Physician shortage - JASE Medical

April 4th is National Vitamin C Day!

Each year this powerhouse vitamin is celebrated for all the ways it benefits our health

What is vitamin C?

Vitamin C, also known as L-ascorbic acid, is a water-soluble vitamin, meaning that it dissolves in water and does not get stored in the body. Since we are unable to produce these vitamins, they must be consumed daily.

Sources- Food and supplements

(Source from NIH fact sheet on vitamin C)

Vitamin C is found in many food sources. Probably the most well known is the citrus family. While citrus fruit contain vitamin C, there are many other sources.

Food Milligrams (mg) per serving Percent (%) DV*
Red pepper, sweet, raw, ½ cup 95 106
Orange juice, ¾ cup 93 103
Orange, 1 medium 70 78
Grapefruit juice, ¾ cup 70 78
Kiwifruit, 1 medium 64 71
Green pepper, sweet, raw, ½ cup 60 67
Broccoli, cooked, ½ cup 51 57
Strawberries, fresh, sliced, ½ cup 49 54
Brussels sprouts, cooked, ½ cup 48 53
Grapefruit, ½ medium 39 43
Broccoli, raw, ½ cup 39 43
Tomato juice, ¾ cup 33 37
Cantaloupe, ½ cup 29 32
Cabbage, cooked, ½ cup 28 31
Cauliflower, raw, ½ cup 26 29
Potato, baked, 1 medium 17 19
Tomato, raw, 1 medium 17 19
Spinach, cooked, ½ cup 9 10

 

Other sources include rose hips (made into tea), sauerkraut, and supplements such as sodium ascorbate; calcium ascorbate; other mineral ascorbates; ascorbic acid with bioflavonoids.

A study revealed Liposomal vitamin C  is more bioavailable for the body. Liposomes are tiny, nano-sized bubbles normally made out of sunflower lecithin that mimic the body’s own cell membranes. It is absorbed directly into the cells compared to the bloodstream with supplemental vitamin C.

Health benefits

Increases iron absorption in foods

A recent study concluded that taking supplemental vitamin C with an iron supplement did not increase iron absorption.

Taking supplemental vitamin C along with iron rich non heme (not animal source) foods, such as  dried beans, nuts, grain products increased iron absorption.

However, when food sources of both vitamin C and iron are consumed iron absorption increased.

Vitamin C also:

  • Helps activate B vitamins
  • Is an antioxidant, neutralizing free radicals
  • Modulates natural killer (NK) cells
  • and stimulates immune system,
  • Provides protection against oxidative stress
  • Reduce heavy metal toxicity
  • Production of collagen
  • Aids in wound healing
  • Natural antihistamine
  • Lessens duration of colds
  • Improve insulin resistance and stabilize glucose levels

Dosage

Supplementation should be considered only if you are not able to consume enough vitamin C rich foods. Since there are so many versions of vitamin C on the market the following table, obtained from the NIH should be used as a guide only. Most supplements contain ascorbic acid which as been found to be the purest form.

Age     Male   Female Pregnancy     Lactation

0–6 months   40 mg*         40 mg*                  

7–12 months  50 mg*         50 mg*                  

1–3 years       15 mg 15 mg          

4–8 years       25 mg 25 mg          

9–13 years     45 mg 45 mg          

14–18 years   75 mg 65 mg 80 mg 115 mg

19+ years       90 mg 75 mg 85 mg 120 mg

Smokers        Individuals who smoke require 35 mg/day more vitamin C than nonsmokers.

If taken as a supplement, vitamin C should be taken in the morning or during the day, not at night, especially in people with GERD as this can make symptoms worse.

Vitamin C deficiency

Symptoms of vitamin C deficiency include:

Fatigue, inflammation and/or bleeding of the gums, brittle nails and hair, bruising easily, iron deficient anemia, and joint pain.

Vitamin C deficiency is unusual in developed countries; however some diseases can deplete vitamin C stores and lead to deficiency. Individuals with irritable bowel disease, celiac or other forms of intestinal inflammation are at risk for vitamin C deficiency.

Side effects of vitamin C supplementation

It is almost impossible to get too much vitamin C from diet alone. There are several side effects from taking vitamin C in supplement form. In most cases, excess vitamin C is excreted in urine within 24 hours. Some side effects are:

  • Nausea, vomiting and diarrhea
  • Heartburn
  • Stomach cramps or bloating
  • Headache
  • Skin flushing
  • Insomnia
  • Fatigue

Who should not supplement with vitamin C?

Consult with your primary care provider about vitamin C supplementation if:

  • Kidney disease or a history of kidney stones
  • Hereditary iron overload disorder (hematochromatosis)
  • Smoker (may need more than stated dose)

- Brooke Lounsbury, RN

Medical Content Writer

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Don’t Get Complacent- Avoid Prepping Burnout

5 Tips to get back on track to self-sufficiency.

Its that time of year again. Tax time, Spring break, plans for summer vacation, getting your garden started,playing and working outdoors are all forefront in our minds.

Oh yes, and pending war, famine, next pandemic, social unrest, solar flares, record breaking weather patterns (tornados in the South, epic rainfall and snow in the West), food and gas prices spiraling out of control, bank failures, supply chain disruptions. In fact, probably the most disturbing news so far came from the World Economic Forums’ Global Cybersecurity Outlook 2023 report where 86% Business and 93% of cyber leaders believe global geopolitical instability is moderately or very likely to lead to a catastrophic cyber event in the next two years. A mass cyber event would have far-reaching and untold hardship in ways we can’t even comprehend.

Let us not forget our medical system

 Our medical system is now at tipping point leading to total collapse.  Hospitals closing, staff shortage, medical device shortage,( Cardiac diagnostic, and monitoring products, Specimen collection – testing supplies and equipment, Radiological devices, General ICU/ hospital products) the inability to perform procedures due to shortages of medications and instruments.

Overwhelmed? Now is NOT the time to shut down

As the war drums continually beat, as high food, energy and gas prices steadily climb to new highs, and as we face the reality that our medical system is in crisis, this isn’t the time to be complacent.

Breaks and vacations are important but don’t live there

Take a break from the noise of all the crises but don’t let this become your “new normal”. In fact, short vacations, hobbies, time with family and friends are vital to overall health and wellbeing. Schedule time away from screens and technology. Information overload causes us to feel we are powerless. This leads to complacency and the inability to think clearly. The survival of our families is dependent on our ability to navigate this unchartered territory.

We are entering a time never seen before in the history of the world.

Our global economy and trade have positioned us in a very precarious position; one where we may feel powerless. This couldn’t be further from the truth. We have amazing, untapped talents and abilities we never knew we had until we decide to get back in the game.

5 tips to get back on the track to preparedness and self-sufficiency

  1. Attitude is everything

Everything we believe we can or can’t do starts with attitude. Attitude can move mountains. By focusing on solutions instead of allowing the media and others to pull you down, step away from the negativity and work out ways to overcome obstacles. If the obstacle is too big, shelve it and revisit at a later date.

Start your day off on the right foot, and continue.

  • The first hour upon awakening sets the tone for the rest of your day. Stay off your phone that first hour. Instead, meditate, pray, reflect on what you are grateful for and if able get some natural first morning sunlight.
  1. Prioritize your day, week, month and year. Set realistic goals.

Set aside uninterrupted time to prioritize goals. Start by writing down the goals, then prioritizing them. Which are the most pressing and important? Number them, starting with #1 as the most important and pressing. Do you have a goal of paying off debt? Weight loss? Finishing a project or starting a hobby? Do you want to eat better within an already strained budget?

The SMART acronym

A very popular tool for goal setting.

Specific- Narrow down what goal you wish to achieve, take time evaluating the goal.

Measurable- Is the goal measurable? For instance, if you want to lose weight, how much?

Achievable- Is the goal realistic and achievable. Some of this is based on your attitude and ability to achieve the goal. Do you feel you can achieve the goal and do you have the resources and tools needed?

Relevant- Is your goal relevant in your life? For instance, would losing 10 pounds add value to your quality of life?

Time-bound- Make sure your goal has a completion date. This can be modified as needed as you work towards achieving your goal.

  1. Be flexible but stay the course

Life happens, roll with the punches, but always go back and reflect on your reasons for why you are preparing. If you need to step away for a time, go ahead, but don’t make this a permanent way of life. It you have experienced major life changes it is time to refocus and reevaluate your goals and get back on track as soon as you are able.

  1. If it was easy, everyone would do it

The discipline, focus, drive and determination needed to prepare for our uncertain future isn’t an easy road but it will be rewarding and bring peace of mind. You can’t possibly do everything. Find others that are like minded that can help fill in the gaps for you and reciprocate. Check with local emergency responder groups, gardening and livestock communities along with family friends and neighbors for support. We aren’t an island. We need each other now more than ever before.

  1. Be an example. Be a leader

People are watching us even if we don’t realize it. We will inspire others more through our actions than any other way. As more people come together to solve local and regional problems facing all of us, we will all not just survive but thrive while navigating the waters of the unknown,

By the way, have you ordered your Jase Case for each member of your family yet?

- Brooke Lounsbury, RN

Medical Content Writer

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Over 600 Rural Hospitals at Risk of Closing

Throughout the nation many rural hospitals are on the brink of closure, citing physician shortages and lack of adequate funding to keep their doors open.  A report from the Center for Healthcare Quality and Payment Reform (CHQPR) revealed that more than 600 rural hospitals – nearly 30% of all rural hospitals in the country – are at risk of closing in the near future.

These hospitals are not just emergency rooms, many are the anchor for primary care, rehabilitative therapies, labs and x ray departments and maternity care. If the hospital closes many , if not all, other rural healthcare services in the area will also disappear.

Lack of adequate revenue

Rural hospitals and clinics are forced to operate many times at a loss- not because they are inefficient but because they have the same overhead as their urban counterparts.

 ER staffing 24/7- Urban hospitals have more patients coming through their doors than their rural counterparts. Even though both require adequate round the clock staffing, the volume of patients in urban areas offsets the overhead.

There are over 1,000 small rural hospitals, representing more than 25% of all the short-term general hospitals in the country, but they receive only 2% of total national hospital spending.

Insurance reimbursement disparity

A recent report by Center for Healthcare Quality and Payment Reform (www.CHQPR.org):

“A common myth about rural hospitals is that most of their patients are on Medicare and Medicaid. In fact, about half of the services at the average rural hospital are delivered to patients with private insurance (including both employer-sponsored insurance and Medicare Advantage plans). Low margins or losses on patients with private insurance, combined with losses on Medicaid and uninsured patients, can force small rural hospitals to close.”

Physician shortage

According to NHRA (National Rural Health Association)

“Ease of access to a physician is greater in urban areas. The patient-to- primary care physician ratio in rural areas is only 39.8 physicians per 100,000 people, compared to 53.3 physicians per 100,000 in urban areas. This uneven distribution of physicians has an impact on the health of the population.”

Some reasons cited for the rural physician shortage are long hours, lower reimbursement of insurance compared to urban areas, aging population of physicians that are nearing retirement, managing patients with higher proportion of chronic illnesses (diabetes, coronary heart disease) and lifestyle of rural living.

Rural hospitals and clinics serve farmers, ranchers, and others that provide food and services for the entire nation. Many of the nation’s natural resources- coal mines, oil and natural gas production are in these areas. Rural hospitals and clinics also provide care for visiting tourists to national parks and outdoor recreation if an emergency arises. If this population can’t continue to live and work in rural areas because of lack of medical services, the entire nation will suffer.

Solutions

  • Match reimbursement with cost of doing medicine

Current insurance reimbursements are below cost of delivering care. Saving Rural Hospitals states that increasing spending to meet cost of services (total would be 4 billion annually) could help offset the financial losses. This sounds like a lot of money, however this amounts to only 1/10 of 1% of total national healthcare spending, which is more than $1.3 trillion spent on all urban and rural hospitals in the country.

  • Telemedicine

 Rural communities could benefit from telemedicine, which solves the problem of rural patients having to drive long distances (sometimes over 70 miles) to see a doctor or consult with a specialist. Telemedicine can treat chronic conditions and provide a preventative approach to healthcare not usually found in rural areas.

  • Establish more rural residency programs and mentoring opportunities. As more rural physicians enter retirement age they are ideally positioned to mentor and support new physicians in rural medicine.
  • Utilize midlevel providers to offset the long hours the physician faces along with providing care more economically. Midlevel providers- nurse practitioners and physician assistants- are a more economical way to support the physician and can provide relief from long hours faced by rural physicians.

Until such a time that above solutions can be implemented, anyone living in rural areas should consider the very real possibility that their local hospital could be shut down in the near future. Are you prepared for such an event?

- Brooke Lounsbury, RN

Medical Content Writer

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Everyone should be empowered to care for themselves and their loved ones during the unexpected.
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