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Monday
May122014

What is the HbA1c Test and What is a Good Result?

As the number of Americans who have diabetes and pre-diabetes is rapidly increasing, more people with the chronic condition and those related to or friends with them have heard about the HbA1c. The HbA1c test is a common blood test used to diagnose type 1 and type 2 diabetes and then to gauge how well you're managing your diabetes. The HbA1c test goes by many other names, including A1C, glycated hemoglobin, glycosylated hemoglobin, hemoglobin A1C.

The HbA1c test result reflects your average blood sugar level for the past two to three months. Specifically, the test measures what percentage of your hemoglobin — a protein in red blood cells that carries oxygen — is coated with sugar (glycated). The higher your HbA1c level, the poorer your blood sugar control and the higher your risk of diabetes complications.

The goal for many nonpregnant adults with diabetes is an HbA1c level below 7.0 percent. However, less aggressive goals may be appropriate for certain groups of patients, including older adults with multiple health problems, or those with decreased functional status, or persons who are at prone to have low blood glucose readings (i.e., hypoglycemia).

It remains unclear the degree to which "tight control" benefits older adults given that earlier studies of intensive glucose control in diabetes excluded elderly patients. Indeed, tight control may cause harm, such as hypoglycemia and potentially higher death rates, as suggested in recent studies of older individuals -- for example, in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study.

Current advice: The American Geriatrics Society advises adults over 65 who are healthy to aim for an HbA1c between 7.0 and 7.5 percent. If your life expectancy is less than 10 years and you have other chronic conditions, such as heart or kidney disease, a goal of 7.5 to 8.0 percent might be appropriate. For those with even a shorter life expectancy who are being treated for multiple medical conditions, an HbA1c of 8.0 to 9.0 may be reasonable.

However, otherwise healthy and robust older adults may benefit from glycemic targets similar to those recommended for younger adults (HbA1c less than 7 percent). In general, goals should be discussed with your doctor and should be individualized for each patient. May 8, 2014

EF adapted this the May 8, 2014 post in Diabetes.

Thursday
May082014

Yoga for Travelers

It is important to maintain your physical routine, as you travel. Many hotels in the US and Europe have exercise rooms.  These may include swimming pools, water aerobics classes, and machines for cardio-vascular exercises, such as running or biking, to maintain physical well-being.  Yoga complements these activities by allowing the body to feel the stretch and help diminish fatigue by breathing into the postures. 

It is never too late to begin a regimen of what I term physical therapy movement. In fact, you should begin yoga practice several months before your trip, so you will be comfortable with several poses and stretches. One major benefit of yoga is that it is portable and can go anywhere with you.

There are different levels of yoga and different styles.  If you have never done yoga, I recommend taking small group instruction and allow the teacher to make any necessary adjustments to your body alignment.  I personally find Iyengar yoga and Anasura yoga to be very comprehensive and precise. Always remember to begin with a level that meets your needs and abilities.

Often yoga classes that a gym offers is akin to a physical education class.  The instructor may have too many people in the class to offer adjustments.  The age level tends to be young and more experienced with yoga.  The pace is often too fast for novices and meditation and breathing exercises are often not part of an athletic club's yoga program.  These classes can sometimes lead to injuries that include stress on the knees and can also acerbate back problems. 

If you are able to get up and down from the floor, my recommendation would be to look for a Yin Yoga class or a restorative class. Yin yoga targets the denser, deeper, connective tissues such as the ligaments, joint capsules, cartilage, bones and facial networks of the body, These tissues are found in the upper body as well as the lower body. We can apply the principles of Yin Yoga all over the body. Normally it focuses on the lower body because as we age it is this area that tightens up the most. But we can, indeed, do Yin Yoga for the wrists, arms, shoulders, and neck. The instructor will make it easier to hold poses for a long length of time by providing bolsters, blocks, additional mats and blankets.  It is also a beautiful practice to do before retiring for bed. 

For information on postures, you may wish to look at the following website: http://www.yinyoga.com/ys2_2.0_yinyoga_asanas.php

For people who cannot tolerate being on the floor, you can gain benefits by doing a chair yoga practice. You can include in your routine different swim stokes to work on strengthening the arms and shoulders.  If you always loved dancing, incorporate dance movements with your feet and legs in a chair.  The important factor is to keep moving.  Include some breathing (pranayama) exercises before starting the practice and at the end of your session.  Breathing is essential if you are encountering any pain issues. Look up: http://www.abc-of-yoga.com/ayama/pran/.  Here is a website for getting started with a chair yoga program: http://thehealthylivinglounge.com/2010/01/20/8-of-the-best-office-chair-yoga-exerises/.

Allow yoga to become a part of your daily regimen because it takes time and practice to ultimately feel the benefits.    Many yoga studios throughout the world offer donation community classes.   Use a search engine such as Google and type in yoga studios and the name of the cities in which you would like to practice. A yoga class is a good way to meet new people while traveling.  Most yoga studios provide mats. 

Elliot Barenbaum  is a staunch yoga supporter and teaches yoga classes in the San Francisco, California area.

Monday
May052014

Obtaining an Approved POC and or Oxygen at Home and at Your Destination 

Coninued from May 1, 2014

Once you have decided on your oxygen needs, you will need to contact your oxygen provider. Your home oxygen supply company may be a valuable source of assistance, when looking for suppliers at your destination. Your firm will be able to calculate the amount of O2 you will need during your trip. They also may be able to recommend foreign supply companies.

If using a Portable Oxygen Concentrator (POC), your company will know if it is approved for air travel. If it is they can give you a list of places where you can have your machine serviced and buy additional supplies (e.g., batteries, masks). If not, see if they can provide you with an approved POC or recommend a company who does. You should rent the approved POC early to be certain that you become comfortable with using prior to your long trip.

You will need sufficient battery power to cover pre-flight, in-flight and post-flight time. Remember you will need to arrive at the airport 1 – 2 hours ahead of your flight time. At Gate Check-in you must have battery power for at least 50% longer than your scheduled flying time. You will need to cover your travel time to the airport, airport waiting time, your flight time and the time it will take you to deplane, pick up your checked baggage and travel to your final destination. Plan ahead for any possible delays.

The Department of Transportation (DOT) provides public tips on safe carriage of batteries and battery-powered devices such as medical equipment. For information on how to safely travel with oxygen equipment batteries, please visit the DOT web site.

At the Airport you will need to pass through Airport Security. If you are traveling with an approved POC, that will need to be identified on the POC itself. All TSA approved oxygen systems can safely be x-rayed if requested. If you are traveling with an approved POC, you will be allowed through the security area after inspection and may take the system to the gate. It is very important that you are familiar with the Transportation Security Administration (TSA) guidelines for “Travelers with Disabilities and Medical Conditions” before you go to the airport (www.tsa.gov/traveler-information/travelers-disabilities-and-medical-conditions).

Before you book your trip, find the names, locations and phone numbers of O2 suppliers near the airport or docks and in the cities/towns in which you intend to visit. In some countries, there are major O2 companies that can oversee your entire trip. Call in advance the identified foreign O2 supplier(s) to arrange for renting or buying equipment at your arrival city (or at any stopover in-between). You will need a letter from your doctor explaining your lung disorder, your need for and flow rate of O2. If you need to then you can contract for a POC and assure that these are available for you immediately after the plane lands or boat docks. Make arrangements with the O2 distributors at your destination to supply service while away from home. 

The International Air Transport Association (www.iata.org) of which virtually all US airlines with international routes are members, has a medical manual which includes forms and procedures for documenting medical conditions. Included is a FREMEC (frequent medical travelers medical card) from, which seems designed to streamline the medical clearance process across member airlines.

Remember, you may need to bring electrical plug adapters and electrical current converters.

RF

 

 

 

 

 

 

 

Thursday
May012014

Tips for Travel by Air, Sea, or Train with Oxygen en route

Continued from April 28, 2014

Having consulted your physician, the next step is to contact the companies who provide the air, cruise and train lines that go to your destination about your need for continuous oxygen. All three modes of transportation are available to persons who require supplemental oxygen en route. Negotiating the many obstacles, however, can be challenging.

As an oxygen user it is your responsibility to make your own arrangements. Patience, perseverance and having the appropriate information available will help you plan your trip. A helpful tip: keep written information in front of you, note with whom you speak, and write down contact information. Transportation policies are subject to change without notice.

It is recommended that you notify the air, cruise or train line at the time of reservation and 48 hours before flight time that you will be flying with oxygen to verify its policy, and that you carry a copy of the policy and your oxygen prescription with your airline tickets while traveling.

Air and cruise travelers may be required to send your doctor’s letter for their medical department to assess. Some airlines insist that your doctor complete its own particular form. The required form is available to you on the airlines’ web site. Go to “travelers with special needs” or “medical oxygen”. You also should ask the cruise line whether

Train lines, while allowing POCs it may need to meet specifications. For example, Amtrak requires that the power source must be able to operate a minimum of four hours with available on board electrical power (in the event of a power disruption onboard). The O2 equipment must be Underwriter’s Laboratory (UL) or Factory Mutual (FM) listed and weight limits may apply.

Remember, if you can reach your destination non-stop, your travel will be infinitely easier. You will only need to prepare for the trip to your destination and return. 

Be sure to take a sufficient number of extra batteries for the (POC) to cover waiting time, flight duration, and possible delays. You also should ask the cruise line whether  you may use the ship’s electrical source, while in your cabin or to recharge batteries.

Check with your medical and/or trip insurer if your policy will cover supplemental O2 during your trip.

Take all medication and your rescue inhaler in your carry-on baggage.
Request a wheelchair or a cart upon arrival at the airport, dock or train station to take you to and from the arrival and departure gates/docks. This request is made when making your reservation. Confirm all details with your airline or cruise line before you purchase tickets.

Readers: Let us hear if you have flown, cruised or taken a train with a POC?

RF

Continued on May 5, 2014: The next entry discusses obtaining an approved POC at home and at your destination

Monday
Apr282014

COPD, Oxygen and Traveling Abroad: Physician Consult

Chronic pulmonary lung disease (COPD) is a progressive illness that makes breathing difficult (e.g., chronic bronchitis, emphysema or asthma.) Many people with COPD depend on supplemental oxygen, and they can and do travel abroad. As of May, 2009, the Department of Transportation final rule "Nondiscrimination on the Basic of Disability in Air Travel" contains air carrier requirements regarding the use of respiratory assistive devices on aircraft.

The rule requires that air carriers conducting passenger service must permit someone with a disability to use an FAA-approved portable oxygen concentrator (POC) on all flights (on aircraft originally designed to have a maximum passenger capacity of more than 19 seats) unless the device does not meet applicable FAA requirements for medical portable electronic devices and does not display a manufacturer’s label that indicates the device meets those FAA requirements. There are now more than 20 POCs approved by the FAA to carry on board your flight. The key to travelling with a POC device is to prepare and plan well in advance of the trip.

Several months before your trip, visit your doctor to discuss your travel plans and where you want to visit. Some key questions are:

Are my current medications and immunizations adequate? Do I need lung function and blood gas tests?

What over-the-counter drugs should I bring with me?

What should I do if I have a flare up? Which rescue inhaler should I use and how frequently?

If I travel by air, do I require an adjustment of my oxygen intake?

Discuss the list of approved POCs (http://www.homeoxygen.org/airline-travel-with-oxygen); ask if the one you are currently using is alright to travel with; if not which one should you bring?

Request that your doctor write on his/her letterhead the following: approval for air travel, contact information, medical Information about your lung disorder, verification of the need for oxygen (O2) and the O2 flow rate necessary for flights. Take multiple copies of that letter as they are required by the airline for each flight for their medical department to evaluate your needs. This letter also may be offered to O2 suppliers during your travels.

Information sources: COPD Foundation (www.copdfoundation.org) and the American Lung Association (www.lungusa.org).

RF

Readers: Can you add other factors that need clarification with your physician?

Continued on May, 1, 2014; tips for air, ship, or train travel with O2.