Cholesterol Treatment – Guidelines Pocket Cards for Doctors

Did you know that any old person (and by ‘any old’ I mean a regular, non-doctor person, not any OLD person!) can purchase the American Heart Association’s “guidelines pocket cards” meant to keep doctors up to date on latest treatment protocols/recommendations?

On the American Heart Association website, these pocket cards are described as:

“These quick reference tools provide instant access to current AHA/ASA and ACCF/AHA guidelines in a clear, concise format – available in print and in the Guideline Central Mobile app for iPhone, iPad and Android.”

AHAlogo_lifeiswhy-logoFor months, I have been wondering whether there have been any updates or changes to the November 2013 Cholesterol Guidelines – and how doctors are following – or not – the new guidelines. (More info about the 2013 guidelines here: The NEW guidelines for cholesterol-lowering statin meds).

To me, there’s been a startling dearth of information about how treatment of high cholesterol has changed – or not – since these guidelines were issued. So I was pleased to stumble upon these pocket guidelines for doctors – updated with the latest recommendations.  For just $8.99 I downloaded the cholesterol pocket guidelines and found them largely unchanged since the new guidelines were issued in November 2013.

Which is good, I guess.

That said, one new thing I learned from this pocket guide is that there are established goals for the more in-depth cholesterol tests like C-Reactive Protein and Coronary Artery Calcium – both tests I think I might benefit from.

While my $8.99 purchase would NOT let me print (grr), I was able to grab some text via the handy iPhone app. Love that.

So if you would like a peak at the ‘pocket guidelines’ your doctor may well use when considering how to treat your high cholesterol, read on. Fair warning: it’s, um, quite detailed and uses acronyms (it is, after all, for doctors) so I’ve included a simple glossary for some of the medical terms.

Here goes – what follows is the ‘key points’ section of the doctor ‘pocket guide’ for treating high cholesterol:

TITLE: Cholesterol Adult Management

KEY POINTS

  • Encourage adherence to a heart-healthy lifestyle. A healthy diet, regular aerobic physical activity, smoking cessation and maintenance of a healthy weight are critical components of ASCVD risk reduction. Control hypertension and diabetes, when present.
  • Statin therapy is recommended for adults in groups demonstrated to benefit. ASCVD risk reduction clearly outweighs the risk of adverse events based on a strong body of evidence in 4 groups:
    • Secondary prevention in individuals with clinical ASCVD
    • Primary prevention in individuals age ≥ 21 years with primary elevations of LDL-C ≥ 190 mg/dL
    • Primary prevention in individuals with diabetes 40 to 75 years of age who have LDL-C 70 to 189 mg/dL
    • Primary prevention in individual without diabetes and with estimated 10-year ASCVD risk ≥ 7.5%, 40 to 75 years of age who have LDL-C 70 to 189 mg/dL
  • Statins have an acceptable margin of safety when used in properly selected individuals and appropriately monitored. If no baseline abnormality, monitoring of hepatic transaminases is not routinely needed. CK should not be routinely measured unless there is a personal or family history of muscle problems. You may need to discontinue and then restart the statin to determine the cause of muscle symptoms.
  • Engage in a clinician-patient discussion before initiating statin therapy, especially for primary prevention. Discuss the potential for ASCVD event reduction, adverse effects, drug–drug interactions, and patient preferences. Additional factors may be considered when a risk-based decision is uncertain.
    • These include LDL-C ≥ 160 mg/dL, family history of premature ASCVD, hs-CRP ≥ 2.0 mg/L, CAC ≥ 300 Agatson units, ABI < 0.9; lifetime risk of ASCVD.
  • Use the newly developed Pooled Cohort Equations for estimating 10-year ASCVD risk. Calculating the estimated 10-year ASCVD risk should be the start of the clinician-patient discussion and should not automatically lead to statin initiation.
    • For other ethnic groups, use the equations for non-Hispanic whites, although these estimates may underestimate the risk for persons from some race/ethnic groups, especially American Indians, some Asian Americans (e.g., of south Asian ancestry), and some Hispanics (e.g., Puerto Ricans), and may overestimate the risk for others, including some Asian Americans (e.g., of east Asian ancestry) and some Hispanics (e.g., Mexican Americans).
  • Initiate the appropriate intensity of statin therapy to reduce ASCVD risk.
  • Evidence is inadequate to support treatment to specific LDL-C or non–HDL-C treatment goals. “Treating to goal” may result in treatment with less-than-optimum statin intensity or adding unproven nonstatin therapy.
  • Regularly monitor patients for adherence to lifestyle and appropriate intensity of statin therapy. Obtain a fasting lipid panel before and after initiating statin or other drug therapy.
  • Nonstatin drug therapy may be considered in selected individuals.”

Going Lo-Co GLOSSARY:

  • ASCVD -atherosclerotic cardiovascular disease
  • Hypertension – high blood pressure
  • Statin Therapy – treatment with statin drugs, like Lipitor
  • Individuals with clinical ASCVD  – people with cardiovascular disease or who have had a ‘cardiac event’ like a heart attack
  • LDL-C – level of LDL cholesterol in the blood
  • 10 year ASCVD risk – risk of a cardiac event in 10 years, as measured by the calculator issued with the November 2013 guidelines.  More here: Going LoCo Calculator Post
  • hs-CRP – measure of “C-Reactive Protein” which is a marker for inflammation
  • CAC – coronary artery calcium which measures the thickness of fatty accumulation in the arteries and is used to predict heart disease risk

While managing cholesterol down to a specific goal is no longer the treatment standard, that doesn’t mean you shouldn’t be tracking your cholesterol and managing non-dangerous/risky high cholesterol with lifestyle choices. And remember, if your LDL cholesterol is at/over 190 mg/dL or you have other risks, discuss a statin with your doctor.

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Answers Q&A

As you may know, as “cholesterol expert” I’ve written many articles for Answers.com, which you can find in two places. First, on the cholesterol page of the Answers.com site. Also I have all the articles listed by title on the “Answers.com Published Articles” page on this Going Lo-Co site.

And now, new news…

This week, Answers.com added a new page to their site: a Q&A with me.  Of course, if you have cholesterol questions, you can always email me/comment right here on the Going Lo-Co site. But now you can also ask me a question (but not, of course, for medical advice!) on the all new www.answers.com/karenswanson site.

Just mentioning…

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Do You Have FH?

The cholesterol-watching world is filled to the brim with acronyms and easily confused verbiage.  Who can remember what LDL and HDL stand for – much less which is the good and which is the bad cholesterol?  And then there’s Apo-B and LDL particle size to boot. But today I learned one that was total news to me: FH.

Turns out, FH stands for Familial Hypercholesterolemia which, in a nutshell, is very high LDL (bad) cholesterol that is caused by genetics. A more complete definition is given on The FH Foundation website:

FHlogo“FH is short for Familial Hypercholesterolemia. It is an inherited disorder that leads to aggressive and premature cardiovascular disease. This includes problems like heart attacks, strokes, and even narrowing of our heart valves. For individuals with FH, although diet and lifestyle are important, they are not the cause of high LDL. In FH patients, genetic mutations make the liver incapable of metabolizing (or removing) excess LDL. The result is very high LDL levels which can lead to premature cardiovascular disease (CVD).”

I was amazed to find there’s a site – indeed, an entire foundation – dedicated to high cholesterol caused by genetics.  And a bit miffed – because I know my high cholesterol is genetic… so I can’t believe I didn’t know about this very useful source of information.

And it’s important – because FH is a serious condition and essentially requires choleterol-lowering medication or other intervention:

“Nearly 100% of people with FH will require cholesterol-lowering medications. For some people with FH, more aggressive measures are needed, including LDL-apheresis (a very simple procedure in which LDL-C cholesterol is removed from the blood on a weekly or biweekly basis.)

The American Academy of Pediatrics recommends that if a family has a pattern of early heart attacks or heart disease defined as before age 55 for men and 65 for women, children in that family should have cholesterol testing after the age of 2 years and before age 10.”

All this very sobering information compelled me to track down the excel spreadsheet I use to track my cholesterol results over time.  I was quite pleased to discover that although my high cholesterol is largely caused by genetics, it does not look like I have FH. In my most recent test, I’d brought my LDL (bad) cholesterol down through diet and exercise to 132 (under 130 was the goal before new guidelines were established).  And according to The FH Foundation website, FH is suspected when untreated LDL is above 190 (or 160 in children).

Whew.  Good news for me on the FH front.

Not so good news for me to ‘discover’ that my last cholesterol test was in March 2013.  Um, more than a year and a half ago.  It seems I have “forgotten” to keep track of my cholesterol levels.  Probably because I spent a lot of time this past year at Shake Shack.

So next week, at my annual ob/gyn appointment, I’ll take the blood test order my doctor always gives me and use it to have my cholesterol tested.

And if you have high LDL cholesterol that has not declined with diet and exercise and/or a family history of early heart disease / heart attacks, consider learning more about FH at The FH Foundation site and discuss with your doctor.

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Roasted Cherry Tomatoes To Get Back On Lo-Co Track

I don’t know about you, but when life throws me curveballs, my lo-co lifestyle gets flattened.

From blog technical issues to family-member health crises to having a college kid home for the summer (and the requisite, very stressful conversations that include: “why do I need to tell you what time I’ll be home,” and “I can’t get home by 2am” among other gems) let’s just say I’ve not been cooking.

OK, let’s tell the truth: several times a week this summer, my routine was a 3 mile fast-paced walk for exercise followed immediately by dinner at Shake Shack. Because, um, they serve beer. And you can sit outside. For me, nothing is better than sitting outside in workout clothes enjoying delicious, cold beer from a tap along with dinner? Oh, and the dinner – Shake Shack fixed their fries and those burgers continue to be outrageously good. This from someone who does not care for most burgers – and who eats almost no other red meat – except for Shake Shack.

Yes, I could order Shake Shack’s bird dog.  Yes, my virtuous husband does.  Yes, that’s incredibly annoying because NO, I do not make smart dining choices when I’m stressing. What I do is not eat very much at all – or eat very badly.  Or, more to the point, first I stop eating/eat very little. Then when I realize I’m not eating, I eat very very badly.

That was pretty much my summer in a nutshell. On the plus side, my weight is largely unchanged (the only good part of the not-eating-due-to-stress segment of this summer). But I’d be scared to get a cholesterol reading right now.

With my son finally — finally — back at college,  I actually cooked a meal this week. (Word of advice – do not consider schools on a trimester/quarter system as they start in LATE September. LATE. Like WEEKS after all other college kids have gone back to school.)

Not only did I cook – I cooked a meal I have never made before – and I didn’t even follow a recipe. I usually rely on recipes – don’t always follow them all the way through, but I do usually require them as a starting point (aka crutch).  So this was unusual behavior for me.

What happened was, my friend Chris and I had a meeting for a consulting project we’re working on and she had a veritable raft of gorgeous cherry tomatoes from her garden, which she insisted I take, telling me to roast them in the oven and they’d be prefect for bruschetta.

So I planned to do that, but forgot to buy bread.

Sigh.

But then I remembered she’d also said that roasted cherry tomatoes burst open when poked with a fork so they kind of make their own sauce.

Perfect. No forgotten ingredients necessary.

RoastedCherryTomatoesI just cranked the oven to 425 degrees, drizzled the cherry tomatoes with olive oil and salt (and since there was room in the Pyrex pan AND we had one red pepper in the fridge, I sliced it and oiled/salted that too). Then last second, I decided to throw in a handful of garlic I’d slivered.  Once it was all slicked up, I just roasted it all for 20 minutes.

I had forgotten how amazing it smells in your house when you, um, cook.  Especially garlic.

Meanwhile, I cooked up some high fiber penne (!) and warmed a can of LeSeur baby peas (hey, it was the only green thing I had on hand other than lettuce).

RoastedCherryTomatos PastaVoila.  A healthy, lo-co dinner in 30 minutes.  All I had to do was dish out the pasta, spoon in the peas, roasted tomatoes and roasted pepper slices, then pour the fabulous olive oil with roasted garlic left in the Pyrex over it.  And it was fun to then burst the tomatoes and create a kind of tomato sauce. My husband tossed some fresh pepper flakes in for a kick but I left my garlicky olive oil with burst tomato ‘gravy’ unsullied.

It’d have been nice if I had a little bread (ha ha) – and some fresh mozarella (also funny as my fridge was quite barren) for some protein, but even without, it was quite tasty.

I popped the top off a Corona and toasted buh-bye to my so-not-lo-co Shake Shack summer.

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How To Calculate Nutritional Value For Any Recipe

Wondering about the nutritional value and/or calories of a favorite recipe? It’s one of my pet peeves about cookbooks and interesting recipes found online or in a newspaper or magazine – the recipes rarely list the calories and key nutritional info (like fat, cholesterol, sodium, sugar, etc) included per serving.

Well, wonder no more.

I’ve written multiple posts about the fabulous app, My Fitness Pal (I Heart My Fitness PalI Love Me Some Nutrition Graphs; and Better Than Salad at Wendy’s to name a few) but I just discovered an update to their site that enables you to quickly and easily – using copy/paste – import recipes and see their nutritional value.

The basic ability to input recipe ingredients and calculate the nutritional value – and save the recipe into My Fitness Pal so you can use it to track your calories/nutritional intake – is not new. But they’ve now made it far faster and easier by adding the ability to copy/paste recipe ingredients rather than enter each one manually. But wait, there’s more!  Their recipe importer stops the guesswork – for example, it automatically translated ‘1 medium onion’ into 1/2 cup onion – an equivalency I always just guessed at before (um, even when cooking).

To me, this is miraculous. (OK, OK, I know, I need to ‘get a life.’)  But I heart technology, what can I say.

Now calculating the full nutritional value of any recipe is so, so simple.  Just login to your My Fitness Pal account on your PC or Mac, and under the ‘Food’ tab, click ‘Recipes.’  That brings up the Recipe Importer – importing from a URL didn’t work for me, but right underneath that, just click on ‘Add Recipe Manually.’  Then copy/paste your ingredients into the box, name the recipe, adjust the # of servings, and click the green ‘match ingredients’ button under the input box.  Either all your ingredients will either magically match – or if there are any issues, it’ll point them out for you to adjust manually.

Then save it and it appears in your ‘recipe box.’  To see the nutritional value, just click the recipe title in your recipe box and this is what appears (this is the nutritional value of my favorite homemade salad dressing: Mustard Vinaigrette):

Mustard Vinaigrette

 

I tried  out My Fitness Pal’s new copy/paste recipe importer for this 5 ingredient mustard vinaigrette and ALSO for a more complicated recipe.  I’ll write about that recipe, Risi E Bisi, separately – but the recipe importer worked beautifully for both a very simple recipe like this vinaigrette and a more typically complex dinner recipe.

So if you are ever in need of nutritional value of a meal at a fast food place OR a side dish you’re making or even a full recipe, check out My Fitness Pal.  My husband and I (and several friends) have found it a tremendously easy-to-use and very helpful way to pay attention to what you’re eating – for both calorie counting/losing weight and also for tracking cholesterol and fat (or any other nutritional value) of a recipe or meal out.

Note: I am in NO WAY associated with My Fitness Pal. Though LOL,  I think I need to contact them about putting an ad on my blog…

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Women Unaware of Heart Disease Risk

A recent study in Canada found that 75% of women did not understand that high cholesterol (and high blood pressure) are major symptoms of heart disease.  And about half didn’t know that smoking increases risk of heart disease.

How is this possible?

How?

And if it’s true in Canada, I’ll bet it is true in the U.S. as well.

The study, by the University of Ottawa Heart Institute and published in the Canadian Journal of Cardiology (CJC), reports results from “the first ever Canadian national survey of women that focuses on knowledge, perceptions, and lifestyle related to heart health.”  Surveyed were 1,654 women aged 25 and over across Canada in the spring of 2013.  

According to the University of Ottawa Heart Institute, the study, Perceived vs Actual Knowledge and Risk of Heart Disease in Women: Findings From a Canadian Survey on Heart Health Awareness, Attitudes, and Lifestyle, found “that a majority of Canadian women lack knowledge of heart disease symptoms and risk factors, and that a significant proportion is even unaware of their own risk status.”  

Specifically, the study shows women are woefully under-informed/mis-informed about cardiovascular disease (CVD) risk:

  • Smoking: only about 1/2 of women understood smoking to be a major a risk factor of heart disease.

  • High cholesterol and high blood pressure (hypertension): less than one-quarter of women surveyed understood these as symptoms of heart disease risk.

  • Doctors do NOT discuss heart disease risk with women, and need to: As reported on Medical News Today, most women in the survey said they preferred receiving information from their doctor, but just half reported that their doctor had discussed heart disease prevention and lifestyle with them.

  • Women feel they are less at risk than they truly are:  Medical News Today reported, “The survey also shows that women who are at the highest risk perceived themselves to be at a much lower risk. In a comparison of actual and perceived heart disease knowledge, 80% of women with a low knowledge score perceived that they were moderately or well informed.”
  • Women incorrectly – and dangerously – believe a cardiac event is a one-time event when it’s really CVD (cardiovascular disease) and needs ongoing treatment. Medical News Today goes on to say, “Additionally, 35% of women with CVD viewed their event as only an episode that has now been treated, after which they resumed their pre-diagnosis lifestyle “Out of Sight, Out of Mind” phenomenon.”

Admirably, “the University of Ottawa Heart Institute will be launching the Canadian Women’s Heart Health Centre this fall (of 2014) to address the disparities in diagnosis, treatment and ongoing care for women with heart disease.”

I wish we’d do the same in the U.S.

Just so we are all quite clear, the U.S. National Heart, Lung and Blood Institute explains key heart disease risk factors on their What Are Coronary Heart Disease Risk Factors? webpage.  There are two types of risk factors: risks you cannot control and risks that are controllable with lifestyle, diet and, if necessary, medication.

Heart disease risk factors you can’t control (but should be discussed with your doctor) include age, gender, and family history of heart disease.

Risk factors that are controllable with lifestyle, diet and, if necessary, medication include:

  • High blood cholesterol and triglyceride levels
  • High blood pressure
  • Diabetes and prediabetes
  • Overweight and obesity
  • Smoking
  • Lack of physical activity
  • Unhealthy diet
  • Stress

Please know the heart disease risk factors in general.  And more specifically, you can actually see your predicted heart disease risk!  As many know (and I’ve reported about), in late 2013 the US guidelines for treating cholesterol were changed – and they now include an assessment of heart disease risk.  There is a FREE online calculator which assesses your heart disease risk. Read more about it on my blog posts:

Knowledge is power.  Use it to lower your heart disease risk.

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Aetna is killing my cholesterol

If stress increases cholesterol (and it does) then Aetna is killing me. And others, too. Seriously.

Back in December 2013 we switched our healthcare plan to Aetna: we are self-insured, health insurance is a huge ticket item for us, and Obamacare changed a lot about insurance so we needed to make a change. We did a lot of research and after much deliberation and analysis, we chose a non-Obamacare Aetna program. One that had been up and running for years. One that should work just fine no matter what.

This program came highly recommended from my insurance broker.  Aetna is a huge company. Most of my doctors accept the plan. All should have been fine.

So what’s the problem?

Aetna’s billing system is so incredibly screwed up that they have cancelled my plan TWICE (!!) for non-payment even though I’m fully paid up.  And I know that I am not alone in this: my insurance broker is mortified and told me I’m not the only one with this problem.

Aetna has a billing systems issue that is seriously flawed. And it’s causing me huge stress, which, in turn, is very likely increasing my already-too-high LDL (bad) cholesterol. According to Dr. Lisa Matzer, in an Everyday Health article entitled, How Does Stress Contribute To Cholesterol:

“The more anger and hostility that stress produces in you, the higher (and worse) your LDL and triglyceride levels tend to be.”

Let me tell you:  it’s wildly stressful to find out your insurance has been erroneously cancelled – and then have it take HOURS over several DAYS to get it reinstated. And then have them cancel it AGAIN 2 months later.  Let’s just say, anger and hostility abound, which Dr. Matzer says raises bad cholesterol.

I have tried to get Aetna to fix my bill for seven — SEVEN — consecutive months. I have had to call each and every month. I’m assured it’s fixed.  Then it’s not. Then they cancel me even though I’m fully paid up.

It would be funny if it wasn’t so stressful.

The first time Aetna cancelled me was in May.  May 14, 2014 to be exact. There was NO warning.  No phone call. No letter. No email. Nothing. I found out at CVS. I was trying to fill a prescription and the pharmacy tech told me my insurance was cancelled. For non-payment (BTW, my account was on AUTO-BILL to my credit card which was totally valid, LOL.)  Though it was seriously not funny.  We were days away from our bike trip to Croatia. Imagine if I’d had to spend the several hours over several days while in Croatia unraveling Aetna’s mistake (theirs, not mine) that led to them erroneously canceling my policy? Or worse, imagine if we’d gotten sick in Croatia and tried to explain that our health insurance really wasn’t cancelled?

But I was lucky. I found out about Aetna’s mistake before we left the country. So fix it we did, after many, many, many hours on the phone.

Turns out my credit card wasn’t being charged even though it was set up to be auto-billed to a valid credit card. The reason: Aetna’s flawed system didn’t hit my credit card with a charge – no invoice was being generated on their end because of a problem with how my husband’s part of the bill was created way back in December.

They promised it would be fixed.  But just to be sure, since auto-bill to credit card didn’t work, we switched to paper invoices.

Which I have NEVER ONCE received. Not one invoice in the mail, ever. And it’s not a U.S. Mail problem: post facto, I receive via U.S. mail both a cancellation notice AND a reinstatement notice (amusingly, I get them the same day).  And my address is correct.

It’s not a mailing problem. It’s an Aetna billing system problem.  The Aetna system shows they are creating/mailing a bill – but they do not.  So now, since both auto-pay AND U.S. Mail do not work to deliver an invoice, now I am forced to call at the beginning of each month to pay my monthly premium.

Because at least I am reliable. I enter it in my calendar and call. In fact, on June 3 at roughly 9:00 am I called Aetna to pay my June invoice (as usual, no mailed statement and the online invoice was wrong).  The customer service rep agreed with what I know I owed and I paid that amount on the phone. She then confirmed my payments were all current through June.

Then incredibly, at 2:33 that same afternoon, I got a phone message stating that my May payment (May!) was past-due and I was at risk of being cancelled.

THE SAME DAY I paid June and was confirmed that I was current through June, Aetna calls to tell me I am going to be cancelled.

At least this time they called.

Naturally, I called Aetna. A-freaking-gain I had to call Aetna to work things out. The rep said not to worry about that call about cancellation. She said she could see I was paid up – that both May and June were paid.  She confirmed I was current through JUNE and assured me they would not cancel me.

Then they cancelled me.

This is nearly fraud. I’m paying close to $1000/month and I am fully paid up and Aetna keeps canceling my policy.

It’s incredibly stressful.  I have spent HOURS, literally, on the phone.  I’ve been nice.  I’ve yelled.  I’ve asked to talk to a billing supervisor – to talk to any supervisor.  The supervisors can never come to the phone.  Two times the rep said they’d have a billing supervisor call me. We reviewed my phone number.  They promised the supervisor would call.  They do not. Ever. Call.

I have names and ID numbers galore of the customer service reps who promise they’ve escalated this issue. That it should have been fixed months ago.  That it will be fixed for the next invoice.

IT NEVER IS.

MY BILL IS STILL WRONG. AND I’VE NEVER RECEIVED AN INVOICE.

I know what the problem is.  An Aetna rep explained it to me back in January and I’ve explained to the Aetna reps I talk to every month.  It all traces back to the very beginning and that their system is not generating an invoice.  They agree that’s the problem.

They just can’t freaking fix it.

Aetna Incorrect Bill Screencap_0001Today, I confirmed once again with Aetna that I’m paid through July.  I asked, nicely, then why is my billing statement online STILL wrong. Why does it show that I owe $194o … and why does it show that I’ve been cancelled (circled on screen cap here.) And why can’t this be fixed? That I’d like to wait on the phone while it’s fixed.  Or get a call back that it is fixed.

This latest person – actually, I spoke with her  back in May also – tried to get a supervisor on the line and talked to billing and also to member benefits. She tried to help solve this vexing issue that has plagued me for 7 months now.  To no avail. Even after a 1 hour and 16 minute phone call (I timed it) to ensure I won’t be cancelled again, my bill is still wrong and I fear Aetna will cancel me. Though she assures me I won’t be cancelled again.

She was nice. She tried hard. But I don’t believe her. I just know that Aetna is going to cancel me for a third time because the problem clearly still exists.  The proof is right there, in that screen cap that shows I owe $1940 even though Aetna billing people and customer service people confirm I owe $0.

This has been seriously stressful – which is not good for my cholesterol.  Sure, there are many many more serious things that could happen to a person. But I have to say, this ranks up there.

Not only that, it’s reprehensible on the part of Aetna. I’m highly educated and have the time to spend hours with Aetna.  What about others who don’t have that luxury?

And what about the fact that this is likely raising my already high LDL (bad) cholesterol.

I’m tired of calling every month. I’ve tried to work within the system to get this fixed, and it hasn’t worked.  So now I’m ranting about how this is raising my cholesterol (sorry to my readers if this has been dull; but the message is that stress is bad for cholesterol, and you should try to reduce stress any way you can – for me, it’s been venting. Sorry, I’ll be back to more typical cholesterol topics next week!)

Mark Bertolini (@mtbert) according to your twitter profile, you “tweet about my work and my life experiences in health care.”  So I’m posting and tweeting and facebooking you about mine, sir.  Your organization has a serious billing issue. Please get someone at Aetna to stop canceling me when I’m fully paid up — and also fix my bill.  Please.

 

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Healthy Homemade Chicken Tacos

With summer grilling, it seems easier to eat healthily – especially if you are not the person in charge of the grill! But barbecued fish or chicken night after night can get old… and no one wants to roast vegetables in the oven when it’s 80 degrees.

When I’m tired of grilled dinners and am hankering for a fresh, spicy flavor profile that’s perfect for summer, I turn to my friend Sylvia’s fabulous, healthy homemade chicken tacos.

My friend Sly is from San Diego and growing up, her mother would frequently make what Sly calls a ‘fresh sauce’ and serve it for lunch or afternoon snack atop chicken tacos. Sly made it for me when we were in business school, and I was immediately hooked. At the time, I didn’t know much about cooking and had never considered making a salsa (which is essentially what Sly’s mother’s ‘fresh sauce’ is) from scratch.  Not only is it easy to make and out of this world delicious – Sly’s fresh sauce served on top of just about any healthy protein makes an incredibly healthy dinner.

The fresh flavor of this simple ‘fresh sauce’ is so bright that it just feels like summer. I should make these healthy tacos all year round, but every winter, I forget all about them until I plant my cilantro in the spring.  Then I get happy just thinking about them.

While this dish is incredibly easy to make, it does take a decent amount of time to prepare because there’s a lot of slicing and dicing.  This, actually, is why I probably stop making it once summer is over – because while some love the chopping part of cooking, it’s the part I like least.  That said, even if you’re like me and wielding the chef’s knife is not your favorite thing, these are well worth the effort.

And this dish is incredibly healthy because the ingredients are healthy: just tomatoes, onion, a jalapeño pepper, cilantro, tortillas and chicken – and a dollop of reduced fat sour cream.

To make, all you do is make the ‘fresh sauce,’ warm up a tortilla, put a dollop of sour cream on the tortilla, load the center of the tortilla with cut-up chicken (warmed or cold) and add about 2 tablespoons of the delightful, fresh (and spicy) ‘fresh sauce.’  Roll it up and devour.  Then repeat.

Plus, if you don’t finish off all the ingredients, the sauce saves well for 1-2 days so it’s a great, healthy lunch the next day.

Here’s the recipe for Chicken Tacos Going LoCo Style (thank you Sylvia!).  It should make about 10-12 tacos, enough certainly for 4 people.

A few quick things to note about this recipe:

  • This ‘fresh sauce’ is SPICY – and this from someone who likes vindaloo!  But try it as is, with one jalapeño pepper because when you use this sauce in the taco, it’s the perfect amount of spice, IMHO.  But fair warning: if you try the sauce or dip it with a chip, it’ll be pretty spicy…just letting you know.
  • Personally, I do not like raw onions in salsa (or anything, actually).  But the onions do not taste raw here – maybe because the tomatoes are ‘cooked’ first? I don’t know why, but it just works, even if you do not care for raw onion.
  • Give yourself about 1 hour to make this dish because cutting up a whole chicken and dicing the onion, jalapeño and cilantro takes time.
  • When Sly or her mom makes this, they actually blacken the jalapeño pepper on an open flame – but I find that a bit intimidating, so instead I microwave it as per the directions, but if you like charring peppers on an open flame, have at it!

I made this for dinner last night, and can’t wait to have it again for lunch. Give this recipe a spin for a tasty, healthy, spicy dinner option.

P.S. to Sly and her mom: I can’t remember if your recipe included the sour cream or if that’s my anglicized version of it – apologies if I’ve inadvertently modified your recipe and didn’t mention that (gosh, it’s been a long time since business school – I had a laugh at the date of the recipe, way back in the 1990s!)

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Harvesting Container Herbs

I’ve found over the years that I’m more motivated to cook a healthy home-cooked, low-cholesterol dinner when I have fresh herbs on hand. So, sometime between Mother’s Day and Father’s Day every year, we go out and purchase a dozen or so herbs and plant them in three large containers we keep on our deck.

While a garden would be great, we have too many deer and rabbits and other critters to make that possible. Oh, who am I kidding. I’m from the Bronx…and am so very NOT outdoor girl. Frankly, the thought of gardening in an actual garden makes me sweat.  (And not because it’s hot. Gardening – for real – is a lot of work and I know absolutely nothing about it.  And that is probably as it should be.)

Though it is fun to visit my friend Chris’s amazing garden.  And she’s very generous with her bounty, so that’s fantastic.

Herbs_June2014But truly, I do find that I cook more – and more healthily – if I have fresh herbs at hand all summer long. Hence, three huge pots on our deck. And one big problem.  I know how to plant them…and water them (which is pretty much never…thus my success.)  But I do not understand how to harvest each one properly – and some, not at all.

Sure, I go out there with my scissors and cut chives- that’s pretty self-explanatory. But every summer I wonder if I’m supposed to cut the woody part of the rosemary.  Or how to tame the oregano that tries to take over.

And the arugula, well, I have no idea. I’ve tried just cutting a few leaves. I’ve tried cutting it to the soil.  No matter what I do, I can’t seem to figure out how to harvest that arugula before it flowers and turns bitter.

I decided to give up on arugula, but then had an idea.

I could, um, try to learn how to clip arugula … and rosemary… and all my other herbs.

Amazing concept, right?

In just an hour or so on the internet, I learned a lot. (Anyone who is a gardener and can supply more insight, please comment!)

The best resource I found online was from a site called, Gardener’s World. In their aptly titled article, How To Pick Herbs (!), here’s what I learned overall and about four of my favorite herbs:

Overall – the idea is to clip early and often! And don’t let parsley chives or basil go to seed (oops, I need to get rid of the chives I was so happy made it through the winter outside!)

“Culinary herbs are the original cut-and-come-again crop, so if you’ve got them in the garden, don’t be afraid to get snipping and picking. The plants really will benefit from it, and you’ll have wonderful flavours to add to dishes. Most herbs and leafy plants naturally want to create seeds, and once they get to that stage, it means the end of a herb like parsley, chives or basil. So pick leaves early and often to encourage the plant to put out more foliage and prevent it from running to seed. It may be cheating Nature but it extends the life of your plants and gives you handfuls of herbs to enjoy.”

  • PARSLEY. “When cutting parsley, always remove the whole leaf, together with the leaf stalk, nipping it back to where it joins the clump. Avoid the oldest leaves as these tend to be tough.”  This was total news to me – I used to just cut the leaves…and let it flower.
  • CHIVES. “Chives grow quickly in spring and summer. Cut as you need them for use, trimming right down to the base. Keep four or five pots at the ready, so you always have some at different stages to harvest.”  For me, never going to happen, so I’ll just keep cutting my one chive plant down – that should keep me in pasta heaven all summer.
  • ROSEMARY.  “Cutting rosemary for culinary use will prevent the plant from becoming woody. Use secateurs (???) to trim 10cm – 15cm from each shoot, as required. Avoid cutting back into woody, leafless branches.”  LOL: secateurs are British for pruning clippers. Which, um, I don’t even own.  So I’ll be using scissors.
  • BASIL.  “When harvesting basil, nip out with scissors or between finger and thumb, the tips of the plants back to just above a pair of leaves. New growth will emerge at this point. Don’t nip just below the leaf, leaving a short stem, as this will simply wither.”  I had to read this about 5 times before I realized it said, simply, to make a cut ABOVE where 2 leaves join, not below.  

But it didn’t help me with my all-time favorite herb, cilantro. From a site called GardeningKnowHow.com, I learned How To Harvest Cilantro.  Essentially, you have to clip some EVERY WEEK or it will ‘bolt’ which apparently means go to seed. And you clip off the top 1/3 or so – don’t clip down to the soil. I was doing NONE of this in prior years, so am happy to give this a whirl.

Last but not least is arugula.  And sadly, it seems clear from my research that I need to give up on arugula, because you have to plant it over and over again to keep it going all summer long, and frankly, I have the patience of a gnat. That said, I had already bought 2 plants, so I’m going to try what I learned from heirloom-organics.com’s How To Grow Arugula:

To harvest Arugula, pick off the outside tender leaves at the base of the plant. Leave the center growing point intact for future harvesting. Discard larger leaves as they tend to get tough and very bitter tasting. Leaves can also taste bitter in warmer weather. Eat fresh or cooked like spinach.”

Lastly, regarding oregano, it seems that it’s just bound to take over, so I’ll just let it.

I’m looking forward to a summer of herbs inspiring healthy home cooking.

Recipes anyone?

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Spinning to Cardio Fitness

Daily exercise is a key part of lowering cholesterol without medication, and in the long, cold winter months, my exercise of choice is tennis (and my real exercise is spin class.)

For those who’ve not tried it yet, spin class is an amazing cardiovascular workout.  Some shy away because they’ve heard it’s intense…and it can be. But it doesn’t have to be – if you’re curious, drop by your local gym or spin studio and try a class.  First class is often free and – like yoga – it’s best at least at first to go at your own pace and don’t worry about what everyone else is doing. If you get hooked, like I did, you’ll find it’s a fun class that you can adjust as your fitness level improves – and believe me, after just 2-3 weeks of spin, you’ll be amazed at the change in your cardio fitness. (For more info about spinning, check out the explanation at the fun place I get to spin: Joyride.)

Why am I talking about spin class?  Well, I use spin class for straight-up cardio workouts all year long AND also to train for the Backroads bike trips we go on every two years.

When I’m not ‘training’ for an upcoming vacation (I know, I know, oxymoron to some – but for us, it’s really a blast) I spin – at most – just once or twice a week, and play tennis the rest of the time.  But one of the side benefits of these biking vacations is that you MUST get in shape or you won’t have fun – and that sends me to spin class about 3 times a week for the 3 months leading up to the trip.

Hence my two most recent posts about heart rate – where I could literally see my cardio improvement (and the reason for lapse in posting – first a technical issue with my site, then iffy wifi in Croatia.)

So spin got me in great cardio shape – but what it failed to do this time is to prepare me for the long, long hills we had to climb in Croatia.

Which is odd, because I’ve never had this problem before.  For our other bike trips, spin got me in great cardio AND hill-ready biking shape. Well, mostly – there was still that long, long walk-of-the-bike to the top of San Gimignano in Tuscany…but that was our very first trip 10 years ago and we had NO IDEA the level of hills we had signed up for!

My guess is this time, I didn’t amp up the resistance enough during class, though I thought I did.  OR it was that I didn’t do enough training with huge resistance on a SEATED climb, which his what most of the Backroads hills are – you are tackling a 5-7 kilometer hill and that’s far too long to stand on the bike – at least it is for me.

IMG_4916So this is me, next to the van that boosted me up a 7k hill that I chose not to ride (but the downhill part was a BLAST).  Truth be told, I didn’t boost up ALL the hills on this trip (and I’ve almost never boosted up a hill on other trips).  But the nature of this particular trip was you had to get to certain locations by certain times so you wouldn’t miss the boat that took you to the next island’s biking. So we took the van up certain (huge) hills so we could ride more of the route – and still make the boat.

I must say, I didn’t love taking the van up several hills. I’m, um, so intensely competitive that it was hard to convince myself that we were making a good CHOICE, not that we were failing. But that said, I need to do a little more research into how to use spin class to train for hills for our next trip. (Because I don’t feel safe biking where I live – crazy drivers.)

IMG_4989Luckily, I’ve got 2 years to work this out. And I really want to because where else but a Backroads trip can you see signs like this? All week we saw these crazy signs (but luckily we didn’t see the wild boar it warned of – though we did have a near run-in with a passel of sheep).

 

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