Pioneer practitioners

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The independent nurse practitioner with her or his own business is a rare breed. Though most of these professionals work for others, change is looming. Large numbers of baby-boomer-aged family physicians are poised to retire in coming years. The Physicians

Foundation says nearly half are over age 50, so a shortage of primary-care doctors is predicted.

It seems that nurse practitioners may step up to fill the gap. Luckily their numbers are rising. In the past five years the yearly number of NP licenses issued has increased from 946 to 1383.

For five years Linda LaRocco, who has a master’s and a doctorate in nursing, has been seeing patients at her Pine Bush office. She has five examining rooms, a staff of two and a collaborating physician who reviews her patient charts quarterly. While insurance billing first had to be done through the collaborator as well, now it goes directly to her office. It is also performed now by an outside billing company rather than staff, which streamlines paperwork further.

Many people still aren’t sure what a nurse practitioner is exactly. “People don’t know how it works,” LaRocco told me, “who we are and what we do.” She’s trying to change that. “I’ve spent five years trying to get the word out,” she added. “I’m a doctor but not a physician.”

She has a doctorate, a Ph.D., not unlike other advanced medical practitioners who go on for advanced study, such as nurse anesthetists or nurse midwives. “One patient calls me ’noctor,” she said. By state law, she told me, she can’t just put “DNP” on her shingle. She has to spell it out: Doctor of Nursing Practice.

The profession began in the 1960s in Colorado, initially to treat medically underserved children. Dr. Loretta Ford and Dr. Henry Silver, a nurse and a pediatrician, started the first educational program at the University of Colorado.

These professionals start with a registered nurse license, and then go back to school for a master’s degree before they are eligible to sit for the NP licensing exam. Some, like LaRocco or those required to do so for teaching, return yet again for a doctorate. Once licensed they practice with a philosophy that stresses prevention, care and cure, and can perform physical exams, diagnose and treat illnesses both acute and chronic, interpret lab tests, prescribe medications, counsel patients on health and illness issues and refer them to specialists.

“I’ve developed relationships with them,” said LaRocco. “I’m colleagues with many specialists. I refer people to them and they are just a phone call away.”

The degree of physician involvement varies state to state. In a minority of states — 11 to 19, depending on the source — NPs can practice absolutely autonomously with no collaborators needed. New York is not one of these states, hence the quarterly reviews by LaRocco’s collaborator.

Healthy winter skin

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When you were a kid, did anyone ever tell you, “Your epidermis is showing?” Maybe you looked down at yourself trying to figure out what that was, before you learned it meant the outer layer of your skin and it was all over.

Well, although less of it shows in the winter, you may want it to look the best it can, and even the parts that are covered with sweaters and warm pants should be comfortable, supple and free of itches or cracks. Many people, from dermatologists to experts in natural supplements, have opinions on what can help skin ravaged by winter air, whether the cold outdoor kind or heated indoor, both of which take a toll on our tender but strong outermost layer.

At about eight pounds, give or take, the skin is the largest organ in our body, although as a 22-square-foot, tissue-thin layer that covers us, it hardly resembles the bloody masses we imagine our internal organs to be. But an organ it is, as essential for life as heart or brain. Many burn victims who lose much of their skin do not survive. When I worked in a hospital 20 years ago, patients with more than 50 percent of it burned didn’t usually survive. But with modern treatments 90 percent body burn patients can survive, per the American Burn Association.

This amazing organ protects our body’s interiors from sunlight, heat, cold, chemicals and infection. It is waterproof. It is insulator, protector and shield. It is conduit and translator as the brain’s interface with the world, and like the eyes, part of our sex appeal. It contains natural antibiotics and is an important part of the immune system. As part of the endocrine system it makes vitamin D, which is actually a hormone that helps calcium make our bones strong.

Although it changes in structure and thickness over different parts of the body, the skin has three layers. That epidermis — what shows — is very thin and constantly renewing itself. Underneath is the dermis, with sebaceous glands for perspiration, and elastin and collagen for flexibility and strength. The innermost layer is the subcutaneous fat layer, or subcutis, which helps cushion, protect and insulate us.

The thinner skin of the fairer sex is a little more dainty and delicate than men’s. It is less oily and sweaty, making us more prone to damage from the elements like sun, wind and drying air. Cold winds, drying indoor heat and drinking less because we’re less hot and thirsty in the winter all combine to cause dry skin. Sometimes the condition goes beyond mild discomfort to very unpleasant itching, eczema or cracks and fissures in the skin.

Keep Your Brain Healthy

[wide]alzheimer's[/wide]In the recently released trade paper edition of The Alzheimer’s Prevention Program: Keep Your Brain Healthy for the Rest of Your Life, Gary Small and Gigi Vorgan reiterate the latest prognosis about the insidious disease that steals our loved ones from us — indeed, as it takes away life as we know it from anyone stricken. No, there is still no cure for Alzheimer’s. And diagnosis remains iffy, with detection often inadvertently postponed until frightening symptoms have presented themselves.

The hope Small and Vorgan point to hangs on research that has uncovered the possibility of prevention. By becoming aware of lifestyle habits that promote a healthy brain, we can, they proclaim, push back the onset of dementia caused by aging and even offset the potential of genetic predisposition for the disease.

For those of us still in possession of our mental marbles, this is good news. Solid scientific investigation into the vitality of the human brain indicates that measures can be taken to slow down and stave off the damaging effects of Alzheimer’s disease and the development of those pesky amyloid plaques and tau protein tangles evident in the autopsied brain matter of its victims. These waxy proteins and twisted fibers are the unwelcome microscopic evidence left in areas of the brain that control memory and functions such as language, decision making, and personality. What isn’t known is whether they are the byproducts or the causes of the ailment, but by studying what goes on in the brain as it ages, researchers have found that healthy lifestyle habits — a wholesome diet, regular physical activity, and robust cognitive engagement — might be key in preventing cognitive decline.

In an otherwise upbeat report, The Alzheimer’s Prevention Program outlines some of the more sobering statistics of Alzheimer’s disease. Every 70 seconds, another American is diagnosed to be suffering from it. By midcentury, a new case will develop every 30 seconds. Victims currently number up to 36 million worldwide. The worldwide costs of medical and social care, including estimated informal care from unpaid family members and others, totaled $604 billion in 2010 — more than the annual revenue of Walmart. That plaques and tangles begin to build up in an affected brain decades before symptoms emerge, and even in the brains of otherwise healthy people as young as 30.

Garlic, anyone?

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The Roman writer Horace hated garlic. He associated the odor with vulgarity. Homer, on the other hand, has Ulysses attribute the virtues of yellow garlic to his escape from being turned into a pig by Circe. De Candolle, in his 1883 treatise on the Origin of Cultivated Plants, wrote that the plant originated in southwest Siberia and was carried to southern Europe. Dumas has described the air of Provence as being “particularly perfumed by the refined essence of this mystically attractive bulb.”

Through the centuries, garlic has been touted as curing or preventing most of what can ail us humans. It’s been variously identified a diaphoretic (something that brings on a good sweat), diuretic, expectorant, stimulant, stomachic. Its antiseptic qualities have been long recognized. It was believed useful against leprosy and smallpox. It was the principal ingredient in the ‘Four Thieves’ Vinegar,’ said to have been used successfully against the plague at Marseilles in 1722. Apparently four thieves confessed that while protected by the liberal use of a garlic infusion, they plundered the dead bodies of plague victims and lived to tell about it.

Syrup of garlic was used to treat asthma, hoarseness, coughs, chronic bronchitis and most other lung disorders. A clove or two of garlic, pounded with honey and taken two or three nights successively, was supposed to be good for rheumatism. (Then, of course, there’s its efficacy against vampires.)

More currently, garlic has been promoted as a cholesterol-lowering agent, but a recent study, funded by the National Center for Complementary and Alternative Medicine, NCCAM, testing this effect came up with interesting results.

Sweet cachinnation

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Photo by Flickr user XeuBix/used under Creative Commons license

Laughter is wine for the soul — laughter soft, or loud and deep, tinged through with seriousness… the hilarious declaration made by man that life is worth living.— Sean O’Casey from “Saturday Night” in Green Crows (Grosset & Dunlap, 1956)

The more you laugh the healthier you’re likely to be, physically and mentally. Or maybe healthier people laugh more, researchers still don’t know for sure. Regardless of which comes first, the relationship between seeing someone’s tongue stuck to an icy ski-lift handle and activity in the nucleus accumbens, a brain region associated with cocaine induced rapture, is of growing interest to the scientific community. And it seems the benefits of a good laugh go beyond the pleasure pathway.

For example, researchers at the University of Maryland School of Medicine in Baltimore have demonstrated that laughter is linked to the healthy function of blood vessels, and seems to offset the deleterious effects of stress on the cardiovascular system.

The test findings led the University of Maryland School of Medicine investigators to conclude that laughter, at the very least, offsets the harmful effects of stress on the endothelium, and by extension, the whole cardiovascular system.

They also noted that these salutary cardiovascular effects were about equal to what you might expect of ten minutes on a rowing machine. The researchers were careful to point out, however, that they did not recommend dropping plans to work out to watch reruns of Comedy Central.

Earlier studies have found connections between laughter and a strong immune system, improved mental and emotional health, greater pain tolerance and speedier recovery from surgery or serious illness. The specific mechanism of these healthful changes is still a mystery. The movement of the diaphragm during a belly laugh, endorphin release, nitric oxide production (a substance that contributes to blood-vessel expansion), all might play a role.

Regardless of what makes you laugh, a growing body of data suggests that it’s a good idea to do it as frequently as possible.