Back to Basics – Weight Loss

Exercise Outdoors

Disclaimer: This article is not intended to provide medical advice. Before starting dietary changes, and/or exercise, please consult your physician.

When it comes to weight loss, the best approach is to go “Back to Basics.”

We are living in the era of “enlightenment,” and are constantly flooded with data on this or that. Weight loss happens to be one of those areas where there is literally an abundance of data. Sadly, an abundance of information and little time to sift through it leaves us sometimes bewildered.

One then asks, “who do I believe?” “What do I do?” “What course must I follow?” To this, there is no straightforward answer. But, do not despair. One thing that I have found in my personal journey is that the “Back to Basics” approach is a tried and tested one. Yes, there might be a little tweaking here and there necessary. The reason for this is that one size does not fit all in this case.

What are the basics? Well, we all know that. With few exceptions, it is as simple as energy balance. If energy consumed equals energy used, then everything remains the same. Taking this premise, we can conclude that if energy used is greater than energy consumed, then a deficit is created and, therefore, weight loss will follow (as mentioned above, there are few exceptions to this rule).

Now, many will go the wrong way, and opt out for energy deprivation. Not good. You can only sustain this approach for so long, and we all know the potential consequences (health related issues, regaining all the weight soon after, and so on). This is not the safest way to lose weight if you want to keep it off.

Now, the more sane approach. You can combine healthy eating with a good exercise regime. Yep, no way around this. If you are truly looking to make a long lasting impact, you MUST add exercise. Now, it can be as simple as walking three to five times a week for half an hour. There are scores of things you can do to exercise. I won’t beat that old horse here, but I cannot overemphasize the necessity of exercising.

So, to lose one pound, you need to burn (create an energy deficit) 3,500 calories. You don’t need to start accounting for every calorie you consume unless you want to do that. You do need to consume less calorie dense foods like vegetables, fruits, beans, grains, etc. These kinds of foods should compose the bulk of what you eat. Beware of processed and refined foods.

I personally have found that a combination of light aerobic exercise and strength training works really well. One will help you lose weight while the other will assist in weight loss and tone your body. To me, this is a win-win combination.

What I have shared comes out of my empirical experience. May this info be of help to you.

I would like to leave you with the following quote:

“No one climbs the ladder of success with their hands in their pocket.” —Nido Qubein

With kind regards,

Edward Lara

Advance Medical Directives

Patient In Hospital Bed

STATEMENT OF ILLINOIS LAW ON ADVANCE DIRECTIVES AND DNR ORDERS

You have the right to make decisions about the health care you get now and in the future. An advance directive is a written statement you prepare about how you want your medical decisions to be made in the future, if you are no longer able to make them for yourself. A do not resuscitate order (DNR order) is a medical treatment order that says cardiopulmonary resuscitation (CPR) will not be used if your heart and/or breathing stops.

Federal law requires that you be told of your right to make an advance directive when you are admitted to a health-care facility. Illinois law allows for the following three types of advance directives: (1) health care power of attorney; (2) living will; and (3) mental health treatment preference declaration. In addition, you can ask your physician to work with you to prepare a DNR order. You may choose to discuss with your health-care professional and/or attorney these different types of advance directives as well as a DNR order. After reviewing information regarding advance directives and a DNR order, you may decide to make more than one. For example, you could make a health care power of attorney and a living will.

If you have one or more advance directives and/or a DNR order, tell your health-care professional and provide them with a copy. You may also want to provide a copy to family members, and you should provide a copy to those you appoint to make these decisions for you.

State law provides copies of sample advance directives forms. In addition, this webpage provides a copy of these forms and a copy of the Illinois Department of Public Health (IDPH) Uniform Do Not Resuscitate (DNR) Advance Directive.

  • Article I. Health Care Power of Attorney

    The health care power of attorney lets you choose someone to make health-care decisions for you in the future, if you are no longer able to make these decisions for yourself. You are called the “principal” in the power of attorney form and the person you choose to make decisions is called your “agent.” Your agent would make health-care decisions for you if you were no longer able to makes these decisions for yourself. So long as you are able to make these decisions, you will have the power to do so. You may use a standard health care power of attorney form or write your own. You may give your agent specific directions about the health care you do or do not want.

    The agent you choose cannot be your health-care professional or other health-care provider. You should have someone who is not your agent witness your signing of the power of attorney.

    The power of your agent to make health-care decisions on your behalf is broad. Your agent would be required to follow any specific instructions you give regarding care you want provided or withheld. For example, you can say whether you want all life-sustaining treatments provided in all events; whether and when you want life-sustaining treatment ended; instructions regarding refusal of certain types of treatments on religious or other personal grounds; and instructions regarding anatomical gifts and disposal of remains. Unless you include time limits, the health care power of attorney will continue in effect from the time it is signed until your death. You can cancel your power of attorney at any time, either by telling someone or by canceling it in writing. You can name a backup agent to act if the first one cannot or will not take action. If you want to change your power of attorney, you must do so in writing.

  • Article II. Living Will

    A living will tells your health-care professional whether you want death-delaying procedures used if you have a terminal condition and are unable to state your wishes. A living will, unlike a health care power of attorney, only applies if you have a terminal condition. A terminal condition means an incurable and irreversible condition such that death is imminent and the application of any death delaying procedures serves only to prolong the dying process.

    Even if you sign a living will, food and water cannot be withdrawn if it would be the only cause of death. Also, if you are pregnant and your health-care professional thinks you could have a live birth, your living will cannot go into effect.

    You can use a standard living will form or write your own. You may write specific directions about the death-delaying procedures you do or do not want.

    Two people must witness your signing of the living will. Your health-care professional cannot be a witness. It is your responsibility to tell your health-care professional if you have a living will if you are able to do so. You can cancel your living will at any time, either by telling someone or by canceling it in writing.

    If you have both a health care power of attorney and a living will, the agent you name in your power of attorney will make your health-care decisions unless he or she is unavailable.

  • Article III. Mental Health Treatment Preference Declaration

    A mental health treatment preference declaration lets you say if you want to receive electroconvulsive treatment (ECT) or psychotropic medicine when you have a mental illness and are unable to make these decisions for yourself. It also allows you to say whether you wish to be admitted to a mental health facility for up to 17 days of treatment.

    You can write your wishes and/or choose someone to make your mental health decisions for you. In the declaration, you are called the “principal” and the person you choose is called an “attorney-in-fact.” Neither your health-care professional nor any employee of a health-care facility in which you reside may be your attorney-in-fact. Your attorney-in-fact must accept the appointment in writing before he or she can start making decisions regarding your mental health treatment. The attorney-in-fact must make decisions consistent with any desires you express in your declaration unless a court orders differently or an emergency threatens your life or health.

    Your mental health treatment preference declaration expires three years from the date you sign it. Two people must witness you signing the declaration. The following people may not witness your signing of the declaration: your health-care professional; an employee of a health-care facility in which you reside; or a family member related by blood, marriage or adoption. You may cancel your declaration in writing prior to its expiration as long as you are not receiving mental health treatment at the time of cancellation. If you are receiving mental health treatment, your declaration will not expire and you may not cancel it until the treatment is successfully completed.

  • Article IV. Do-Not-Resuscitate Order

    You may also ask your health-care professional about a do-not-resuscitate order (DNR order). A DNR order is a medical treatment order stating that cardiopulmonary resuscitation (CPR) will not be attempted if your heart and/or breathing stops. The law authorizing the development of the form specifies that an individual (or his or her authorized legal representative) may execute the IDPH Uniform DNR Advance Directive directing that resuscitation efforts shall not be attempted. Therefore, a DNR order completed on the IDPH Uniform DNR Advance Directive contains an advance directive made by an individual (or legal representative), and also contains a physician’s order that requires a physician’s signature.

    Before a DNR order may be entered into your medical record, either you or another person (your legal guardian, health care power of attorney or surrogate decision maker) must consent to the DNR order. This consent must be witnessed by one person who is 18 years or older. If a DNR order is entered into your medical record, appropriate medical treatment other than CPR will be given to you. This webpage provides a copy of the Illinois Department of Public Health (IDPH) Uniform Do Not Resuscitate (DNR) Advance Directive that may be used by you and your physician. This webpage also provides a link to guidance for individuals, health-care professionals and health-care providers concerning the IDPH Uniform DNR Advance Directive.

  • Article V. What happens if you don’t have an advance directive?

    Under Illinois law, a health care “surrogate” may be chosen for you if you cannot make health-care decisions for yourself and do not have an advance directive. A health care surrogate will be one of the following persons (in order of priority): guardian of the person, spouse, any adult child(ren), either parent, any adult brother or sister, any adult grandchild(ren), a close friend, or guardian of the estate.

    The surrogate can make all health-care decisions for you, with certain exceptions. A health care surrogate cannot tell your health-care professional to withdraw or withhold life-sustaining treatment unless you have a “qualifying condition,” which is a terminal condition, permanent unconsciousness, or an incurable or irreversible condition. A “terminal condition” is an incurable or irreversible injury for which there is no reasonable prospect of cure or recovery, death is imminent and life-sustaining treatment will only prolong the dying process. “Permanent unconsciousness” means a condition that, to a high degree of medical certainty, will last permanently, without improvement; there is no thought, purposeful social interaction or sensory awareness present; and providing life-sustaining treatment will only have minimal medical benefit. An “incurable or irreversible condition” means an illness or injury for which there is no reasonable prospect for cure or recovery, that ultimately will cause the patient’s death, that imposes severe pain or an inhumane burden on the patient, and for which life-sustaining treatment will have minimal medical benefit.

    Two doctors must certify that you cannot make decisions and have a qualifying condition in order to withdraw or withhold life-sustaining treatment. If your health care surrogate decision maker decides to withdraw or withhold life-sustaining treatment, this decision must be witnessed by a person who is 18 years or older. A health care surrogate may consent to a DNR order, however, this consent must be witnessed by one individual 18 years or older.

    A health care surrogate, other than a court-appointed guardian, cannot consent to certain mental health treatments, including treatment by electroconvulsive therapy (ECT), psychotropic medication or admission to a mental health facility. A health care surrogate can petition a court to allow these mental health services.

  • Article VI. Final Notes

    You should talk with your family, your health-care professional, your attorney, and any agent or attorney-in-fact that you appoint about your decision to make one or more advance directives or a DNR order. If they know what health care you want, they will find it easier to follow your wishes. If you cancel or change an advance directive or a DNR order in the future, remember to tell these same people about the change or cancellation.

    No health-care facility, health-care professional or insurer can make you execute an advance directive or DNR Order as a condition of providing treatment or insurance. It is entirely your decision. If a health-care facility, health-care professional or insurer objects to following your advance directive or DNR order then they must tell you or the individual responsible for making your health-care decisions. They must continue to provide care until you or your decision maker can transfer you to another health-care provider who will follow your advance directive or DNR order.

MONITORING YOUR CREDIT REPORT

Credit

Have you applied for a car loan?  Asked to have cable TV or internet installed?  Tried to get a mortgage on a house or condo unit?  Tried to rent an apartment?  Applied for a new credit card?  In each case described above, someone checked your credit report.

What is a credit report?  A credit report is a document which contains information about your credit such as loan paying history and the status of your credit accounts.  Lenders use these reports to make lending decisions.  The credit report tells how much credit you have, how much credit you have available, and how much you are using.  It tells if a debt collector or bill collector is collecting on money you owe.

Credit reporting companies compile these reports and make them available.  The three major credit reporting companies are EQUIFAX, experian, and TransUnion.   It is important that you request copies of these reports once a year.  You can request them all at once and compare the information.  You may prefer to spread your requests over the year so you can monitor your credit report more frequently.  Check them to be sure they are correct.  If you see an error, send a letter to dispute it.

You can get a free copy of your credit report by completing the request form at AnnualCreditReport.com or call (877)322-8228.  Be careful that you do not use another site.  Other sites may pretend to offer you a free credit report, but they may require that you purchase another item or service.

Mail the completed form to the following address:

Annual Credit Report Request Service
P.O. Box 105281
Atlanta, GA  30348-5281

Your credit score will not be included in your free credit report.  If you need your credit score, you can purchase it directly from EQUIFAX, experian, and TransUnion.

For further information about credit scores, go to www.consumerfinance.gov.

By Karen Centowski

SLOWER THAN MOLASSES IN JANUARY – Nursing Talk

Nursing Talk

Dear Cassandra,

A month ago I received an e-mail from Human Resources asking me to fax a copy of my current nursing license. Two weeks later HR left a message on my voice mail reminding me to fax the copy of the license. Yesterday I received a letter telling me that my personnel file is not in compliance with DSCC and IDPH rules because it does not contain a copy of the nursing license. HR has verified my license on the Illinois Department of Financial and Professional Regulation Web site. I’ve been busy. What’s the big hurry?

In Slow Motion in Matteson

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Dear In Slow Motion,

One day you get your mail out of the mailbox. Sandwiched between the Value Pack Coupons and the free note pad from the Nature Conservancy is a letter from the Illinois Department of Revenue. You filed your tax return by April 15, and it is now July. You were expecting a refund of $72.00, but you don’t recall ever receiving it. This must be the refund. Instead, it is a request for a copy of your real estate tax bill. If you supply the document, the State of Illinois will allow your real estate tax credit and send the refund of $72.00. If not, you owe $143.00. That gets your attention. The next day you make a copy of the real estate tax bill and mail it to the state. Your refund arrives several weeks later.

Maybe you are looking through your mail, and you discover a letter from the Internal Revenue Service, the big boys. Your heart stops. They want proof that you, not your ex-husband, have the right to claim your three children as dependents. If you send the documentation by the deadline, all is well. If not, you owe $7,800. Faster than ice melting on a sidewalk in August, you gather the documentation and mail it to the IRS. Whew! You just saved $7,800.

In business, the concept of responding quickly to key business matters is called having a sense of urgency. The customer expects and appreciates prompt, efficient service. A sense of urgency is a process of treating key business or personal matters as if one’s life depended on it. It is a determination to stay focused on results and deadlines until the task is completed. A sense of urgency is common to highly productive people, companies, and countries.

What if you were trying to get a mortgage or rent an apartment? The lender or apartment manager faxes a verification of employment and income to your employer. Your application will not be processed without that information. Do you want your employer to take a month to respond?

When you don’t respond to simple requests from your employer, you are disrespecting your employer. You are making the staff waste valuable time contacting you again and again. You are inviting trouble in an audit because your personnel file is not in compliance with DSCC and IDPH regulations.

It’s time to adjust your attitude. Resolve to respond promptly to requests. Your money or your livelihood may depend on it.

—Cassandra

Note: First published on American Home Health's news, April 2011.

ILLINOIS STATE TREASURER’S UNCLAIMED PROPERTY AUCTION

Auction

Illinois Treasurer Michael W. Frerichs has announced that an Illinois State Treasurer’s Unclaimed Property Auction of 12,600 items worth $57,000 will be held online March 28, 2016 from 10:00 A.M. to April 1, 2016 at 10:00 A.M. Among the items to be auctioned are silver bars, rare gold coins, baseball cards, jewelry, and sterling silver.

The Illinois State Treasurer’s Office is the custodian of unclaimed property left in safe deposit boxes, lost bank accounts, insurance policy proceeds, and unpaid rebate cards. Items are auctioned after public and private entities have tried for at least ten years to locate the owners. Auction proceeds are kept in perpetuity by the State of Illinois so they can be given to the owners or heirs.

To preview the auction items, go to ILLINOIS STATE TREASURER’S UNCLAIMED PROPERTY AUCTION MARCH 28-APRIL 1. Click on PREVIEW ITEMS. See the pieces including 1983 one ounce gold Krugerrands, 1897 Liberty Head five dollar gold piece, Morgan silver dollars, Kennedy half dollars, and Indian Head pennies. Look at the freshwater pearl bracelet, the gold pendants and charms, the sterling silver bracelets, the 14K gold rings, and the 14K gold pins and pendants. Appreciate the value of the wrist watches and sterling silverware. Smile at the baseball trading cards.

If you wish to participate in the auction, remember that many of these things are collectors’ items. Others have great value because of their gold and silver content. It is interesting to look at the items even if you do not intend to bid on anything.

By Karen Centowski

Drugs Influencing the Respiratory System

Medications and Respiratory System

  1. Corticosteroids

    These drugs produce an anti-inflammatory effect. Used to reduce mucous secretions, swelling and inflammation. Used in conjunction with bronchodilators to open airways in conditions such as asthma and COPD.

    Examples: Flovent, Solumedrol, Azmacort, Decadron

    Side Effects: Masks infections, hyperglycemia, slow wound healing.

  2. Beta Agonists

    These are drugs having an affinity for the Beta 2 receptors sites. These sites are found primarily in bronchial and vascular smooth muscles producing bronchial relaxation and arterial dilation to skeletal muscles.

    Used to relieve bronchoconstriction, for short term treatment of acute exacerbations, and long term treatment to control symptoms. Used for nocturnal symptoms.

    Examples: Alupent, Serevent, Proventil

    Side Effects: Tachycardia, headache, angina, muscle tremors

A PIG IN A POKE – Nursing Talk

Nursing Talk

Dear Cassandra:

Why did the company switch to using Clockworks instead of timesheets? Why do we have to call in from the parent’s phone rather than using our cell phone? Why do we have to submit copies of our nursing license and both sides of the CPR card?

Just Asking in Aurora 

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Dear Just Asking:

Say you have lived in your house thirty-four years. A few years after you moved in, you had a new roof installed. You chose asphalt shingles with a twenty-five year warranty. Now the shingles are curling, and you are noticing extra granules in the gutters. You need a new roof. You find a flyer in your door from an out of town roofing company. The flyer says they are doing work in your area and would like to give you a free estimate. You ask for the same high quality asphalt shingles with a twenty-five year warranty. The price is agreeable, and you have the work done. You pay the bill. A year later you discover that cheap, poor quality shingles were installed. When you try to contact the company, you discover that the company is out of business. You learn that the Better Business Bureau has received numerous complaints about this company. You are a victim of fraud. You are devastated.

Fraud is a deliberate misrepresentation which causes another person to suffer damages. Defrauding people or entities of money or valuables is a common purpose of fraud. It is a crime. In the Middle Ages, meat was scarce, but feral cats were abundant. A confidence game or trick was to sell a cat in a sack instead of a pig in a sack. This confidence game was called a pig in a poke.

Fraud is a huge problem in business today. The typical organization loses 5% of its annual revenue to fraud, with a median loss of $160,000. Medicare fraud is estimated at $60 billion a year.

Businesses try to prevent fraud by various methods. For example, timecard fraud occurs when an employee has a co-worker or another person punch in/ punch out. Businesses try to prevent timecard fraud or “buddy punching” by using fingerprint based punch in/punch out machines or systems like Clockworks.

The Clockworks system uses a unique ID and password to record the number of hours worked. The employee must call from the parent’s phone, the phone in the house of the client. That guarantees that the employee is actually in the home, not calling from another location. Clockworks helps ensure that employees are paid for legitimate hours worked.

Clinical notes must be written every two hours and must match the time in/ time out recorded in Clockworks. Making up clinical notes for care not given is fraudulent. Cases of fraud are reported to the Illinois Department of Financial and Professional Regulation. The State of Illinois can revoke a nursing license if the person is found guilty of fraud.

The advent of computer technology has made it possible for individuals to create fake nursing licenses and CPR cards. These counterfeit documents are presented to potential or current employers. To combat this type of fraud, the employer must verify the licenses on the Web site of the Illinois Department of Financial and Professional Regulation. The State also requires that the personnel files contain both the front and back sides of CPR cards. The employer can verify the CPR card by contacting the school or organization sponsoring the CPR class. Verifying the licenses and CPR cards helps ensure that qualified nurses are caring for the clients.

Employers need to expect good behavior from their employees and monitor their activities. As Ronald Reagan said regarding the Soviet Union and nuclear arms, “Trust but verify.” If employees are committing fraud, employers must hold employees accountable for their actions.

—Cassandra

Note: First published on American Home Health's news, March 2011.