ahead and indulge in leafy greens, bell peppers and citrus fruits like oranges and grapefruit, all rich in vitamin C. This vitamin inactivates histamine, the substance responsible for your runny nose and congestion, and helps reduce the inflammation that accompanies colds and viruses. In fact, according to a study at the University of California at Berkeley of 160 healthy adults, those who took 500 milligrams of vitamin C a day for two months had a 24% drop in C-reactive protein, a protein associated with inflammation and chronic disease. Brightly colored greens and other vegetables also contain large doses of immune-enhancing antioxidants that help fight wintertime illnesses. So, load up on strawberries, cantaloupe, blueberries, tomatoes, broccoli, and sweet potatoes – all a boon for your immune system. To make winter and spring vegetables more appealing, consider adding some to soups, stews and sauces. And down a glass of low-sodium tomato or vegetable juice now and then – they’re both great sources of vitamin C.

5. Go Nuts
Instead of chips or cheese doodles for an afternoon snack, reach for a handful of nuts or seeds. Studies show vitamin E, a powerful antioxidant, fights respiratory infections, including colds. It boosts the responses of antibodies and certain immune system cells when we’re under stress – and who isn’t? A quarter cup of sunflower seeds has almost all the vitamin E you need daily. A quarter cup of almonds provides 50% of your need. And Brazil nuts pack a whopping dose of selenium, a mineral that also boosts wintertime defenses.

6. Hit the Spice Rack
Both garlic and onions contain compounds that rev up the activity of immune-system cells called natural killer cells and T-helper cells. While they’re fending off colds, they’re also helping defend us from cancer and heart disease – not a bad side activity at all. If a cold does catch you and you get stuffy, a bite of garlic will also help clear your nose (not to mention the room).

7. Spoon in the Yogurt
In a year-long study at the University of California, adults who ate three-fourths cup of yogurt a day had 25% fewer colds that those who didn’t. The yogurt cranked up the production of a substance called gamma interferon, which helps squelch virus reproduction, a death knell for your cold.

Dehydration can also lower your defenses. Drink at least eight 8-ounce glasses of water and other fluids every day. And if you’re already sick, double that.

Now you know what to eat. But what foods should you avoid?

Skip Sugar and Fat
Even as little as two sugary sodas a day can lower the power of your cold-busting immune cells by 40%. And animal studies have shown that diets high in both sugar and fat reduce the numbers of natural killer cells.

For a healthy immune system, health experts also encourage reaching a healthy weight, taking a multivitamin that provides essential minerals (like zinc and selenium), exercising 30 to 60 minutes most days, and sleeping at least eight hours every night.

Are You a Health Food Nut?
Lentils. Fish. Nuts. You know health food is good for you, but that doesn't necessarily make a bland block of tofu any more appealing. Experts insist that health food is essential to your diet, but do you know why? Test your knowledge on healthy fare - from garlic to green tea - with this health food quiz.

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Basic Facts About Child Sexual Abuse

THERE IS NO SUCH THING AS A "TYPICAL" CHILD MOLESTER. Most molesters appear normal, hold responsible positions within the community, and are generally regarded as "model" citizens.

Nearly 85% of molesters are someone the child knows, loves, or trusts.

Current studies indicate that:
# 1 in 3 girls and 1 in 6 boys will be sexually abused before age 18.
approximately 14% of child molesters are female; approximately 86% are male.

# child sexual abuse occurs in all racial, ethnic, economic, and religious groups.

INCEST between parent or parent-figure and child or between siblings is the most prevalent and most harmful form of child sexual abuse.

Bribes, threats, affection, coercion, and/or manipulation are COMMON STRATEGIES used by abusers, rather than physical force, to sexually abuse children and to prevent them from revealing the abuse.

INDIVIDUALS WHO SEXUALLY ABUSE CHILDREN MAKE A CONSCIOUS CHOICE TO DO SO. The blame for the abuse belongs solely with the abuser, NOT THE CHILD. Child sexual abuse THRIVES ON SECRECY; therefore, if you know of, or suspect, the sexual abuse of a child, take IMMEDIATE steps to stop the abuse and protect the child. Since most abusers are REPEAT OFFENDERS, the reporting of an incident of child sexual abuse may help prevent other children from being victimized.

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Is Penis Enlargement For You?

Ramone Johnson

Penis size is a sensitive issue for many men, including gay men; and penis enlargement is a big business. But, before you try the numerous products on the market promising to make your penis bigger, know the facts and beware of false techniques.

What is the average penis size?

The average penis is five to seven inches (127 to 178 mm) long when erect (measured from the tip of the penis head to the abdomen). Read The Truth About Penis Size for more penis facts and myths.

What are the common penis enlargement techniques?

• Vacuum Pumps
  Vacuum pumps promise to increase the size of the penis by forcing blood into the penile shaft through suction. This method may sound reasonable and easy to perform, but it can result in loss of feeling, impotence and damaged blood vessels.


• Medication and Pills
  Always beware of advertised miracle pills, especially ones that promise to make your penis bigger. Since there is no FDA-approved medication for penis enhancement, advertised penis enlargement pills are not regulated. As a result, there is no guarantee as to what ingredients or medications the supposed penis enhancement pill contains. These meds can pose serious health risks. Not to mention, the pill may be a placebo.


• Hanging Weights
  Some believe penis enhancement can be achieved by hanging weights from the tip of the penis repeatedly over time. This is perhaps the oldest method of enhancement, but there is no scientific basis and any enlargement that was actually achieved happened over years. Hanging weights may increase the length of a flaccid penis over time, but they do not increase thickness. Weights can also result in stretch marks, lesions and decreased sensation in the penis.


• Surgery
  There is a surgical procedure that involves cutting the suspensory ligament (which elongates your penis), but due to safety risks most doctors are not willing to perform this procedure. And, of course, no surgical procedure should ever be performed at home or without a qualified medical professional.


• Exercises
  Like weight training programs, penis enhancement exercise methods promise that the penis can be made bigger through strength training and conditioning. However, this myth can also be busted. There are no muscles in the penis and therefore strength training and exercise cannot increase its size.

Why penis enlargement techniques do not work:

Many programs and products claim to have found the one true secret to a bigger penis. Potential clients should take caution, however, because there is no scientifically proven method of increasing your penis size without risk. Any by "scientific" I don't mean a team of infomercial professionals, but a regulated, licensed and controlled body of research, like the Federal Food and Drug Administration.

Don't sacrifice sensation or permanent damage for a false promise of size enhancement. By attempting to increase your penis size, you run the risk of losing sensation in your peripheral nerves (making it more difficult to ejaculate), impotence, scarring, lesions or other permanent damage. Few advertised penis enlargement products or processes are open about potential side affects or permanent damage.

Don't confuse swelling and irritation for size enhancement, either. Most techniques can cause irritation to the penis, which can result in temporary swelling- eventually leading to permanent damage.

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The Bitter Side Of Blood Transfusion

For weeks now, Kanat Alseidov has been sitting only a few feet from the doctor who is on trial for prescribing a blood transfusion for his 2-year-old son, who had pneumonia.

Two months after receiving the transfusion, Alseidov's son, a ruddy, playful boy named Baurzhan who plays constantly with his twin sister, tested positive for HIV, the virus that causes AIDS.

"I couldn't understand why the doctor said my son needed a blood transfusion or he would get worse," Alseidov said.

Baurzhan's exposure to HIV was only the beginning of an epidemic that has engulfed Shymkent, an industrial, car-choked city along the Uzbekistan border. Since last summer, 93 children who were treated at a children's hospital in Shymkent have tested positive for HIV.

And as the trial has progressed, a possible reason why the doctor prescribed a blood transfusion to treat pneumonia has become increasingly clear: The parents of HIV-infected children in Shymkent allege that doctors charged each patient $20 for 415 cubic centimeters, or 14 ounces, of blood, splitting the proceeds with the local blood bank. A profit of as much as $10 on every transfusion may not sound like much, but it is a considerable amount in a country where doctors' salaries begin at $175 a month.

Many doctors and patients in Russia and Eastern Europe, Central Asia and parts of China and India believe that infusions of fresh blood can fortify a healthy body and remedy diseases that are not blood related, Western doctors with extensive experience in the region say. While pervasive corruption encourages many unnecessary transfusions, patients also frequently demand transfusions, which they associate with modern health care.

As a result, Western health experts say, local doctors prescribe tens of millions of unnecessary transfusions throughout the developing world, putting people at heightened risk of contracting AIDS or other diseases transmitted in the blood.

"It's dumb medicine," Max Essex, chairman of the Harvard AIDS initiative and professor at the Harvard School of Public Health in Boston, said in a telephone interview. He said that a measure taken in the United States in the late 1980s, "even after HIV blood tests were available was to drastically cut down the number of blood transfusions given."

"In that region of Asia," he said, "there has been a tremendous expansion of the HIV epidemic. Even if they were doing the state of the art testing there is big danger in overusing blood transfusions."

All of these factors seem to have converged on the children of Shymkent. One 8-month-old boy received 25 unnecessary blood transfusions, according to court documents. The boy's transfusion regime was halted only last summer when he was diagnosed with HIV.

The situation in Shymkent raises echoes of another noteworthy legal case involving the spread of HIV through tainted blood: Five Bulgarian nurses and a Palestinian doctor have twice been sentenced to death in Libya after being judged guilty of infecting more than 400 children. The case has dragged on for nearly eight years.

Speaking about the transfusions in Shymkent, Michael Favorov, an epidemiologist and Central Asia program director for the Centers for Disease Control and Prevention, based in Atlanta, said simply: "It's insane."

Favorov headed an extensive medical investigation by the agency, which identified transfusions of tainted blood as the source of the Shymkent outbreak. "This kid needed no blood," he said, referring to Baurzhan Alseidov.

Kanat Alseidov, the father, said that doctors had told him that no family member could provide the blood, so he went to a private blood bank. He said he had been told at the blood bank that the doctor would receive half the $20 price for the blood.

"Our hospitals are like a factory line," Alseidov said. "The doctors sometimes take not even $10 but they make their money from volume."

Doctors say that their low wages force them to search for ways to generate additional revenue. "Salaries are very low and even increases don't make a difference because of inflation," said Amangeldy Shopaer, deputy chief physician at the Shymkent Infectious Diseases Hospital, where the infected children have received treatment.

Families of the infected say government neglect has compounded their predicament. They say health officials have refused to regulate blood banks or police doctors who routinely prescribed blood transfusions to make a profit. "It's not popular to blame the government but the evidence is clear," said Alseidov, the father of the child who originally had pneumonia. "Veins are not garbage bins."

Families of HIV-infected children are often forced to move to seek anonymity after being ostracized by friends and neighbors. More than half the fathers of HIV-positive children have left their families, according to members of the families attending the trial.

Despite the detailed study by the U.S. agency, Shopaer maintained that the cause for the outbreak remained "not concretely known" and defended the practice of ordering blood transfusions for illnesses unrelated to the blood, including pneumonia. "In some cases it is required. It depends on what kind of pneumonia."

Frequent blood transfusions put people in developing countries especially at risk because of galloping rates of HIV infection.

The biggest HIV epidemic in the region is in neighboring Uzbekistan, which straddles major drug-trafficking routes and where the number of reported HIV cases has more than doubled since 2001 to 31,000, according to the World Health Organization. Kazakhstan may have three times its officially stated number of 7,000 HIV cases, according to the most recent statistics compiled by Unicef.

The Kazakhstan government has responded to the outbreak by firing the health minister and breaking ground on a planned pediatric AIDS facility in downtown Shymkent.

Small outbreaks continue to haunt the developing world, however, especially the former Soviet Union, where corruption in the medical system is rampant and belief in the remedial powers of new blood runs deep. Russia alone has reported more than 200 outbreaks of HIV associated with unnecessary blood transfusions.

"We have been screaming and yelling since 2002, but there is limited funding to address the problems," Favorov said, adding: "Unfortunately before you see the thunderstorm" nobody wants to open an umbrella.

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Reduce Infant Death Rate Using Pacifiers

A recent study suggests that the use of a pacifier in infants below one year of age is associated with a 90 percent reduction in sudden infant death syndrome or SIDS. SIDS is any sudden and unexplained death of an apparently healthy infant aged one-month to one year.

A pacifier is a rubber, plastic, or silicone nipple given to an infant or other young child to suck upon. According to an article in Nursing for Women's Health, recommendations from the American Academy of Pediatrics' (AAP) Task Force on SIDS, suggests that medical practitioners should give adequate knowledge to new parents on the potential benefits of using a pacifier.

AAP also encouraged pacifier use for children less than 1 year old but parents should know how to use it safely and should discourage it's use before the age of one month in breastfed infants to avoid any hindrance in regular feeding habits.

Experts also added that infants should not be forced to take a pacifier once the infant falls asleep. It should also be replaces after short time and cleaned regularly. Additionally, professionally made pacifier is always better than homemade pacifiers with strings or cords that hang the pacifier around the neck of a child.

According to experts, the raised surface of the pacifier holds the infant's face away from the mattress, thus reducing the risk of suffocation.

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Lost Memory During Weight-Lose Surgery

A new U.S. study has found that obesity-reduction surgery such as gastric bypass and stomach binding can result in memory loss of a patient. The obesity surgery results in deficiency of vitamins that is the main cause of memory loss, confusion, co-ordination, and other neurological problems.

The study, which was published in the issue of Neurology, says that the memory loss can have serious consequences stemming from loss of names of people to many of them forgetting about their finances.

The condition is called Wernicke encephalopathy - a severe syndrome characterized by loss of short-term memory. It is linked to damage to the mammilla bodies in the brain, and is the result of inadequate intake or absorption of thiamine (Vitamin B1) coupled with continued carbohydrate ingestion. The most common cause of an onset is severe alcoholism, though there are several other causes including weight loss surgery.

The study also revealed that the problem is more common in people who vomit within one to three months after the surgery is done and recovery is still ongoing. It can however be controlled by a supplementary dose of thiamine immediately after the weight loss surgery.

Experts recommend taking a daily dose of Vitamin B1 to avoid its occurrence in more people in the future. If the condition is treated immediately after the surgery, the results are usually good.

Gastric bypass surgery makes the stomach smaller and allows food to bypass part of the small intestine. The patient feels full more quickly than the stomach was its original size, which reduces the amount of food he or she eats and thus the calories consumed. Bypassing part of the intestine also results in fewer calories being absorbed, which leads to weight loss.

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Care conflict over BC sextuplets sparks bloody row

Owen Dyer

It is written in the Book of Leviticus: "As for any man who eats any sort of blood, I shall certainly set my face against the soul that is eating the blood, and I shall indeed cut him off from among his people."

An injunction against cannibalism, perhaps? To most practising Christians, this is probably one of the lines in the Bible that is best skimmed over without too much analysis. But to Jehovah's Witnesses, it has become a central tenet of their faith — one that many are quite literally prepared to die for.

Or perhaps to let others die for. Coping with the unwillingness of Jehovah's Witnesses to accept blood transfusion has become an accepted feature of the doctor's job. In all western countries, the patient's right to refuse transfusion has been upheld again and again in the courts. But there remains the thorny problem of treating the children of Jehovah's Witnesses, especially premature neonates, who are very likely to need transfusion.

This quandary has landed on the doorstep of British Columbia's government in a big way, with the arrival of Canada's first known sextuplets, born prematurely to a family of Jehovah's Witnesses.

Before the birth, the parents had refused selective reduction, which would have terminated some fetuses to improve the chances of the others. All four boys and two girls were born weighing less than two pounds. Within a week two had died. Doctors at BC Children's and Women's hospitals insisted that the surviving infants needed transfusion, but the parents refused. The hospital then appealed to the provincial government to take the babies into protective custody, which it did. Two received transfusions. Almost nothing is known about their progress since, except that all four are still alive.

They are all now again in the legal custody of their parents, but the legal wrangle continues, with the anonymous parents accusing the government of not letting them present evidence to a court before going ahead with the transfusions. "We have been stripped of our parental rights and been labelled unfit," they say in their filing with the BC Supreme Court. Under a provision of the BC Child, Family and Community Service Act, the government may act before a scheduled hearing takes place, if it has reasonable grounds to believe a child's health is in danger.

Needless to say, the case generated a fine media storm, and put the church organization of Jehovah's Witnesses in Canada on the defensive. "It is important for the media and others to avoid making stereotypical assumptions regarding Jehovah's Witnesses," they said in a statement.

IT'S IN THE BLOOD
Jehovah's Witnesses are often painted as medical Luddites, but in fact they have no issues with most modern medical treatment — their objections are very tightly focused on blood products.

The Watch Tower Bible and Tract Society of Pennsylvania, based in Brooklyn, is the Jehovah's Witnesses' equivalent of the Vatican. It actually monitors medical developments rather closely, always on the lookout for ways to improve treatment of its members without breaching this fundamental ordinance.

The society has kept abreast of technologies like intraoperative blood salvage and isovolaemic haemodilution with autotransfusion, which recycle the patient's blood during surgery. As long as it remains in contact with their circulation, it's deemed acceptable. They've also moved to accept new minor blood fractions and substitutes as they've appeared. They also permit members to use vaccines, even though these are often made with albumin.

There's even a modern hospital which specializes in "blood avoidance" medicine for the children of Jehovah's Witnesses: Schneider Children's Hospital in New York. In fact Schneider provided the escape route last time British Columbia ran into a sticky ethics case. A 14-year-old Jehovah's Witness girl was required to undergo transfusion with her cancer therapy, and her refusal was overruled by the BC Supreme Court because she was a minor (see "BC teen ordered to get treatment despite religious objections" May 30, 2005 , Vol 2, No 10). (A similar case, involving a 15-year-old Winnipeg girl with Crohn's disease, has just concluded with the girl being forced to undergo transfusions.) The BC teen fled to Ontario, and was eventually treated at Schneider after that province negotiated a deal with her family.

Crossing the continent was evidently not feasible for four fragile neonates in incubators, however. What's more, the substitute therapies favoured by the church, such as recombinant human erythropoietin, are usually poorly suited to neonatal treatment. They often take time to work, and are usually treatments instituted when a patient has time to prepare for elective surgery.

This time, the doctors were insistent: transfusion was the only option. Under BC law, they had a duty to inform child protection workers if parents refused therapy they deemed essential to a child's health.

The basic assumptions of medical ethics as practised in Canada undoubtedly support the hospital's decision. University of Victoria bioethicist Eike-Henner Kluge summed up the position succinctly to the Globe and Mail: "While the parents are at liberty to make martyrs of themselves, their children are not."

But what about the parents? Jehovah's Witnesses are clearly willing to assume risk. Indeed, this is a church with 6.5 million "witnessing" members and perhaps another 10 million who attend services, yet whose doctrine preaches that only 144,000 elect will ascend to Heaven.

It's possible that the problem will go away on its own. The church is open to blood replacements, so a technical fix may be over the horizon. And the Watchtower Society may be softening its position. In 2000 it abandoned its long-held policy of "disfellowshipping" any member found to have accepted a blood transfusion. This essentially meant excommunication, and followed a formal investigation. There were even disturbing anecdotal reports of other Jehovah's Witnesses visiting hospital patients to check they were not transgressing.

Today, a Jehovah's Witness who accepts blood is held to have "disassociated" himself from the congregation. There is no investigative process, so if medical confidentiality is upheld, the patient can sneak a blood transfusion without being punished. The 2000 directive also made it clear that a member must take the blood "wilfully and without regret" to have broken a core tenet of the faith.

That would seem to leave the BC kids in the clear. It would also potentially open the door to transfusing unconscious adults. A 2003 survey of European doctors in the Postgraduate Medical Journal found that two-thirds would transfuse an unconscious Jehovah's Witness who was losing blood, and 41% said they would not tell the patient on awakening. God may see all our sins, but the Watchtower Society evidently does not.

The opinions expressed are those of the author and are not necessarily the views of the National Review of Medicine.

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Life-Saving Cancer Genetic Testing Grossly Neglected

A study released today at the Society of Gynecologic Oncologists 38th Annual Meeting on Women’s Cancer found few patients were aware of genetic cancer syndromes and the high risk of developing cancer if genetic mutations were found. Fewer still were motivated to follow up on this information with their own healthcare provider or genetic counseling/testing services.

Approximately 10 percent of all cancers have a strong hereditary component. The Society of Gynecologic Oncologists (SGO) estimates that more than 500,000 American women are at a high-risk of developing hereditary cancers, which include breast, ovarian, colon and uterine cancers. Two of the most common familial syndromes that cause gynecologic cancers are familial breast-ovarian cancer syndrome, and hereditary non-polyposis colorectal cancer syndrome (HNPCC), which confers a high risk for uterine and ovarian cancers, in addition to colon cancer.The study, “Cancer Risk Assessment in a Community Setting: Prevalence of Patients with High Risk Family Histories,” was led by Michael Manuel, M.D., M.P.H., a gynecologic oncologist in private practice in San Jose, Calif. Dr. Manuel conducted the study at the large community-based mammography center, Breast Care Center at Good Samaritan Hospital, also in San Jose.

“This study is important because these are real people in an average American community. The troubling aspect is that the high risk women we identified [through patient surveys] were unaware of their elevated risk for developing hereditary cancers,” said Dr. Manuel. “We need community education and resources to allow identification of women with strong family histories of cancer. Referral to genetic counselors for accurate risk assessment and genetic testing when appropriate can prevent cancer deaths. Women who carry mutations in cancer causing genes should undergo more intensive cancer screening and, in many cases, preventative surgery is advised.”

“Although genetic testing for gynecologic and other hereditary cancers has been available for over a decade, awareness of this potentially life-saving intervention is woefully inadequate among both physicians and the public,” said Andrew Berchuck, M.D., incoming president of SGO. “Women are needlessly dying of cancers that could have been prevented entirely or detected at an early stage while their disease was still curable. We have all of this great knowledge to help reduce cancer mortality in high-risk women, but most women are unaware of their personal risk and the available help.”

What Women Should Know About Hereditary Cancers

A clear understanding of a family’s history of cancer is vital to reducing deaths associated with hereditary cancers. There are many options available to women who are at risk of developing hereditary cancers including genetic counseling and testing, preventative surgery and screening programs. Women should discuss past and present personal and family history of cancer with their primary physicians and gynecologists on an annual basis. These doctors can help determine the potential risks, as well as the best modality of treatment or screening that could very well save a woman’s life.

Women should also take advantage of available resources such as the Women’s Cancer Network’s online cancer risk assessment at http://www.WCN.org. Developed by physicians who are gynecologic cancer experts, the assessment is free and confidential, providing a wealth of information on a woman’s potential risk for cancer.

Study Overview

This study assessed the prevalence of patients with a high-risk family history of cancer in a community setting. The cancer syndromes assessed included breast/ovarian, hereditary non-polyposis colorectal cancer (HNPCC) or Lynch syndrome, and p16/melanoma.

Approximately 10% of breast, ovarian, colon and uterine cancers are linked to known genetic mutations that confer a high risk of cancer throughout a family. Specifically, Breast Cancer (BRCA) 1 and 2 mutations increase a person’s lifetime risk of breast cancer to greater than 80% and ovarian cancer to 20 - 65%. Similarly, persons inheriting a mutation in one of the HNPCC genes (MLH1, MSH2, or MSH6) have a lifetime risk of colon cancer approaching 90% and uterine cancer risk of 40-70%. These individuals also have a 12% lifetime risk of ovarian cancer, as well as increased risks of stomach cancer. More recently, mutations in the p16 gene have been associated with increased risks of melanoma and pancreas cancer.

Surveys were handed out over a four-month period to all patients presenting for mammography services at a large, community-based mammography center. Interest in completing a family-history survey was high, resulting in 2,745 surveys collected. The surveys were divided into high or low risk categories.

Of the 2,745 surveys collected, there were a total of 313 (11.4%) patient family histories that indicated a substantial probability for a genetic mutation in BRCA, HNPCC, or p16/melanoma. Of the high-risk surveys, most were indicative of a possible BRCA mutation (88.4%), versus HNPCC (6.0%), p16/melanoma (3.8%), or more than one syndrome (1.5%). The total number of patients with a previous personal history of cancer who also met high-risk hereditary cancer criteria was 148 or 47.2% of the high-risk surveys.

Although 69.9% of patients indicated interest in follow-up to obtain more information, less than 3% of those found to be high risk had undergone genetic counseling/testing at the time of data collection/analysis.

While interest in completing this study was high, few patients were aware of these syndromes and the high risk of developing cancer if a genetic mutation is found. Fewer still sought genetic counseling or indicated an intention to seek genetic consultation. This study demonstrates a clear need for community education and outreach, as well as facilitated access to genetic counseling and/or testing services for high risk women and their families.

“Cancer Risk Assessment in a Community Setting: Prevalence of Patients with High Risk Family Histories,” was conducted by Dr. Manuel, Shannon Kieran, M.S., and James Lilja, M.D., from Bay Area Gynecologic Oncology practice, San Jose, Calif. The study would not have been possible without the support of the Breast Care Center at Good Samaritan Hospital, San Jose, Ca.; Mary Beattie, M.D. and Beth Crawford, University of California, San Francisco Cancer Risk Program; California Center for Healthcare and Biotechnology Foundation; and Myriad Genetics Laboratories.

The 2007 Annual Meeting on Women’s Cancer is the premier educational and scientific event for physicians and health care professionals involved in the field of gynecologic oncology and is being held March 3-7 at the Manchester Grand Hyatt in San Diego, California. For more information visit, http://www.sgo.org/meetings/2007Annual/media.cfm.

About SGO

The SGO is a national medical specialty organization of physicians who are trained in the comprehensive management of women with malignancies of the reproductive tract. Its purpose is to improve the care of women with gynecologic cancer by encouraging research, disseminating knowledge which will raise the standards of practice in the prevention and treatment of gynecologic malignancies and cooperating with other organizations interested in women’s health care, oncology and related fields. The Society’s membership is primarily comprised of gynecologic oncologists, as well as other related medical specialists such as, medical oncologists, radiation oncologists and pathologists. SGO members provide multidisciplinary cancer care including chemotherapy, radiation therapy, supportive care and surgery. More information on the SGO can be found at http://www.sgo.org.

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The Best 5 Women Abdominal Exercises

Women’s abs exercises are slowly becoming the most popular topic here at Real Women’s Fitness. Women want to know how to flatten their abs and get more definition and tightnesss. Here are the five best exercises for developing a sexy midsection.

1 - Hanging Knee Raise

The hanging knee raise is one of my favorites and is the best exercise for the lower abs by far. Your legs are quite heavy objects and using your abs to lift them up and then to do a reverse crunch is an excellent method of targetting and punishing the lower abs.

The hanging knee raise should be done slowly whilst hanging from a chin up bar. You should never swing your legs in place but instead the motion should be controlled and your abs should be tensed throughout the whole ROM.

One of the temptations in the exercise is to let your upper legs do the work or to lean back half way through it to make it easier. If you want the best results you have to keep everything nice and controlled. The best way to do this is to keep your mind focussed on your lower abs and make sure they are doing the work.

2 - The Decline Crunch

If you have a decline sit up board at your gym you should use it every time you train your abs. Doing a sit up or a crunch on a decline board is one of the best ways to make your abs do a little bit more work and it is a very effective exercise for building midsection strength and power.

One of the things I love most about this exercise is that there are so many ways to jazz it up. For example, you can:

* alter the height of the board
* do a crunch or a full sit up
* add a twist to the top of the motion
* add a weight to your chest
* perform super slow declines

If you try to vary the way you do it each time you go to the gym you will see unprecedented success with this exercise.

3 - Bicycle Crunches

Recently a fitness book I was reading wrote that in their studies of the abs exercises it was the bicycle crunch that caused the abs to tense the most. It was (supposedly) twice as effective as the crunch for ‘crunching’ your abs.



I found this interesting and so I began experimenting with it. At first I pumped them out quickly and didn’t find them very challenging at all. However, when I slowed down the bike crunch and focussed on my abs and my breathing I found that it worked quite well.

The idea is to mix both the lower and the upper abs in one exercise. You fully extend out one leg while the other is bent and you touch your opposite elbow to the bent leg as if you are doing a twisting crunch. Then you repeat for the other side without taking any rest or dropping your torso back down so the whole time you are doing them your upper body is in a crunch position. It’s tough.

4 - Fitness Ball Crunches

I love these things and I will always write about them even when the ‘fitness ball craze’ is over. Why? Because they work so well.

Fitness ball crunches take the pressure off of your back and target your abs so well that the other muscles that usually come in to play during a crunch are left alone. This is a great thing for people who are struggling to get the movements right or who have a big waist and want to minimize the amount it gets worked so as to avoid it getting bigger.

When you get the motion of the fitness ball crunch right you are in for some serious growth. The idea is to roll the ball backwards as you crunch down so that your butt gets closer to the ground and then do the opposite on the reverse part. Try it.

5 - Sprinting

What the…? I hear you all say! Sprinting? Is he crazy? Well, you won’t find this listed at any other fitness site as a great abs exercise and if you do you know they are copying from Real Women’s Fitness.

When I was in sprinting training my abs grew like no other time. It is a mixture of the faster weight loss and the massive amounts of horemones that are released when the fast running is done. Also, the art of running is quite beneficial to the abs.

So, next time you are in the mood for some weight loss exercise try a few sessions of sprinting and see whether your abs respond. I bet they do!

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10 Things You Must Know About The Hospital

"Oops, wrong kidney."

In recent years, errors in treatment have become a serious problem for hospitals, ranging from operations on wrong body parts to medication mix-ups.

At least 1.5 million patients are harmed every year from being given the wrong drugs, according to the Institute of Medicine of the National Academy of Sciences. That's an average of one person per U.S. hospital per day.

One reason these mistakes persist: Only 10% of hospitals are fully computerized and have a central database to track allergies and diagnoses, says Robert Wachter, the chief of medical service at UC San Francisco Medical Center.

But signs of change are emerging. More than 3,000 U.S. hospitals, or 75% of the country's beds, have signed on for a campaign by the not-for-profit Institute for Healthcare Improvement to implement prevention measures such as multiple checks on drugs.

Though the system is improving, it still has a long way to go. Patients should always have a friend, relative or patient advocate from the hospital staff at their side to take notes and make sure the right medications are being dispensed.

Infections and the chain of command

"You may leave sicker than when you came in."

A week after Leandra Wiese had surgery to remove a benign tumor, the high school senior felt well enough to host a sleepover. But later that weekend she was vomiting and running a fever. Thinking it was the flu, her parents took her back to the hospital. Wiese never came home. It wasn't the flu but a deadly surgical infection.

About 2 million people a year contract hospital-related infections, and about 90,000 die, according to the national Centers for Disease Control and Prevention. The recent increase in antibiotic-resistant bugs and the mounting cost of health care -- to which infections add about $4.5 billion annually -- have mobilized the medical community to implement processes designed to decrease infections. These include using clippers rather than a razor to shave surgical sites and administering antibiotics before surgery but stopping them soon after to prevent drug resistance.

For all of modern medicine's advances, the best way to minimize infection risk is low-tech: Make sure any hospital staffers who touch you have washed their hands. Tubes and catheters are also a source of bugs, and patients should ask daily if they are necessary.

"Good luck finding the person in charge."

Helen Haskell repeatedly told nurses something didn't seem right with her son Lewis, who was recovering from surgery to repair a defect in his chest wall. For nearly two days she kept asking for a veteran, or "attending," doctor when the first-year resident's assessment seemed off. But Haskell couldn't convince the right people that her son was deteriorating.

"It was like an alternate reality," she says. "I had no idea where to go."

Thirty hours after her son first complained of intense pain, the South Carolina teen died of a perforated ulcer.

In a sea of blue scrubs, getting the attention of the right person can be difficult. Who's in charge? Nurses don't report to doctors but rather to a nurse supervisor. And your personal doctor has little say over radiology or the labs running your tests, which are managed by the hospital.

Some facilities employ "hospitalists" -- doctors who act as point people to conduct flows of information. Haskell urges patients to know the hospital hierarchy, read name tags, get the attending physician's phone number and, if all else fails, demand a nurse supervisor, likely the highest-ranking person who is accessible quickly.

"Everything is negotiable, even your hospital bill."

When it comes to getting paid, hospitals have their work cut out for them. Medical bills are a major cause of bankruptcy in the U.S., and when collectors are put on the case, they take up to 25% of what is reclaimed, according to Mark Friedman, the founder of billing consultant Premium HealthCare Services. That leaves room for some bargaining.

Take Logan Roberts. The 26-year-old had started work as a business analyst near Atlanta but had no insurance when he was rushed to an emergency room for an appendectomy. The uninsured can pay three times more for procedures, says Nora Johnson, the senior director of Medical Billing Advocates of America.

Roberts was billed $21,000. "I was like, holy cow!" he says. "That's four times my net worth."

After advice from advocacy group The Access Project, Roberts spoke with hospital administrators, telling them he couldn't pay in full. Hospitals frequently work with patients, offering payment plans or discounts. But to get it, you have to knock on the right door: Look for the office of patient accounts or the financial-assistance office. It paid off for Roberts, whose bill was sliced to $4,100, 20% of the original.

Be smart about bills

"Yes, we take your insurance, but we're not sure about the anesthesiologist."

The last thing on your mind before surgery is making sure every doctor involved is in your network. But since the answer is often no for anesthesiologists, pathologists and radiologists, what's a patient to do?

Los Angeles entertainment lawyer and patient advocate Michael A. Weiss repeatedly turned away out-of-network pain-management doctors on a recent visit to a hospital.

You don't necessarily need to go as far as Weiss did, but do ask for someone in your network if you're alert enough. If it's an emergency and you're stuck with an out-of-network doctor, call your insurance company to help resolve the issue. If it's elective surgery, ask a scheduling nurse in the surgeon's office to find specialists in your plan, says South Bend, Ind., billing sleuth Mary Jane Stull.

If you know your procedure will be out of network, call the hospital billing department to negotiate. It will likely point you to a patient representative or the director of billing. Once you've dealt with the hospital, then try the surgeon or other specialists involved -- some hospitals will back you in those discussions, Friedman says.

"Sometimes we bill you twice."

Crack the code of medical bills and you may find a few surprises: charges for services you never received or charges for routine items such as gowns and gloves that should not have been billed separately. Clerical errors are often the reason for mistakes. One transposed number in a billing code can result in a charge for placing a catheter in an artery versus a vein, a difference of more than $3,900, Stull says.

So how do you figure out if your bill has incorrect codes or duplicate charges? Start by asking for an itemized bill with "miscellaneous" items clearly defined. Some telltale mistakes: charging for three days when you stayed in a hospital overnight, a circumcision for your newborn girl or for drugs you never received.

Ask the hospital's billing office for a key to decipher the charges or hire an expert to spot problems and deal with the insurance company and doctors (you can find one at the Medical Billing Advocates of America). Their expertise typically will cost up to $65 an hour, a percentage of the savings or some combination of the two.

If you want to be your own billing sleuth, talk to the highest-ranking administrator you can find in the hospital finance or accounts office to begin untangling any mistaken codes.

"All hospitals are not created equal."

How do you tell a good hospital from a bad one? For one thing, nurses. When it comes to their own families, medical workers favor institutions that attract nurses. But they're harder to find as the country's nursing shortage intensifies; by 2020, 44 states could be facing a serious deficit. Low nurse staffing directly affected patient outcomes, resulting in more problems such as urinary-tract infections, shock and gastrointestinal bleeding, according to a 2001 study by Harvard and Vanderbilt university professors.

Another thing to consider: Your local hospital may have been great for welcoming your child into the world, but that doesn't mean it's the best place to undergo open-heart surgery. Find the medical center with the longest track record, best survival rate and highest volume in the procedure. You don't want to be the team's third hip replacement, says Samantha Collier, the vice president of medical affairs at HealthGrades, which rates hospitals.

The American Nurses Association's Web site lists "magnet" hospitals -- those most attractive to nurses -- and a call to a hospital's nurse supervisor should yield the nurse-to-patient ratio, says Gail Van Kanegan, a registered nurse and a co-author of "How to Survive Your Hospital Stay." She also suggests calling the hospital's quality-control or risk-management office to get infection statistics and asking your doctor how frequently the hospital has done a certain procedure. Though reporting these statistics is still voluntary, more hospitals are doing so on sites like one of the U.S. Department of Health and Human Services, which compares hospitals against national averages in certain areas, including how well they follow recommended steps to treat common conditions, says Carmela Coyle, the senior vice president for policy at the American Hospital Association.

How to improve your odds
"Most ERs are in need of some urgent care themselves."

A new study from the Institute of Medicine found that hospital emergency departments are overburdened, underfunded and ill-prepared to handle disasters as the number of people turning to ERs for primary care keeps rising.

An ambulance is turned away from an ER once every minute due to overcrowding, according to the study; the situation is exacerbated by shortages in many of the "on call" backup services for cardiologists, orthopedists and neurosurgeons. And it's getting worse. Currently, 73% of ER directors report inadequate coverage by on-call specialists, versus 67% in 2004, according to a survey conducted by the American College of Emergency Physicians.

If you can, avoid the ER between 3 p.m. and 1 a.m., the busiest shift. For the shortest wait, early morning -- anywhere from 4 a.m. to 9 a.m. -- is your best bet. If you are having severe symptoms, such as the worst headache of your life or chest pains, alert the triage nurse manager, not just the person checking you in, so that you get seen sooner, says David Sherer, an anesthesiologist and author of "Dr. David Sherer's Hospital Survival Guide." Triage nurses are the traffic cops of the ER and your ticket to getting seen as quickly as possible.

"Avoid hospitals in July like the plague."

If you can, stay out of the hospital during the summer, especially July. That's the month when medical students become interns, interns become residents, and residents become fellows and full-fledged doctors. In other words, a good portion of the staff at any given teaching hospital is new on the job.

Summer hospital horror stories aren't just medical lore: The adjusted mortality rate rises 4% in July and August for the average major teaching hospital, according to the National Bureau of Economic Research. That means eight to 14 more deaths occur at major teaching hospitals than would normally without the turnover.

Another scheduling tip: Try to book surgeries first thing in the morning and preferably early in the week, when doctors are at their best and before schedules get backed up, Sherer says.

"Sometimes we don't keep our mouths zipped."

Contrary to what you might think, sharing patient information with a third party is often perfectly legal. In certain cases, the law allows your medical records to be disclosed without asking or even notifying you. For example, hospitals will hand over information regarding your treatment to other doctors, and it will readily share those details with insurance companies for payment purposes.

That means roughly 600,000 entities that are loosely involved in the health-care system have access to that information. These parties may even pass on the data to their business partners, says Deborah Peel, the founder of the Patient Privacy Rights Foundation in Austin, Texas.

If you want to access your medical records, you don't have to steal them like Elaine did on "Seinfeld" after she learned a doctor had marked her as a difficult patient. You are legally entitled to see, copy and ask for corrections to your medical records.

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16 Ways To Cut Down Your Insurance Rates

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If you're buying life, disability, long-term care or health insurance, your insurance company wants to know more about you. Depending on the type of policy, it could inquire about your habits, medical records and family history. Based on the answers, it will slot you in one of several categories that will help determine just how much you pay for coverage.

What you say and how you say it can make a difference in how your insurance company sees you and what it charges.

"It's not enough to say you got a good rate," says Randy Herz, senior vice president of Herz Financial, an insurance advisory firm in Farmington, Conn. "You have to look at what their classifications are. Then you have to understand your own health. Health is one of the biggest factors in determining the cost of your insurance."

Here are some tips from insurance insiders to help you get the best health ranking -- and the lowest rates:

Communication counts

Tell the truth, the whole truth and nothing but the truth. Think that leaving something shady out of your health history might help? Wrong, for two reasons. First, the insurance company will likely find out (it is reading your records, after all), and it will assume the problem is severe because you didn't mention it. Even worse, if you withhold information that the company regards as material, it could cancel your life policy within the first two years, says Bob Hunter, director of insurance for the Consumer Federation of America.

Give your complete health story, but do it on your own terms and give the complete picture. Don't just say you have high blood pressure. Say you were diagnosed with high blood pressure five (or however many) years ago and have successfully controlled it with medication.

"The consumer should think about it from the side of the insurance company," says Robert Hoyt, head of the risk management and insurance program at the University of Georgia and president of the American Risk & Insurance Association. "To the extent you give them good, complete information and reduce the uncertainty, then ultimately you're going to get a fairer price."

If your agent or broker knows what wrinkles might give you a problem, he can shop you to the companies most likely to take you on at a good rate.

Watch your language. Sometimes incomplete answers can paint a bad picture. And insurance underwriters are trained to assume the worst. So be clear and complete in your answers. If you had a nonaggressive cancer removed from your face one time several years ago, don't simply say you had cancer removed, says David Johnson, an insurance agent and board member with the Georgia Association of Health Underwriters. List the specific type -- basal cell, for instance -- and that it was done once with no recurrence.

Sometimes an application will ask the ever popular question, "Which of the following conditions have you been treated for?" Instead of just checking "chest pains," include the fact that it turned out to be indigestion and no follow up was needed.

Know the rules of the game. "You need to ask what the (health) ranking is based on," says Hunter. "There should be objective criteria. And you really should shop a little. The criteria vary."

Find out what your ranking is with a specific company and why, says Hunter. It could be that something they don't know will improve your ranking and decrease your premium.

Shop around. It's common consumer advice, but it can be even more important with insurance. Two different companies can view a person's health and the risk he or she poses very differently.

"Most companies try to put you in the right slot," says Hunter. "But if they make a mistake, you don't want that to be the only one you talked to."

Even the lingo varies from company to company. A ranking of "preferred" or "standard" might mean two very different things, with different rates, at two different companies.

Smart shopping is very important for smokers, especially people who only occasionally smoke a cigar or pipe. While some companies will automatically put you in a less-desirable category with a higher premium, others won't penalize you for that once-a-year stogie.

Your physician can help

Alert your doctor. Insurance companies want to talk with your doctor's office and look at your most recent records. Failing that, they might have to use only the records from the Medical Insurance Bureau (a repository for medical records used by insurance companies), which might not be to your advantage. Sometimes a doctor can give some perspective to a condition that might look worse in black and white (for example, a high cholesterol condition that's being treated successfully).

But a busy doctor's office can sometimes drop the ball, says Dave Evans, vice president and publisher for the Independent Insurance Agents & Brokers of America. And the insurance company will only try so many times before it gives up.

So let your doc know you're applying for insurance. A little advance notice can ensure the call isn't overlooked and give you the best chance at a good rating.

Make sure the company gets all of your records, not just some. To get the most complete, up-to-date picture of your health, the company needs all of your records.

"If you've moved or migrated doctors, the fact of the matter is you probably have to be more proactive," says Evans.

Shop quietly. Similar to a lot of inquiries on your credit, a lot of inquiries on your insurability can throw up a red flag, says Herz. Instead, choose an agent or broker who can quietly do some informal shopping to narrow your options before you do anything official. "It avoids you getting declined or rated," says Herz.

In addition, if you use several different agents or brokers, let them know you're shopping around. That way, "everyone knows what they're working with and it might make them more competitive," says Herz.

Pick your insurance professional carefully. Not every agent is up to the task, especially if you've had some health problems in the past.

"If you're dealing with someone who does this a lot, they can help coordinate and shepherd you along because they are comfortable with the process," says Evans.

If you anticipate problems, it's especially important to have someone who knows the system. This can be an agent or broker who knows which companies are likely to give you the best rates and someone who knows how to talk to underwriters to convey the true risk -- or lack of risk -- you would pose.

"The worse your health is, the more this matters," says Herz.

About your vices: Cut them out

Develop good habits. The insurance company probably won't ask how many times a week you work out, how many grams of fat you consume or how many glasses of water you drink. But all of those things impact the criteria they will examine. So hit the gym, lose those extra pounds and keep yourself healthy.

"These things can make a difference for people, not just in getting coverage but in the price you'll get," says Evans.

Want to drop 30% from your life insurance premium? Kick the cigarettes.

"Smoking can add up to 30% to the cost of your life, disability and health insurance premiums," says Johnson.

Avoid drugs and alcohol. If you take illegal drugs, you're not going to find an insurance company that wants to take you, says Johnson.

"If (a person) has a recent history of drug use, they're not going to be able to get insurance," he says.

If you're a recovering alcoholic, "You're probably going to be able to get coverage, but it could be a higher premium," says Johnson. Emphasize, with medical records to back you, how long you've been sober. The insurance company could see a relapse as a risk to them, so the more you can show how unlikely that is, the better for your rates.

Prepare for your exams. In some cases, the insurance company will require either a physical or a short exam by a paraprofessional, which can include taking your vital signs and drawing some blood.

To get the most accurate reading, schedule it first thing in the morning on an empty stomach. (Obviously, if you have a condition that makes that tricky, talk to your doctor first.) Give up vigorous exercise like that three-mile run 24 hours in advance. Get a good night's sleep. And some experts recommend forgoing your morning coffee, or even water.

Follow up on the details of your medical records. Do your records contain a recommendation for a test that you never got? The insurance company could see that as a bad sign, says Herz. "Have the doctor note in your records that you didn't need it after all -- or get it done," he says. Otherwise the company is likely to think that you could have some undiagnosed problem.

Think about your future. If you're healthy now and considering buying term life insurance, make sure that it's renewable and convertible, says Evans. "What that means is that you can convert to permanent coverage without a physical. That would be worth paying extra for," he says.

Keep trying and keep asking questions

Try to get coverage even if you've had health problems. Work with a professional you trust and have him quietly look into what kind of ratings you would get, says Herz. Bear in mind that a number of conditions aren't the black marks they used to be.

"A person who had open-heart surgery used to be declined," says Herz. "Now they can get regular rates."

Ditto for folks who are using medications to control conditions such as high blood pressure and high cholesterol.

"I've seen people who have cancer, heart (problems), all sorts of things, get insurance because they were able to get a favorable prognosis," says Evans.

Ask why. If you are declined or end up with rates higher than you were expecting, find out why. Talk with your agent and ask how to get a copy of your records from the Medical Information Bureau, says Evans.

Don't give up. "Don't consider a (lower health ranking) or decline in the past as indicative of future events," says Herz. It could be that last time around your agent didn't work hard enough for you, or it could be that today, with new drugs and treatments, your condition wouldn't pose as much of a risk, he says.

And time does heal -- even in the insurance business. "Sometimes, the further you get from (an event)," says Herz, "the better off you are."

By Dana Dratch, Bankrate.com

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9 Vital Questions To Ask Before Choosing The Right Health Plan

The open enrollment period for your health-insurance plan comes once every year, usually during the fall. The corresponding paperwork typically generates as much enthusiasm as your yearly tax forms. But don't be tempted to just put a check mark next to your current plan. With so many insurers and employers raising health-insurance premiums and scaling back benefits, you need to know how your health plan stacks up against any others offered to you at work and whether it's the best choice for you.

After all, you're stuck with your decision for a whole year. If you don't know that your plan is dropping coverage for your brand-name prescription allergy drug, you'll be in for a rude awakening next year when the pharmacist asks you to hand over $180 for 100 tablets rather than your usual $25 co-payment. You won't be able to go back to your benefits administrator and ask to switch to a plan that will pay for your prescription.

The following information will help you make the best decision during the open enrollment process.

What types of changes can I make to my health-insurance plan during open enrollment?

If you're not currently enrolled in a health-insurance plan, you may enroll at this time. If you are enrolled, you may switch plans (if this is an option), correct inaccurate information, or add eligible dependents, such as a spouse and children not previously covered.

Which is more important when choosing a plan: cheaper premiums or less expensive co-payments?

It depends on your situation. If you're young and healthy, you can go for lower premiums and higher co-pays. But if you're older, have a chronic health condition, or have young children who make frequent visits to the doctor, you're better off with higher premiums and lower co-pays. You also have to weigh the value of your health plan vs. price. If you go with a cheap health plan but it doesn't pay for the benefits you need, you are not getting good value for your health-insurance dollars.

What is a lifetime maximum benefit?

A lifetime benefit maximum is a cap on the amount of benefits available to a policyholder. The cap is designed to keep the cost of benefits affordable and to stabilize potential future costs. Many health plans cap lifetime benefits at $1 million and are most often applied to mental illness, drug and alcohol treatment, or organ transplants.

If a plan has a relatively low lifetime maximum cap, think carefully about how much risk you're willing to assume. Even if you're healthy, the expenses incurred from one severe car accident -- including hospitalization and outpatient physical therapy -- could easily exceed a $100,000 cap.

Can I switch health plans without undergoing medical screening for pre-existing conditions?

Yes. This is the one time a year (unless you experience a "qualifying event," such as the birth of a baby) during which you may make changes to your plan without having to sit out any pre-existing condition exclusion period. Otherwise, late enrollees in group health plans may have to wait up to 18 months for coverage of pre-existing conditions.

What's better, an HMO, PPO or POS? And what is an HMO, PPO and POS?

There are several health plan varieties, including traditional indemnity fee-for-service plans (FFS), health-maintenance organizations (HMOs), point-of-service plans (POS) and preferred provider organizations (PPO). Each plan has its own features to consider before making your choice.

HMOs are the least expensive, but also the least flexible. They require that you select a primary care physician (PCP) and obtain pre-authorizations for certain medical procedures and in order to see specialists. POS plans are more flexible than HMOs, but they also require you to select a PCP.

PPOs give policyholders a financial incentive -- in the form of reasonable co-payments -- to stay within the group's network of practitioners, but you can usually visit out-of-network specialists without pre-approval.

What is a drug formulary and what are pharmacy benefit tiers?

A formulary is the list of medications for which a health plan pays. Most health plans that pay for prescription drug benefits have pharmacy benefit tiers that group certain medications together for pricing purposes. Brand-name drugs that are usually in the top tier are most expensive, while generic medications are in the lower tiers and are least expensive. Your prescription drug co-pay for a medication in the lowest tier may range from $5 to $10, while your co-pay for drugs in the highest tier may range from $25 to $50. Most health plans have three or four pharmacy benefit tiers, but some have as many as seven.

What are FSAs and HSAs?

A flexible spending account, or FSA, is a benefit plan that allows companies to give their workers the opportunity to pay for their out-of-pocket health and dependent care costs on a pre-tax basis, which -- over time -- lowers payroll-related taxes for both the employer and employees. However, if you don't use the money you've set aside by the end of the year you lose it.

A Health Savings Accounts, or HSA, is technically a trust. It's designed to let you save money specifically for health costs, and receive a tax break in the process. HSA funds not used in one year can roll over to help pay for future expenses the next year, unlike the flexible spending account.

How can I judge the quality of competing health-insurance plans?

For those who have a choice of health plans, price and whether the family's doctors participate in the plan's network of doctors are the most important factors. However, there are other criteria to use.

Accreditation groups, such as The National Committee for Quality Assurance, measure plans using a variety of quality standards. Ratings companies, such as Standard and Poor's, A.M. Best, and Moody's Investors Service, give you a picture of a health plan's financial strength. "Report cards" published by consumer groups, independent Web sites, and state insurance officials are another good source of consumer satisfaction with health plans.

Who can help me if I have questions?

Your human resources director or benefits administrator at work, and/or insurance company customer service departments, can answer most of your questions. Health-insurance analysts with your state department of insurance can also answer your health-insurance questions.

If you have questions about a self-insured health plan (meaning your employer pays all your health-insurance claims), contact your regional office of the United States Department of Labor (DOL). Self-insured plans are governed by the Employee Retirement Income Security Act (ERISA) and are regulated by the federal government, not your state department of insurance.

On the Internet since early 1995, Insure.com is a leader in providing insurance information and is unequalled in its breadth and depth. The site currently hosts more than 20,000 pages of content, including interactive tools to assist consumers in their insurance decisions, and adds 30 to 40 new items each week. Insure.com is regularly ranked as one of the Web's best providers of consumer insurance information and guidance.

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Doing Without Aches And Pains At Old Age

Sore shoulders. Achy hips. Throbbing knees. Lower back pain. Creaky bones. Regardless of how many birthday candles we have blown out in our lifetime, the mind will continue to tell us we are still 30 years old, that we can bounce out of bed and move throughout the day without limitation. Our physical body does not always agree, and the little aches and pains seem a reminder that our age is catching up with us. But, are the aches and pains of aging a way of life we need to accept as we get older?

Not necessarily. With a few changes in routine, we can keep the spring in our step and maintain a pain-free vitality we have come to expect and enjoy. UCLA physical therapist Ziya Altug offers an anti-aging program designed to turn back the hands of time. In The Anti-Aging Fitness Prescription, Altug outlines an exercise and stress reduction program in maintaining flexibility and strength of both body and mind; simple skin and hair tips to regain a youthful look; recipes, meal plans and nutrition diary to make the most of our efforts.

While no one is telling us we will eliminate all the aches and pains of aging, there are proactive steps we can take to greatly minimize the annoying pain that creeps into our muscles and joints when we were not paying attention to the calendar. The more our body hurts, the less we move — the less we move, the more our body hurts. The less we move the more weight we are likely to gain. Carrying around extra weight is hard on the joints. Foremost, is managing weight gain. Basically, losing weight results in moving more and eating less — and in eating the right foods.

Next is exercise. Yoga, Pilates, Tai Chi, walking, swimming, biking, dancing, low-impact sports and exercising with weights are some of the ways to incorporate the kind of exercise that will make a difference as the years unfold. Stretching exercises add flexibility, weight-bearing exercise add strength. After that, Altug recommends chondroitin and glucosamine supplements, aspirin and/or ibuprofen to manage and control the aches and pains of aging.

Bottom line though, we should not accept the pain that slows us down as a fact of life as we age.

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Other Medically Acceptable Options To Blood Transfusion

A new study guide produced by the Faculty of Health and Social Care at the University of the West of England focuses on the range of treatment options available to medical staff as alternatives to blood transfusion.

Medical and other health care staff are frequently faced with patients who for cultural, religious or other reasons may choose not to have blood transfusion in cases where it would be the standard medical procedure. The new guide is aimed at trainee doctors as well as practicing medical staff, and outlines the other medical options available in these circumstances.

The guide entitled 'Medicine and Surgery without Blood Transfusion: Facilitating Patient Autonomy with a New Standard of Care' is a collaborative venture between the University of the West of England and the Hospital Liaison Committee, which carries out medical liaison on behalf of Jehovah's Witnesses.

Shekar Bheenuck, principal lecturer at the University of the West of England, who co-coordinated the development of the guide says, "There are well known cultural and religious objections to blood transfusions which can result in ethical dilemmas for medical staff. Recent years have also seen an increase in the number of screening procedures for blood and blood products as a result of concerns over CJD and HIV infections and this has driven up the overall cost of blood transfusions. There is a clear need to reduce the number of blood transfusions which are being carried out and fortunately there are a number of medical alternatives available. The aim of this guide is to make these options more widely known to medical and other health care professionals faced with difficult ethical decisions."

"At the end of the day patient care is paramount. When someone has expressly made their wishes known about blood transfusion medical staff will be better prepared if they are able to suggest alternatives for that patient."

The study guide details examples of procedures which can be used to conserve blood and examples of 'bloodless' medicine and surgery. Alternatives to standard blood transfusions are for example when the patients own blood is recovered and can be stored and reinfused when needed (known as autologous procedures). Another option is for a patient's own blood to be recovered during or after surgery, for it to be cleaned and reinfused as appropriate.

Pul Bradley, Professor and Director of Clinical Skills at the Peninsula Medical School says, "This is a useful guide which we will use with some of our medical students. Both the ethical issues and the information on medical procedures contained in the guide will help medical staff to be better equipped to address these difficult medical decisions and dilemmas. We are also concerned nowadays to empower patients to be more directly involved in decisions about their medical care and this will help in that process."

David Smith of the Hospital Liaison Committee who collaborated on the guide said, "We welcome this initiative and hope that it is made widely available to medical staff. There is a clear need for a guide like this which will help medical staff become more aware of blood conservation techniques and transfusion alternatives where difficult decisions regarding blood transfusion need to be made."

The manual also carries a number of case studies for discussion in which difficult ethical and medical issues are highlighted, such as religious objections to blood transfusion.

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