Yhoctrongcuocsong: tháng 7 2015

Thứ Sáu, 31 tháng 7, 2015

Weight training has been shown to improve the health of people with type 2 diabetes, especially when part of an overall fitness plan.

Medical science has well established the benefits of aerobic exercise for people with type 2 diabetes. Now, researchers believe that a diabetes and exercise plan also should include a regular weight-training routine. (The federal government recommends that all people, even those without chronic illness, strength train at least twice a week.) Strength training has been shown to improve the symptoms of type 2 diabetes and, when part of a workout plan that includes aerobics, can put the person with diabetes on the path to long-term good health.

Diabetes and Exercise: The Benefits of Strength Training

Studies have found that strength training can help people with diabetes by improving the body's ability to use insulin and process glucose. This occurs because:

You experience an increase in lean muscle mass, which boosts your base metabolic rate and causes you to burn calories at a faster rate. Burning those calories helps keep your blood glucose levels in check.
The ability of your muscles to store glucose increases with your strength, making your body better able to regulate its blood sugar levels.
Your body fat-to-muscle ratio decreases, reducing the amount of insulin you need in your body to help store energy in fat cells.

Even better results have been observed when people with type 2 diabetes combine a weight training routine with regular aerobic exercise. The two forms of exercise work together to create better health benefits than either does on its own.

Diabetes and Exercise: Protection Against Complications

Strength training also can help guard against some complications of diabetes by:

Reducing your risk of heart disease
Helping control blood pressure
Increasing your levels of good cholesterol while reducing bad cholesterol levels
Improving bone density
Preventing atrophy and loss of muscle mass due to age

Diabetes and Exercise: Starting a Weight Training Routine

A weight-training routine involves performing movements that work specific muscle groups in the body. A strength-training workout is broken down into exercises, reps, and sets:

The exercise is the specific movement that works a muscle group; for example, a bicep curl or a chest press.
A rep, or repetition, is one completed motion; for example, one rep of a bicep curl is lowering the dumbbell and then raising it to the starting position.
A set is the number of reps performed together; sets are separated by a short rest period.

The American Diabetes Association's guidelines for a weight-training routine call for:

Strength training two or three days every week, with at least one day off between sessions (to allow muscles to rest and rebuild)
At least 8 to 10 weight exercises per session to work all the major muscle groups of the upper and lower body
Exercises of low or moderate intensity. Low intensity involves two or three sets of 15 reps with lighter weights. Moderate intensity involves two or three sets of 8 to 12 reps with heavier weights. There should be 2 to 3 minutes of rest between sets.
A workout time of 20 to 60 minutes per weight-training session

Diabetes and Exercise: Practice Common Sense

To ensure good results and prevent injuries, follow these common-sense rules:

Get your doctor's clearance. As with any exercise program, you should check with your doctor before starting a weight-training regimen.
Focus on your form. Always observe proper posture. Be sure to perform each exercise exactly as required, even if it means you need to use less weight.
Breathe. Exhale while lifting the weight and inhale while lowering it.
Allow for variety. Every now and then change the exercises in your workout or alter the number of sets or reps you are doing. Your body adapts to exercise, and your progress can plateau if you don't keep your body guessing.
Ask for help. If you need some guidance, consider working with a trainer or joining a weight-training class at your local gym or YMCA.

Always give yourself time to recuperate. Don't work out using a muscle or joint that feels painful. In other words, don’t overdo it.

Thứ Hai, 13 tháng 7, 2015

How to Reach Your Weight Loss Goal

By Regina Boyle Wheeler
Reviewed by Cynthia Haines, MD

Want to lose weight and keep it off? Follow these tried-and-true strategies for a weight loss plan that works

Many people look for a fresh start by resolving to lose weight. If you make that promise time after time but find yourself unable to make true progress, you’re far from alone. A major reason why people abandon their weight-loss goal is because their goals are too big and their expectations are unrealistic, says Michael Zemel, PhD, professor emeritus and former director of the Nutrition Institute at the University of Tennessee in Knoxville.
Changing your lifestyle is often easier said than done. Dr. Zemel says that people often resolve to go to the gym every day or change their diet completely, and when they can’t do it, they feel like failures and throw in the towel. Many people lead hectic lives, and that healthy meal you envision eating for lunch or dinner may be reduced to finding what’s in the vending machine or going through the fast food drive-thru. “Life can get in the way of your best intentions,” Zemel says.
Losing weight involves more than a vague dream and a refrigerator full of diet foods. To make your weight loss plan a winner this year, use this step-by-step plan as your diet road map:
Set Realistic Weight-Loss Goals
Erika Anderson, a grant writer in the foundation department at Children's Healthcare of Atlanta, says she tried and failed at losing weight many times because her goals were too ambitious. But in January 2010, she decided to go about weight loss with a different approach. Erika joined a weight loss program and learned how to lose weight gradually using diet and exercise. “This time, I set small goals — five pounds at a time,” she says. Each five-pound increment took her about two weeks or sometimes longer to lose. “I remember thinking about how many more pounds I had to go. But those five pounds add up little by little,” Anderson says. So far, she has dropped 120 pounds and blogs about her weight-loss journey. “If I had set out to lose more than 100 pounds, I definitely would’ve quit. That’s way too overwhelming, but five pounds at a time is doable.”
Zemel says setting attainable goals will help you feel successful and motivated to keep going. Plus, you can see results in the mirror, and your clothes will start to fit better.
It’s the Little Things That Count
Making small changes can add up to big results over time. Since drastic lifestyle changes often don’t work, find one aspect of your diet that you can change fairly easily. For example, instead of ordering large fries at lunch, opt for the medium or small size, Zemel suggests. Find little ways to work extra physical activity into your day, too. Take the stairs instead of the elevator and find the farthest parking spot at the mall or office lot. When talking on the phone, get up and walk around instead of sitting.
Be Accountable to Yourself
Monitor your behavior to see where you can make improvements. Smartphone apps can help, Zemel says, such as using a free pedometer app that will count your steps in a day. A good weekly goal is to add 2,000 to 3,000 steps a day with an ultimate goal of 10,000 steps each day, which is equivalent to about 5 miles. Using a pedometer can also help you realize how sedentary you may be during the day.
Be mindful of what you eat as well. Take a mental note or, better yet, use a food diary, to keep track of exactly what you’re eating. You may not realize that you’re dipping into a bowl of mints every night as you watch your favorite TV shows. When you realize how you could be sabotaging your weight-loss goals, you can change your behavior, Zemel says.
Find Support
Anderson says that writing her blog and getting support from her co-workers helped her stick to her weight-loss plan. “The blog saved my life,” she says. Before her weight loss, Anderson says she was a compulsive overeater who used food as her “drug” of choice to cope with the death of her mother.
You can easily build your own support network to strengthen your weight-loss challenges:

The social network. Posting progress and getting encouraging words from friends on your Facebook or Twitter network can keep you motivated.
A buddy. A diet or exercise partner can help you stick to your weight-loss plan. Anderson says her exercise buddy helped keep her going during summer boot camp sessions that began at 5:30 am.
Your family. Family support can make or break your weight-loss goals. If a spouse is not behind your efforts, dropping pounds can be very difficult, Zemel says. Explain your goals and get them to rally behind you.
Reward yourself. Find non-food ways to reward yourself. Zemel suggests splurging on a new, slimmer outfit when you reach a milestone.

Measure Progress Carefully
Be prepared to hit some weight-loss plateaus, but don’t be tempted to try a crash diet to jump-start more weight loss, Zemel says. This can cause your body to resist, slowing your metabolism and making weight loss even harder.
“There were times when I got really frustrated because the scale wasn’t moving, but I was never willing to give up,” Anderson says. “Eventually, that perseverance moved the scale.”
In addition, Zemel says that the numbers on the scale don’t always measure progress accurately. As you get fitter, lean muscle will replace fat, but your weight may stay the same. Focus on the way your clothes feel — if they fit better or are getting looser, your weight-loss plan is headed in the right direction.
Anderson says when she starts to veer off track, she recalls when she was heavy and felt far older than her 38 years. “I walked around like I was 70 years old, and I was sick and tired of feeling sick and tired,” she says. She also keeps her “before” picture close at hand to remind her of just how far she’s come.

Last Updated: 1/1/2015

Foods to Fuel Your Workout

By Regina Boyle Wheeler
Reviewed by Pat F. Bass, III, MD, MPH

Energize your exercise routine by choosing the right preworkout foods. Whether you’re an early-bird exerciser, a midday mover, or a night owl, here’s how to fuel your engine.

Whether you're heading out for a morning jog or going to a midday spin class, knowing what to eat before your workout can make or break your exercise routine. Preworkout foods should be high enough in calories to sustain the intensity of your workout, but the meal shouldn’t be large enough to slow you down, says Franci Cohen, a personal trainer, certified nutritionist, and exercise physiologist in Brooklyn, New York. “Fuel your body; don’t drag it down,” she advises.
According to Cohen, the perfect meal before exercise should be low in fat, moderate in easily digested carbohydrates and protein, and low in fiber, and it should contain some water. Here’s why this combination works: Carbs are stored in the liver and muscle for energy use, and protein (amino acids) is the building material of muscles and is needed to keep your red blood cells healthy. Those cells carry oxygen to your working muscles, Cohen explains. Water is essential to replenish the electrolytes and fluids lost when you sweat during exercise.
Of course, the best thing for you to eat (and the best time to eat it) also depends on the intensity of your workout. Marathon runners often have a big pasta meal the night before a race. The reason is simple, says Cohen. Carbs are broken down and stored as glycogen in muscles and the liver, but this process takes time — digesting a big meal can take from three to five hours. “While we sleep, the body undergoes this digestion," Cohen says. "By the time we wake up, the storage is complete — we're all set and fully fueled for the big race!”
But you don’t have to run marathons to be mindful of what you eat and when you choose to exercise.
Foods for Morning Workouts
If you’re up at first light and like to run with the roosters, should you eat something beforehand or head out on an empty stomach? “There’s conflicting data on the subject,” says Cohen. “One school of thought maintains that ‘fasting aerobics’ (exercising at 75 to 80 percent of your maximum heart rate without eating) is best. It’s thought that your body will burn stored fat because it can't burn your breakfast."
In fact, a small study published in the British Journal of Nutrition found that exercise before breakfast gives you an advantage. Ten overweight, sedentary men took part, and each underwent three trials: eating breakfast and not exercising, walking briskly for an hour before breakfast, and doing the same workout after breakfast. The researchers found that exercising before eating resulted in a larger fat loss and lower levels of fat in the blood than after-breakfast exercise. Not surprisingly, the researchers found that before or after meals, exercising was better than skipping workouts altogether.
The opposing school of thought maintains that if you eat first, your body will have more energy, so you’ll be able to work harder and thereby get a bigger payoff from your workout. “Both schools of thought have been substantiated through well-designed clinical trials, so the bottom line is, It’s totally up to you,” Cohen says. If you choose to eat beforehand, think of it more as a snack than a meal. Cohen suggests a handful of whole grain cereal, a glass of skim milk, and a few raw almonds — just enough to get you fueled and on your way.
If you do opt to eat, keep the timing in mind as well. Generally, feeding your body a combination of carbs and protein one to three hours before exercise is ideal, according to the Academy of Nutrition and Dietetics. “If you plan on grabbing a light breakfast and rushing off to the gym, your body will not have sufficient time to digest your food before exercising,” says Cohen. This can lead to cramping and other intestinal distress. If you’re tight on time, Cohen advises that you stick with simple carbs, which are broken down easily (in the small intestine), instead of proteins and fats, which take longer to break down and are digested in the stomach.
Foods for Midday Movers
If you’re motivated to exercise in the middle of the day, Cohen says you need a super lunch to get you through your workout and to prevent a three o’clock slump. That’s when blood sugar dips and you find yourself struggling to make it to five. “You want a lunch that will keep you happy, energized, and smiling straight through until dinnertime,” she says. She suggests an oldie but goodie: ants on a log. Spread some almond butter or low-fat peanut butter into a few celery sticks. Top with a row of raisins. Throw a hard-boiled egg onto the plate, says Cohen, and you’ve got a combination that “provides slow-release energy, enabling you to power through your workout from start to finish.”
Foods for Evening Exercise
“If you’ve made it through the day and still have the energy to work out, then hats off to you,” says Cohen. In the evening, your circadian rhythm is already preparing the body for sleep. Sleep hormones are kicking in, and energizing hormones are being suppressed, so you’ll need a boost to jump-start a workout. “My top pick is green apples,” says Cohen. They provide a modest amount of sugar and valuable pectin fiber, which slows the absorption of sugar into the bloodstream. That means you'll avoid blood sugar peaks and crashes. “Add a few almonds or a glass of skim milk,” Cohen suggests, “for more protein.”
Postworkout Foods
Whether you work out in the morning, at noon, or at night, tired muscles need to be refueled afterward. A combination of carbs and protein eaten within about 20 minutes of exercise will do the job best. Reach for these satisfying suggestions from Cohen to fuel your body and prepare it for your next workout:

Greek yogurt with natural granola and fresh strawberries
Whole-grain cereal with skim or low-fat milk
Fresh turkey breast on a multigrain rice cake with some leafy greens and tomato
A smoothie made with almond milk or skim milk and lots of fresh fruit
An egg-white omelet with spinach and mushrooms and a slice of whole-grain toast on the side

Choosing smart workout foods will leave you feeling energized rather than running on empty, both during and after your fitness sessions.

Last Updated: 1/1/2015

Is There a Killer Squirrel Virus?

Zoonotic bornavirus from variegated squirrel tied to fatal CNS infections in German breeders.

by Michael Smith
North American Correspondent, MedPage Today

Action Points

Three squirrel breeders in Germany likely died of a novel virus they caught from the animals.
Note that genomic analysis found a previously unknown bornavirus in a contact squirrel and in brain tissue from the three men, and that the new virus -- called variegated squirrel 1 bornavirus (VSBV-1) -- is separate from the other species.

Three squirrel breeders in Germany likely died of a novel virus they caught from the animals, researchers said.
Over a 2-year period, the three men developed progressive encephalitis or meningoencephalitis that led to death within 2 to 4 months, according to Martin Beer, DVM, of the Friedrich-Loeffler-Institut in Greifswald-Insel Riems, Germany, and colleagues.
The men, all from the German state of Saxony-Anhalt, bred variegated squirrels, a species native to Central and southern North America that is kept as an exotic pet in Europe, Beer and colleagues reported in the New England Journal of Medicine.
Genomic analysis found a previously unknown bornavirus in a contact squirrel and in brain tissue from the three men, the researchers reported, and it is the "likely causative agent" in their deaths.
The known bornavirus species infect a range of warm-blooded animals, from birds to primates, and are currently not thought to be responsible for human disease, Beer and colleagues noted.
But the new virus -- dubbed variegated squirrel 1 bornavirus (VSBV-1) -- is separate from the other species. "VSBV-1 is likely to be a previously unknown zoonotic pathogen transmitted by the variegated squirrel," they stated.
The investigation began in late 2011, when three men in succession (ages 63, 62, and 73, respectively) developed similar symptoms including fever, shivers, or both; progressive psychomotor slowing; confusion; unsteady gait, and myoclonus, ocular paresis, or both.
All three also developed bilateral crural-vein thrombosis, with a subsequent pulmonary embolism in two.
Finally, they lapsed into coma and died, Beer and colleagues reported, despite anti-infective chemotherapy.
The three men were friends, members of the same squirrel-breeding association, and often traded animals.
While they were alive, their cerebrospinal fluid showed pleocytosis, and MRI showed growing lesions in the cerebral cortical areas and basal ganglia or meninges.
While that finding is consistent with a viral infection, doctors were unable to find an infectious agent, despite detailed investigations of cerebrospinal fluid samples, biopsy samples, and serum, the researchers reported.
Analysis of the affected brain areas showed tissue swelling and necrosis, glial activation, and lymphocyte infiltration, but no viral inclusions or microorganisms, they said.
Beer and colleagues thought the squirrels might have played a role in the disease.
To investigate, they tested for a range of pathogens using a squirrel owned by the third patient, but when that screening came up negative they went on to analyze samples from the animal using metagenomic sequencing.
That analysis detected five RNA sequence fragments that were similar to a known bornavirus, Mammalian 1 bornavirus, in liver, lung, and kidney tissue and in chest-cavity fluid.
Using polymerase chain reaction methods, Beer and colleagues found similar RNA in other samples from the squirrel and in fresh-frozen brain tissue from all three patients.
Control tissues from patients with unrelated brain diseases and from healthy people did not contain any of the viral RNAs, they reported.
Deep sequencing of RNA from the squirrel and the third patient showed the two viral sequences were nearly identical and had a standard bornavirus genomic structure. Analysis showed the novel virus is a separate lineage from the known bornavirus species.
Finally, Beer and colleagues found that the third patient had antibodies to the virus in his serum and cerebrospinal fluid.
Taken together, the evidence isn't enough to prove that the novel virus caused the three deaths, Beer and colleagues concluded, but they argued it was highly suggestive of a novel zoonotic illness.
They added that the route of transmission from squirrels to patients "remains uncertain" although family members reported that two of the patients had been bitten or scratched.
They also noted that all three of the patients were older than 60 and had pre-existing medical conditions -- hypertension, diabetes, or obesity -- that might have "conferred a predisposition to clinical infection with this unusual agent."
It also remains unclear whether the virus was imported with the squirrels or whether it originated in mammals that were in contact with the breeding facilities, Beer and colleagues said.

Thứ Năm, 9 tháng 7, 2015

Nhiều người Việt đang ăn để… chết

Cập nhật : 10:26 | 09/07/2015

Thông thường ăn là để... sống chứ đâu phải ăn để… chết, nhưng trước thời buổi làm ăn chộp giật, “lướt sóng” hiện nay thì nhiều khi ăn lại là để chết.

Xem bài khác trên Vef.vn

Đầu tiên là “chết” tiền. Những ngày vừa qua, báo chí xôn xao việc thực khách bỏ tiền ra mua một con cua nặng 1,2kg để rồi cuối cùng thực chất chỉ ăn được 420 gram. Số tiền còn lại hao phí cho cho 780 gram sợi dây và hao phí khi luộc!

Rồi câu chuyện hai vợ chồng Việt kiều vào một quán phở tại Hà Nội ăn, sau khi ăn xong ra tính tiền chủ quán đòi 800.000 đồng cho hai bát phở. Hai vợ chồng này không hài lòng và thắc mắc thì được người chủ này đáp lại bằng cách chém con dao xuống mặt bàn và quát “không nói nhiều”. Sau đó các vị khách phải trả 800.000 đồng rồi lẳng lặng ra về.

Chặt chém, ép giá tại các khu du lịch không còn là “chuyện lạ”. Dư luận đã không thể không bức xúc khi thốt lên rằng: Đó chẳng khác gì ăn cắp và nếu nói đây là “ăn cắp” thì đó là hành động “ăn cắp” trắng trợn. Dù vậy, sự ăn để “chết” tiền vẫn chưa nguy khốn bằng sự ăn để chết người. Bởi đây là chết thực sự, chết vì ốm đau bệnh tật, chết theo đúng nghĩa đen của nó.

Mới đây nhất, ngày 6/7, khi kiểm tra tại một lò giết mổ thuộc phường Hiệp Thành, Phòng cảnh sát điều tra tội phạm về môi trường và Đội Quản lý thị trường Quận 12, thành phố Hồ Chí Minh đã phát hiện tại cơ sở này có một số lượng lớn vỏ chai thuốc hiệu Combistress. Loại thuốc này được chủ lò mổ thừa nhận dùng để tiêm vào heo trước khi mổ để thịt có màu sắc bắt mắt, tươi hơn bình thường. Song điều đáng nói, theo một cán bộ thú y, lượng thuốc Combistress tồn dư trong thịt (mà chắc chắn là tồn dư vì thuốc được tiêm trước khi heo chết) sẽ ảnh hưởng đến sức khỏe người ăn phải như làm giãn mạch máu, hạ huyết áp, rối loạn giấc ngủ và nguy cơ ung thư rất cao.

ung thư, tiêm thuốc, đầu độc, hóa chất, thịt thối, ung-thư, tiêm-thuốc, đầu-độc, hóa-chất, thịt-thối,

Nhiều lò mổ lớn có thể bị ảnh hưởng bởi hệ lụy của thịt heo tiêm thuốc an thần (Ảnh: Người đưa tin)

Có lẽ chưa bao giờ mà cả xã hội lại lo ngại, thậm chí hoang mang về chất lượng thực phẩm như hiện nay. Ăn gì, uống gì và dùng gì cũng sợ. Gạo nhựa, trứng giả, mực cao su, rau quả ngâm thuốc kích thích, bún, bánh phở có chứa formol… thôi thì đủ cả. Đến giấy lau miệng và chén đũa cũng được các chuyên gia khuyến cáo hóa chất phụ gia tồn dư từ quy trình sản xuất khăn giấy có thể ảnh hưởng xấu đến sức khỏe…

Trước tình trạng bệnh hiểm nghèo gia tăng và nhu cầu bảo vệ, tăng cường sức khỏe, nhiều người đã tìm đến với các loại thực phẩm chức năng, hiếm, độc như một “cứu cánh” nhưng rồi cũng nhanh chóng thất vọng bởi thực phẩm chức năng cũng bị làm giả từ sữa ong chúa, nhau thai cừu, Glucosamin, Collagen… và gần đây nhất là yến huyết.

Theo VTV, một tư thương kinh doanh yến tại quận Tân Bình, TP. HCM cho biết, chiêu thức làm yến huyết như sau: đầu tiên, xịt tổ yến cho ẩm rồi bỏ vào thùng xốp. Sau đó sẽ đào một cái hố để cho thùng xốp vào và ủ phân hữu cơ lên. Ủ khoảng hai tháng, tổ yến sẽ chuyển sang màu hồng do trong phân hữu cơ có chứa NH3 phản ứng với Oxy có trong không khí, tạo ra Nitrit. Nếu để thêm một tháng thì toàn tổ yến sẽ chuyển từ màu trắng sang màu đỏ. Còn theo cách thứ 2, nếu không làm vệ sinh ở nơi chế biến, làm tổ thì trên thành tường sẽ có phân chim và NH3. NH3 phản ứng với Oxy sẽ tạo thành màu đỏ dưới chân tổ. Lâu ngày, tổ yến sẽ đỏ từ dưới chân tổ lên trên, dần dần sẽ đỏ toàn tổ".

Theo những cách trên, nếu lỡ có bị pháp luật “sờ gáy”, tư thương sẽ lấp liếm rằng, sự hình thành yến huyết tại nhà yến của họ hoàn toàn tự nhiên chứ không nhuộm màu hay tác động gì. Với những chiêu thức “làm giả ăn thật” như vậy, người tiêu dùng nhiều khi “tiền mất tật mang”, bỏ hàng trăm triệu đồng ra mua yến huyết giả, để phải đối mặt với nguy cơ bị bệnh tật, ung thư.

10 Things Your Doctor Won’t Tell You Before Surgery

By Jennifer J. Brown, Phil

Questions to ask, tips to know, and homework to do to make sure your procedure goes as well as possible.

For the best outcome, prepare before surgery.

Wednesday, March 26, 2014

Your doctor tells you or a loved one that you need surgery and has helped you find a surgeon. You've read all you could find about the procedure. But here are 10 things your doctor may not have mentioned, and that you should be sure to do for yourself to be prepared and feel empowered.

1. You need the most experienced surgeon you can find. When it comes to surgeries, practice makes perfect — and so the more experienced the surgeon, the better the results are likely to be. Ask directly: How many of these surgeries have you done? Consider looking for someone who's been doing surgery for more than five years with over 30 surgeries each year. Compared to a surgeon who's immersed in patient care, the clinician researcher may be more involved in research than in day-to-day surgery, cautioned Alexander Marmureanu, MD, a cardiothoracic surgeon at the California Heart & Lung Surgery Medical Center in Los Angeles.
2. I might have been sued by former patients. Contact the state medical licensing board for your state, or the county clerk's office in your area to find out about medical malpractice lawsuit cases involving your surgeon (or any doctor). This is public information you have the right to know.
3. My hospital may not be up to snuff. Try this Medicare tool to compare hospitals based on their surgical records. You might discover that your hospital is better than average — or worse — for care before, during and after surgery. You can also check that your hospital provides high quality care at this site, and for surgical centers, this site to see that they're accredited organizations. This means a hospital or outpatient clinic meets strict patient quality and safety standards.

4. Schedule surgery during banking hours. You might think having surgery on a weekend or at night is a great idea. Wrong. These are off hours for regular healthcare staff who are essential for a successful surgery, including the most experienced nurses, a patient advocate or a social worker. For the best care, schedule your surgery during the week — Monday through Thursday — between 9 and 5, recommends Dr. Marmureanu.
5. I'm great...but you still need a second opinion. Do you really need surgery now? Always confirm the necessity to have surgery with more than one source. Unless you're having emergency surgery, you'll have time to weigh your options. Get the name of a second surgeon by asking your primary health care provider, the first surgeon, or a service like Grand Rounds. A second surgeon’s opinion — and even a third — will help you decide what’s best.
6. Don't mind my lousy bedside manner. You want a surgeon who's confident and great at his or her job, but you're not going to spend a huge amount of time with them. Clear communication and skills are more important than a great personality.
7. Ask me all your questions...and make sure you get answers. What are the risks and benefits of the surgery? How long will the benefits last? What are the alternatives to surgery? What if we skip the surgery? How long will it take to recover from surgery? If the surgeon doesn’t welcome questions, you should look around for someone qualified who will. Put questions in writing, and follow-up by asking the attending nurse.
8. Your incision size could be negotiable. Your condition may have surgery options that are less invasive and come with fewer risks. This can mean a shorter hospital stay, quicker recovery, and even lower cost for you. Ask about different ways to get the same end result. Minor surgery, like laparoscopic surgery, might work as well as major surgery.
9. Get a friend to take notes. Support of family or a friend when you discuss surgery options with the surgeon can make all the difference. Bringing an assertive companion with you for these visits — as your patient advocate — can help you raise your voice and be heard. They can ask questions and even take notes for you, recommends Carolyn M. Clancy, MD former Director of the Agency for Healthcare Research and Quality, AHRQ, Center for Outcomes and Effectiveness Research in Rockville, MD. But what about when you don't have that special someone to come along with you? Reach out to ask for a patient advocate from the hospital or hire one from a private service. A professional patient advocate may be a social worker, a nurse, or even a chaplain.
10. Forgo makeup and nail polish. It’s important to shower with antibacterial soap or medicated soap from your doctor before surgery. In addition, you’ll want to remove makeup and nail polish (even if it's clear polish) because clinicians look at your nails for clues to your oxygen levels while you recover.

10 Things Your Doctor Won’t Tell You About Anesthesia

By Susan E. Matthew

If you’re about to go in for surgery, here’s what you need to know first about going under.

Hopefully you won't be one of the 20,000-40,000 patients who wake up during surgery.

You’re ready to go in for surgery. You’ve read everything you can about your condition and how the surgery will help you. You’ve even used our tip sheet to schedule your surgery for the right time, with the right doctor. Just to make sure you’re as prepared as you can be, here’s what your doctor may not tell you about anesthesia, which will help you get through the procedure with as little pain and awareness as possible.

1. You could be awake during the procedure. For most major surgeries (think open-heart), you’ll be put completely under so that you’re both blissfully unaware of what’s happening, and so you won’t move and disrupt the work of the doctors. But for certain surgeries, you might just get localized anesthesia, meaning that you won’t be able to feel where the doctors are operating, but you are aware of your surroundings. This might happen if the procedure is minor, like dental surgery, or if it’s important that the person is aware of what’s happening and responding, as can be the case for certain brain surgeries.
2. It could make you more forgetful. Undergoing anesthesia has been shown to affect memory in some people, sometimes for weeks or months after the surgery. Patients with postoperative cognitive dysfunction (POCD) report that their memory is impaired following surgery for days, weeks, or even months, but there’s little evidence to show long-term impairment. Researchers have found that anesthesia kills brain cells involved in memory and learning in mice.
3. Your age might affect your recovery time. Cognitive issues following surgery seem to be especially pronounced for older adults. Problems with concentration and attention have been reported in 25 percent of patients over 60 in the week following surgery, but they do tend to subside over time. There’s currently a medical debate as to whether anesthesia increases the risk of Alzheimer’s disease in the elderly, with some research showing it does, and other studies show it has no effect.
4. You’re not just “asleep.” You’re actually unconscious — which is helpful, because it means you won’t respond to pain. But it also means that someone will have to monitor your vital signs, like your pulse and your breathing, at all times.
5. Your insurance may not cover your anesthesiologist, even if your procedure is covered. If someone’s going to be monitoring your vitals throughout the entire surgery (and making sure you're getting the proper amount of anesthesia medication to keep you under), it’s going to cost you. Anesthesiology yields the sixth-highest earnings compared to other physician specialties, according to a 2013 report. Unfortunately, that cost may not be covered by your insurance, even if your procedure is. Women who have needed an epidural while giving birth have found this out the hard way. The same is true of other more minor procedures, such as a colonoscopy. Ask if your anesthesiologist is in-network, and ask what the service will cost before-hand.
RELATED: 10 Things Your Doctor Won't Tell You About an MRI
6. You might wake up during the surgery. This is called anesthesia awareness, and it’s estimated to happen 20,000-40,000 times a year in the United States. That means it occurs in one or two for every 1,000 surgeries performed. The scary part is that while you might wake up, the drugs may prohibit you from talking, moving, or signaling that you’re awake. It’s more likely to happen if the anesthesia drugs are delivered only intravenously, rather than inhaled, so talk to your doctor about your options if this is something you’re nervous about. If you do wake up during the surgery, your anesthesiologist should realize it and correct the problem.
7. You need to disclose a drug or alcohol addiction. If your body is used to processing large quantities of alcohol or other drugs, your liver may process these sorts of drugs more quickly than the average person. This is important because it will also mean your liver is more effective at processing anesthesia drugs. Be sure to disclose any sort of addiction to your doctor, so you receive the correct level of anesthesia.
8. You might wake up with a sore throat. You may be intubated with a breathing tube to be sure your body is getting enough oxygen during the surgery. While you’ll have muscle relaxants to ensure that your windpipe doesn’t interact with the tube, it’s still likely that you’ll wake up with a sore throat. Other side effects of anesthesia include dry mouth, hoarseness, sleepiness, shivering, nausea, and vomiting.
9. The risk of dying is relatively low, but it exists. Death rates from surgery in which general anesthesia was used have improved dramatically in just the last 50 years. While in the 1970s, 357 patients for every million patients died, by the 1990s and early 2000s that had dropped to just 34 patients for every million, a 2012 analysis found. The risk of dying simply from anesthesia is just 1 in 250,000, lower than the mortality rate for household injuries.
10. Your anesthesiologist may be on Facebook during your surgery. Still, you’ll want to make sure your anesthesiologist is up to snuff. Take, for example, Christopher Spillers, an anesthesiologist who is being sued for checking and posting to Facebook while supposedly monitoring a patient during surgery. Check out your hospital’s quality score here, first. You can also check the status of your doctor's licence with your state's Board of Medicine.