Kaiser | Bonnie Modugno, MS, RD

What Happens When I Health Screen Myself

October 18, 2011 by

I am a Kaiser patient, now for over 20 years. I like my physician but often get tired of navigating the system. It feels like swimming upstream. The system is designed to provide the maximum range of health care to meet the median need. I’m sure it is far more cost effective than most health care models. I don’t like feeling like another peg in a hole.

I opened email today to learn of a new digital health screening tool and linked education resources offered through Kaiser. Before I could stop rolling my eyes, I decided to fill out the initial questionnaire. I wanted to see what questions they are asking. I wanted to find out what they would recommend for me.

THE REPORT
With 17 pages of feedback, I find that I ranked 84, very good but not excellent. I’m taken aback, but already know a few of the issues. I just happen to view things differently. What was recommended? Here’s the short list.

1. Lose weight

2. Decrease cholesterol and LDL cholesterol levels

3. Get counseling for my depressive symptoms

4. Decide if I want my skin to be safe from the sun

On every other issue I received a bright green check mark and a hearty “Good job!” I exercise regularly, sleep adequately, and manage stress pretty well.

I eat a healthy diet. I drive safe, I have been faithful for 27 years with the same man and I am up to date with my pap smear, mammography, colonoscopy and immunizations.

BUT I DISAGREE

Too bad the screening tool is not sophisticated enough for a patient to address why digital counselor’s recommendations are off the mark. My number one complaint is that the tool doesn’t offer any place for the patient to explain their position.

The assumption is that anything other than willingness to go along with the algorithmic recommendations indicates someone who is not motivated to take care of their health.

Why does a tool that is supposed to help makes so many assumptions that feel paternalistic and patronizing?

Up next–my responses to each of the recommendations.

Filed Under: Blog Tagged With: cholesterol, health, health screening, healthcare, Kaiser, LDL cholesterol, skin cancer, stress, sun, sunscreen, therapy, weight

I Was Told To Lose Weight

October 18, 2011 by

I recently completed a health questionnaire on the Kaiser website. Here is the 2nd of 5 blogs on the findings.

A range of 120-163 pounds is given for my height. The last time I weighed 120 pounds I was anorexic. So 120 is too low for my size and body build. What about 163?

I’m not so sure I am ready to feel like I am starving myself. I am already extremely careful with what I eat. The health screening tool didn’t have much to recommend on that front.

ALREADY EATING A NUTRIENT DENSE DIET

I got high marks for the fruit and vegetables in my diet. I eat mostly whole grains, albeit very few of them. I just don’t handle carbohydrates very well.

My diet is rich in grass fed meat and milk from grass fed cows. I enjoy fish several times a week and take omega three supplements regularly. I use pastured butter and olive oil preferentially for cooking. I cook at home using raw ingredients 5-6 nights a week. I shop at farmer’s markets for delicious farm fresh produce and farm fresh eggs, chickens, pork and beef.

I eat when I am hungry and mostly stop when I am satisfied. I rarely feel full or uncomfortable. I don’t eat many sweets, except for the occasional piece of dark chocolate two or three times a week.

ASSUMPTIONS WITHOUT ENOUGH QUESTIONS

Maybe this tool needs to ask me why I am unmotivated to change instead of assuming that there is change to be made. The assumption is made just because my weight is higher than the ideal range. I wonder how many muscular and athletic people are also given misguided direction to lose weight?

There is no place to address lean body mass even though I was asked about my usual activity level. I bike most days of the week both for transportation and recreation. I walk with friends 1-2 times a week and enjoy a yoga twice a week. I received a hearty “good job” for my level of exercise from the screening tool.

The evaluation summary did mention I could increase my weight bearing activity. Evidently the tool assumes that yoga is only good for stretching, not building muscle. These people don’t know the class I attend.

JUST A NUMBER, NO PERSPECTIVE

I wonder if the designers ever considered asking me what I already do to manage my weight before suggesting what I should do differently.

In the end, I suppose I am just not willing to be more restrictive. I understand that quality of life and longevity have far more to do with overall health and not some silly ideal number range.

How many of us are tired of mindless recommendations with little perspective? I’m only slightly less annoyed that this recommendation comes from a digital screening tool. I am appalled it is supported by my health care provider.

Filed Under: Blog Tagged With: anorexia, cycling, dark chocolate, exercise, fruits, grains, grass fed, health screening, hungry, Kaiser, lean body mass, lose weight, muscle, restriction, vegetables, walking, weight, yoga

Get Counseling for Depressive Symptoms

October 18, 2011 by

I recently completed a health questionnaire on the Kaiser website. Here is the 4th of 5 blogs on the findings.

On May 13 I answered two questions on a Health Questionnaire provided by Kaiser Permanente online. I was curious and wanted to know how I ranked. I was only slightly put off by the “very good”, not “excellent” assessment.

I pretty much knew I would be flagged for weight and cholesterol. Kaiser tends to interpret these numbers with the most conservative and conventional positions. I happen to disagree.

I find the pervasive belief that weight is a reliable surrogate marker for health to be misguided. Current thinking that total and LDL cholesterol is a reliable marker for cardiovascular disease is simplistic.

The third recommendation completely took me by surprise. The questionnaire determined that I am depressed.

GET COUNSELING FOR DEPRESSIVE SYMPTOMS

I don’t know whether to laugh or cry. Wait…maybe I better not use that expression.

In the survey I acknowledged sometimes feeling overwhelmed. Occasionally I feel sad. There was no place to answer why.

I parent a son with special needs. He is doing rather well, but navigating life with a teenager is trying for most parents.

I own my own consulting business. Along with most business owners, I am alarmed at the enduring challenges of our crippled economy. especially during the last three years.

I watch as politicians from both parties vote for ideology and political positioning, more than the good of the country. I hardly think my feelings are out of place.

DIAGNOSIS WITH A QUESTIONNAIRE; TREATMENT OPTIONS VIA EMAIL

In 2001 Allan Horwitz wrote Creating Mental Illness. He suggests that we are pathologizing normal responses to difficult or traumatic conditions. Consider Kaiser’s questionnaire and feedback Exhibit 1.

Twice during the next week I was encouraged to seek help with the following presumptuous emails:

May 14, 2011. Want to move beyond blue? Login to steer toward a brighter tomorrow.
HealthMedia® OVERCOMING™ Depression

May 16. 2011. The sun always rises. So can you. A new approach to managing the way you feel.
We wanted to remind you of our invitation to enroll in HealthMedia® OVERCOMING™ Depression.

These emails felt intrusive, obnoxious, patronizing and completely out of line. This is the response to occasionally feeling overwhelmed? This is the response to sometimes feeling sad? Why do these very typical human emotions generate suggestions to treat depression?

Ironically, I am a hearty supporter of therapy. I have benefited greatly from wise and supportive therapeutic counsel over the years. I am pretty happy to ask for help when I need support.

THIS IS NOT EFFECTIVE HEALTH CARE

I’m not sure who wrote the program, who approved the algorithm, and who thinks this is a viable approach to providing health care. Unsolicited advice is never a good idea, especially when it is generated by a digitally programed algorithm. No perspective, no insight, just a couple of check marks and a cascade of suggestions.

If this is what passes for effective health care, we all have reason to feel depressed.

Filed Under: Blog Tagged With: Allan Horwitz, Creating Mental Illness, depression, emotions, feelings, health care, HealthMedia, Kaiser, Kaiser Permanente, overwhelmed, sadness

Kaiser Recommends: Take Better Care of Your Skin

October 18, 2011 by

I recently completed a health questionnaire on the Kaiser website. Here is the 5th of 5 blogs on the findings.

Kaiser’s last recommendation is only mildly irritating. Directives to lose weight, lower cholesterol and get counseling struck far more sensitive nerves. The issue of sun exposure is challenging because the recommendations don’t really address the full scope of the issues regarding vitamin D.

VITAMIN D and IMMUNE FUNCTION

It seems risk of skin cancer is Kaiser’s primary concern. The risk is real and I appreciate the warning. At the same time, my vitamin D status is low and the there are far scarier risks associated with inadequate vitamin D status.

The immune system is intensely compromised when Vitamin D status is insufficient. I first learned this years ago at a seminar sponsored by D-Action , a grassroots coalition of scientists and clinicians looking to address a global epidemic of inadequate vitamin D status. Soon I learned the benefits of enough Vitamin D for myself.

Last winter I bumped my vitamin D supplements up to 5000 IU per day. I was taking 2000 IU per day for over a year and watched my vitamin D status barely budge. Since I bumped up the dose I have not been sick in any significant way. This is a significant turn of events.

WISHING FOR JUST A COLD

Over my lifetime I have been incredibly vulnerable to every cold, sniffle and cough. I could feel bronchitis settling in my chest within days. I always chalked it up to a childhood of allergies and asthma bad enough to keep me home up to 2 months during any one school year.

Thankfully I grew out of the allergies and asthma, but I can still get really sick. I have lamented for years that I can never just catch a cold. I always end up with some kind of secondary bacterial infection. After suffering for weeks, I finally get a prescription and feel relief in hours.

Last winter I finally had just a cold–barely. I felt a dry cough and it was gone in less than two days. A couple of cups of tea, a nap or two plus getting to bed earlier than usual was all it took. Unbelievable.

VITAMIN D AND RISK OF DISEASE

The benefits of adequate Vitamin D attract plenty of attention today. When I studied nutrition 30 years ago the research drew a big yawn. I learned about Vitamin D as one of four sleepy fat soluble vitamins. Vitamin D was supplemented in milk to prevent rickets. Warnings alerted everyone to the risks of an overdose. There was little other attention. Today we realize Vitamin D is more of a hormone than a vitamin.

A review of Vitamin D status and risk of disease by Holick and Grant summaries the benefits of adequate vitamin D. Vitamin D receptors are found on most tissues in the body. The range of impact is significant, from diabetes, cancer and heart disease to multiple sclerosis and more.

Studies list a range of maladies that are associated with vitamin D deficiency and insufficiency. Work by Garland and associates identifies an inverse relationship between vitamin D status and other cancers. This means the lower the Vitamin D status, the higher the risk for both breast and colon cancer.

Despite this insight, health warnings about sun exposure are everywhere. Kaiser’s directive to start taking care of my skin is case in point. Ironically scientists studying vitamin D insufficiency point to use of sunblock as a primary factor increasing vitamin D insufficiency and deficiency.

WHAT ABOUT THE SUN

Ten minutes of unprotected sun exposure is enough time to produce more than adequate active Vitamin D as long as the right UVB rays are available.

In Southern California that means between March and October when solar UVB 290-315 rays reach our skin. During the other months of the year, there is no conversion. We don’t access the appropriate UVB rays when we are tilted away from the sun no matter how much sun exposure.

I knew I always felt healthier, stronger, leaner during the summer months growing up. I certainly wonder if Vitamin D was the unknown factor.

While I don’t need to worship the sun as I did during my youth, I hope Kaiser can figure out that modest unprotected exposure to the sun is worthwhile. A recent editorial in British Medical Journal sums up my position best:

Dermatologists should soften their stance on sun exposure. 5-10 minutes of daily sun exposure is considered a judicious dose of sun rays for vitamin D production.

Filed Under: Blog Tagged With: breast cancer, bronchitis, cold, colon cancer, D Action, Garland, Holick, immune function, Kaiser, multiple sclerosis, rickets, skin cancer, sun, sun block, vitamin D

What Happens When I Health Screen Myself

I Was Told To Lose Weight

Get Counseling for Depressive Symptoms

Kaiser Recommends: Take Better Care of Your Skin

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