disability

RECENT POSTS

Why To Exercise Today: For Women, Svelte Aging Without Disability — And It’s Not Sitting

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This winter is a struggle. We’re awash in excuses not to get outside and move freely, and exercise seems secondary to just getting through the day. Yesterday, when it started raining ice, for instance, didn’t you just want to wrap up in layers with a hot cup of sweet tea? But, of course, that’s precisely what you shouldn’t do.

Two recent reports re-emphasize everything you already know, but with added detail: fitness (and that involves weight, nutrition, exercise and overcoming a sedentary lifestyle) matters.

Why? Well, here are some of the specifics (that are not actually about exercise per se, but related to it): for women, staying at a healthy weight and avoiding obesity can truly allow you to age (past 85, even) without disability.

Here’s Paula Span in The New York Times on “Weight Gain and Older Women“:

When the researchers looked at the impact that obesity or being overweight — calculated by body mass index — took on the women’s health, “we found that women with a healthy body weight had a greater chance of living to 85 without developing a chronic disease or a mobility disability,” Dr. Rillamas-Sun said. “The heavier you are, the worse your chances of healthy survival.”

And in another blow to the reclining life, researchers at Northwestern report that “every additional hour a day you spend sitting is linked to doubling the risk of being disabled.”

This is less a “why to exercise” finding than a “why not to sit” finding. Still, my point is that the more you’re jogging (or doing water aerobics, or yoga, or shoveling when necessary) the less you’re sitting.

Here’s how the Northwestern news release sums things up: “If there are two 65-year-old women, one sedentary for 12 hours a day and another sedentary for 13 hours a day, the second one is 50 percent more likely to be disabled.” Continue reading

Abercrombie: ‘No Uncool.’ Now Victoria’s Secret: No Mastectomy Bras

Abercrombie & Fitch models (Wikimedia Commons)

Abercrombie & Fitch models (Wikimedia Commons)

This is what we call an aggregating post, in which we pull together related news items, and the items I’m aggregating today concern companies that define their brands as “exclusive” — not as in “luxurious” but as in “We choose to exclude certain populations, such as disabled people or women who’ve lost breasts to cancer or are not sylphs.”

First, this just in from CBS News here: Victoria’s Secret Will Not Make Mastectomy Bras, despite the 128,000 signatures on a petition asking for them.

Despite immense public support, Victoria’s Secret will not manufacture a mastectomy bra, the company said Monday.

“Through our research, we have learned that fitting and selling mastectomy bras in the right way…a way that is beneficial to women is complicated and truly a science. As a result, we believe that the best way for us to make an impact for our customers is to continue funding cancer research,” Victoria’s Secret said in a statement.

Allana Maiden had started a petition on Change.org earlier this year, urging the company to create bras for women who had a mastectomy. Maiden’s mother Debbie Barriett underwent a mastectomy over two decades ago when she fought breast cancer.

The Victoria’s Secret decision, of course, says nothing like “We want our brand to be linked to sexy models, not mastectomy patients,” but it immediately made me think of the still-resonating impact of a 2006 Salon interview with Abercrombie and Fitch CEO Mike Jeffries. It was resurrected earlier this month by Business Insider, and includes this much-spread quote: Continue reading

Barriers Block Disabled Patients From Specialty Care, Study Finds

If you’re disabled and in a wheelchair, gaining full access to basic medical care can still be elusive, a new report finds.

The study, published online in the journal Annals of Internal Medicine, focuses on speciality care and concludes that even in our high-tech environment, something that seems fairly low-tech — getting a patient on to an exam table — doesn’t happen in many doctor’s offices. “Many sub-specialists could not accommodate a patient with mobility impairment because they could not transfer the patient to an examination table,” the report states.

It’s widely known — and a huge problem — that adults who use wheelchairs often face difficulties getting a complete physical examination because they have trouble getting on the exam table, says Dr. Lisa I. Iezzoni, director of the Mongan Institute for Health Policy at Massachusetts General Hospital. (Iezzoni, who has used a wheelchair for nearly 25 years because of multiple sclerosis, recently authored a report that found people with disabilities face major obstacles accessing a range of health services, from cancer screening to various medical treatments.) As a result, the study authors note, this patient population receives “less preventive care than their able-bodied counterparts.”

Dr. Tara Lagu, an internist at Baystate Medical Center

Dr. Tara Lagu, an internist at Baystate Medical Center

To investigate the problem further, researchers led by Dr. Tara Lagu, an internist at Baystate Medical Center in Springfield, enlisted medical students and residents to make appointments for a fictional obese (219 pounds), wheelchair-using patient with a recent stroke. They called doctors in four states (Massachusetts, Georgia, Oregon and Texas) and included a range of specialists — endocrinologists, gynecologists, orthopedic surgeons, ophthalmologists and psychiatrists, among others.

“We wanted a real-life snapshot of accessibility,” Lagu said. The callers would say: “I’m an internal medical resident trying to make an appointment for my patient — they had a specific script they had to adhere to.”

Shockingly, many of the office staff flat out refused to make an appointment, the researchers report. When asked why, some of these office staffers were quite direct and said it was not possible to get the disabled person on to the exam table.

You can listen to Lagu discuss the research here. But the bottom line (from the abstract) is this:

Of 256 practices, 56 (22%) reported that they could not accommodate the patient, 9 (4%) reported that the building was inaccessible, 47 (18%) reported inability to transfer a patient from a wheelchair to an examination table, and 22 (9%) reported use of height-adjustable tables or a lift for transfer. Gynecology was the subspecialty with the highest rate of inaccessible practices (44%).

Lagu said the study tracks with her “real life experience,” after 10 years as a doctor. “Pretty much everywhere I’ve been in my career, I’ve encountered this or a similar problem,” she said. Continue reading

Must-Read: Globe Series On Children and SSI

No one’s evil. Everyone means well. But many low-income children end up on psychiatric drugs at least in part, it seems, because if they’re medicated, their families are likelier to be approved for hundreds of dollars a month in disability payments.

That’s my takeaway from the first installment of the superlative, nuanced and deeply reported series by Patricia Wen now running in the Globe.

But I’m no expert. I asked for a reaction from Robert Whitaker, award-winning journalist and author most recently of Anatomy of an Epidemic, a new book that investigates the skyrocketing number of adults and children disabled by mental illness.
His response:

“I think the families–and our society–really need to look at the toll that this can take on the child. The child declared eligible for SSI is now going to be medicated on a constant basis–after all, the child is now seen as seriously mentally ill– and often the drug treatment may include a powerful antipsychotic. Over the long term, such drug treatment can cause a host of physical, emotional and cognitive problems, and you are also setting the child on a ‘career path’ of lifelong mental patient. I don’t think the families are thinking about that when they turn to SSI for financial help; they don’t see what that this will do to their child down the road. And our society should also take a look at the extraordinary long-term financial cost of putting a child onto this path of life-long disability.”

Today’s installment of the series describes the heavy use of “speech delay” as a reason to put a child on disability payments, and the frequent failure to follow up on whether the disability remains.

House Calls: Caring For A Very Sick Man, And An Incurable Young Woman

Part I:

When was the last time a doctor, nurse or any other medical provider spent more than an hour taking care of you — at your own home?

Well, it happened this week in Revere.

At 10 am on Monday, nurse practitioner Therese Willette stood outside a neat brick apartment complex on Lantern Road. She and a social worker named Jen Pinto were paying a visit to Rolando Guillama, an 81-year-old Cuban-born man who takes 18 prescription medicines to treat a laundry list of complicated conditions. He’s had a heart attack and bladder cancer, undergone aortic valve replacement, coronary artery bypass surgery and abdominal aortic aneurysm repair. He suffers from hypertension, chronic obstructive pulmonary disease, hyperlipidemia, depression, diverticulosis, peripheral vascular disease, a peptic ulcer, carotid artery stenosis, diastolic heart dysfunction, chronic kidney disease, and anemia.

“I had a lousy day yesterday, and a bad night,” wheezes Mr. Guillama, above the hum of his oxygen machine. His belly and ankles are swollen, his face is puffy. He looks exhausted. “When his feet were so swollen last night,” his wife, Joanne, chimes in, his body “started jumping.”


(Video with permission from Rolando and Joanne Guillama)

I tagged along to the Guillama home trying get a feel for the medical side of Commonwealth Care Alliance, the Boston nonprofit I profiled earlier this month, as part of our series on unique health care delivery programs. Continue reading