Health Care and Gymnastics

One very popular sport is gymnastics, and especially when the Olympics roll around every four years. Gymnasts appear to be treated like rock stars if they attain the level of medal winners, and they typically get lucrative endorsement contracts. But the few seconds spent on the international stage at that level are only a result of many years of painful pJractice�countless hours of attempting that perfect vault, that ethereal experience on the parallel bars, or that unbelievable floor routine.

When that young man or women finishes a spotless performance, the crowd roars to its feet with thunderous applause. But if there is a fall, or a break in the pattern, or some other mistake made by the performing athlete, a collective sigh comes from the audience, and the gymnast is aghast in disbelief. Gymnastic routines take special training, and the effort can be brutal. The work is punishing, and the injuries can be traumatic. As Jim McKay used to say on ABC Wide World of Sports some years ago: �the thrill of victory, and the agony of defeat� are certainly emotions felt by everyone who enters this physical training and activity.

When you think of gymnastics, you may picture young women doing flips on the 4-inch-wide beam, or men doing incredible feats of strength on the rings. But those images actually represent only two of the seven commonly-defined types of gymnastics, according to the website for gymnastics. Women's artistic gymnastics has the most participants and is generally the most well-known of the types of gymnastics. It's also one of the first tickets to sell out at the Olympic Games.

The Events: In women�s artistic gymnastics, athletes compete on four apparatus (vault, uneven bars, balance beam and floor exercise). Olympic competition consists of:

� Team -- Five athletes are on a team. In preliminaries, four athletes compete on each event and three scores count. In finals, three athletes compete on each event and every score counts towards the team total.

� Individual All-Around -- An athlete competes on all four events and the total score is added up.

� Individual Events -- An event champion is named on each apparatus.

Men�s artistic gymnastics is the second most popular type in the United States, and the oldest form of gymnastics. Men compete on six apparatus: floor exercise, pommel horse, still rings, vault, parallel bars and horizontal bar (usually called high bar). Olympic competition is held in the same format as women�s artistic gymnastics, with team, all-around and individual events competition. The only difference is that the men compete across their six events, whereas the women compete across their four events.

With Rhythmic gymnastics, gymnasts perform jumps, tosses, leaps, and other moves with different types of apparatus. This is currently a female-only sport in the Olympics. Athletes compete with five different types of apparatus: rope, hoop, ball, clubs and ribbon. Floor exercise is also an event in the lower levels of competition. At the Olympics, rhythmic gymnasts compete in:

� Individual All-Around -- An athlete competes on four of the five events (every two years, one apparatus is rotated out for that time period) and the total score is added.

� Individual Events -- A gymnast is named champion on each of the four apparatus currently in rotation.

� Group Competition -- Five gymnasts compete two different routines. In one routine, all of the athletes use the same piece of apparatus. In the second routine, the gymnasts use two different pieces of equipment (e.g. three gymnasts will use ball and two gymnasts will use hoop).

While not all injuries can be prevented, the risk of injuries can be reduced. The following is information from the American Academy of Pediatrics about how to prevent gymnastics injuries.

--Coaches: It is important for coaches to be experienced and familiar with the rules. Coaches should also be certified in CPR and first aid.

--Spotters: Proper supervision and spotting should be available at all times.

--Rules: "Clowning around" should not be tolerated in the gym, especially around the foam safety pit or trampolines.

--Equipment: Safety gear should fit properly and be well maintained.

� Clothing that allows for easy movement. (Body piercing should not be allowed around the face or mouth.)

� Wrist pads/braces like "Tiger Paws" to protect the wrist and decrease wrist pain.

� Heel supports like Tuli's heel cups placed in an ankle brace or Cheetahs (which have a heel cup built into a wrap around the ankle brace) cushion the heel for the barefoot athlete.

� Grips to protect the palms. Basic palm protectors are used by beginners. Dowel grips are used by the advanced gymnast.

� Apparatus should be well maintained and checked on a regular basis.

--Emergency Plan: Teams should develop and practice an emergency plan so that team members know their roles in emergency situations. The plan would include first aid and emergency contact information. All members of the team should receive a written copy each season. Parents also should be familiar with the plan and review it with their children.

For more info in greater detail about types of common injuries and some preventive medical needs by gymnasts, visit the website for Healthy

Gymnastics safety is dependent on the gym owner and coaching staff taking responsibility for the safety and welfare of their athletes and for the policies and procedures operating within the gym. First and foremost, to run a safe, successful gymnastics program, gym owners must ensure that their coaching staff is qualified, experienced and insured. The original outlay for a safe, effective program includes training, equipment and insurance. It can be an expensive endeavor, but is necessary to prevent injuries and the lawsuits that may arise from them. The safe use of gymnastics equipment requires certain measures such as preventive maintenance and education. Much more info can be found at the AZCentral Healthy Living website.

Gymnastics is a fun and rewarding sport, and for even those who are not competing for trophies, medals, or awards, it is a great way to get fit and healthy. There are many local gymnastic facilities around the country, and you can join them for a nominal membership. Gymnasts often start out young, so as a parent you need to do your homework to find a location that is clean, reputable, and has good business policies, a trained and caring staff, and great customer service. You and your kids will benefit.

Until next time.

CA Doctors Could Face Potentially Nasty Surprise

A little-noticed provision in the Affordable Care Act allows exchange participants a 90-day grace period to pay their health insurance premiums.  This was designed to help those who are not used to paying health insurance premiums.

During the first month of grace period when the premium has not been paid, the insurance companies must continue to pay claims incurred by the patient.  During the second month if the patient is still delinquent the insurance company can pend any further claims.  After the third month if the insured has not paid the premium, the insurance company can terminate the coverage.

In the event that the premium is not paid during the grace period and the policy terminates backwards 90 days, doctors  and other healthcare providers in California will have to go after the patient to collect payment for all outstanding claims. 

Essentially this means there can be a 60-day period during which a medical provider who accepts exchange-level health plans is not going to be sure if or when he/she may ever get paid for the medical services provided.

Excellent article from Family Practice News about this.



Are you a parent or guardian that uses or has used a daycare facility for your children? Don�t put yourself down if you do. Many parents use this type of option if one or both parents are working outside the home. However, there may be some things about daycare that you would want to know and that may surprise you.

There are few parenting issues as hot-button as daycare -- is it good for kids or a glorified form of neglect? According to iVillage Health, recent studies have weighed in on both sides, saying that poor quality care can lead to behavior problems, while more nurturing, attentive environments can lead to higher test scores in grade school. But to many parents, exactly what happens in that romper room between 9 and 5 is still unclear. According to some mothers who�ve popped by unexpectedly and longtime daycare workers, a lot more goes on than you think. Here is one of the sixteen tips they suggest are worth your time to know:

Your Child May Be Calling the Daycare Teachers �Mommy�--Kids, especially young ones, often transfer feelings of affection from one person to another -- and the language that goes with it. If your children spend all day with someone who is feeding them, changing them, hugging them and treating their boo-boos, it�s perfectly normal for your child to attach the name usually reserved for that role -- �Mommy� -- to that person. Often the daycare worker will be embarrassed that she�s been given this name, however, and forgo telling the parent.

What to do: Don�t take it personally. It doesn�t mean your child loves you less, or wants to pack a bag and move in with �Miss Kathy.� It does mean she feels comfortable with her caregivers. Consider it a bonus that your child is being well-cared for and loved.

For the other 15 tips on daycare expectations, you can find them at this website: .

Also, according to this website , one of the important functions of a daycare facility is to keep an eye on the weather. Watching the weather is part of a child care provider�s job. Planning for playtime, field trips, or weather safety is part of the daily routine. The changes in weather require the child care provider to monitor the health and safety of children. What clothing, beverages, and protections are appropriate?

1. Clothe children to maintain a comfortable body temperature (warmer months - lightweight cotton, colder months - wear layers of clothing).

2. Beverages help the body maintain a comfortable temperature. Water or fruit juices are best. Avoid high-sugar content beverages and soda pop.

3. Sunscreen may be used year around. Use a sunscreen labeled as SPF-15 or higher. Read and follow all label instructions for the sunscreen product. Look for sunscreen with UVB and UVA ray protection.

4. Shaded play areas protect children from the sun.

Much more information about daycare in general can be found at their home page website: .

A good quality daycare facility can be expensive. Options range from in-home with small numbers of children to large urban locations with large staffs, many workers, and lots of kids. Some are secular and some are faith based. The size of your city and whether you choose a center or in-home care can affect the rates. You should research how full centers usually remain, the training/experience of the childcare provider, and what is included in the rate. What you pay for childcare is not as important as whether you are comfortable with the care your child is receiving and whether your child is in a safe and nurturing environment. More information with lots of regional examples for pricing are disclosed at this website: .

About 8.2 million kids�about 40 percent of children under five�spend at least part of their week in the care of somebody other than a parent. Most of them are in centers, although a sizable minority attend home day cares, according to New Republic magazine. Experts recommend a ratio of one caregiver for every three infants between six and 18 months, but just one-third of children are in settings that meet that standard. Depending on the state, some providers may need only minimal or no training in safety, health, or child development. And because child care is so poorly paid, it doesn�t attract the highly skilled. In 2011, the median annual salary for a child care worker was $19,430.

Do you have a back up plan? Regardless of your child care setting, family child care or center-based, it is important to think about a back up child care plan before you need one. There may be times when you know your provider will not be available and there will be times when your provider may have to be closed on short notice due to illness or an emergency, according to the Child Aware website. To avoid last-minute searches for back up child care, have a plan in place when you start with your primary child care provider. Here are some helpful hints:

--Check with your provider. Your child care provider may have information about back up child care that they suggest or have made arrangements with.

--Plan ahead. Know your provider's schedule. Make note of dates they will be closed (holidays and vacations). These may have been included in the parent handbook or contract. While you can not predict illness, you can be prepared for the planned closures.

--Have more than one back up. You may have family in the area willing to help out from time to time. There may be a stay-at-home mother who has mentioned that she's available if you ever need someone. Create a list of those willing to help out when back up care is needed.

Will your employer help out? Check to see if there are any back up child care programs available through your company. Some employers may offer on-site back up care that employees are able to access. There are also companies that have designated "back up spots" at child care centers within the community. Depending on your job, you may be able to work out a telecommuting arrangement while your provider is closed. More details about daycare and available options can be found at this website: .

Back up is not just back up. When locating a back up provider take the same steps you did in your initial search. Ask the questions, conduct the interviews, visit the location, and ask for references. A temporary solution can still leave a lasting impact on your child. You want to make sure you and your child are both comfortable with the arrangement you select. Do your research so you can feel comfortable with your choice of a daycare facility, according to's website.

Also, there are pre-tax credits available that can help you save money using those dollars to offset the out of pocket costs you pay for daycare. Daycare and childcare payments can take a big bite out of your paycheck. That's especially painful in a tough economy, when you are looking for ways to cut expenses. Fortunately, you can recoup some of the costs by either enrolling in a flexible spending account (FSA) or taking the childcare credit at tax time.

To qualify for either an FSA or the childcare tax credit, both you and your spouse must have earned income. Exception: One of you was a full-time student for five months of the tax year. If you work for a company that offers an FSA, here's a website that is very detailed that can show you how to figure out which option is best for you. Either way, it's like getting a sale price on childcare � something that's virtually never marked down. Go to : .

Regardless of your situation, when daycare is involved, you can bet that you will have a certain amount of angst when it comes to making your decision. However, with the right location, and the right personnel, you can leave your child with confidence. That being said, it�s never easy. Many parents are concerned about their children's safety, health, social and emotional feelings, and more. In most cases, those fears are soon dissipated. If you ever have concerns, though, about any daycare or its staff, always do the right thing by considering the welfare of your child above all else. As well, report any problems that you notice, no matter how slight. After all, their job is to take care of your kids. Your job is to make sure they do it right.

Until next time.

Covered California Will Have HSA Plans in Exchange

According to information provided in the last day or so by Michael Lujan at Covered California, the exchange does intend to allow HSA compatible health plans inside both the individual and SHOP exchanges.

Last week sources were told by a spokesperson at Covered California that HSA plans would not be included in the individual exchange.  

As with all things related to the implementation of ObamaCare, information is subject to change at any time and what we know today may well be changed or invalid tomorrow.

If Michael Lujan is correct (and there's no reason to doubt that he is) then the previous blog post is now incorrect.


No HSA Compatible Plans in Covered California Individual Exchange

Update: According to Michael Lujan at Covered California yesterday, the exchange will in fact have HSA plans available in both the Individual and SHOP exchanges.  This information contradicts earlier information from the exchange which was the basis for this blog post.

Word out is that the Covered California Individual & Family Health Exchange will not contain any HSA compatible health plans.

HSA compatible health plans are generally higher-deductible plans with some special design requirements.  HSA compatible health plans do not allow any first dollar benefit coverage (except for preventive care which is covered in full) and the drug benefit of the plan must be part of the medical benefit plan and subject to the medical deductible.  

Compatible health plans allow for the establishment and funding of a Health Savings Account (HSA) with an account provider like a bank, credit union or investment firm.  Think of the HSA as a medical IRA account.  Contributions can be tax deductible and funds can be used to pay medical expenses of the health plan as well as many expenses not part of the health plan such as dental, vision and so on.

Anyone wishing to purchase or continue an HSA compatible health plan will have to purchase a plan in the private market (if HSA plans are provided in that market).  Those eligible for subsidy from Covered California will either have to forego an HSA plan to obtain subsidy or choose to lose out on the subsidy to purchase in the private market.

I believe the logic of this move is that high deductible HSA compatible health plans offered inside of the exchange may entice individuals and families with high subsidy levels to purchase them to further reduce their premium outlay while not being able to afford the expenses of either funding an HSA or paying for services under the high deductible.



One of the essential building blocks of the human body is protein. Commonly perceived as being a major component of meat, protein is actually present in many types of foods. Healthy individuals usually have sufficient amounts of protein in their body, but in some cases you can actually consume more of it than you need on a daily basis.

According to the National Institutes of Health (NIH), proteins are part of every cell, tissue, and organ in our bodies. These body proteins are constantly being broken down and replaced. The protein in the foods we eat is digested into amino acids that are later used to replace these proteins in our bodies. Protein is found in the following foods:

� Meats, poultry, and fish
� Legumes (dry beans and peas)
� Tofu
� Eggs
� Nuts and seeds
� Milk and milk products
� Grains, some vegetables, and some fruits (provide only small amounts of protein relative to other sources)

Proteins are made up of amino acids. Think of amino acids as the building blocks. There are 20 different amino acids that join together to make all types of protein. Some of these amino acids can't be made by our bodies, so these are known as essential amino acids. It's essential that our diet provide these. In the diet, protein sources are labeled according to how many of the essential amino acids they provide:

� A complete protein source is one that provides all of the essential amino acids. You may also hear these sources called high quality proteins. Animal-based foods; for example, meat, poultry, fish, milk, eggs, and cheese are considered complete protein sources.

� An incomplete protein source is one that is low in one or more of the essential amino acids. Complementary proteins are two or more incomplete protein sources that together provide adequate amounts of all the essential amino acids.

For example, according to the NIH, rice contains low amounts of certain essential amino acids; however, these same essential amino acids are found in greater amounts in dry beans. Similarly, dry beans contain lower amounts of other essential amino acids that can be found in larger amounts in rice. Together, these two foods can provide adequate amounts of all the essential amino acids the body needs. More information can be found at this site: .

According to this website, , while the body can manufacture several amino acids required for protein production, a set of essential amino acids needs to be obtained from animal and/or vegetable protein sources. Animal protein sources contain the complete set of essential amino acids, while all the essential amino acids can be obtained by eating a wide variety of plant foods. There is considerable debate over the amount of protein a person needs to consume per day, the current recommended daily intake (RDI) of protein is 46 grams for women aged 19-70 and 56 grams for men aged 19-70. Any excess protein consumed is turned into energy by the body, and it is controversial whether this excess protein causes a strain on the liver. A deficiency in protein leads to muscle atrophy, and impaired functioning of the human body in general.

Here are five tips for getting sufficient protein in your diet, according to the Harvard School of Public Health, found at this site :

1. Mix it up. Most reasonable diets provide enough protein for healthy people. Eating a variety of foods will ensure that you get all of the amino acids you need.

2. Go low on saturated fat. Beans, fish and poultry provide plenty of protein, without much saturated fat. Steer clear of fatty meats and use whole-milk dairy products sparingly.

3. Limit red meat�and avoid processed meat. Research suggests that people who eat even modest amounts of red meat have a higher risk of developing colon cancer, heart disease, and diabetes, and a higher risk of dying from heart disease, cancer, or any cause. There�s also substantial evidence that replacing red meat with fish, poultry, beans, or nuts, could help prevent heart disease and diabetes�and could lower the risk of early death. So make red meat (beef, pork, lamb) only an occasional part of your diet�no more than two 3-ounce servings a week�if you eat it at all. And skip the processed stuff�bacon, hot dogs, and deli meats�since that�s linked even more strongly to cancer, heart disease, and diabetes risk.

4. Eat soy in moderation. Tofu and other soy foods are an excellent red meat alternative. In some cultures, tofu and soy foods are a protein staple, and we don�t suggest any change. But if you haven�t grown up eating lots of soy, there�s no reason to go overboard: Two to 4 servings a week is a good target; eating more than that likely won�t offer any health benefits and we can�t be sure that there is no harm. And stay away from supplements that contain concentrated soy protein or extracts, such as isoflavones, as we just don�t know the long term effects.

5. Balance carbs and protein. Cutting back on highly processed carbohydrates and increasing protein improves levels of blood triglycerides and HDL, and so may reduce your chances of having a heart attack, stroke, or other form of cardiovascular disease. It may also make you feel full longer, and stave off hunger pangs.

It's important to eat the right amount and the right kind of protein to get the health benefits. Be mindful of the types of protein you consume as well as the amounts. There are protein supplements you can take, but talk with your doctor first before starting a regimen using those products or any other type of high protein diet. Sometimes, too much of a good thing is not good for you. As always, each person is different in their physical makeup. Your family doctor can help you design a good plan for your individual health needs, and you can be referred to a dietician if you have special needs. Protein is good, but be careful about your consumption.

New Medicare cards are coming starting in April

The Centers for Medicare & Medicaid Services (CMS) will start mailing redesigned Medicare cards to beneficiaries in Washington state aft...