Posts filed under 'stroke'
Today would be no exception to my rule that men really don’t see a world that has consequences until they are old enough that they see the consequences happening to others their own age, or even to themselves.
I spent part of yesterday evening in the emergency room with my nephew who had finally conceded that three hours worth of rapid heart beat (85-110) and high blood pressure (160/110 as measured at Walmart) was reason enough to see a professional. He is 38 years old and by his own admission, inactive and at 6′3, 250, overweight.
I cut him some slack last night, but today let’s discuss his experience. His self admission of being overweight was actually cutting himself some slack. He knows about body mass index (BMI) as well as I do and he knows that his build puts him solidly in the obesity category. “Overweight” is a way many of us use to gloss over the fact that obesity carries with it a number of potential health issues, only one of which became all to real to him last night.
As we waited for lab results and talked, he admitted that he hadn’t been to a doctor in three years. This is a guy who reads my blog and knows my opinion of guys (yes, including me) and their stupidity about their own health. He confessed that his real concern with the labs that were being worked on was that he would be found to have type 2 diabetes, one of the risks of obesity, a risk he knows about all too well because he is also a life insurance agent who works with diabetics frequently. He admitted that he has had concerns about his blood pressure because of his lifestyle. All that is to say that he was aware that he was probably due for some health problems.
My nephew was no different than my average client laying in the emergency room last night. He knew he has been heading down the wrong road for a while. He knew that, at some point, his lack of attention to his health could hurt him or kill him, yet he did very little to change that direction. He bought a bike that he doesn’t ride. He doesn’t like to walk, so he doesn’t. The only thing last night that set him apart from the average guy is that he went to the ER knowing that he has an adequate amount of life insurance in force.
So, why regular checkups? For my nephew, one good reason would be that he would be hearing from a professional that he was treading on thin ice with obesity, a recipe for disaster. For all of us it could well give us that advantage of an early diagnosis of something that can be serious left undetected. If we flip through life with our immortality shield up, never getting checkups, a heart attack could be how you find out you have heart disease or diabetes. A stroke could be the way we find out about hypertension, the silent killer. Regular checkups are wake up calls that don’t hurt.
Bottom line. Prayers were answered last night and my nephew, with a fresh look at life, should be fine. We should all work harder at being proactive about our health. There are people that would miss us.
December 14th, 2008
You know the rates I’m talking about. You see them advertised everywhere and it makes it seem as though life insurance is almost free, simply there for the picking. In the industry those rates are called things like preferred plus, preferred elite, select preferred, or jokingly, Superman rates.
The question really revolves around whether you do, in fact, have to be superman or woman to get those rates? Is perfect health required? Do companies go out of their way once you have applied to find a way to disqualify you? If the truth was really known, would they actually bump Superman out because of his genetic weakness to kryptonite or because he is a private pilot (of sorts)?
OK! Let’s cut to the core of this question. All people do not qualify for those “best rate class” rates. Those who call up with diabetes, a history of depression, or heart disease and get all indignant because they don’t qualify are, well, living in la la land. Life insurance underwriting is to the best of its’ ability a measure of mortality risk. People with health issues and especially health issues with obvious mortality assumptions will be asked to pay a higher rate than those with no health issues.
There are a few health issues that balance in between. High blood pressure is one of those. Most companies will not allow their best rate class if you are treated for high blood pressure. High blood pressure of course has links to heart attacks and stroke. There are a few companies, two that I know of, that will allow their best rate with blood pressure treatment as long as the treatment is working and the blood pressure is well controlled.
Cholesterol is probably a better example as companies seem to be split about 50/50 on cholesterol treatment. About half seem to think it is OK to be treated with good control and the other half think you should pay more because of the cholesterol link to heart disease and heart attacks.
So, the question is “do you have to be in perfect health”? The answer is not cut and dried, but I would say no. We’ve placed a lot of best rate class life insurance on people with less than perfect health. Can you stretch that very far? NO!
Bottom line. Once again the edge for you goes to the independent agent. If you are locked into one company the chances of catching a break is slim to none. Be forthcoming and straightforward about any medications you take and past or present health issues you have and tell your agent that your goal is the best possible rates that you qualify for. Be realistic and you won’t be disappointed.
October 14th, 2008
If you talk to most life insurance applicants who fall into the obese or morbidly obese categories according the their BMI, they have usually been told that they aren’t insurable or that the prices are so high as to render uninsurable because they can’t afford it.
Let’s not dance around the subject. Life insurance underwriting is all about assessing mortality risk, your chance of dying compared to someone in average health. One of the things they consider are the risk factors that you have and the health issues you might, or in some cases are likely to acquire.
In the case of obesity, it is a known risk factor for high blood pressure, heart disease, stroke, cancer and diabetes. So honestly it is not just the weight that impacts the outcome of the life insurance application, but the compounded perceived risk. Given the risk factors, while you may not agree when you have to pay higher premiums, life insurance companies are actually pretty generous with their build charts.
As I was running quotes for a person 5′11 and 395 pounds today, I was impressed by the fact that, number one, he was insurable and number two, while he may not be able to afford all he wants, he can still afford to make sure that his family is taken care of. Back when I did a series of blogs on the TV show Fat March, it generated a lot of attention to see the contestants on that show go from uninsurable to insurable, to great rates as their weight came down. Probably the most important aspect of that show and that series of blogs was the great discussion it generated over not just life insurance rates, but how life style changes could have such a huge positive impact on health and longevity.
Bottom line. If your only issue impacting life insurance at this point is weight, bite the bullet and find an independent agent to shop for the best possible rate for you. The picture isn’t going to get any prettier if you drag your feet and other health issues pop up and compound the issue. While there is a point where weight alone can keep you from getting traditional life insurance, chances are you aren’t there even if you’ve had a decline letter or two.
October 7th, 2008
Remember the good old days when livers were done in by drinking too much? Cirrhosis of the liver can eventually lead to liver failure or liver cancer, kind of a no win situation unless you have a spare hidden in the closet.
Now studies show that obesity can lead to a situation called non alcoholic fatty liver disease, which left unchecked (you don’t lose weight), can lead to cirrhosis, failure and cancer and eventually to that hunt for a spare liver. This is becoming alarmingly frequent in young people who, unfortunately, are rarely tested for liver functions.
I will continue to beat this obesity issue to death just on the off chance that someone, even if they aren’t in the market for life insurance, will read and learn that the number of ways that those extra pounds can kill you is simply staggering. Diabetes, high blood pressure, heart disease, stroke, several kinds of cancer and yes, liver disease.
Just a few plugs for common sense. If you are obese and don’t have any of these things going on yet, buy life insurance now. If you are obese and can’t lose weight through traditional methods, seriously consider gastric bypass. Forget those people who say that’s just taking the easy way out of your problem. This is about your life and saving it. Just consider it. Talk to your doctor.
Bottom line. The weight of obesity is crushing our nation and especially the young people. Overweight teens have no concept of the problems they will be facing in their 30’s and 40’s if they don’t do something now.
September 9th, 2008
A lot has been made over the years about diet and exercise being key components of a successful battle with hypertension or high blood pressure. But from the fringes we keep hearing snippets about drinking a glass of wine a day, eating dark chocolate and other things that seem oddly out of place.
Diet and dark chocolate! Diet and dark chocolate! Almost seems oxymoronic. I know from my experience that when I’m munching down dark chocolate, the word diet is secretly deleted from my brain during that moment. Maybe that is the power of antioxidants. Maybe they aren’t really good for you, they just erase guilt from your mind so, a little wine, a truffle….life is good.
But such is not the conclusion of studies that show that antioxidants actually do lower high blood pressure. This happens through a process of antioxidants inhibiting something called free radicals (sounds like something out of the 60’s).
This ability to inhibit free radicals can have far reaching effects, staving off high blood pressure which can prevent strokes and helping to prevent some of the big boys like heart disease and cancer.
So, will you get lower life insurance rates if you explain on your application that you eat blueberries or dark chocolate or (yum), dark chocolate covered blueberries from Harry and Davids, daily? Well, not from the mere mention of the fact you won’t, but a healthier you is a better life insurance risk and that should lead to lower rates.
Bottom line. Do what your mom told you. Eat chocolate and drink wine….and eat your vegetables. Science is on her side.
June 24th, 2008
I have written in the past about life insurance underwriting on type 2 diabetes and also on heart disease. I think I have been very clear about the fact that life insurance underwriters are adamant about good control of diabetes and also we’ve discussed the problematic underwriting of the combination of diabetes and heart disease.
We’ll see where current studies guide diabetics and how underwriters react, but one recent studysuggests that type 2 diabetes, well controlled or not, results in a high occurrence of heart disease.
Heart attacks and strokes are the leading cause of death among type 2 diabetics and the ADA suggests that the rate of death among diabetics due to heart disease is possibly as high as 75%.
All of that is to say that perhaps life insurance underwriters are putting to much emphasis on driving glucose numbers down, possibly putting too high an emphasis on a low hbA1c. Current studies would indicate that may be the case, but don’t look for underwriters to jump on the bandwagon until more conclusive results are brought forward to back up the initial findings. I can see any changes going one or two ways. They may become less stringent about glucose levels, but may adjust mortality tables to reflect the high occurrence of heart disease in diabetics.
Currently the most critical underwriting factors for diabetes are age of onset, level of control as measured by the hbA1c, and any complications that have manifested themselves due to the diabetes such as neuropathy, retinopathy and heart disease. The best underwriting and rates would go to late onset (after age 50), an hbA1c of 6.5 or under and no complications.
Bottom line. The studies throw out some pretty sobering news and also, I think, some very useful news for those who have been battling to drive down their glucose levels. I’ll keep you posted as to any changes we see in underwriting guidelines, but as I said, I suspect those changes will be slow in coming.
June 7th, 2008
We all know about the link between high blood pressure and strokes and/or heart attacks. In my slightly unscientific mind it is something like blowing up a balloon a little too much a few too many times.
There is a thing called white coat syndrome, named such because of the white coats that most doctors used to wear when they would see you in their office (they’re much more casual now). Anyway, the result of white coat syndrome is that a person whose blood pressure is normally, if not always, in the normal range, will without fail have a spike in their blood pressure readings when they have their blood pressure taken at the doctor’s office.
Studies have shown that white coat syndrome has little or nothing to do with a conscious fear of going to the doctor, the doctor or nurse themselves, or the office. It is apparently some kind of subconscious reaction. But, conscious or subconscious, the result is spikes in blood pressure that, if they were the norm, would have to be treated as they are generally spikes to very high levels.
The dance I wonder about in all of this is, if a patient is determined to have white coat syndrome and not treatable hypertension, what if there are other things that subconsciously elevated their blood pressure also? Could it be blood pressure spikes are a fairly frequent occurrence and that the only place it is noted is at the doctor’s office? I wonder how a doctor can determine that, even though a patient tells them the readings at the local drug store or with a home monitor are normal, that readings if they were taken in a traffic jam or at the dentist’s office or during football games, aren’t elevated also.
If the visit to the doctor’s office is just the tip of the blood pressure iceberg, it seems that there is a real chance of people with chronic blood pressure spikes running around out there not getting the medical help they should. Call me a skeptic, but if something can trigger this subconsciously in a doctor’s office it seems that you’re talking about a fairly strong subconscious.
From a life insurance standpoint well controlled, treated high blood pressure is really not a big deal. Most companies will offered preferred, if not preferred plus rates. If you are applying for life insurance and have been told that you have white coat syndrome, tell your independent agent right up front. This gives your agent a chance to do a couple of things that may help you put the syndrome in context for the insurance company.
First, your agent can let the examiner know so they might take more than the normal three readings. Often successive readings will get lower. The examiner will also know to time a blood draw so that it doesn’t impact the blood pressure readings by creating a nervous situation. Second, the agent can let the company know about your diagnosis of white coat syndrome so that they are not surprised by readings in your medical records. And lastly, you should make sure that your doctor has, in fact, diagnosed white coat syndrome and noted it in your medical records. If it isn’t addressed in your medical records the insurance companies will not buy it as a defense for high blood pressure.
Bottom line. White coat syndrome has been a real diagnosis for a long time. Whether or not I completely buy into it, if it is well tested and documented, it can be used as an affirmative defense against otherwise damaging high blood pressure readings on an insurance exam or in your medical records.
Just a personally skeptical aside. If I was told I had white coat I believe I would asked to be tested across a broad spectrum of psychologically stressful situations. I would hate to go through life merrily believing I had some subconscious quirk that elevated my blood pressure only in one situation, only to find out when I suffer a stroke talking to a mortgage banker that the issue was more wide spread than was thought.
June 2nd, 2008
I was having a discussion with a private pilot concerning life insurance one day. This particular pilot had been a client for some time and a few year earlier had suffered something akin to a stroke. The FAA had pulled his license after the incident.
He was calling to let me know that the FAA had just cleared him to fly again so he wanted to get back on track with his goal prior to the health issue of obtaining more life insurance. His logic was that if the FAA considers him well enough to fly an airplane, certainly insurance would agree that his medical risk had substantially improved and would offer him good rates. Ultimately we found a company that would accept the risk and would cover his aviation, but not at the rates he had hoped for. We hope to improve on that in the future, but it was clear that there was not a direct correlation between the FAA opinion and that of life insurance underwriters.
This is an issue that we see in many forms, usually not as clear an argument as this. The truth is that there is no direct correlation between medical opinion and underwriting. While there is certainly weight given to the opinion of the treating doctor, ultimately underwriting is about assessing mortality risk, not short term health.
That is where the rub occurs. How often have I heard from clients that “my doctor said I’m doing just fine” or “the doctor said I have the heart of a person half my age”? Are the doctors lying to their patients? The answer is probably not. Doctor’s treat medical conditions and aren’t in the business of making long term projections. It would be a rare visit to the doctor indeed if you were told that “everything looks just fine and I expect you should live another 23.5 years if we stay on this course of treatment”.
I don’t fault doctors for this. It’s not their job to project you life span. On the other hand, a life insurance underwriter isn’t concerned with your short term health. They are more concerned with, based on mortality experience, assessing the risk based on factors such as how old you were when you had a heart attack and what the course of treatment was and how your current cardiac health might impact your life span.
One other note on life insurance underwriting. I know a lot of people think they make decisions without the medical knowledge they think it takes. The truth is that all insurance companies have a medical director, a physician who reviews all of the more complicated cases. So, as part of the process, the underwriter does obtain a medical opinion just to make sure they’re being fair.
Bottom line. You just can’t connect the dots between your doctor’s opinion and the opinion of a life insurance underwriter. They aren’t looking at it from the same perspective. They don’t focus on the same things. They weren’t born on the same planet. While I have had my fair share of disagreements with underwriters, I have probably had a similar number with doctors.
June 1st, 2008
Probably one of the most challenging parts of life insurance is explaining to clients why their, at least to them, seemingly innocuous health issue impacts their life insurance rates. Their belief is that if it isn’t bothering them too much and their doctor hasn’t told them to buy a house close to the emergency room, what’s the big deal?
Sleep apnea is one of those issues. In most cases of obstructive sleep apnea a person would probably claim that they had overcome their only real mortality issue, that being their demise at the hands of their spouse if they didn’t do something about the snoring.
The most common risk factor (cause) of sleep apnea is obesity. While it is not uncommon in other cases, it is a relatively frequent occurrence among those who have lost control of their weight. In most cases the issues that arise from sleep apnea, snoring and sleep deprivation, are those kinds of things that fall into the “so what” category when a person is trying to wrap their mind around their own perceived life insurance risk.
The issue that very often doctors don’t talk about with their patients is the connection between sleep apnea and CAD (coronary artery disease), stroke and congestive heart failure. It is my belief that most doctors aren’t real keen on attempting to help people get a grip on lifestyle issues, so they treat the symptom and don’t discuss the underlying causative issues.
There is a definitive link between these issues, although the still unclear factor is whether sleep apnea leads to an increased risk of heart disease and stroke, or whether it is obesity that is the real culprit. Studies are ongoing to determine that answer. The other issue of congestive heart failure seems to be very clear. While sleep apnea doesn’t cause CHF, it absolutely aggravates it.
From a life insurance standpoint, while none of these cause and affect scenarios are consistent from person to person, underwriting has to consider the issues. Sleep apnea, if well controlled, is ultimately insurable at very good rates as long as it is characterized after testing as mild to moderate. Severe sleep apnea is generally still insurable, but there can be increased rates.
Bottom line. It’s not your snoring that concerns life insurance underwriters. If you have sleep apnea and need life insurance, find an independent agent who understands sleep apnea. They will know what questions to ask and most importantly, what companies will help you and what companies to avoid.
May 24th, 2008
White coat syndrome is a fear reaction that people have to doctors and nurses (hence the white coat) that causes their blood pressure to spike when one of these professionals takes readings. This presents several challenges both for the patient and doctor and also for the life insurance underwriter.
When talking with a client who has white coat syndrome they will tell you that in fact they aren’t really scared of the doctor or nurse, but something about them strapping the cuff on causes them to react. They can go before or after to a local drug store that has a blood pressure monitor and when they do it themselves, they come out with normal readings.
One of the challenges for a life insurance underwriter is determining if it is true white coat syndrome, in other words, is the doctor’s office the only place where blood pressure spikes? One of the concerns is that the “white coat” is really just an anxiety reaction that could also be duplicated in other normal, everyday occurrences such as traffic jams, being pulled over by a policeman, meeting with a banker or perhaps being called in to discuss something with your supervisor at work. Is it really just restricted to the doctor’s office?
Doctors will sometimes test patients by providing them a cuff so that they can provide a more comprehensive study of their blood pressure outside the office. There is also a 24 hour monitor that will provide readings over a full day so a person doesn’t have to consciously be concerned with the test or compiling the results. This will help the doctor determine if the situation is truly isolated or if they patient actually should consider treatment because readings pop up as high in other situations.
Blood pressure, of course, is of concern to both doctors and life insurance underwriters because it is a risk factor for heart attacks and stroke. High blood pressure or even borderline high blood pressure should be monitored and treated if the elevation warrants.
Bottom line. Blood pressure is worth paying attention to. High readings at your doctor’s office should always be checked out in other ways to determine if it is a white coat anomaly or the tip of a dangerous iceberg.
May 5th, 2008
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