The Wonders of the Human Immune System

With a recent visit to the USDA food safety lab still fresh in my mind, as well as the growing hooplah about swine flu, coupled with a steady stream of salmonella reports, I've been thinking a lot about my own immune system. I take vitamins, get lots of rest and vitamin C, but I've been wondering how I cna make my own natural defenses even stronger.

There's a lot of good and really bad immunology information out there, but the Life extension website combines practical advice with hard science that is easy to understand. Here is a link to a great immune system boosting article on their website.

From fourth grad science, we all know that our immune system is what keeps germs and diseases out of our bodies. It also attacks transplanted organs, leading doctors and patients to find new ways to suppress immuno-functions in order for transplants to succeed. Kidney patients are a large group who have to go under careful regulation of their own immune system so that they're new kidneys keep working. Drugs like sand-immune must be taken on a regular basis to keep a stable balance between the immune system and the kidney, but it can have ravishing side effects on a patients demeanor, energy-level and other body functions.

I've been thinking a lot about this because kidney disease tends to effect rural patients more frequently than Urban patients, according to data from the Georgia Department of Community Health's Disparities Report. Dialysis requires frequent doctors visits, and a 30-60 mile commute can become a logistical nightmare for a person who i both on dialysis and trying to maintain an active life.

The immune system is a key factor in medicine, and it differs from person to person. This outline by the London Clinic explains the building blocks of the immune system, and I found it really informative. Epidemiologists tend to depend on immune system functioning to better understand the morphology of diseases, but it can also be very helpful to the individual patient to know the system and take some of the mystery out of staying well.

Pasturize it!

There has been a food fad sweeping the Athens/Oconee locavores: raw milk.
It's a national movement really, and the gist of the pro-raw milk argument is this: grass fed cows who have been exposed to the germs in their environment develop stronger antibodies, and subsequently, healthier milk. By pasteurizing this milk, we lose the health benefits of these enzymes, antibodies, and friendly bacteria. A really great article detailing the raw milk debate in North Carolina can be found here and here.

For many of raw milk's fans, policy and regulations against the beverage keep them from getting to what has recently been hyped as a bit of a super food, one that will cure what ails ya if you start drinking it early enough. Germs get onto animal udders from feces, and even though sanitary milking procedures can get rid of these germs, pasterization is the most sure fire way to kill unwanted microbes in milk.

University of Georgia researchers though have been working very hard against this hype, reminding people that unpasteurized milk contains bacteria and disease and drinking it can lead to serious infections. Amid any hoopla about getting back to nature, and raw milk being healthier for the earth, it is easy to forget that food still needs to be handled properly to get rid of pathogens that can cause e. coli, listeria, and in some cases, rabies. Ag extension agents across the state have seen more cheeses and other products made from raw milk cropping up at farmer's markets lately.

To know whether or not you are buying products made from raw milk or pasteurized milk, look at the label. A standard label includes the manufacturer, the weight of the product in ounces and in grams, a list of ingredients and whether or not it is made from pasteurized dairy.

Pasteurization is an easy process to perform on milk, and it neither changes the flavor or promotes new allergens. Moreover, when Louis Pasteur introduced the process in the 19th century, fewer people than ever got sick from drinking their milk.

Keeping Track of Doctors

The South is known as a bit of a refuge for shady doctors, the ones who bill patients inappropriately and order unnecessary exams. The ones who abuse pills and perform drunken exams. The ones who touch patients when there not supposed to. The ones who have escaped suspensions in other parts of the country, and come here to seek new practices and patients. Florida is a notorious den for these charlatans, and if all bad pennies shake to the bottom, then Georgia may not be far behind.

Industrious patients keen to know more about their doctor can check on the easy to access and use Georgia Medical Board website, www.medicalboard.georgia.gov. The internet savvy can cycle through old articles, suspension notices and legal actions against doctors. It is a thorough and up to date record, and the Medical Board of Georgia should be commended for their accurate and up to date record keeping.

Witht that being said, there are still lions in the mist, those who seek out and prey upon paitents. The doctor/patient relationship is one built out of trust, and many patients many do not feel comfortable enough to speak up and charge their doctors with impropriety. The NIH has developed a patient's bill of rights. This document outlines the expectations that patients should have for their doctors, and elucidates many different facets of care that unseasoned hospital-goers may not be aware, such as the right to complete information about a diagnosis, the right to refuse to be used in research, and the right to have secondary physicians communicate information with your primary physician.

So then, what to do when your rights have been violated? The AMA has a complete list of state license boards and agencies that will take patient complaints about ethics violations, as well as details the procss of reporting a violation. Still, if you believe that your doctor has broken the law, then your local police department can investigate and arrest him or her, usually in conjunction with the state medical board.

The unfortunate reality is that very few people are watching out for the welfare of patients, but there avenues to deal with dubious docs.

Economic woes hit Oconee County, too.

So, it might be common knowledge that Oconee County is one of the richest in the state, but this does not insulate the entire population from the woes that come from an economic meltdown. The Northeast Georgia Food Bank, the Athens Area Food Bank, and several smaller churches have all seen nearly double their normal demand.

In Oconee County, ACTS, (Also known as Are Churches Together Serving), is the traditional place to go for people who do not have food. For the past several years, the ACTS food bank has served around 80 families a month, mostly African-American. Recently though, the demand has ballooned to 200 families a month, with an even mix of ethnic groups. this suggests that poverty in Oconee is much less segregated than I originally thought.

The Athens Banner-Herald is running an article on the ACTS Food Bank this Friday, and it should be disclosed that fellow UGA health blogger James Hataway is the writer. He brought this to my attention, and after I made some calls and talked to a few local government officials, it seems that the commonly held notion that "poor people just don't like in Oconee County, because it is easier to move to Athens" is starting to fall apart.

The stereotypical food bank client is often seen as an impoverished person or family, having an incredibly difficult time pulling together enough money to meet all the household needs. One demographic that might be fueling the local need the often over-looked and maligned "asset-rich, cash poor" group. These people probably live in nice houses, drive their own reliable and completely paid for cars, but like many families in this economy, no longer have a consistent source of income. Assets like cars, houses, art, and other possessions require time to be sold and turned into cash, and so to live in the interim, many formerly affluent families can find themselves struggling to get by.

Charlotte, NC based food bank Loaves and Fishes has long been aware of this dynamic, and director Beverly Howard says that families living with debt may have at one point found that debt manageable, but given the changing economy, leveraged mortgages and declining stocks, these financial demands become just as insurmountable. "It is a hard situation to explain, and can be counterintuitive to people who deal with poverty for a living. We, like most other people I'm sure, sometimes get bitter when those who have more stand in line to receive the same services."

The key though isn't to blame the rich. It is important to realize that household economies, just like large national ones, are also currently in flux, and can leave the people behind the wheels of the Bentley's and inside the McMansions just as hungry and wanting during the short term. You can't invest in food and save it for a rainy day. It is a consistent need and it requires a consistent pay check, and when any family loses there income, they still need to go places to find some food.

St. Patrick's Day Photo Gallery

So, for St. Patrick's Day, the locally renowned Highland Hills choir performed a selection of traditional Irish songs for retirees from Watkinsville and Bogart. It was an absolute pleasure to behold, and I learned that, like other independent living centers, Highland Hills employs an activities coordinator who is especially attuned to the art and science of getting people to be social. Her name is Edmonda Snow, a vivacious and outgoing lady who has been working for St. Mary's for twenty-five years.

Snow explains that social activities like choir concerts not only keep the residents active, but also provide a way to keep people from pondering anyone's failing health or upcoming death. Aside from concerts, shopping trips, and dinners, one of the most frequent events that Edmonda has to plan for is someone's memorial service. "That's kind of the worst part of this job" she says. "Each of these people is a bit like a grandparent to me, and it gets harder and harder each time one of them goes. Still, we like to remind ourselves that death is not the reason why we are here."

While maintaining close relationships to the residents, Snow also notes the importance of keeping the brain active later in life. She coordinates music lessons, golf lessons, sewing lessons and art lessons for the residents, citing medical findings that learning new skills late r in life helps stave off the onset of senility. Many of the Highland Hills singers are first-timers, pushed into singing by Snow and the sense of community that singing brings. Attached are several pictures from the performance.

The concert was well-received and well attended and included a collection of traditional, popular and less well known Irish tunes. Choir member and Highland Hills resident "Tweet" Moore said this was her first performance with the group, and that was thrilled to be involved. "Moore sang in her church choir as a little girl, but had only recently started singing again. It was an activity she took up to meet people shortly after her husband passed away. Moore is considering lessons, and a few of her friends have take up the piano.

Music lessons open up neural pathways and release certain hormones in the brain that counteract anxiety, depression, stress and promote well-being according to the American Music therapy Association. The association also points out that adults who engage in any form of music-making also display fewer adverse health affects. But for the members of the Highland Hills choir, singing together forms a common bound between strangers and old friends, and gives everyone in the choir a reason to perform.

Ways to think about and deal with death

So far on this blog, there has been very little talk about what old age leads to: death. But over the past four weeks at Highland Hills, there have been 4 different memorial services for residents, each person a noticeable presence in the community who has left behind close friends and family.

Edmonda Snow, the event and activity coordinator for Highland Hills, has to plan and schedule these memorial services. But also, as the activity coordinator, she spends quite a bit of time getting to know residents socially and personally. "I probably take my job too seriously," she says as she starts to tear up. "We think of ourselves as a big family here, each person becomes like a grandparent and gets to be really hard to see them go."

"Tweet" Moore moved into Highland Hills with her husband last summer, and the two had only been there a short while when she passed away. He was living in their personal care wing, and she had an apartment in the independent living wing, but she would often spend nights in his apartment until he died suddenly in August. "I wasn't prepared for it, I guess no one ever is, but the staff and my friends and neighbors really help me through."

In fact these friends and neighbors are all acutely aware of each others mortality, and this sense of inevitably creates a strong camaraderie. "The key is to stay positive and to live for the moment," says Tweet, "because when someone starts to get hopeless it isn't long before they go."

Some nights, the dining room at Highland Hills is filled with all of the rambunctious hijinks of a high school cafeteria, and everyone seems to try and get in on the fun. Just from looking, you would never think that anyone was close to death. But perhaps it is under the impending specter of death that people find the importance of savoring every minute of life.

"Welcome to our cruise ship, without the water."

From the moment I stepped onto the Iris Place campus, just off Epps Bridge Rd., I knew I was in for a different experience. Seated atop a rolling hill overlooking lush woods and private gardens for the residents, it is a type of retirement paradise, the kind of well-kept community that 401k managers have in mind when seeking out shrewd investments.

Iris Place, and its parent company Holiday Retirement (if there were ever a more telling and transparent company name, I have yet to find it), only accept private pay, no long term-care insurance policies, no Medicare and no Medicaid. Just the type of cold-hard cash that people tend to have on hand after years of thoughtful planning and saving. (The company is actually starting to take VA benefits as well, opening the door for customers who in the past haven't had the same access. Side note: this deal was negotiated by a man with the last name Machete, and by all accounts he fought for the acceptance of veteran's benefits with all of the steely resolve that his name implies.)

Ron Smith and his wife Jackie are one set of live-in managers at the facility, and whenever they show the place to someone new, they always like to say, "Welcome to our cruise ship, without the water." Holiday Retirement owns over 370 independent living facilities across the US, and one of the unique amenities offered to Iris Place residents is the ability to travel all over the country and stay for free at any of the other Holiday Retirement facilities.

This mobility is the main sticking point in thinking about independent care. When we tend to think of independent living, we tend to think of spry seniors, engaging in retirement community hijinks, but as Ron Smith pointed out, the definition of “independent” has changed over the past thirty years. Whereas at one point we amy have viewed walkers, oxygen tanks, wheelchairs and even personal caregivers as clear signs that a person was losing their independence, the official policy at Iris Place and for Holiday Retirement nationwide is that each of these things are a tool that enables a person to maintain their own independence.

Though on the one hand this seems to be a very empowering way of talking about aging, it also represents a subtle effort on the part of the company to loosen the rules and keep people living in independent living facilities longer. Iris Place does not have any assisted living facilities, and so once a person loses their independence, they have to move somewhere else, thus causing Iris Glen to lose the minimum $2200 monthly rent the person had been paying.

There is also research that shows that when the elderly maintain their independence, they also maintain a higher quality of life and are more likely to live longer than expected. So we can’t and shouldn’t demonize affluent retirement communities for offering a desired service to people who can afford it, and who show health benefits from it. But we can call into question and make sure that they are still offering the level of care that they claim to offer, and that the residents are as happy, healthy and satisfied as they seem to be.

Reasons to Plan Well

Just over the Oconee County line, down Jennings Mill Road, past office parks and housing developments that look more like country clubs, sits the Highland Hills Retirement Community. With open door policies among all the staff, meals in an exquisite dining room, and a list of activities to make any cruise ship participant jealous, Highland Hills prides itself on the quality of life that they can offer their residents.

“Depression is the number one enemy, and we try to fight that by being involved in the lives of the people who choose to live here,” said Beth Guthrie-Johnston, the sales coordinator for Highland Hills. “About 2/3 of the residents only see there families on holidays, so we try to at least stay aware of what is going on in there lives.”

Highland Hills offers both independent living and assisted care to the elderly. As a person ages, their quality of life can fade as routine chores and tasks become more difficult.

“What I tell people is this: you don’t want to find yourself hurt or drastically ill, all of sudden needing to go to a nursing home where you are dependent on so many other people. If you come out of your normal routine into something so drastic, you’re going to be depressed. Come here, or to a place like this, where you can get used to having people take care of you while you take care of yourself and experience a still normal life. We like to help people make the transition,” Guthrie-Johnston said.

Quality of life is expensive though. Highland Hills costs around $2000 a month, buying the resident food and access to medical care, as well as a very attentive and well-trained staff. To live at Highland Hills, a person needs to maintain a certain level of independence and mobility, though staff at the facility admit that have been making certain concessions.

“It’s warm and it feels like home here, probably because they keep treating you like a person when you move in. They remember your name, they look at you when you talk to them,” said Mr. Hughes, a resident.

St. Mary’s bought Highland Hills seven years ago, but until recently had been hands off on running the facility, and this distance allowed Highland Hills to maintain its community atmosphere, Guthrie-Johnston said. Given the recent economic crunch though, St. Mary’s has been looking for ways to cut costs, turning their attention to Highland Hills, even instituting the first price increase in seven years. As the hospital takes a more active role in running the facility, Gutherie-Johnston said that she and other staff worried that the community will slip away and start to feel much more corporate.

Over twenty residents have full-time outside caretakers, or “sitters.” These sitters allow the residents to maintain a certain level of independence, keeping them out of more intensive assisted-living facilities and nursing homes. St. Mary’s though has decided to look more closely at the residents using sitters and may decide to move these residents if they are declared “not independent enough” to live at Highland Hills. Guthrie-Johnston and other staff members have expressed a displeasure with this change in policy, saying that it will leave too many beds open at the facility and disrupt the valuable sense of community they have achieved.

Community seems to be the key concept, casting Highland Hills as a neighborhood made up of late-lifers who will fight and slyly cajole their way into staying. And for good reason: those who can afford it and have planned for it are all very well taken care of.

If Only Sickness Were Always this Posh

Crossing into Oconee County from Athens, there is a billboard just over the county line. “Hey mom, watch this!,” it reads and in the bottom corner advertises the convenient 24 hour varied-services of Athens Regional Medical Center, for those cute little emergencies that you sometimes can't plan for. The billboard screen then flips to reveal an add for high-end orthodontics. It's almost like the sign marks passage into a land where health-care is both abundant and convenient, where rich parents are paying heftily to keep their children healthy.

Just past the sign, there sits the prime jewel in the St. Mary’s Health Center crown. Perched along the edge of the Epps Bridge Parkway, 10 minutes away from St. Mary’s main campus in Athens, is the new and fairly posh St. Mary’s Outpatient, Rehab and Wellness Center at the exchange. Built in 2007, the facility is capped by a state of the art fitness center on the top floor that shines like a good health beacon through the floor-to-ceiling plate glass windows.

To me, this center is representative of a type of convenience medicine that is less likely to impact your routine and lifestyle. When people have options for their health care, convenience is the key to getting their attention, (and their insurance dollars, I'm assuming) said Marc Ralston, the PR Director for St. Mary’s. At the facility, patients can receive CT scans, MRI’s, mammography, bone density scans and a slate of outpatient services for whatever illness you might have. Ralston said that the center has cut down on traffic to the main hospital by allowing people to receive many of the more time-intensive and long term treatments without having to travel the ten miles to Athens.

My favorite part (and perhaps the most noticeably ostentatious) is the sleep clinic. Ralston said that it features 8 hotel quality beds with “luxurious private bathrooms” and 24 hour monitoring and counseling to help diagnose and treat sleep disorders. If my insurance paid for high-end hotel rooms, I could see myself quickly developing the most complex form of sleep-walking insomniac night-terrors witnessed by medical science.

Assuming there is nothing wrong with you that requires expensive treatments or sleep analysis, but you still crave some professional advice on how to get healthy, you can get a personalized wellness consultation from the fitness and wellness center doctors. They test your metabolism, put you through stress tests, eventually developing a highly specialized diet and workout regiment for the patients.

“I’m really starting to understand how uniquely my body functions,” said Mary Thompson of Watkinsville. “I now know the ways I need to specially care for myself to have the most productive life.”

When I asked Ralston about Oconee’s presence in other counties, he quickly pointed out that they provide home health care and hospice in each of the counties adjacent to Athens, but was also quick to admit that the Outpatient, Rehab and Wellness Center in Oconee County was the only building like it in the hospital system. What he did not say was that the money drew the hospital there, only saying that thanks to the facility, the hospital is more accessible to patients in Oconee and other counties. It has been noted by other DeepSouthHealth bloggers that there is a lack of hospitals and hospital funding in many of Georgia’s rural counties, but here in Oconee County, there is at the very least a place that patients can go to when they do not need long term or emergency care. And when they do get sick, at least patients can see a doctor in both comfort and style.

The Most Popular Yoga Spot in Town

It's a Thursday afternoon at the Oconee County Senior Center in Watkinsville, and the most popular class of the day is just starting to begin. Yoga mats are on the floor as the most popular yoga session in Oconee County is set to begin.

Three years ago, two yoga instructors approached the center interested in offering yoga classes to the elderly of Oconee County. Since then, the beginner and advanced yoga classes have been the most popular offerings at the center, trumping cooking classes and the ballroom dancing classes.

Margaret Farr, a staff member at the Senior Center, says that she has noticed a real difference in people's health since the center added yoga classes. She says that one local resident cured her chronic hip pain after three weeks of regular yoga. Keeping seniors activity has been a challenge for the Oconee County Senior Center, but it seems that yoga has been a bit of a magic bullet. The importance of staying active as you age cannot be overstated, and the national Senior Fitness Association has a list of the benefits of yoga for seniors here, as well a series of poses that are specially tailored for aging bodies.

But aside from the direct physical benefits of regular activity, regular group yoga sessions also offer a much needed community connection. Depression and isolation can target the elderly as they age, especially if they lose connection with their family and friends, Farr said. She also said that when they make connections with those around them more freely, elderly residents take better care of them and show a higher sense of self regard.

It's easy to forget that our psyches as well as our bodies change as we get older, and that we should pay attention and take care of our mental and emotional health as well. After all, if the teachings of yoga are truly correct, then our bodies and psyches are permanently connected, and changes in one truly affect the other.

On Money

So I've been asking myself, what is so interesting about Oconee County? It is an extremely affluent county, and most of the conflicts in the county stem from land use and development issues that are often stereotyped as the "boring plight of the bourgeoisie."

So I may have just let my hand show. I often find myself more attracted to how the marginalized and ignored communities operate and function, and the trials they face in meeting common, daily needs. But often, the dirt we dig is not always filled with the gold we want.

With that being said, how about some government facts. I've been on a bit of a statistics binge lately, and came across the Georgia Health Disparities report, produced by the Georgia Health Equity Initiative. I recommend you read it. It can be found here: http://dch.georgia.gov/00/channel_title/0,2094,31446711_40829902,00.html

One of the more interesting statistics calculated for each county is the "Years Per Life Lost" statistic, which tells how many gross years of life are lost by people who die before they hit the average life expectancy. If Average Life expectancy is 72, and someone dies at 62, then that is measured as 10 years of life lost for that individual.

The report goes into this a little bit, but when people die early, that has an affect on the rest of the community. Their wisdom, the years of grandparenting, and their place within the social fabric of a community disappears. When an entire community or ethnic group within a community has a very high YPLL, we can think of that as a huge loss of collective wisdom and guidance within that group, as well as a marker for widespread risks to that localized group.
Oconee County has 5 years of life lost, compared to the many thousands of YPLL for other counties, showing that people in Oconee County tend to live a pretty long time.

Below is Oconee County's report card from the Georgia Health Disparities report. In my opinion, it reinforces that Oconee county is a very affluent area, with a large white population. Racial disparity among Georgia's health services seems to be an almost foregone conclusion, but it is really about money. In the report card, you see several D's and an F in access to mental health services. The report shows disparities in care, and these low grades reflect the fact that Oconee County offers very few "safety net" services for poorer individuals.

Evan Mills, of the Clark County Government Homelessness Task Force, said that many people living in poverty in Oconee County come to Clark County to get services, but in his estimation, that it is a very small population doing so. As in all things, money equals access, and if you live in Oconee County, on the whole you probably can afford access to better care. Which doesn't mean that your health care doesn't come with its own set of issues, but affording care is the first river to cross when looking for good care.

Oconee County Overview and Activism

To know Oconee County, one must first understand the level of civic engagement happening in the community. Celesta Sharpe made a documentary entitled "Carving Up Oconee." The film is about the rigorous debate between those who want to bring developers into Oconee County and those who want to keep it rural and protect farmland. It portrays Oconee citizens as exceptionally literate and informed about modern land-use issues and grassroots organizing.

You can see the trailer here: http://carvingupoconee.com/

The land use debate seems to be the overarching narrative for Oconee County, and as this blog develops, I am sure that land-use issues will color the coverage and provide a background for most stories. It is a rural county that wants to stay rural, but also has the highest per capita income in Georgia. A higher per capita income often reflects a more educated and engaged community, and at the outset, it seems that the citizens of Oconee have a stronger sense of self-determinism and clarity about how they want their community to develop.

Celestae's film portrays these informed and engaged citizens in opposition to the deep pockets and political interests of wealthy developers who see Oconee's farms as fields filled with a different kind of green. From a health perspective, development begets all types of water and land use issues, which in turn affect the environment. Nothing can be more controversial than poorly controlled construction run off. During a time when Northeast Georgia is experiencing one of its worst droughts, it is also important to keep an eye on how new development will affect existing water resources.

For a current and in depth analysis of development issues within Oconee, you can follow Lee Becker's blog: http://www.oconeecountyobservations.blogspot.com/

Disclaimer: He's taught me in class, but this link should not be seen as a direct endorsement. If you are interested in the ins and outs of Oconee Coutny public policy, there are few people who follow it with the same rigor.

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So then, where does that leave this blog? What space does it occupy? Well, we'll see. This should be an adventure, especially as we begin to discover what it is like to live in Oconee County and breath the air, walk the streets, meet the neighbors, and catch the germs. Expect more facts and demographics to come soon.

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