Ahh…spring, when a young lady’s fancy turns to thoughts of…Farmers’ Markets! Yes, the Markets are open again and I find it amazing the number of people who have never visited one.

So, maybe a little primer to help encourage you to explore one of these wonderful places.  The photos have been provided by Kevin Stallings and were taken at the Madison City Farmer’s Market, Madison, AL.

Let’s start with some definitions:

Organic—a farming method that avoids the use of pesticides, herbicides, or man-made fertilizers, any of which may leave a residue on the food. Many farmers employ organic growing techniques but, to avoid raising the costs of their products, do not become certified.

Conventional—methods that employ pesticides, herbicides, or man-made fertilizers resulting in higher yields and potentially lower cost. The advantage over conventional store produce is that it is picked at the peak of freshness, taste, and nutrition and brought right to you.

Raw (Straight out of the cow) Milk—has been neither pasteurized (heated to kill harmful microorganisms) nor homogenized (the cream floats to the top and will need to be shaken for best flavor). In Alabama, the sale of raw milk is legal for farmers with a commercial feed license only for pet consumption.

Unlicensed Kitchen—any kitchen (e.g., one located in a home) that has not been inspected or licensed by any agency.

Genetically Modified Organism (GMO)—when the DNA of the organism has been artificially changed.

Grass-finished Meat—results from livestock fed exclusively grass during the last few weeks or months prior to being processed.

Grain-finished Meat—results from livestock fed grains during the last 90-160 days prior to being processed. Resulting in more marbling of the meat, many feel this enhances the flavor and tenderness but may also be less healthy.

Pasture-raised Livestock—livestock that lives in pastures, or may even forage in woodlands, but have access to shelter. Their diet may be supplemented with grain.

So, now that you know some of the lingo, how do you approach shopping? First, you need to understand that this is not the grocery store chore. Think of it as an outing. At our local Market in Madison, AL, you can stroll through the Market or have a seat and listen to the local musicians play while sipping coffee or tea sold by a local vendor. Well behaved, leashed pets are welcome. When they are not busy, chat with the vendors about new products, farming methods, food storage, produce selection, or recipes. They love to share their knowledge and will get to know you by name and tastes.

Civility, which seems to be generally in decline, is delightfully present at the Market. Patrons patiently wait for the Market to open and quickly leave at closing. Lines magically form as each person waits to purchase especially popular or scarce items. If someone appears to be contemplating a purchase, it would be very poor form to grab the item without asking. Occasionally, I have selected the last of an item only to find someone behind me came early to purchase that very thing. Handing it over to another just seemed the right thing to do, and yes, this gesture has been reciprocated!

While it is not an uncommon practice to purchase from wholesalers and resell at low cost roadside stands, this is not allowable at most farmers’ markets. Many of today’s local farmers who share their crops at the Market not only farm organically (producing less quantity) and harvest (sometimes by hand) but also transport (requiring time away from the fields) their wares. In my opinion, this produces a better quality product brought to us in a timely way, and prices have to reflect costs of running the business. Vendors are not used car salesman and do not price their wares expecting to haggle. Happily, you may find they offer a discount for bulk or throw in a new product for you to try. But, if price if an issue, walk around and take a peek at what other vendors have to offer.

If samples are not available and you really want to try something, don’t grab…ask! Many times it will be provided. Produce is gently handled and never squeezed which may cause bruising preventing a future sale. Instead politely sniff for an enticing aroma, and examine with the eyes for size and spoilage. At the Market, food is usually picked ripe because it is brought to sell within hours, unlike the supermarket offerings which are picked to ripen along the journey across the country or around the world.

While some vendors have credit card processing capacity, start by bringing smaller bills until you get to know the ins and outs of who’s selling how. This will also allow you to move quickly through the Market without having to wait for change. Best variety is at opening with limited items going fast. Regulars know this and will head to these vendors first.

So next Market day, slap on the sunscreen and your wide-brim hat, pick up those reusable shopping bags, and head out to your local Market. I will see you there!

Want a bit more information? Join Dr. McCleskey for Shop-with-a-Doc Farmers’ Market edition at the Madison Farmers’ Market, 1088 Hughes Road 7:45 am May 26, 2018. RSVP 256-280-3990.  We will meet at the east end of the Market.

When Before Disaster Strikes Part 3 –Evacuation

14. Is your vehicle adequate to transport people, pets, luggage, AND medical equipment? If not, with whom can you make arrangements for shared transport?
15. Can all members of the household survive without heat or A/C, given their medical conditions? (For example, severe respiratory symptoms could occur in 100o heat/80% humidity or extreme cold for COPD or asthma patients, respectively.) If not, evacuation may be the best choice.
16. Think ahead about accommodations outside your local area. If applicable, call hotels and learn about availability of handicap-accessible rooms and equipment such as bath chairs, raised seats for toilets, etc. Record this info (and the date it was obtained) and keep it with your emergency papers so it is at the ready if needed. If advance warning of an event occurs, reserve your room(s) early, because most hotels have only a few handicap-accessible rooms.
17. A question for some real soul searching: Are you able to travel? Nobody wants to leave home or evacuate to a shelter. But if you must leave your home, are you realistically physically and medically able to travel outside your area, perhaps a great distance? If not, your best option may be a special-needs shelter with medical staff to assist you. Since not every shelter provides for special needs, you may want to contact your local emergency management agency for assistance in finding one or look at the resources provided at the end of this blog entry. Also, ask how you register with the local EMA as a person possibly in need of transportation should evacuation become necessary.
18. Neighboring states may open a shelter as was the case for Hurricane Irma. Find the zip codes for your chosen evacuation areas and add this information to your disaster plan file. These zip codes will help you in determining if a shelter in that area is available should the need arise.
19. Many will assume they can stay with friends or family. Let’s say Aunt Matilda offers a welcome into her 1930’s style house with two bedrooms, six entry-door steps, and tiny doorways. What is your plan to get your wheelchair-bound parent up the steps and into the bathroom? Will the house accommodate four adults, two teenagers, one child with a seizure disorder, and a service animal? Gratitude in the moment and a miserable time for all might well be replaced with a more suitable evacuation experience if some forethought is given.
20. Pets and service animals will require their own “luggage,” including, but not necessarily limited to, food, bowls, medications, leashes, collars/tags, service vests, documentation of vaccination, note of microchip numbers and provider phone numbers, contact information for veterinarian, crates, bedding, and toys. Pets, especially cats, may become very stressed by the change experience and need additional attention to their emotional needs and oversight to prevent their escape.
21. If you are receiving dialysis, home-health, or hospice services, ask about plans for patients who desire to evacuate. For example,
a. If I evacuate to City-State, with which provider can you arrange for me to receive services? If none, ask what options are available per the agency’s policy/procedures.
b. How long can treatments, etc., be safely interrupted if patient shelters in place?
c. What are the criteria by which the home health or hospice agency will no longer allow their personnel to visit patients, e.g., wind >50mpg, flooding.
d. Does the agency have a tentative plan/date for restoration of limited or full service?
22. Speak with your doctor, pharmacist, or other health care provider for additional suggestions.

By no means is this an exhaustive list. Each individual has his or her own unique resources and needs, and this should be a starting point to begin examining yours. We want you to be best prepared to act in the best possible way if “that” day comes.

The following resources include much more extensive information regarding sheltering and how to make an emergency family plan. A short internet search will also yield resources in your specific city/county, so recruit a grandchild or neighbor’s kid if you need someone to search and print information from the Internet, but please–take a few minutes to plan ahead.

ReadyAlabama.gov
Ready.gov
Redcross.org
FEMA.gov
Disasterassistance.gov

–BE SAFE AND BE HEALTHY–

When Before Disaster Strikes
Part 2 – Medical Equipment

7. Don’t forget fresh batteries for hearing aids and wheelchairs, remote monitoring devices for pacemakers, etc. Small medical devices such as spacers for inhalers should be stored with medication. Colostomy bags, urinary catheters, and the like may need to be readily accessible. Perhaps someone in your household uses a product such as a thickener to assist with swallowing; if evacuating, this may be necessary during the journey, so keep some handy. Some of these items are available in single-use packages for handy pocket/purse or emergency kit use.
8. Are any special foods or food preparation equipment necessary? While hot dogs may taste great, a diabetic needs something better suited to her dietary needs. What about those who require a soft diet; no electricity means no blender. At least three days of non-perishable food that meets specific medical needs can be very important. (Don’t forget to periodically check those expirations dates and replace if necessary.) The stress of the event is enough; the body doesn’t need to be further taxed by depriving it of nutritious food.
9. In the event of a tornado or similar situation, have you identified and prepared a safe place which can be reached by a loved one who is confined to a wheelchair or hospital bed? If not feasible, do you have an alternative plan regarding how and where to move him so as to keep him and yourself as safe as possible?
10. Utility companies sometimes provide expedited relief to patients with documented severe health issues, especially in cities which have programs that pre-register them for prioritized repairs. Check with your utility companies now; don’t wait until the next disaster is knocking on your door because they will not have the manpower to evaluate and act on the request at that 11th hour.
11. If medical equipment is supplied to you by a medical supply company or your loved one receives services of hospice or home-health providers, know their emergency policies. For example, ask:
a. Will the medical supply provider deliver a supplemental oxygen tank (which does not require electricity) to my loved one in advance of the oncoming storm for his use should loss of electrical power render his oxygen concentrator unusable?
b. What is the plan to provide service to patients during and after the event?
c. How is patient status prioritized with regard to deliveries, etc., after the event?
d. How are patients contacted if phone systems are out of service?
e. If your work site experiences facility damage or destruction, what is the back-up source for supplies and delivery?
12. Do you have a C-pap machine, oxygen concentrator, etc.? Smaller equipment could be run on battery power IF the patient has the resources to purchase and a way to recharge it. Some choose to have a generator for their home. While a good option for some, especially professionally-installed models, keep in mind that all have maintenance tasks/costs, some can be difficult to operate, and all are potentially dangerous. NEVER operate a portable generator inside a structure, as carbon monoxide poisoning can easily occur. Fires are also potential dangers, and electrocution of homeowner or utility company line workers can occur if improperly used. (Note: NEVER connect a portable generator directly into the home’s wiring; feedback can electrocute line workers!)
13. A few example questions for rehab and long-term care facilities should you have a loved one in residence:
a. Does the facility have back-up generators? If so, where are they located and to what extent are they protected from flooding, wind, etc.?
b. What is the procedure regarding assessment for adequate staffing and where are the staff physically located in the facility throughout the emergency event?
c. What is the policy regarding moving patients to the safest location within the facility?
d. Is a family member allowed to stay with her loved one?
e. How will food preparation be accomplished during a power outage, especially if the patient is on a special-needs diet?

When Before Disaster Strikes
Part 1 – Medicines & Papers

Wildfires to the west; hurricanes to the south; blizzards in the north; and tornadoes in the Midwest: Wherever you live a natural disaster can occur, an evacuation might be ordered, or a disruption of medical services could result. Are you prepared? While all possible medical scenarios and preparations are well beyond the scope of these three blog entries, hopefully the information presented will help you organize your thoughts, research further, and proactively prepare for the future emergencies we hope never arise.

Part 1 – Medicines & Papers

1. The stress of an emergency situation can impede your thought process and make difficult the collection of needed supplies. Create a list of necessary medical supplies prior to the event. It will decrease the time necessary for their collection and packing and minimize forgotten items. Be sure to set a reminder to update the list semi-annually or when the medical history of any family member changes.
2. If you take medication, don’t run out. Keeping a three- to seven-day supply of your medications on hand at all times can literally save your life. Some sources suggest even longer reserve supplies, i.e., up to 30 days, although many third-party payers will not authorize such extremely early refills. Most will, however, allow you to refill a few days ahead of schedule, giving you the reassurance of having a few extra doses on hand.
3. Some folks put their extra medicine in an emergency “grab bag” for easy retrieval in the event of an evacuation. If you don’t choose this approach, try as much as possible to store all your medicines together so you can gather them quickly. Consider keeping a sealable plastic bag folded up with them to facilitate packing. However you choose to consolidate your medications for travel, leave them in their original bottles. This can prove helpful in many ways, not the least of which is if you need an unfamiliar physician or pharmacist to refill your medicines. Outside your own home it is best to be discreet about your medications, especially if they are of the type desired by those who suffer with substance abuse issues.
4. Do any of your medicines need to be refrigerated, and if so at a specific temperature? Ice in a cooler is hard to regulate; you may want to invest in a thermometer to insure that the correct temperature remains constant. Don’t assume your neighbors with generators will be willing to assist you. Talk to them in advance about willingness and comfort level regarding keeping your medications in their refrigerator. And, always have a back-up plan, in case Neighbor #1 with whom you have made the arrangements is not available.
5. Paper copies of your medical paperwork, insurance cards, health history sheet (we discussed in a prior blog), vaccination records, etc., should be included with your other important papers that will be evacuating with you. Don’t forget information about medical equipment or implants (pacemaker, etc.).
6. Although not specifically related to medical history, you will need to gather birth certificates, social security cards, marriage/divorce certificates, banking information, etc., so you will know exactly where they are and can quickly retrieve for packing.

The Patient’s Advocate – Helping You to Navigate the Healthcare System
Something most of us have in common is doctor visits. If you have seen the doctor any time in the last few years, you have probably noticed an increasingly complicated system-more forms, more ancillary staff, a computer in the exam room, and briefer face to face time with the physician. And let’s hope you do not have to experience the hospital admission process!

So, one efficient tool to help you navigate this increasingly complicated healthcare system is a Health History sheet. It can be a simple 3” x 5” card or a complex color-coded chart. What are the benefits? A busy mom may not remember if it was John or Joe who had the medication reaction. This tool may prompt the person to clarify with a family member before the appointment regarding childhood surgeries or illnesses. If faced with multiple health problems, this sheet may facilitate the exchange of information with new specialists. And, in the event of an emergency, this information carried near the driver’s license provides the emergency response team an advantage in treating at the scene.

(1) Start with your name and the date. If you have a common name, adding a middle name or address may be helpful. The information you share with your physician is confidential, but you could drop or misplace the sheet, potentially making your personal information, well…public. Therefore, NEVER put your social security or health insurance identification numbers on it.
(2) Allergies (if color coding your sheet, print this in red). List anything to which you are allergic AND what happens when you are exposed. (Example: Penicillin—Rash.) Include environmental exposures like bee stings or latex. Some physicians only want to document a “true” allergy which includes swelling, hives, itching, rashes, or trouble breathing. Some electronic medical records may not provide a field for a reaction such as vomiting. So you may want to create an Adverse Reactions section on your Health History sheet where you can identify other reactions or intolerances. (Example: Statins—Muscle Pain.)
(3) Medications. Keep an UPDATED list which includes all prescribed and over-the-counter medications, as well as herbal and vitamin supplements. Remove all discontinued items and add all new ones before your appointment. Don’t forget to change the date on your card so your physician knows they have the most current information. Include the name of the medicine, the strength (usually shown as mg or mg/ml (for liquids), and how frequently you take it. Example: Gabapentin—100 mg twice a day). Medications taken “as needed” such as antacids for heartburn can be listed “as needed.” Complete information reduces the potential for medication interactions.
(4) Current Health Problems. List your current health issues, including those for which you do not take any medication or those which are partially or completely controlled by your prescribed medication. Examples might include arthritis which is managed with daily stretching, or hypertension or diabetes which is controlled with medication
(5) Past Health Problems. Suppose a gout or kidney stone attack occurred ten years ago. These may be more likely to crop up again, so your doctor needs to know.
(6) Past Surgeries. Physician awareness that something has been removed, added, or replaced, may help avoid unnecessary testing.
(7) Family History. Unless there is more information than you can easily remember, this section may not be necessary. Your physician will be especially interested in cancer, diabetes, and heart disease in parents and siblings.

Ask about submitting a copy of your Health History sheet in place of completing the health history form at your new-patient appointment. At subsequent visits, hand a copy of your Health History sheet to the medical assistant or nurse to update your chart. A Health History sheet takes a few minutes to create and update, but communicates accurate at-a-glance information that your provider appreciates.

Helping You to Navigate the Healthcare System