Ask the Doctor: Cardiac Rehab Under Medicare; Hearing Loss & AD; Whole Grains & Diabetes

Q: I understand that Medicare covers up to 36 weeks of cardiac rehabilitation, and longer if necessary. How do you know how much cardiac rehab you’ll need?

A: Cardiac rehabilitation (or rehab, for short) is an exercise-training program that seeks to improve your physical condition after you go through heart surgery, experience a heart attack, or if you suffer from chronic angina. You’re right that Medicare will usually cover 36 weeks of cardiac rehab. If your doctor believes that more rehab is medically necessary, Medicare may cover another 36 weeks. If you qualify for what is known as “intensive rehabilitation services,” you may be covered for several sessions per day for an additional 18 weeks. The determination of whether you qualify for more rehab beyond the initial 36 weeks depends on several factors, such as your symptoms and a physical evaluation of your health that may include a stress test and other screenings. It’s important to remember that your cardiac health is monitored throughout the rehab process, so your health care providers will have a good idea at the end of rehab about your needs moving forward.

Studies have demonstrated that people participating in cardiac rehab have better stamina and strength than those who do not participate. But these studies have also shown improved control of weight, blood pressure, and cholesterol in those who did rehab.

Q: I’ve read that hearing impairment can put you at greater risk for Alzheimer’s disease. Is this true?

A: Several studies have found an association between sensory impairment and Alzheimer’s disease (AD). Some of these sensory problems seem to involve the reduced ability of the brain to process information provided by the eyes, ears, or nose. But it’s still unclear whether the sensory problems precede AD or whether AD causes the sensory problems. In one study, researchers found that participants who had hearing loss had a 30 to 40 percent greater cognitive decline per year than those who had normal hearing. Rates of cognitive decline were directly related to the level of a subject’s hearing loss. Researchers suggest that AD may affect nerve pathways that carry auditory information to the brain or interfere with a person’s ability to make sense of what he or she hears. Another theory is that hearing impairment may compromise mental processes because the person’s cognitive resources are redirected to interpreting sounds, rather than higher thinking and memory. Also, social isolation frequently accompanies hearing impairment, stemming from a reduction in sensory input. Assistive devices, such as hearing aids, and telephone and television amplifiers, may slow or prevent cognitive decline.

Q: Because whole-grain foods are high in carbohydrates, is it okay to eat them if you have diabetes?

A: The short answer is “yes.” Carbohydrates have gotten a bad rap in recent years with the popularity of high-protein diets. But carbs are a healthy and important part of your diet. Even if you have diabetes, you can safely eat foods that contain carbohydrates, as long as they are the right kinds of foods.

Easily digested (simple) carbohydrates from processed foods like white bread or soda can rapidly raise your blood sugar and cause spikes in insulin. But complex carbohydrates from whole grains, beans, fruits, and vegetables break down slowly in the body. This helps to maintain a normal blood sugar level. What makes complex carbohydrates a better choice is their high fiber content. Fiber is the one kind of carbohydrate that does not raise your blood sugar. Therefore, complex carbohydrates, like whole grains, are safe for people with diabetes. You should still ask your doctor which foods are best for you and which ones you should avoid.

If you follow your doctor’s instructions, you should be able to reap the benefits of a diet rich in whole grains without any problems.

—Editor-in-Chief Bruce A. Ferrell, MD

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