Category: Healthy Living

Texting while thriving

A new program aims to use text messages to help obese patients achieve healthier lifestyles.

We’re a nation of texters, LOL’ing our way to instant (and addictive) connection and communication with those around us.

But those messages don’t have to be mundane, goofy or superficial.  In fact, some of them have the potential to save—or at least improve—lives.

Beginning in June, members of Dr. Theodore Friedman’s obesity group at the county’s Martin Luther King, Jr. Multi-Ambulatory Care Center will begin receiving text reminders, tips and other information designed to empower them to stick to  health goals. In the new program, the mobile phone acts as a virtual health coach between visits to the doctor.

Maybe it’s a reminder: Zumba class at 4 p.m.  Or this techno-friendly nudge: “Did you meet your goal of eating a healthy breakfast today?”  Or it could be a “mood” question: “How did you feel when you found out that you had high blood pressure?”  If you chose “confused,” another text assures you that your feelings are normal.

“This is a way to harness technology that everybody is using and embracing,” said Dr. Ellen Rothman, interim medical director for the health center.  The technology does not allow for live text conversations with the doctor, but between appointments, an automated reminder is next best thing, Rothman said.

Drs. Ellen Rothman and Theodore Friedman

This week the County Board of Supervisors approved an agreement between the  care center,  Charles R. Drew University of Medicine and Science  and CareMessage, Inc. to begin a pilot program with about 200 patients who are part of the obesity group, which has been in existence for about 16 months. The initial $500-a-month program is paid for with grant funds from Drew University so there is no direct cost to the county.

“We are going to break down…therapeutic goals into bite-sized pieces,” Rothman said. “A goal might be: I’d like you to walk for 30 minutes a day. I’d like you to cut out that cereal and milk at bedtime that everybody thinks is so healthy; I’d rather have you eat a slice of bread with some peanut butter that’s more filling and nutritional.”

The CareMessage program is not set up to offer advice quite as personalized as Rothman’s. But it can provide a menu of customizable programs designed for specific problems.  Options include teen pregnancy, stress management, stress monitoring, smoking cessation or nutrition.

During an initial consultation with a medical professional, the patient will work with the doctor to set up his or her own mobile device to receive text messages. The patient can choose the frequency of reminders or customize a diet or exercise program to their age, weight or fitness level. CareMessage programs are available in English and Spanish.

Friedman chose the obesity group for the pilot because obese patient health care often calls for lifestyle changes rather than medications. That’s where the text-coaching can help, he observed.

“Obesity is not a medical disease,” Friedman said. “This is all about motivation.”

While the text messaging program has not yet begun, current hospital efforts and research point toward potential success.  Low-income patients may not have computers or land-line telephones, but 70 to 80% of the care center’s low-income patients have mobile phones with texting capability. “And that’s going to go up each year,” Friedman said.

The facility has seen great improvement in the number of patients showing up for scheduled appointments if they get telephone reminders, but calling is labor-intensive and often results in no answer. Automated texts would not only save time and effort but could also reach a greater number of patients.

If the program expands, the technology may also make it easier for the hospital to gather survey information, too. Paper survey forms can be off-putting but with the new system, “you can do it on your phone while you are waiting for an elevator,” Friedman said.

But key for obesity patients, doctors say, is increasing the odds of lifelong behavioral changes. Among MLK’s economically disadvantaged clients, doctors say they’ve observed an uptick in health literacy over the past 15 years. Still, misinformation abounds, including a widespread belief that clear soda is healthier than colored soda.

“I like the idea of touch points, or teachable moments,” Rothman said. “We have limited resources and a lot of patients.  It’s an interesting opportunity to catch people in their teachable moments.”

Dr. Friedman has been meeting with the obesity group for about 16 months.

Posted 5/22/14

Staying strong for the marathon

Seth Gamradt

Dr. Seth Gamradt is director of orthopedic athletic medicine at Keck Medicine of USC and team physician for USC athletics. Here’s his quick rundown for surviving Sunday’s race:

Fuel:  It is critical to fuel your body before the race.  Eat high carbohydrate meals (80 percent of intake) for several days prior to the race to build up your store of glycogen, a crucial energy source for your body.  On the morning of the race try to eat a 500-800 calorie breakfast 2-3 hours before the race.  Limit fiber to avoid mid-race gastrointestinal upset. Predictability is key:  eating foods you know and that worked well on your long training runs is critical for a calm stomach and high energy on race day.

Shoes:  It seems obvious, but avoid changes in equipment on race day, especially shoes.  Wearing your tried and true runners will help to prevent the foot pain and blistering that are common in long-distance running.

Hydration:  Before the race, pay attention to urine color, aim for light yellow as a sign of adequate hydration. Although sweat rates vary from runner to runner, a good guideline for hydration is 6-8 ounces of fluid every 20 minutes.  Avoid over-hydrating, which can lead to stomach upset.  Make sure your race-day hydration consists of energy drinks containing carbohydrates and electrolytes and water.  Consuming water alone during the race can lead to hyponatremia, which is caused by dilution of the blood’s sodium level and can be very dangerous.

Energy Gels/Bars:  Commercially available pre-packaged carbohydrate sources are an important fuel source in triathlon and distance running.  Again, familiarity is key to avoid race- day stomach upset, so stick with energy snacks you’ve consumed during your training.  Consume one 45-60 minutes (with water) after the race starts and every 45-60 minutes thereafter.

Lubrication/Skin Protection:  Lubricate sensitive areas with anti-chafing, anti-blister products.  Believe it or not, severe blistering or chafing can end your race prematurely. For sun protection, apply sports sunscreen that protects against UVB and UVA rays at least 30 minutes before running, and consider wearing sun protective clothing made specifically for running.

Pace:  The adrenaline of the race start will lead to the possibility of starting too fast. Begin your pace near or slower than your typical pace from your long training runs to avoid a late race flame out.

Pain:  You may experience pain, soreness, muscle ache and fatigue on race day from training.  If you typically take non-steroidal anti-inflammatory drugs (NSAIDs – Advil, etc.) or acetaminophen (Tylenol) before training runs, do not change this on marathon day.  However, if you have not been using these over-the-counter medications, race day is probably not the time to experiment.

Danger Signs:  As mentioned, some soreness is expected on race day.  However, if you begin to experience sharp pain with each step, swelling in a joint, escalating pain anywhere in your body or you begin to limp, it is not advisable to push through these types of symptoms and finish the race.  In addition, confusion, light-headedness, chest pain, and shortness of breath all can be signs of a significant medical issue—seek medical attention immediately.

Completing the L.A. Marathon is an important goal you have set for yourself. Make sure you do the things on race day that support the training you have done up to this point and you will have the best opportunity to hit the finish line feeling like a winner!