Author Archives: Alan Leibowitz

Alan Leibowitz

About Alan Leibowitz

Alan I. Leibowitz, MD, FACP, is chief academic officer at Banner Health and oversees all medical education residency programs at Banner Health’s Arizona facilities.

Vitamins for health

This “D” Makes The Grade For Good Health: How Vitamin D Can Help Keep The Doctor Away

When it comes to good health, there’s one D that is vital to your health — vitamin D. It helps our body absorb and use calcium to build and maintain bones and teeth, and interacts with our immune system, muscle and nerves to maintain our health.

As we age, our risk of osteoporosis (bone thinning) increases because we decrease our ingestion of milk and other foods fortified with calcium and vitamin D. But, our bodies provide us with vitamin D by producing it when our skin is exposed to ultraviolet light (vitamin D is called the “Sunshine” vitamin). We are fortunate to live in Arizona, as we are blessed with more than adequate sunshine year-round. Our relatives in Northern climes may not be able to produce vitamin D during the cloudy winter months when they’re either sitting inside or are outdoors bundled up with very little skin exposure. Fortunately, these folks should be fine during the winter as long as they maintain a good diet, which brings us to vitamin D content and supplementation of food, and the use of multivitamin tablets.

When considering taking vitamin D to supplement your diet, be sure to include calcium-containing foods, use current guidelines for recommended dietary allowance and read the labels. For most adults, at least 600 IUs (International Units) of vitamin D each day will maintain bone health. Those age 70 and older need as much as 800 IUs daily. Foods, of course, are excellent sources of vitamin D. A serving of cold water fish (only 3 ounces of salmon or tuna) may have 300-400 IUs, and foods fortified with vitamin D, such as cereals and milk (milk or fortified orange juice, can provide 100 IUs per cup).

Women have recognized that during perimenopause and menopause there may be accelerated bone loss leading to the risk of osteoporosis. Combine this with aging, decreased vitamin D and calcium intake and decreased estrogen production, and the stage is set for osteoporosis. Interestingly, in the last 20 years, studies have demonstrated that men had a decrease in their levels of vitamin D, while women have shown no decline. This is probably due to women heeding the dietary recommendations and increasing their use of calcium and vitamin D supplementation.

Now, about that sunshine.  Skin types (dark skin vs. fair), aging, smog, cloud cover, use of sunscreens, as well as the risks of sun exposure, make it next to impossible to reassure someone that he or she will safely produce sufficient vitamin D. Instead, it is recommended that you limit your sun exposure, without sunscreen, to your face, arms back and legs for 5-10 minutes, twice a week between the hours of 10 a.m. and 3 p.m.  But, remember that the sun’s rays can damage skin and cause skin cancer. Beware of thinking that if a little is good for you, a lot may be better, as that is surely not the case.

If you’re healthy, eat a well-balanced diet and spend at least a little time outdoors each week, you’re probably just fine. If you have questions, be sure to talk to your doctor about vitamin D and calcium supplements before you begin taking any because too much of anything can be harmful.

Modern Medicine

‘Good Old Days’ Of Medicine Are Best As Fond Memories: New Technologies Are Helping All Patients

It’s not unusual to occasionally hear people refer to the good old days when doctors made house calls, or they might wax nostalgic about TV’s Marcus Welby, M.D., whose main character came across as the perfect embodiment of medicine.

There’s no denying that the 1960s and ‘70s were simpler times in many ways, but for health care in particular, they weren’t necessarily better. Medicine has come a very long way over the past 40 years, and we’re all beneficiaries of numerous medical discoveries and innovations that have not only improved our health and well being, but just as importantly, have made us safer and more informed health care consumers. Marcus Welby notwithstanding, doctors and the hospitals that they work in are not perfect.  So adieu to Dr. Welby, but spare us from “House” (unless we need his expertise).

Patient safety was not a major topic in health care during the last century, but today it is a top priority for all health care providers, government agencies and payers. The complexity of technology and care have caused many entities to invest many millions of dollars in new technology, such as Electronic Medical Records (EMR), Computerized Physician Order Entry (CPOE), simulation training, remote ICU monitoring and other innovations to make hospitals as safe as possible for patients.

Even before the U.S. Department of Health and Human Services reported in 2001 that more than 770,000 people were injured or died each year in hospitals from Adverse Drug Events (ADEs), Banner Health was at the forefront of proving the benefits of an electronic ADE alert system. In 1998, a team of faculty from Banner Good Samaritan Medical Center conducted and published the results of the first-ever study to prospectively evaluate a computer support system with real-time intervention for reducing injury from a broad range of ADEs.

In those “early days” of the electronic record, phone calls and faxes to and from the laboratory, pharmacy and physician served as a way to catch issues before they occurred. Today, every Banner hospital in Arizona is equipped with an EMR that includes electronic alerts to help prevent ADEs from happening. Patients should feel assured that if they receive care in one Banner hospital and then go to another, their medical history with tests, as well as medications, will be easily accessible at every location. This is important, because the general public may not be aware of the number of drugs that have similar sounding names, such as Clonidine for high blood pressure or Klonopin for seizures; Celebrex for arthritis pain or Celexa for depression. If you’re at a Banner Hospital and a drug is ordered for you, an ALERT will pop up right at the nursing station and require immediate attention if it doesn’t match your medical condition or if it might cause a reaction with your other medications. At a point in the not too distant future, if it hasn’t already occurred, your physician’s office will be tied into a system that provides your medical record and safety features at all sites of care.

But, even with all of these innovations, patients should know that they have an important role and responsibility for ensuring their own safe care during a hospitalization. First and foremost, if at any time something doesn’t feel right, or if you’re unsure about something, SPEAK UP! You have the right to question anything. Also, proper hand hygiene is critical. Make sure that all caregivers and visitors, including your own family and friends, who come into your room wash their hands with soap and water or use antibacterial gel. Here are some other tips for ensuring your safe care:

  • Provide your complete and accurate health history information at the time of admission, including all allergies you might have
  • Know your medications and tell your care providers what you’re taking, including herbal and over-the-counter supplements, and how the drugs affect you.
  • Always confirm your identity — all hospital staff should check your wristband and ask your name before they draw blood, administer tests, give medicine or provide any treatments
  • Follow your health care instructions — never tamper with your IV pump, monitors or other devices. When you are ready to go home, get your health care instructions in writing and make sure you understand how to follow them. Again, ask questions.

The safest medical care occurs when everyone is working together as a team, including the patient, and utilizing all of the tools available to ensure the most successful outcome.

Living healthy

Fitness Exercise Guru Jack Lalanne Epitomized A Healthy Lifestyle — And You Can, Too

Having demonstrated his strength by pulling a locomotive with his teeth, Jack LaLanne left no doubt about the benefits of his daily exercise and diet routine. LaLanne, who passed away recently at the age of 96 years young, was ahead of his time in not only promoting, but also performing and teaching proper exercise, strength and conditioning routines. While we don’t know how much LaLanne’s genes played a part in his longevity, we do know that it took hard work and commitment to gain his chiseled physique and stamina.

Much has been written about LaLanne over the years. He demonstrated his commitment to health and exercise by opening the nation’s first health and fitness center in 1936, which included a gym, juice bar and health food store. While a great idea in hindsight, he once told the New York Times that most people weren’t ready to bet on a healthy living craze.

“People thought I was a charlatan and a nut,” he told the Times. “The doctors were against me. They said that working out with weights would give people heart attacks and they would lose their sex drive.”

Even in his 90s, LaLanne began each day with a two-hour workout that included weight training and swimming. It’s a lesson in wellness we could all heed and one that doesn’t involve complex diets, gym equipment or pricey trainers.

As 2011 begins, many of us are vowing to start or resume a healthy living routine. Some baseline suggestions include:

  • If you smoke, commit to quitting. If you need help, see your primary care provider to discuss a plan to help you achieve success.
  • Start exercising. No matter what your age or medical history, some form of exercise is a good and healthy idea — and one that LaLanne surely recognized. Your physician will know your health status and can help recommend an exercise program that includes at least four days a week at 30 minutes each time. Try to take the time, find a friend and make it fun. If you haven’t exercised regularly, at the outset you should start slowly and gradually work up in duration of activity. Remember that your physician should be your guide.
  • Improve your diet. Try cooking meals that use fresh fruit and vegetables, whole grains and lean meats. Reduce your consumption of soda and fast food. Concentrated sweets (candies and such) should be minimized, and if you take the time to read food labels you’ll be surprised by the amount of sugar and sodium hidden in foods. Finally, be adventurous; try new recipes and healthy cuisine. Spices tend to be low in calories, sodium and have no fat, so they are good, favorable salt substitutes.
  • Avoid stress. Today, we are busier than ever, so staying stress free and living a healthy lifestyle are all the more challenging. Try participating in simple stress-reducing techniques such as yoga, reading, meditation, journaling and exercise. Reducing stress can go a long way toward fulfilling a healthy lifestyle.
  • Routine and preventative care. You are the only one who knows how you feel. You should make regular visits to your primary care provider and complete regular screenings. Heed warning signs, know what to watch for and remember to follow your physician’s advice.

While no one will recommend pulling a locomotive with your teeth, we would all do well to remember LaLanne’s oft-quoted mantra: “The only way you can hurt the body is not use it. Inactivity is the killer and, remember, it’s never too late.”

A hospitalist’s professional focus is caring for patients in the hospital.

Hospitalists Provide Focused Care During Your Hospital Stay

An overnight (or longer) stay in the hospital can be scary and stressful. The new surroundings, medical terminology and encountering new faces and medical devices are confusing enough, let alone keeping track of which doctor is working with the health care team taking care of you.

Over the past several years, there has been a shift in which doctor provides the medical care for patients when they are in the hospital. Primary care doctors, be they family physicians, internists or pediatricians, spend the majority of their time in their offices seeing patients and spend little or no time caring for their patients when they are hospitalized.

In years past, the family doctor would conduct “rounds” on their patients in the hospital, either first thing in the morning, at the end of the day, or both. Now, specialized physicians called “hospitalists” are filling much of the inpatient care role. And, that’s a good thing.

A hospitalist’s professional focus is caring for patients in the hospital. This focus allows them to increase their expertise in hospital care and to be more readily available than physicians who work both in the office and the hospital. Depending on the length of your hospital stay, more than one hospitalist may care for you, but they all are part of your care team of doctors, nurses, aides, and others who should be communicating with you and each other about your medical condition.

After you leave the hospital, the hospitalist team is responsible for communicating with your personal doctor, so that he or she is fully informed and can resume your care. And, always remember, the MOST important person on your care team is YOU, or a person you have designated in the event you can’t speak for yourself. If you don’t know or aren’t sure who someone is, or if you sense something isn’t right … SPEAK UP.

Here’s a check-list of what you should expect from your hospitalist physician, adapted from the Society of Hospital Medicine:

  • Prompt and complete attention to all of your care needs including diagnosis, treatment, and the performance of medical procedures (within their scope of practice).
  • Collaboration, communication and coordination with all physicians and health care personnel caring for you.
  • Safe transition of your care within the hospital and from the hospital to the community, which may include oversight of care in post-acute care facilities.
  • Provides safe, quality and efficient care for you in the hospital.

You may notice that the majority of these items include communication, communication, communication — with you, other physicians, your primary care physicians and the members of your health care team in the hospital.

Food Basket

Listen To Mother: Eat Your Vegetables And Reduce Your Diabetes Risk

Eat your vegetables. Your grandma said it, your mom said it — even Popeye said it — and now your doctor should be saying it regularly as well. A new analysis of existing research suggests that eating more green, leafy vegetables can significantly reduce the risk of developing type 2 diabetes.

Why is this important? Nearly one in five hospitalizations in 2008 involved patients with diabetes, according to a recent federal report from the Agency for Healthcare Research and Quality. And, the cost of caring for those patients was $83 billion for 7.7 million stays, or nearly one in four dollars of hospital costs that year, according to the report. The report also says the average cost for each of those diabetes-related hospitalizations was $10,937, nearly $2,200 more than the cost of a stay for a patient without a diagnosis of diabetes.

The rates of type 2 diabetes have been going up in the United States as the population has become more overweight, the authors of the analysis noted. So, one of the consequences of not eating our vegetables is that it hits our wallets as drastically as it hits our waistlines. For decades, scientists have been trying to understand the role that diet plays in the development of the disease. Researchers, led by nutritionist Patrice Carter at the University of Leicester in the United Kingdom, examined six studies that looked at the links between diet and the incidence of type 2 diabetes. They found that compared with those who ate the least amount of green, leafy vegetables (0.2 servings daily), people who ate the most (1.35 servings daily) had a 14 percent reduction in risk for type 2 diabetes. However, the analysis didn’t show that increasing overall intake of fruit, vegetables, or a combination of both, would make a significant difference in risk, Carter and colleagues reported in the Aug. 19 online edition of the BMJ (British Medical Journal).

Still, in the analysis, the authors concluded that “increasing daily intake of green, leafy vegetables could significantly reduce the risk of type 2 diabetes and should be investigated further.” Evidence also indicates that these vegetables may play a role in prevention of certain cancers, as well as obesity and its consequences. So, what are some green, leafy veggies of choice? Well, spinach, of course, but also broccoli, kale, sprouts and cabbage can reduce the risk by 14 percent when eaten daily, because they are rich in antioxidants and magnesium, which has been linked to lower levels of diabetes. Whether we like it or not, no matter who it comes from, “eat your vegetables” is sound advice.