Living Well - Spring 2010

livingwell
Spring 2010
With Sharp Community
Medical Group
Don’t Let Asthma
Bench You
I
t’s an important asthma rule: Steer clear of whatever makes your asthma worse. These triggers
may include pet dander, mold, dust, and pollen.
But what if exercise makes you cough or wheeze?
Unlike other triggers, activity is not something
people with asthma should avoid. That’s because
even moderate exercise can boost lung function.
Some people have a condition called exerciseinduced asthma that causes symptoms only during
and after exercise. With treatment, 90 percent of
people with exercise-induced asthma can control
their symptoms and enjoy vigorous exercise. Even
people with severe, chronic asthma can be active and
play sports—as long as they take some precautions.
Work with Your Doctor
If you have asthma, your doctor can help you
design a safe exercise plan. Before you become
active, it’s wise to get your asthma under control.
To check how well your lungs work, your doctor
will probably do a spirometry test. This test measures
how much air you can breathe in and out and how
quickly you can blow it out. While doing the spirometry test, you may exercise on a treadmill or stationary
bike to measure your lung function during activity.
Based on the results, your doctor can tell how
severe your asthma is—and what treatment you
need. Medicines may be one option.
For example, a bronchodilator spray used 15 minutes before you exercise can help prevent symptoms.
You may also need to use a daily medicine to keep
inside this issue:
3 Good Nutrition: A Woman's Best Training Partner
5 The ABCs of Fighting Heart Diseaase
6 Member Rights and Responsibilities
8 Do You Know the Risks of High Blood Pressure?
3
5
6
continued on page 2
8
Adolescent Immunizations:
The Power of Prevention
T
ake advantage of the power of
prevention by staying current
with the recommended adolescent
immunizations.
Adolescents/Pre-teens 11 and 12 years
old need to continue their immunization
series for ongoing protection against serious diseases including meningococcal
disease (a common cause of meningitis),
tetanus, diphtheria and pertussis (whooping cough). The vaccines are recommended
for all pre-teens.
The meningococcal vaccine protects
against meningitis. Meningococcal meningitis is a very serious infection of the lining
around the brain and spinal cord. This
infection can cause brain damage and
even death.
The tetanus, diphtheria, and acellular
pertussis vaccine (Tdap) adds protection
from tetanus, diphtheria, and pertussis.
Diphtheria, tetanus, and pertussis are serious diseases that can cause life-threatening illnesses. Diphtheria can cause breathing difficulties, heart problems, nerve
damage, pneumonia and possibly death.
Tetanus, also known as lockjaw, is a serious illness that causes convulsions and
severe muscle spasms that can be strong
enough to cause bone fractures of the
spine. Pertussis, also known as whooping
cough, is highly contagious with prolonged coughing that can interfere with
breathing.
Help your children transition into their
teen years in a healthy way by staying upto-date on adolescent/pre-teen immunizations, and schedule an appointment with
your child’s healthcare provider. ■
C u s t o m e r S e r v ic e
Members can contact SCMG
for questions regarding:
■ eligibility
■ claims
■ referrals
■ benefit provision guidelines
or criteria
■ provider access issues
■ perceived quality concerns
Don’t Let Asthma Bench You
■ How to voice a complaint
continued from page 1
providers’ names and addresses
your airways from becoming swollen
and narrow.
Other Steps You Can Take
Here are some other steps you can take
to put off asthma symptoms when you
are active:
■ Spend a few minutes warming up
before your workout. This can reduce the
“tight” feeling you may get in your chest.
2
■ Choose a moderate exercise that you
can do for longer periods of time, such as
swimming or walking. These activities are
not as likely to irritate your asthma.
■ Avoid exercising in cold, dry, or
polluted air. Take your workout indoors,
especially if the pollen count is high.
■ After your workout, try a warm bath or
shower to help prevent attacks that occur
after exercise. ■
■ How to find contracted
in order to obtain health care
services
Call our Customer Service
Department at 858-499-2550
during our expanded business
hours: 7:30 a.m. to 5:30 p.m.
Toll-Free outside of the 858
Area Code: 877-518-SCMG (7264).
www.sharp.com
Good Nutrition: A Woman’s Best Training Partner
W
omen who are physically active
reap numerous health benefits—from lowering the risk for
heart disease and breast cancer to boosting energy levels. But between work and
family responsibilities, there’s often limited
time to devote to fitness. That’s why it’s
important to make every workout count.
One way to do this: Focus on proper fuel
for your body.
What you eat and drink during a day
can greatly affect your energy and performance levels during exercise. It also can
impact how quickly your body recovers.
This is true whether you hit the gym a
few days a week or are training for a marathon. To get more from your workouts,
develop a nutrition plan.
Choose Foods that Work for You
For most active women, eating a healthy,
balanced diet will give you all the fuel
you’ll need for workouts. As a general rule:
■ Aim for 45 to 65 percent of total calories from carbohydrates. This is the
body’s main fuel source and can be
found in fruits, vegetables, milk,
and grains such as bread, pasta,
and rice. When choosing grains,
go for whole grains.
living well | spring 2010
■ Try to get 10 to 35 percent of calories
from protein such as lean meat, fish,
beans, and poultry. Protein helps build
and maintain muscles.
■ Limit calories from fat to less than 30
percent but at least 20 percent. Fat is necessary to maintain certain body functions
and provides energy. Choose “healthy” fats
like olive oil and avocados.
If you’re preparing for an athletic
event, consider upping your intake of carbohydrates several days beforehand. Also,
avoid high-protein and high-fat foods, like
fried foods, on event day. They’re difficult
to digest.
Time Your Intake
How you schedule food intake also can
make a difference. Remember these tips:
■ Enjoy a healthy breakfast. Refueling
your body early in the day can affect the
quality of workouts later on.
■ Eat every three to four hours—three
meals plus three to four snacks—to help
maintain energy throughout the day.
■ Have a snack one to three hours before
exercise to provide muscle energy.
■ If you regularly train for an hour or
more, use nutrition to help your body
recover post-workout. Have a snack that
contains fluids, carbohydrates, and protein, like a smoothie made with low-fat
milk and fruit.
Don’t Overlook Fluids
Dehydration allows the body to heat up
faster, making it more difficult to get
through a workout. To keep your body
well-hydrated:
■ Keep a water bottle with you and drink
throughout the day.
■ Drink about 20 ounces of water one to
two hours before intense exercise. Then
drink an additional 10 to 15 ounces
within 15 to 30 minutes of the event.
■ Take frequent water breaks during exercise. If the workout will last longer than
one hour, consider sipping a sports drink
instead of water.
The View on Vitamins
Most women can get all the vitamins they
need from a healthy diet. Taking large
doses of vitamins won’t help your workout and may actually be bad for your
health. However, your doctor may recommend vitamins if you:
■ Follow a strict vegetarian diet
■ Have cut out an entire food group
■ Eat fewer than 1,800 calories a day
■ Are pregnant or plan to become
pregnant ■
3
Reduce Your Risk of
Cardiovascular Diseases
Eliminate Tobacco
Smoking harms nearly every organ of the body, and you
should be aware that all tobacco products are included as risk
factors for chronic illness, not just cigarettes. Although there
may be medical uses for derivatives of some social drugs,
such as alcohol, there is no therapeutic use for nicotine. As
soon as you stop smoking, your body begins to heal itself
from the devastating effects of tobacco. Did you know:
■ 20 minutes after quitting, your heart rate drops
■ Two weeks after quitting, your heart attack risk begins
to drop
■ One year after quitting, your added risk of coronary
disease is half that of a smoker
D
o you know what puts you most at risk for chronic diseases such as heart disease? At the top of the Centers
for Disease Control and Prevention’s list of primary risk
factors for all chronic diseases are smoking, poor nutrition, and
sedentary lifestyle.
Living a healthier lifestyle can help to prevent heart disease.
This includes the following:
■ Eliminating all tobacco products
■ Adhering to a heart-healthy diet
■ Following an appropriate exercise program
The Four W's of Cholesterol
Fact: The World Health Organization estimates that
almost 20 percent of all strokes and 50 percent of all
heart attacks can be linked to high cholesterol.
It’s wise to know the four W's of cholesterol:
WHAT: Cholesterol is a waxy, fat-like substance that
occurs naturally in all parts of the body. If you have too
much in your blood, it can stick to the walls of your
arteries and form plaque.
Your doctor can order a blood test, called a lipid
profile, to check your cholesterol. This test checks for
total cholesterol, HDL (good cholesterol), LDL (bad
cholesterol) and triglycerides.
The goal is to get your LDL number below 100.
WHY: Plaque can narrow your arteries or even
block them. High levels of cholesterol in the blood
can increase your risk of heart disease.
WHO: Anyone with heart disease, other chronic
diseases, or a family history of elevated cholesterol
should talk with their doctor about cholesterol testing
and management.
WHEN: Ask your doctor about having an annual
cholesterol check.
4
Eat Heart-Healthy
One aspect of managing your risk factors for chronic diseases
includes eating a heart-healthy diet, including appropriate
levels of the following:
■ Calories
■ Cholesterol
■ Fat
■ Fiber
■ Sodium
To try and eliminate any confusion, the federal government
has established a food pyramid and food labeling laws.
One size doesn’t fit all. Visit MyPyramid.gov to find more
information about the appropriate dietary recommendations
for your age, sex, and physical activity level. The food pyramid
can help you eat a variety of foods while encouraging the right
amount of calories and fat.
The food guidelines provide authoritative advice for people
age 2 and older about how good dietary habits can promote
health and reduce risk for major chronic diseases.
Maintaining a heart-healthy, balanced diet will help to:
■ Assist in losing weight and boosting energy
■ Prevent or manage other chronic diseases
■ Manage heart attack and stroke risk factors
■ Promote overall good health
Get Moving
Today, with our fast-paced society, people must schedule time to
exercise. Regular exercise is one vital step toward reducing your
chances of having a heart attack. Choose an activity that you
enjoy doing, then talk with your physician about an exercise
plan that meets your individual capabilities and needs.
An exercise program will help in the management of almost
all heart attack and stroke risk factors. It is recommended that
an individual engage in at least 30 minutes of moderate-intensity
physical activity, above usual activity, at work or home on most
days of the week. Regular physical activity will help to promote
health, psychological well-being, and a healthy body weight.
Always consult your physician regarding your healthy diet
and exercise requirements. ■
www.sharp.com
recipe for health
mediterranean
diced salad
Ingredients
1 19-oz. can of chickpeas (also called
garbanzo beans)
1 red pepper
1 cucumber
2 stalks celery
1 cup halved grape tomatoes
Juice of one large lemon, about ¼ cup
1 tbsp. white vinegar
2 tbsp. olive oil
½ cup chopped fresh parsley
The ABCs of
Fighting Heart Disease
F
ebruary is American Heart Month. Heart disease is the number one
killer of women. What is heart disease? It is a disorder of the blood
vessels of the heart that can lead to a heart attack. A heart attack is
experienced when an artery becomes blocked, preventing oxygen and
nutrients from getting to the heart.
Truth or Myth? Heart Disease Can Be Cured
This is a myth. Heart disease is a lifelong condition—once you get it, you
will always have it. Although there are different procedures such as heart
bypass surgery, which can help blood and oxygen flow to the heart more
easily, the heart remains damaged, which means you are more likely to
have a heart attack. Many women die of complications from heart disease
or become permanently disabled. This is why it is so vital to take action
to prevent and control this disease.
One in four women in the United States dies of heart disease, while one
in 30 dies of breast cancer. Women need to take action to reduce their risk
of heart disease.
Make a pledge to take action to reduce your risk of heart disease and
encourage others to join you. By leading a healthy lifestyle, Americans can
lower their risk of heart disease by as much as 82 percent according to the
National Institutes of Health.
What can you do to take action to lower your risk?
It’s as easy as A-B-C:
Avoid Tobacco
Be More Active
Choose Good Nutrition ■
living well | spring 2010
Directions
1 Drain and rinse chickpeas and put in a
large mixing bowl. Core red pepper and
dice into half-inch squares. Add to bowl.
Peel and chop cucumber; slice celery
lengthwise and chop. Add to bowl. Add
halved grape tomatoes.
2 In a measuring cup or small bowl, whisk
lemon juice, vinegar, and olive oil. Pour
over salad ingredients. Toss well to coat all
ingredients. Add parsley and mix again.
Refrigerate until ready to serve. Season to
taste.
Serves six.  
Nutrition Facts:
Each serving contains about 142 calories, 4 g
protein, 6 g fat, no cholesterol, 18 g carbohydrate,
5 g fiber, and 208 mg sodium.
A M e ssag e
t o O u r M e mb e rs
At Sharp Community Medical Group, our practitioners
make utilization management decisions based only on
appropriateness of care and service and existence of
coverage. Practitioners and individuals who conduct
utilization review are not rewarded for denials
of coverage, and there are no financial incentives for
utilization management decision makers to encourage
decisions resulting in underutilization.
5
Member Rights and Responsibilities
As a member of Sharp Community Medical
Group Health Plan, you have the right to:
1. Exercise these rights without regard to gender, sexual
orientation or cultural, economic, educational or religious
background.
2. Be provided with information about Sharp Community
Medical Group, its services and the health care service delivery
process.
3. Be informed of the name and qualifications of the health
care provider who has primary responsibility for coordinating
the member's care; and be informed of the names,
qualifications and specialties of other physicians and
non-physicians who are involved in the member's care.
4. Have 24-hour access to the member's health care
provider (or covering physician).
5. Receive complete information about the diagnosis,
proposed course of treatment or procedure, alternate
courses of treatment or non-treatment, the clinical risks
involved in each, and prospects for recovery in terms that
are understandable to the member, in order to give informed
consent or to refuse that course of treatment.
6. Actively participate in decisions regarding the member's
health care and treatment plan. To the extent permitted
by law, this includes the right to refuse any procedure or
treatment. If the recommended procedure or treatment is
refused, an explanation will be given addressing the effect
that this will have on the member's health.
7. Be treated with respect and dignity.
8. Receive considerate and respectful care with full
consideration of the member's privacy.
9. Receive confidential treatment of all information and
records associated with member's care.
10. Express opinions or concerns about the health care
provider or the care provided, and offer recommendations
to the Member Service Department of Sharp Community
Medical Group.
11. Be informed of the member grievance and appeal process.
12. Change health care provider by contacting the Health Plan
Member Services Department.
13. Receive reasonable continuity of care and be given timely
and sensible responses to questions and requests made for
service.
14. Be informed of continuing health care requirements
following office visits, treatments, procedures and
hospitalizations.
6
15. Have all member's rights apply to the person who has
the legal responsibility to make health care decisions for
the member.
As a member of Sharp Community Medical Group
Health Plan, you have the responsibility to:
1. Be informed about the benefits and restrictions under the
member’s coverage with Sharp Community Medical Group
Health Plan.
2. Provide the member's health care provider with complete
and accurate information.
3. Be on time for all appointments and notify the health
care provider's office for appointment cancellations or
rescheduling.
4. Report changes in the member's condition according
to health care provider instructions.
5. Inform health care providers of member's inability to
understand the information given to them.
6. Carry out the treatment plan that has been developed and
agreed upon by health care provider and the member.
7. Contact the member's health care provider or covering
physician for any care that is needed after that physician's
normal office hours.
8. Treat the health care provider and staff with respect.
9. Obtain an authorized referral from the member's health
care provider for a visit to a specialist and/or receipt of any
specialty care.
10. Be familiar and comply with the health care provider
delivery system regarding access to routine, urgent and
emergent care.
11. Have all of these responsibilities apply to the person who
has the legal responsibility to make health care decisions for
the member.
12. Respect the rights, property and environment of the
health care provider's office.
13. Members have the right to make recommendations to the
Member Rights and Responsibilities statement.
www.sharp.com
Derechos y Responsabilidades del Afiliado
Como afiliado de Sharp Community Medical
Group Health Plan, usted tiene el derecho de:
1. Ejercer estos derechos sin importar el sexo, orientación
sexual o antecedentes culturales, económicos, educacionales
o religiosos.
2. Recibir información acerca de los servicios ofrecidos por
Sharp Community Medical Group Health Plan y el proceso
para obtener dichos servicios.
3. Ser informado sobre el nombre y la capacitación del
Proveedor de cuidados de la salud que estará a cargo de
la coordinación de la atención médica del afiliado, y ser
informado sobre los nombres, capacitación y especialidades
de los otros médicos y profesionales de la salud involucrados
en la atención del afiliado.
4. Tener acceso al Proveedor de cuidados de la salud del
afiliado las 24 horas del día.
5. Recibir información completa sobre el diagnostico, el
tratamiento o procedimiento sugerido, y los tratamientos
alternos así como los riesgos implicados con cada uno
y las perspectivas de recuperación, en términos que el
afiliado pueda entender, con el fin de que este pueda dar
su consentimiento informado o rechazar dicho tratamiento.
6. Participar activamente en las decisiones sobre el cuidado
de salud y plan de tratamiento del afiliado. Hasta donde lo
permita la ley, excepto en casos de emergencia, el afiliado tiene
derecho a rechazar cualquier procedimiento o tratamiento. Si el
tratamiento recomendado es rechazado, el afiliado recibirá una
explicación sobre los riesgos que esto implicara para su salud.
14. Ser informado sobre los cuidados médicos de continuidad
requeridos después de una visita médica, un procedimiento, o
una hospitalización.
15. A que todos estos derechos del afiliado sean transferidos
a la persona que tenga la responsabilidad legal de tomar
decisiones de salud a nombre del afiliado.
Como afiliado de Sharp Community Medical Group
Health Plan, usted tiene la responsabilidad de:
1. Estar informado sobre los beneficios de cobertura y
restricciones para afiliados bajo el Sharp Community
Medical Group Health Plan.
2. Darle información completa y precisa al Proveedor
de cuidados de la salud.
3. Llegar a tiempo a todas las citas médicas y notificar
a la oficina del Proveedor de cuidados de la salud sobre
la cancelación o reprogramación de citas.
4. Reportar cualquier cambio en la salud del afiliado,
conforme a las instrucciones dadas por el Proveedor
de cuidados de la salud.
5. Informar al Proveedor de cuidados de la salud sobre la
dificultad de entender la información proveída al afiliado.
6. Cumplir con el plan de tratamiento que se haya
desarrollado y acordado entre el Proveedor de cuidados
de la salud y el afiliado.
7. Ser tratado con respeto y dignidad.
7. Contactar al Proveedor de cuidados de la salud del afiliado
o médico en guardia, si necesita atención médica después de
las horas de oficina normales de su Proveedor de cuidados de
la salud.
8. Recibir atención médica de manera amable y respetuosa
con total consideración a su privacidad.
8. Tratar con respeto a su Proveedor de cuidados de la salud
y demás personal médico.
9. Trato confidencial de toda información y registros
asociados con la atención del afiliado.
9. Obtener una referencia autorizada por el Proveedor
de cuidados de la salud del afiliado antes de visitar a un
especialista o recibir cualquier atención especializada.
10. Expresar opiniones o preocupaciones sobre el Proveedor
de cuidados de la salud o la atención recibida, y ofrecer
recomendaciones al Depto. de Servicios para Miembros de
Sharp Community Medical Group Health Plan.
11. Ser informado sobre el proceso de quejas y apelación
para afiliados.
12. Cambiar de Proveedor de cuidados de la salud poniéndose
en contacto con el Depto. de Servicios para Miembros del Plan
de Salud.
13. Recibir cuidados médicos de continuidad razonables, y
respuestas oportunas y sensatas a preguntas y solicitudes
de servicio.
living well | spring 2010
10. Conocer y cumplir con el sistema de prestación de
atención médica de su Proveedor de cuidados de la salud
para obtener acceso a cuidados de rutina, servicios de
urgencia o de emergencia.
11. A que todas estas responsabilidades sean transferidas
a la persona que tenga la responsabilidad legal de tomar
decisiones de salud a nombre del Afiliado.
12. Respetar los derechos, la propiedad y el medio ambiente
de la oficina de su Proveedor de cuidados de la salud.
13. Hacer recomendaciones sobre la declaración de los
Derechos y Responsabilidades del Afiliado.
7
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Do You Know the Risks of High Blood Pressure?
C
hances are that whenever you
visit your doctor, someone wraps
a cuff around your upper arm
and checks your blood pressure. But
while you are familiar with this simple
test, you may not understand why your
blood pressure is so important to your
health.
Why It’s a Problem
As blood moves through the arteries, it
puts pressure on the artery walls. This
pressure goes up and down depending
on several things, including physical
activity, diet, and medications. A
person has high blood pressure when
the pressure is elevated most of the
time over a period of time.
It’s important to keep tabs on
your blood pressure. If it's high
and you don’t know it, or if
you don’t control it, you may
be at greater risk of heart
attack, heart failure, stroke,
kidney disease, and other
serious conditions. For
example, a study reported in
Neurology, found that people
with high blood pressure were 60
percent more likely to have “silent”
strokes—strokes that don’t cause
obvious symptoms but damage the
brain—than those with normal blood
pressure. Detecting high blood pressure
early and controlling it can help you
avoid such life-threatening conditions.
Keep It in Check
Blood pressure tends to rise with age.
In addition, people who are obese,
who have certain medical problems
such as diabetes, or who take certain
medications are also at risk. There are
things you can do to prevent and/or
control high blood pressure:
■ Don’t smoke.
■ Maintain a healthy weight. If you
are overweight, lose excess pounds.
Talk to your doctor if you need help.
■ Eat a heart-healthy diet. Choose a
variety of foods that are low in fat, and
include lots of fruits, vegetables, and
whole grains.
■ Be physically active. Get at least 30
minutes of moderate-intensity activity,
such as brisk walking, every day.
■ Watch your salt and sodium intake.
Aim for no more than 2,400 milligrams,
or about 1 teaspoon, a day.
■ Take medication. If you have high
blood pressure, take your medication
as prescribed. ■
livingwell
Bob Trocinski
Director, Provider Services and Customer Services
Living Well is published by Sharp Community Medical Group.
The information is intended to inform and educate about
subjects pertinent to health, not as a substitute for consultation
with a personal physician. ©2010. Printed in U.S.A.
Printed on Recyclable Paper
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