Today I offer my final post. With the holiday season upon us, it seemed a good opportunity to discuss stress reduction. The holidays are accompanied by multiple stressors; crowded stores, travel delays and often family strife. It can be overwhelming.

Before the festivities begin; stop,  take a deep breath and just be. Meditation and breath awareness exercises are a great tool to use when feeling overwhelmed. A regular meditation practice can help one maintain a sense of balance and learn to live in the moment.

Get plenty of rest. Skimping on sleep will leave you cranky and impatient. To ensure a good nights rest keep the room dark and quiet. Limit caffiene and alcohol, both will prevent quality sleep. Before heading to bed, find a relaxing restful activity to help you unwind.

Maintain your exercise routine. Exercise is a natural mood enhancer, helping to chase a way feelings of anxiety and depression. It will also improve the quality of sleep.

Make time for fun and laughter. Laughter releases natural endorphins, lowers blood pressure, reduces pain and improves the mood.

Before signing off, let me wish the readers a happy and healthy holiday season.

    The cold and flu season is upon us, with its fevers, chills and sniffles. The majority of upper respiratory syndromes with cough, runny nose, sore throat and congestion are viral in nature and will resolve on their own in the otherwise healthy individual. The common cold generally responds to rest and fluids. People hope that antibiotics will speed the recovery, but there is a hidden cost to the frequent use of these agents. Antibiotics are intended for bacterial infections, viruses do not respond to these medications. Recent headlines have demonstrated an alarming rate of resistant infections, referred to as "super bugs" that are now being diagnosed among the general population. These infections are worrisome to physicians because they are harder to treat. The CDC has identified antibiotic resistance among the most urgent of health concerns.

In contrast to the common cold, the flu is a more serious illness. It comes on suddenly with high fevers and muscle achiness as prominent features. The young, the elderly and those with underlying medical issues, such as pregnancy, asthma, diabetes, lung disease, heart disease or smokers are at risk for more serious forms of infection and should see their doctor for evaluation. If caught with in the first couple of days, treatment is available with antiviral medication.

 Tips for cold and flu season:

Prevent the spread of disease with simple techniques including regular hand washing.

Keep vaccines up to date.

Get plenty of rest.

For persistent or worsening symptoms see your doctor.

When prescribed antibiotics, finish the whole course as prescribed, partially treated infections foster more resistance.

Do not save old prescriptions and restart them.

Do not use someone else's prescriptions or share your medications.

Be sure to inform your doctor of any previous reactions or possible allergies

With careful and appropriate use of antibiotics, these "miracle drugs" will remain effective tools in our medical arsenal.

I was sorry to miss the recent visit from the Mad as Hell Doctors, but they came to Chico when I was away. Here is a summary for those who missed it.

Health food for thought

I recently returned to Chico after working and traveling out of town. One of my first stops was our local Saturday farmer's market, where I scored a bunch of pomegranates. It was a neighbor who first turned me on to this yummy fruit when she shared some from her ranch.

My recent travels took me to New York City where the famous St Vincent's Hospital was forced to close its doors, a victim of the rising costs of medicine. St Vincent's served Manhattan's West Side for 160 years treating victims from the Titanic and 9/11 disasters as well as serving on the frontlines of the AIDS epidemic.  Its doors are now boarded up, covered with graffiti. Like many hospitals across the country, St Vincent's had been struggling under the burden of low reimbursements and increasing costs of operation. At the time of its closing, St Vincent's was one billion in debt and had been through bankruptcy already. How does a hospital go under?

St. Vincent's is not an isolated case. It is a story being told across the country as communities struggle to keep their local hospitals running. Here in California, Modoc County recently approved a hotly debated tax to keep their small hospital open. The hospital has been losing money for the last decade and now faces a debt of $12.5 million. In the event the hospital closed, residents would have to travel 20 miles over mountainous terrain, which is often impassable in the winter months. Locals feared that the loss of the hospital would lead to a decline in the local population, many of whom are retirees in need of accessible health care.

Maggie Mahar in her exhaustive book Money Driven Medicine describes the hospital business as a "tough business". She refers to a 2004 study in which 1/3 of the nation's hospitals were operating in the red. Hospital revenues frequently fall below the cost to provide care. For example, Medicaid in New York typically pays only half of the expense for an ER visit, Medicare reimburses on average at 4.7% below cost. To make up the difference, hospitals are forced to compete with each other for the patients with the better paying private insurance plans. Hospitals also must compete to woo specialists who can bring in high paying procedures to offset losses in other areas. Insurers meanwhile pit hospitals against each other when negotiating reimbursements. Mergers among hospitals and health systems are a risky but popular attempt to improve their negotiating outcomes. The smaller community hospitals often find they do not have much clout at the negotiating table.

What does the future look like for the hospital business? An article from the journal Health Affairs concludes "more hospitals and health systems are likely to edge toward bankruptcy in the near future" , a worrisome prediction. 

I found myself recently wandering the campus where I went to medical school. It has been closed; the school and university hospital moved across the city. The yellowed and weedy lawn made for a desolate backdrop. There is something sad and eerie about an abandoned hospital.

I imagined all the dramas that have played out over the many years of its existence, the births, traumas, critical illness and deaths that occurred within its walls. Families have celebrated and grieved on the site, as did my classmates and I. So many memories live there, a sacred place really. I was glad to hear, it is being recognized as an historic preservation site.

When I attended, the halls of the school were lined with large pictures from every class that had graduated over its hundred year existence. I would stop and count the number of female faces staring back at me. The University of Colorado was one of the first medical schools to enroll females. The year I finished our class was nearly half female. I was in awe of those who went before me. 

I roamed down the street to the apartment where I lived during those years, remembered the first time my California cat frolicked in the fresh snow. Which in turn reminded me of the spring of 2003. We had nearly three feet of snow overnight, I arrived the next morning on cross country skis, several inches of snow on my head. I don't think I have had so much fun on my commute since.

My next stop, the new hospital and school, a sprawling and modern campus. It was a sharp contrast to the abandoned and fenced off site across town. I watched as determined students rushed between classes. There was excitement as they talked about their studies. I've always loved the energy of a campus, finally things were as they should be.

I was enjoying lunch at a local café when I overheard one staffer say to another that she was facing her twenty fifth birthday soon. She went on to say, 25 is the last "real" birthday, after that "you're just getting old". I had to laugh, since I'm well past that age and holding up. Sure, there are some wrinkles and gray hair to contend with, that's life.

 I remember my last "big" birthday. The first greeting card came from Blue Shield, a full month in advance of my fortieth birthday. They were writing to inform me; I would be entering a new age category and could expect a change in my health insurance rates. Yes, they would be going up. They were even so kind as to pro-rate the dues as my big day fell in the middle of the month, how thoughtful. Well, there was no way of getting around it, I'm getting older.

Still, I 'm not complaining, I rather enjoy the security that comes with age, knowing not everything is a crisis.  Fortunately, many of my friends have crossed this threshold and were waiting with sage advice. They reminded me not to take myself so seriously, let go of worries, be flexible and open minded, most importantly to enjoy every day.

I am lucky too, to have my parents as models for healthy aging. They keep their minds active with regular Scrabble games and crossword puzzle challenges. Dad was still skiing into his seventies and even now in their eighties; they hike, swim and play tennis. At my wedding, it was my parents who spent the most time on the dance floor, waltzing together for over 50 years now.

While visiting recently in the grocery store, my friend and I, both of us now officially middle aged, struggled to recall what we were talking about after a brief interruption. We decided it was a simple case of poor concentration; surely it was not memory loss. We joked about all the advantages of our new status, the wisdom for example, to know better than wearing low rider pants and the ability to laugh at ourselves, forgive quicker and speak our minds more freely.  Yes, there are plenty of advantages and a certain freedom that comes with age, freedom from worrying what others may think and freedom to befriend yourself and accept the imperfections, wrinkles and all.

It turns out; aging is a blessing, a gift to be treasured.

Back to school for many children means returning to the environment in which they are bullied. Bullying is a form of abuse, defined as recurrent episodes of physical or psychological intimidation. It can take the form of taunting, name calling, threatening, stealing and physical assault. Other forms of bullying include the spreading of malicious rumors or gossip and the intentional exclusion of a child. The result is a victim who becomes socially rejected and isolated. Cyber-bullying refers to threats and verbal assaults that make use of emails, texting and social media. It is on the rise, one of the downsides of our techno-age.

A study from the Kaiser Foundation found 86% of youth, between the ages of twelve to fifteen have been teased or bullied at school. What can parents and teachers do?

There are several warning signs to watch for. A child who is bullied may become depressed, withdrawn and try to avoid going to school, often their grades will fall. Parents should inquire as to the school policies to protect children from bullying and bring any concerns to the administration and guidance counselors.

Schools can create a culture to prevent bullying by changing the social environment of the school such that bullying is simply not acceptable. It requires the commitment of everyone from administration to the teachers, the school nurse, bus drivers, custodians and the cafeteria staff. Everyone must be on the lookout for signs of bullying and abuse. It requires a commitment from all members of a school, with training and in-services specifically geared to bullying prevention strategies.

Schools can start a program to prevent bullying by taking an anonymous survey of the students. Often the administration and staff are surprised to learn how prevalent bullying is in their school. The survey can also help identify where bullying is taking place on campus, often on the playground, in locker rooms or bath-rooms. Once the areas of abuse are identified, resources can be focused on those areas. Once policies have been developed for a school or district they must be consistently enforced. The rules should be posted and well known to the students and the parents too. Every child deserves the opportunity to learn in a safe environment.

Blood Source held an annual blood drive this past Friday. It was an opportunity to make a donation and sign up with the bone marrow registry. There was a great turnout from our community; many of the donors were giving for the first time. I was impressed with the efficiency and friendliness of the staff. The nurse assigned to me used corny jokes as a very effective distraction tool.

Blood donation assists a variety of patients, premature infants, accident and burn victims, those with chronic blood disorders and organ transplant recipients. One in seven people entering the hospital will need blood. One donation can save the lives of three people, a good deal for the short time spent.

Blood donors should be generally healthy without any recent symptoms of cold or flu, age 17 and weigh at least 110 lbs. To be a candidate for the National Marrow Donor Program, you must be between the ages of 18-61 and generally healthy. Signing up was easy, a bit of paperwork and a swab of the inner cheek. The potential benefit to someone else whose life depends on a bone marrow match is priceless. The bone marrow program particularly needs donors from diverse backgrounds to meet the needs of patients from all ethnic groups. More information is available at www.bloodsource.org