By Dr. Sanjay Gupta
CNN Chief Medical Correspondent

Last night I was up late covering the senate vote on health care for CNN. The number of e-mails I was receiving while discussing this on air was staggering. I realized that as much as we talked about cloture and reconciliation, most people who didn’t read the 2,000+ page bill (which is most everyone) really wanted to know what this bill means for them. They didn’t care as much about the compromise that was struck by Sen. Ben Nelson, which would obligate the federal government to pick up the Medicaid tab for his state of Nebraska into perpetuity. They are still not sure if a public option is a good thing or not, and they aren’t sure how the exchange would work for them. In short, there is a collision of politics and health care, and sometime the impact on individuals gets a little lost in the shuffle.

I want to use this blog as a platform to try and address some of your specific questions and to also throw out some key information that may have flown under the radar. I will start with a number. 2014. This is the year most of the provisions of the bill would kick in under this version of reform. That’s right – four years away. Many people think health care reform in binary terms. One moment there is a vote, and the next moment you have it. Many wish it were that easy. It is true that children may benefit earlier in some areas, but for the vast majority of the more than 40 million uninsured, things aren’t going to change significantly for a few years. And, speaking of the more than 40 million uninsured, this bill won’t impact all of them, but instead roughly 31 million.

So, let’s start here: Based on what you know about this bill, do you think you will be impacted? Has this affected your current plan, if, for example, you are working for a large corporation? What information is still lacking for you?

As a feature of CNNhealth.com, our team of expert doctors will answer readers' questions. Here's a question for Dr. Gupta.

From the Paging Dr. Gupta blog, Terry asks:

"I would love some advice on choosing a heart rate monitor."

Answer:

Well, it turns out, Terry; our folks at CNN.com gave some great advice on this. Advice that I paid attention to since I’ve been working hard this year to get in better shape and am now training for a triathlon as a part of CNN’s Fit Nation Challenge.

As I train, something I've been focusing on is heart rate target training. It's actually pretty simple to do. First of all, calculate your maximum heart rate. The way that you do that, you subtract your age from the number 220. So, mine would be 180. Now, you calculate a range between 60 percent and 70 percent of that number. Mine would be from 108 to 126. Try and keep your pulse rate in that range while you work out. A heart rate monitor is a simple device to help you calculate your target heart rate and keep track of your workouts so you can measure your progress.

So Terry here is a rundown of heart rate monitors depending on what you’re looking for and how much you want to spend. There are a lot of monitors out there. New monitors are equipped with GPS, speed calculating shoe sensors and data analysis tracking every detail of your performance over time.

So, the experts CNN.com quoted said the new Garmin Forerunner 310XT is the optimal choice, but it is very expensive. It's almost $350. It does work anywhere in the world and you can get your heart rate, measure movement, elevation, distance and speed. Now, if you're looking for something more affordable, like a lot of people, Nike offers a slim watch size unit called the Nike Plus Sport Band. It runs about $59 and displays your distance, pace and calories burned. It holds about 30 hours worth of workout data. Check out more options at CNN.com/technology.

Keep in mind the longer your keep your body at that target heart rate I talked about, the more efficient your cardiovascular system will become, and overall, the fitter you will be. Good luck Terry hopefully tracking your heart rate will help you make your workouts even better.

By Val Willingham
CNN Medical Producer

On November 21, Senior Airman Tre Porfirio was struck in the gut by three high velocity bullets while serving in Afghanistan. Porfirio, from St. Mary's, Georgia, was seriously injured; his entire digestive system was in danger of shutting down. During two operations in combat hospitals, surgeons removed his gallbladder along with portions of his large and small intestines, part of his stomach and a large section of his pancreas.
Porfirio was flown back to the United States immediately after emergency surgery, and taken to Walter Reed Army Medical Center, in Washington, D.C.

Col. Craig Shriver, chief of general surgery at Walter Reed, knew he had to remove the airman's remaining pancreas, which was found to be damaged beyond repair. "The optimal procedure at this point was to remove his entire remaining pancreas to prevent further leakage of the pancreatic enzymes and control the bleeding, which could be fatal," said Shriver. "We knew that the procedure would lead to the most severe and life-threatening form of diabetes, which tends to be very brittle and difficult to control in this type of situation.”

In an effort to save Porfirio from severe diabetes, Shriver turned to other surgeons for suggestions. Dr. Rahul Jindal, a transplant surgeon also at Walter Reed, had training and experience in islet cell transplantation, which is considered the best hope for curing diabetes. In islet cell transplantation, the insulin-producing islets are taken from a donor pancreas, treated and then put in the patient's liver where they begin to produce insulin for the body, even if there is no pancreas. In this case, the islet cells would come from Porfirio's own pancreas.

"Isolation and purification of pancreatic islets is a very intricate procedure, which requires a specialized laboratory, and there are only a few such facilities in the United States," said Jindal.

But Jindal knew of the perfect facility for the job; he turned for help to the Diabetes Research Institute at the University of Miami Miller School of Medicine. The director of the institute, Dr. Camillio Ricordi, developed the method for isolating the islet cells from the pancreas and was considered a pioneer in the field. Ricordi immediately agreed to help, noting that he would do "anything to help a wounded warrior."

Doctors at Walter Reed then proceeded to remove the remaining portion of Porfirio’s pancreas, packed it in ice and sent it to Miami.

On Thanksgiving Day, just five days after Porfirio's initial injury, the cell processing team at the Diabetes Research Institute spent six hours performing the islet cell isolation and purification procedure. "More than 220,000 purified islets were then suspended in a specialized cold solution and flown back to Walter Reed,” said Ricordi.

That afternoon, on that very same Thanksgiving Day, the islet cells were injected into Porfirio’s liver with Ricordi and his team coordinating the procedure with surgeons at Walter Reed via an Internet connection, a sort of high-tech telemedicine event.

In the three weeks since being wounded in Afghanistan, Porfirio has undergone 11 surgeries and, according to doctors, is "doing well." In a press conference held Tuesday at Walter Reed Medical Center, surgeons noted that there was evidence of the airman’s islet cells functioning in his liver less than one week after surgery; 15 days after the procedure, the transplanted islet cells were functioning in the normal range. His physicians say as time goes on, the islet cells in the liver will get stronger; when that happens, Porfirio's insulin requirement is expected to decrease. And although he'll still have a form of diabetes, the complication won't be as dangerous and he'll have a better quality of life.

Doctors from both the University of Miami Miller School of Medicine and surgeons at Walter Reed believe this transplantation is the first of its kind in a wounded soldier. They hope the success of the procedure will allow for more cases of islet cell transplantation in military personnel, as more of our fighting men and women return from war with injuries like those of Senior Airman Porfirio.

By Ashley J. WennersHerron
CNN Medical News Intern

A friend and colleague of mine died in July, from injuries she suffered when she was hit by a delivery van in Ocean City, New Jersey. Casey A. Feldman was a 21-year-old student with a promising future in journalism, balancing a full course load, an internship and the job of news editor for our school paper. Her family recently endowed a scholarship for communications students, so that others will have the opportunity to intern without monetary worries. Few people applied, despite a simple application, requiring only a recommendation, resume and a 200-word personal statement.

I applied, but I didn’t want to. Only a true need for financial aid (and my mom’s encouragement) pushed me to fill out the application. It sounds irrational, but I do not want to take money that could be going to the girl I knew. Nearly five months after her death, I want the money to be waiting for her and I would feel guilty if I won the scholarship. It feels wrong and disloyal to gain profit from Casey’s death, yet she would want others to have the opportunity to explore internship options and career choices.

It’s survivor’s guilt.

People who lose someone tend to find that, in their grief, they experience a sense of powerlessness. This complete lack of control, in all facets of life, stems from our emotional worlds toppling from the loss.

“When we lose our grandparents, we lose our past,” said Diana Nash, a psychology professor at Marymount Manhattan College and a bereavement counselor. “When we lose a sibling or a peer, we lose our present. If we lose our children, we lose our future.”

The idea of losing my present struck a profound and terrifyingly accurate chord for me. The comfy, college bubble of carefree immortality had been yanked away, leaving an acute void. Where I was once planning and daydreaming about my future, I began simply hoping there will be a future for me and wondering why Casey and her family didn’t get to keep their dreams.

The world loses logic when someone dies suddenly. I entered a mode of complete reaction. I couldn’t actively make decisions or plans — everything I did was in reaction to things around me. I felt as if I had no control at all.

The scholarship was something I had some say in. I could decide to apply, or not to apply. It was my decision, I thought, until I realized how difficult it was to make. Nash explained that even the scholarship itself is a plan for the future, something that was just proven hazy. It’s instinctual to avoid exposing yourself to a situation closely related to the experience that just caused so much suffering. The scholarship is a happy thing in itself, but it is also another manifestation that Casey is still gone, and the guilt doesn’t bring her back.

Have you experienced guilt after the death of a loved one? How did you come to terms with it?

Editor's Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.

By Theresa Tamkins
Executive Editor, Health.com

Oh, Mr. Squiggles. You’ve broken more women’s hearts this year than Tiger Woods. Never heard of Mr. Squiggles? Either you’re lucky or, more likely, you don’t have anyone under 12 in your social circle. For the uninitiated, Mr. Squiggles is the hot toy of 2009.

Mr. Squiggles is a little robotic hamster that scurries around, rides a skateboard, rolls around in a hamster ball, and is just as cute as the real version—without the offending smell, cage cleaning, and tendency to bite small fingers.

At a cost of $8 to $10 each, what’s not to love? Mr. Squiggles, you had us – me and my 8-year-old who started crying for you back in August – at the hamster version of hello. And here’s where the heartbreak starts.

You can’t find Mr. Squiggles (he’s the brown one) anywhere. And don't bother looking for his pals Num Nums (gray), PipSqueak (yellow), or the white one (I can never remember its name) either.  These little fellows, collectively known as Zhu Zhu Pets have been sold out at Target, Walmart.com, and Toys"R"Us for ages.

Mr. Squiggles’s stardom means he’s traveling in more rarified circles now. For example, you can find him at amazon.com – at times for $70 or more. Or check out eBay, where a bunch of boobs – like me – are furiously bidding on hundreds of the robotic rodents.

That’s right. Me, who scoffed at desperate parents in the past and has been known to lovingly croon to her children, “You can’t always get what you want…” snuck onto eBay late at night – night after night – to watch the bidding madness.

And finally I pounced – and scored! – a Mr. Squiggles. And it was only about two to three times the original cost.

But the heartbreak just keeps coming. A mere 12 hours later, I discovered Mr. Squiggles might be a toxic toy, potentially contaminated with antimony, according to a report from consumer group Good Guide. Oh, how you crush me, Mr. Squiggles!

Part of me felt like the toy would have to be made out of salmonella-coated plutonium to deter me from my desperate quest. (Did I mention that it included having a second cousin who lives three states away scout out her local stores – unsuccessfully? Thanks for trying, Michele!).

But I thought I’d better dig deeper. Is Mr. Squiggles bad for us? Really? (Meaning our physical, as opposed to mental, health.) In a hastily posted note on Monday (which originally misspelled “hamster,” but was later corrected), Good Guide clarified that it tests toys using a technology called XRF technology, which is different from that used by government regulators.

The Zhu Zhu Pets manufacturer, St. Louis-based Cepia LLC, issued a statement saying “Test results show Mr. Squiggles, as well as all other Zhu Zhu Pets products, are well within U.S. government standards and these results have been certified by the world’s leading independent testing organizations.”

And the Toy Industry Association, which represents toy makers, also issued a statement saying XRF “has not been determined to be a reliable test method overall,” by the U.S. Consumer Product Safety Commission.

“Parents can be assured that things that are on the store shelves do comply with our very strict federal standards,” says TIA’s Adrienne Citrin.

Good Guide eventually issued a correction, saying that Mr. Squiggles was safe after all. Apparently it was all just a horrible mistake.

That’s nice. But between greedy jerks buying up every available toy just to charge parents exorbitant prices online (yes, it’s capitalism, but I don’t have to like it), and mixed up toy testers, I just don’t feel the same about you, Mr. Squiggles.

A bit of a holiday mood killer. What do you think?

As a feature of CNNhealth.com, our team of expert doctors will answer readers' questions. Here's a question for Dr. Gupta.

From Cyrus in Pittsburgh:

“Can obesity be linked to Alzheimer's disease? And can physical activity help ward off the disease?”

Answer:

There are two important questions here. The quick answer, of course, is yes. But obesity, as you might imagine, is just one part of the whole puzzle. First, most things that are bad for your heart are often bad for your brain as well. That’s one way to think about it. You see, it's all about blood flow. So what impedes or affects blood flow to the heart is generally going to cause the same in the brain. Elevated blood pressure, high triglycerides, and high cholesterol all affect blood flow and all increase your chances of developing Alzheimer's disease later in life.

The good news, to the second part of your question, is we know a lot about what we can do to prevent or delay the onset of this disease. Being physically active has been shown to improve mental function and to keep your brain healthier as you age. It's also essential for maintaining good blood flow and encouraging the growth of new brain cells. Studies show exercise that raises your heart rate for a minimum of 30 minutes several times a week seems to be the key. And exercise does so much more: It significantly reduces the risk of heart attack, stroke and diabetes. So stay active to keep your body and brain healthy for those later years.

By Miriam Falco
CNN Medical Managing Editor

This week, Dr. Regina Benjamin, the new U.S. surgeon general, joined 550 health professionals, educators, executives, community health activists, patients and politicians at Morehouse School of Medicine's third annual "National Health Disparities Conference. The goal: to "focus on how to build a better health care system for all Americans" says Morehouse spokeswoman Cherie Richardson. Most of those in attendance are aware of the problems; they've been around for a long time. One of those problems is the lack of minority physicians and nurses. In her keynote address, Benjamin noted that the percentage of minority doctors has not risen in nearly 100 years. A 2004 report on health disparities, Benjamin said, found that although 25 percent of the nation's population is minority, only 6 percent of its physicians are minority. That's the same percentage found in the Flexner report, which was published in 1910. "There's something wrong with that," the surgeon general said.

I had no idea what the Flexner report was – so I looked it up. Abraham Flexner was a research scholar at the Carnegie Foundation for the Advancement of Teaching. He undertook an assessment of medical education in North America, visiting all 155 medical schools that existed in the United States and Canada.

It's hard to disagree with the surgeon general when she says there's something wrong with that. It is hard to believe that we have the same percentage of minority doctors and nurses in this country today, in a population of 300 million people, as we had a century ago, when the population was only about 92 million.

One theory of why the disparity exists was offered by Dr. John Ruffin, who heads the National Center on Minority Health and Health Disparities. He told the gathering: “African American, Hispanics and Native Americans make up 31 percent of college population, but only account for 14 percent of life sciences graduates.”

Benjamin challenged the attendees to do their part to encourage more minorities go back to school and become nurses and doctors. "Our nation faces a growing ethnic and racial disconnect between those who seek care and those who provide that excellent care." Having more medical professionals tending to the needs of all Americans will help the country as a whole, she argued.

Are you a minority healthcare professional? How do you think this disparity can be changed?

As a feature of CNNhealth.com, our team of expert doctors will answer readers' questions. Here's a question for Dr. Gupta.

CNN blogger, Beata, asks:

"Of those who have lived long lives, what is the common thread? What's the one thing I can do today that can make me live longer?"

Answer:

For well over a decade I've been investigating the answer to this question. The good news is there are actually a lot of small lifestyle changes you can make today that will add years to your life. For instance, flossing can add a year to your life – a whole year – just by adding to your daily routine. Turns out there's a pretty clear link between gum disease and heart disease. Flossing is your best bet at stopping that.

Here are a few more: A low-dose aspirin a day could add two years, and limiting your coffee intake to two cups a day could add another year. Simply checking blood pressure regularly could add one and a half years, and exercising three times a week could add three years. Cut work hours down to a manageable 40-50 hours a week and you add another one and a half years. Add it all up – and you have added a decade of functional life.

I will be the first to admit, it isn't always easy to practice what I preach, especially when it comes to the work-hour issue. But, we do know stress affects just about every part of our bodies. Our bodies simply start to shut down and become unable to tolerate the assault being placed on them every day.

Earlier this week I sat down with anti-aging expert Dan Buettner. He explores the world searching for longevity hotspots, known as blue zones, and looks for the lessons we can learn from them. One thing Buettner points out is that the people who live long lives in blue zones around the world are stressed out too. Yet they are still living disease free and often to 100 years old. The difference is they don't internalize their stress as most of us do. They all practice simple techniques to de-stress including praying, napping, even happy hour. Also meditating, which I have started, for 20 minutes every day and taking time for yourself every day can help.

In case you missed it, click here to hear more of my conversation with the world's leading anti-aging experts and get more tips to live a longer, healthier life.

By Ashley J. WennersHerron
CNN Medical News Intern

My preschool-age cousin was hospitalized last year for a bad infection. A happy and good-natured kid, she kept her spirits up with visits from family and friends, as well as multiple viewings of “The Little Mermaid.” After nearly a month, she was well enough to go home, as soon as she had her chest port surgically removed.

The surgery was brief, but required her to have general anesthesia. After waking up, she felt sick from the medicine, she felt pain from where her port had been, she felt frustrated by not being allowed to run around and play like normal — it’s a lot for anyone, and it’s even more overwhelming when you lack the ability to articulate all of those emotions. The feelings build up and, often, crying is the result.

Tears show emotion, but we didn’t always have such a clear indicator. According to a study released this spring by the University of Maryland, humans developed to shed tears to efficiently communicate distress, whether it’s grief, fear or frustration. It’s suspected that before we developed the vocabulary to express our emotions, our tear ducts advanced our ability to effectively communicate.

In the study, participants were shown sets of photographs. They were asked to identify the emotions in each pair. The pictures were identical, except tears were digitally removed in one photo per set. The individuals viewing the photographs ranked those with tears as sad and those without tears as less sad, puzzled or confused, even though the facial expressions were the same in every other way. The tears portrayed sadness for those viewing them, but in the photos without the tears, the same message wasn’t as clear.

Children, without the vocabulary to explain a simple emotion or even a need such as hunger, cry. The tears demonstrate that they need attention for something. When we grow up, we can describe what we want or need, but emotion builds up for even the most-level headed person. No, we don’t necessarily cry because we are hungry or tired, but something sad or upsetting can cause the tears to spill.

We use tears to show others a need for understanding and compassion. It’s a cry for help, literally. It’s instinctual, even as infants, we know crying will bring what we need, even if it’s simply attention.

Why do you cry? How do you react when you see others crying?

Editor's Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.

By Rebecca Leibowitz
CNN Medical Intern

It all started one afternoon. “Grandma,” I asked, “how did Karen like my hand-me-downs?” “What?” she responded, “I didn’t know what those clothes were doing in my trunk. I gave them to charity.” We all knew immediately that something was wrong. And there was more to come. Once a skilled, careful driver, my grandmother terrified her passengers when she blew through a stop sign as if it didn’t exist. I would catch her staring at me in confusion, often calling me by the name of my cousin or aunt. My grandmother, like her own grandmother, two brothers and a first cousin, has become one of the estimated 5.3 million people in the United States living with Alzheimer’s disease – the most common cause of dementia.

Our family has learned what many other families know well: Alzheimer’s disease is devastating. We’ve seen our loved ones change into someone entirely different. According to the Alzheimer’s Association, a person develops the disease every 70 seconds in the U.S., and the amount of people living with Alzheimer’s is expected to double every 20 years. The illness’ economic costs are nearly as distressing as its emotional toll. Each year, an estimated $148 billion is spent on Alzheimer’s, including direct costs of Medicare and Medicaid and indirect costs to businesses. This figure, like the burden of Alzheimer’s disease in the U.S., is expected to only get worse.

Alzheimer’s has no cure and its damage can begin decades before symptoms are apparent. The exact cause is still unknown, but tangles and plaques in the brain are thought to lead to symptoms like memory loss, poor judgment, changes in mood or behavior. Without a cure in sight for this disease, what can people like my mom, who is approaching the age when the disease could already be developing, do to prevent or slow the onset of this debilitating illness?

Researchers are convinced that mental activity and socialization can help. Reading, playing board games, playing musical instruments and dancing have all been shown to decrease the risk of contracting any form of dementia. Engage your brain, build up your social networks and you’ll put off getting the disease or possibly avoid getting it altogether.

Other studies have found a link between unhealthy living and increased Alzheimer’s risk. A study earlier this month in the Archives of General Psychiatry concluded that for people with a family history of the disease, high blood pressure in middle age is a significant risk factor for Alzheimer’s in old age. So, what can you do if Alzheimer’s is prevalent in your family? Don’t smoke, eat a well-balanced, heart-healthy diet, stay stress-free and exercise regularly. Not only will these measures decrease your risk for Alzheimer’s, they will improve your overall quality and length of life.

Unfortunately, this information wasn’t around when my grandmother was growing up. But for my mom, her siblings and myself, (as well as the millions of other Americans with a strong family history of the illness), there is hope. Not only can we decrease our Alzheimer’s risk by maintaining a healthy and active brain and body, but researchers are constantly discovering new things about prevention and treatment of the disease. Perhaps one day we will even find a cure.

Do you have a history of Alzheimer’s disease in your family? Are you taking any measures to try to keep from contracting the disease?

Editor's Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.