MRSA: Believe it or Not - Maggots as the Cure?

Put away the expensive antibiotic gels? Maggots might be the best cure for superbug MRSA infections. A University of Manchester team treated diabetic foot ulcers with green bottle fly larvae, Lucila seicata, and 12 out of 13 were cured within 3 weeks with no adverse reactions. Conventional treatment takes 28 weeks. Known as Maggot Debridement Therapy (MDT), it is the medical use of maggots for cleaning non-healing wound. Researchers in the US at the University of California, Irvine use the common blow fly, Phaenica sericata. Veterinarians are now using MDT to treat non-healing wounds in their patients - especially horses.

"Maggots are the world's smallest surgeons," according to Professor Andrew Boulton, head researcher. His team has been using maggots to treat diabetic foot ulcers for a decade. Other researchers in the UK have been experimenting with maggots for years. "You cannot say maggots are high tech and shiny, but they sure are effective," says Dr. Stephen Thomas, director of Biosurgery at Princess of Wales Hospital. The treatment, known as biologic debridement, is used quietly in the US to treat pressure ulcers in the elderly, using sterile maggots. Limitations to this type of therapy are limited access to sterile larvae and the psychological repugnance patients have towards using it. Clinical trials using maggot therapy for non-healing lower extremity ulcers in diabetic patients have been done here in the US but so far it is not used routinely. Use of Medical Maggots is regulated by the FDA and available by prescription only as a medical device in the care and treatment of wounds.

In 2006, 30,000 National Health Service (NHS) patients in the UK had maggots applied to their wounds. Civilizations have been using this therapy since the beginning of time - by the Mayan Indians and aborigines of Australia. American Civil War Army surgeons began using blowfly maggots to clean battle wounds and promote healing. The maggots produce enzymes which break down necrotic tissue, allowing clean, healthy tissue to grow. The green bottle fly larvae aren't the big, old things we are used to seeing in the garbage from the common house fly - the larvae are smaller than a grain of rice.

We might want to get used to critters as being beneficial to us. Leeches are being used again in microsurgery for reattachment of skin and body part. This is especially significant with injuries to or amputation of the penis where venous congestion of the shaft skin can interfere with reattachment postoperatively. Leeches reduce incidence of swelling and hematoma. Parasitic helminth worms, introduced into patients with Crohn's disease (who swallow them), help with recovery. Bug therapy is cost effective - the bugs are cheap and labor saving aids to treatment.

Thank you Ronald A. Sherman, MD, MSc, DTM&H for use of photo of maggots.

Labels: leeches, maggots, MRSA

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GERD: ACG 2007 Meeting NEWS

The American College of Gastroenterology held its annual meeting in Philadelphia October 12-17, 2007. Gastroesophageal reflux disease (GERD) is more than just heartburn - a common symptom experienced by millions of people everyday. GERD is a physical condition that allows acid from the stomach to back up into the esophagus - and symptoms of heartburn can last for several hours. If heartburn is experienced more than 2-3 times a week or if if there is blood or weight loss associated with heartburn, consult your doctor to see if you have GERD.

The problem with GERD is that continued exposure of acid, digestive enzymes and stomach juices can actually injure the lining of the esophagus. This is due to the lower esophageal sphincter relaxing too frequently, allowing gastric juices to flow backwards into the esophagus. The primary buffer against this is saliva so stop smoking if you smoke. Tobacco inhibits saliva, stimulates stomach acid production and relaxes the LES. Losing weight and not eating 2-3 hours before bedtime can help as well as avoiding foods which are known triggers of heartburn - chocolate, caffeine, fatty greasy food, tomato products, alcoholic beverages, and peppermint.

Many medications are available over-the-counter to manage GERD. The goal of treatment is to eliminate complications like esophagitis - or even more severe problems like esophageal cancer. GERD is also one of the most common causes of chronic cough. Men tend to have increased incidence of upright acid reflux, which occurs when a person is awake. Women tend to have increased incidence of supine acid reflux, which occurs when a person is sleeping.

One of the findings presented at the October ACG meeting is that nighttime acid reflux is associated with significant sleep impairment. Almost 50% of people with GERD report sleep impairment, snoring, sore throat, cough, wheezing or choking. To promote better sleep - follow the recommendations for preventing GERD and try sleeping with a wedge pillow to keep the head elevated.

If you experience pain with swallowing, or difficulty swallowing, have black stools or vomit blood - see a doctor as these a warning signs of more serious disease or complications.


Thank you a shot in the dark for use of photo Dumpr Heart Burn.

Labels: GERD, heartburn

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What You Need to Know Now about MRSA

The Centers for Disease Control and Prevention (CDC) hosted today an important clinician update about community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA). School closures and student deaths due to the so called Superbug are dominating the news. How do we protect our loved ones and ourselves?

The main thing the CDC wants us to be aware of is that 80% of these infections are skin infections. Staphylococcus aureus is a very common organism - 60% of us have it in our nose right now. Otherwise healthy people are getting extremely sick due to this infection as it becomes invasive. Why?

The infection presents as a common skin infection. It looks like a skin abscess or is commonly mistaken for a spider bite. It starts as a painful red bump that becomes necrotic (tissue dies). Clinicians assessing it may mistake it for a furuncle, boil or abscess. In newborns it may appear a breakdown of the skin under the diaper. MRSA now belongs in the differential diagnosis of every soft tissue infection. It is one of the most common causes of osteomyelitis after it becomes invasive.

MRSA infection will need to be treated with incision and drainage and antibiotics. If severe and recurrent, the infection will need to be treated aggressively with IV antibiotics and hospitalization.

Risk factors in the community are:

• Crowded living conditions (military barracks, boarding school)
• Frequent skin to skin contact (e.g. football)
• Compromised skin surfaces (e.g. turf burns - football)
• Sharing contaminated items (e.g. towels - football)

Prevention tactics:

• Good personal hygiene and cleanliness
• Keep all cuts and scrapes clean and covered
• Clean all common surfaces with commercially available disinfectants
• Alcohol based hand sanitizers are as effective as hand washing for MRSA per CDC
• Shower immediately after contact sports
• Wear uniforms and practice clothes only one time
  
• Wash uniforms and practice clothes in hot water and soap
• Do not share soap, towels, deodorant or razors
• Clean and disinfect athletic gear, equipment and gym areas
• Report any infections to school nurse and coach
• Avoid contact with other people's infections
  

Every patient with an MRSA infection needs thorough patient education about wound care. This is crucial to prevent further infection and spread in the community.

Thank you dan wandery for use of photo: Priceless.

Labels: CA-MRSA, CDC, prevention

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Part III of Interview with Dr. Richard Carmona 17th Surgeon General of U. S.

This week we have been running excerpts of an interview we were privileged to have with 17th Surgeon General of the United States Richard Carmona MD, M.P.H., FACS. This is the final part and we hope that Dr. Carmona will find time in his busy schedule to impart more words of wisdom to us.

JC: If you had five minutes of prime time television, what message would you give to the American people about health?


Dr. C: We are headed on a disastrous course. Our quality of life is being seriously eroded and for the first time, we could see our children die before we do – all because of preventable illnesses. The good news is we know how to change it. Each person must take steps to change their behavior to be healthier. We need a cultural change, a sea change to embrace health and wellness. Each one of us must do what we can do today to adopt healthy behaviors.

Read these Healthline articles or view videos to learn more about healthy behaviors:

• Keeping Healthy: Avoiding Risky Behaviors
• Helping Overweight Children
• The Great Egg Debate
  
• Measuring True Fitness

Thanks to Google Images for use of photo.

Labels: Dr. Carmona, healthy behaviors

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Interview with Richard H. Carmona, M.D., M.P.H., FACS: Part II

Healthline is privileged to have Dr. Richard Carmona, 17th Surgeon General of the United States, as a member of our Board of Directors. He also serves at the renowned Canyon Ranch where he is vice chairman of the company, and is president of the non-profit Canyon Ranch Institute, as well as the first Distinguished Professor of Public Health at the Mel and Enid Zuckerman College of Public Health at the University of Arizona. Dr. Carmona has a lot on his mind that he wants to share with all of us about improving health and wellness and he was so generous as to spend some time with me, sharing his ideas.


JC: Could you talk about your work with Canyon Ranch Institute?

Dr. C: Canyon Ranch has established itself as the number-one brand in health and wellness for 28 years. Mel Zuckerman, the founder who created this whole enterprise out of a little piece of desert, feels a strong sense of social responsibility. His mission is to help others choose health and wellness and reject the disease thesis. When the University of Arizona wanted a college of public health, who do you think funded it? Mel and Enid Zuckerman funded it. Their Canyon Ranch has become a global organization with a goal to make the nation and the world healthier.

Once you are Surgeon General, you are always Surgeon General, and all of us Surgeons General are working to improve health disparities in the United States and around the world. This dovetails with my work here at Canyon Ranch Institute. We are doing exciting work in New York City – the South Bronx – one of the poorest communities in the country. We are helping our partner there to start a Life Enhancement Center at their Federally-Qualified Community Health Center in order to promote health and wellness habits. I am working with David Satcher, MD , PhD, 16^th Surgeon General of the United States, on a project in Atlanta. We are working on projects in the Hispanic community in Arizona. We are working with the Cleveland Clinic Foundation on a health education project for high-school students in Cleveland. We are exporting best practices to communities that can’t afford to come to Canyon Ranch. We’re translating the best available science in culturally competent ways to help people understand and use the information to effect behavior change that leads to improved health.

JC: Can you elaborate on the idea of “rejecting the disease thesis”?

Dr. C: The disease thesis is the idea that as we age we are going to have chronic diseases. We live sedentary lifestyles, engage in high-risk activities – drinking too much, smoking, riding in a car without a seatbelt. The reality is that 75% of all chronic diseases are preventable. The national health care budget is $2.1 trillion or 16% of the GNP. $1.5 trillion of that is spent on illnesses that could be prevented – if we reject the disease thesis that we are “inevitably” going to get sick. Diabetes, obesity, cancer – are all preventable illnesses for the most part. We want to change the culture to a culture that embraces health and wellness, and we have the science to support that approach.

JC: What about in poor communities where there is limited access to health-promoting foods like fresh produce?

Dr. C: You are what you eat and we want to improve the health literacy of the nation. One-third of people in the United States don’t understand the connection between what they do and eat and their health. We have unique communities where health disparities exist. Not only is there lack of access to produce, people on food stamps need to stretch their dollars so they buy the cheapest foods – like lots of starches and so forth to fill up with. We have tremendous areas of challenge in our nation

JC: Food deserts, they are called.

Dr. C: Yes, and there could be increased job opportunities, too, but there is the perception that these neighborhoods are too risky. I grew up in neighborhoods like that, and I know that if you empower people with the resources, they can make their communities healthier. It’s about tapping into their social structures and leaders – the people like my abuelita – my grandmother – who made all the food and health decisions for our family.

Thank you straightedge217 for use of photo South Bronx.

Labels: David Satcher, global health, public health, Surgeon General, wellness

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Interview with Richard H. Carmona, M.D., M.P.H., FACS: Part I

I had the honor and joy to spend some time speaking with Dr. Richard Carmona, 17^th Surgeon General of the United States. This week I will post a series of excerpts from my interview with this warm and remarkable man.

Readers of previous posts know that Dr. Carmona is a member of Healthline’s Board of Directors and now serves at the renowned Canyon Ranch, where he is vice chairman of the company, which many of you know as the world’s leading Life Enhancement Company. He is also CEO of Canyon Ranch Health, president of the non-profit Canyon Ranch Institute, and the first Distinguished Professor of Public Health at the Mel and Enid Zuckerman College of Public Health at the University of Arizona. Dr. Carmona has a lot on his mind that he wants to share with all of us about improving health and wellness. Here is some of what he has to say:

JC: Your career has included being a nurse, lifeguard, soldier, business executive, paramedic, SWAT team leader, and trauma surgeon. How did those experiences prepare you for your career now and as Surgeon General?

Dr. C.: There is a common theme that runs through all of them – I have been a first responder my whole life. In every one of those jobs, I have had to stay physically active and healthy to be able to perform my duties. This has given me an appreciation for the need for optimal health and wellness.

You can’t apply for the job as Surgeon General. The president of the United States asks you to do it and the U.S. Senate has to approve you for the position. I took a circuitous route to every other job you mentioned. I grew up poor; I was a high school dropout; I enlisted in the Army at age 17; and I went to Viet Nam and served as a Special Forces medic and weapons specialist. Eventually I became a trauma surgeon, a critical care doctor. Every one of those jobs contributed to my having a broad perspective of the health care system and prepared me for being Surgeon General with the biggest medical practice in the world – 300 million Americans.

Having walked in the shoes of the colleagues in each of the professions I worked in, I understood America’s health care problems from each profession’s perspective. The Office of the Surgeon General calls for multidisciplinary solutions to complex problems and I was prepared because of my experience in all of those different roles.

JC: Tell me about how you became a nurse…

Dr. C: I was a paramedic when I left the service – Army Special Forces Training – in the early 1970s. And in California in those days you could get certification to become an RN with that training. I worked in Long Beach California as an emergency and critical care RN while I was going to school full-time.

JC: You were in medical school then?

Dr. C.: No, I had to start from the beginning, because I had been a high-school dropout. I worked as a nurse on the night shift and went to school full-time during the day. First I had to get a General Equivalency Diploma (GED) and then I went to college as an undergrad. This was just a couple of years after Viet Nam and I was the only male nurse at the hospital where I worked. The nurses saw that I was working hard, trying to study, and they had so much compassion for me. They really took care of me. It was as if they had adopted me. They gave me a hard time about going to medical school – leaving one great profession like nursing for medicine, but they understood. And that is why I remain such a champion of nurses today. My daughter is a nurse in Phoenix, Arizona. The nursing profession is one of the most untapped resources to unify the American people. Nurses are leaders and agents of change. Nurses can help change the behavior of Americans to adopt a healthy lifestyle. Nurses were there to help in New Orleans when Katrina struck – I deployed 2500 nurses to help. They are the most undervalued health care resource we have.

I am so happy I was a nurse first. When a doctor sees a patient, he sees a chief complaint. When a nurse sees a patient, she sees a person in an environment whose health is impacted by many factors. In my view, nurses embody kindness, compassion, and professionalism 24/7.

Thank you interplast for use of photo "PACU Nurse Tina Cerruti Reading to Post-op Patient"

Labels: Canyon Ranch, MD, Mel Zuckerman, nurses, Richard Carmona, Surgeon General, wellness

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Health Care in the Navajo Nation: Dine Hozho

At Healthline, we love receiving reader feedback from all over the world. This week, we received a greeting from Mr. Kimbrow Talk, a health educator on the Navajo Nation. He reports the challenges of delivering health care and education to his people, many of whom still lack running water and electricity. Mr. Talk, father of three, does home visits and provides health education to elders in the Navajo language. He is but one of the unsung heroes of health care, working to improve health care disparities in our world.

The Navajo Nation is the largest tribe in the US - and one of the youngest with a median age of about 22 years. The per capita income is $6,000 compared to the US average of $21,000 and more than 56% of the Navajo population live below the poverty level. The unemployment rate is 10 times the national average - 43% as opposed to 4.3%. The Navajo Nation is a vast geographic territory challenged by lack of infrastructure in the 21st century. Inadequate paved roads, telecommunications, running water, electricity, sanitation and emergency services all make delivery of health care services challenging.

Interestingly, the people of the Navajo Nation fare better than the general US population in cancer and heart disease deaths. Far worse are deaths from diabetes, alcohol, and pneumonia/influenza. The US death rate for pneumonia/flu is 13% and the Navajo Nation is 21%. What can be done to improve that number? Prevention is key, especially for the elderly or the those with chronic illnesses like asthma. Now is the perfect time for an immunization campaign for both pneumonia and influenza.

Other keys to preventing the flu and pneumonia:

• stop smoking: use of tobacco decreases the body's ability to ward off infection
• wash your hands frequently to prevent the spread of germs
• cover your mouth and nose when sneezing and coughing. Germs travel 3 feet when we sneeze!
• discard tissues properly so that others avoid contact with them
• wash dishes in hot water so that others are not contaminated by germs
• wear a mask or scarf over your mouth and nose when cleaning dusty and moldy areas.

Best of luck to the Health Educators of the Navajo Nation! Dine Hozho.

Labels: health disparities, health education, Navajo nation

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Think Twice: New Clues in Schizophrenia

Remember that Phil Collins song advising us to Think Twice before we judge the crazy people in the street? Research published this week in the Journal of Neuroscience confirms that Collins was spot on. Schizophrenia is developmental disease and now scientists are learning that gene-related problems involving neurotransmitters in the prefrontal cortex of the brain may be the heart of the matter. This offers potential promise for better medications to treat abnormalities in the production of the chemical messenger GABA. Researchers have identified problems with the gene GAD1 which produces an enzyme essential for production of GABA and Mll1.

Schizophrenia affects 2 million US citizens and 6.6 million Europeans - yet despite advances in science, we can't shake the stigma attached to the disease. Shizophrenics remain the subject of ridicule, fear and disdain - even though we know rationally they are not possessed by demons, weak-minded or flawed. An accompanying problem is loss of working memory, which may account for the disorganized thinking and loose associations seen in schizophrenia. Clozapine is one antipsychotic medication that appears to help with severe symptoms.

Schizophrenia is an extremely disabling, life-long brain disorder. People whose brains are afflicted with this genetic problem hear voices, have hallucinations and believe others are controlling their thoughts. Schizophrenics have difficulty managing their lives and maintaining employment. Children may not manifest signs of the brain disorder until their late teens. The critical ages are 17-28. So do think twice - that person talking to themselves on the street is someone's child with a brain disorder - someone's child who may not have health insurance and may not have access to medications and treatment needed to control the symptoms of the genetic illness.





Thank you lauradahl for use of HERA[Hemispheric Encoding/Retrieval Assymmetry] Graphic.

Labels: GABA, genetic research, neurotransmitter, prefrontal cortex, schizophrenia

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Thank you Dr. Adam of NY Emergency Medicine for Grand Rounds 4.4

Dr. Adam hosted this week's edition of Grand Rounds at his blog , NY Emergency Medicine. There is something for everyone in his selection, and he included my post Mental Health Awareness Week: October 7-13: What about the Children of our Troops? . Thanks for a great job of putting together some fascinating reading and for including so many Healthline writers.

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Disaboom: Website for People with Disabilities

Disaboom.com is a new - just launched- website targeting the 650 million adults who live with disabilities around the world. 54 million disabled people live in the US. It's mission is to be a resource for the disabled, their caregivers, families, employers and providers. Glen House, MD, himself a C7 tetraplegic, is the founder of the website. He also serves as the Medical Director for the Center for Neuro and Trauma Rehabilitation at Penrose Hospital. He was addicted to adventure, risk and thrill - an extreme skier who fractured his neck when a college student skiing in Utah. That didn't stop him from finishing college, going to medical school and going on to another risky venture - an internet start-up.

The product has been in the works for 4 years. CEO J.W. Roth has helped grow other start-ups. Disability is a scary word to a lot of people - a lot of us don't know how to act or what to say around people who are disabled. People with disabilities are just like the rest of us. Disaboom.com is a community to help people flourish and live fully after suffering a disabling injury or illness. It is based on social networking with content written by the top folks in the industry. It takes people beyond what the health professionals in rehabilitation centers provide
and take the disabled to the next level. Disaboom.com wants to help decrease the stigma of disability.

Disaboom.com is striving to be the biggest job portal for people with disabilities and a conduit for adjusting to job change due to disabilities - including disabilities due to aging. Veterans and wounded warriors - check out Disaboom.com.

They recently acquired Lovebyrd.com, a dating community and friendship network for singles with disabilities, founded in 2002. What to do with your date? Disaboom.com has a Reviews section where both food and accessibility are reviewed. Disaboomers can write blogs and post messages and bios about themselves. This is an exciting new site for people with disabilities and those who care about them.

Labels: disability industry, empowerment, extreme sports

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Who Knew? Hip Fractures pose Greater Risk to Women than Cancers

A recent report in the Journal of the American Academy of Orthopaedic Surgeons
highlights how important osteoporosis is as a public health concern. Patricia A. Thomas, MD, one of the researchers, reports significant morbidity and mortality associated with osteoporosis due to hip fractures.

More women die of hip fractures nationally than die of breast cancer.

• 20 percent of women die within one year
• 20 percent become permanently disabled
• hip fractures cost $18 billion annually in hospital expenditures in the US
• Hip fractures result in one of the biggest Medicare expenditures
  

Dr. Thomas was specifically concerned with health disparities and the lack of awareness about prevention of osteoporosis in minority groups.

• While 41% of white women are familiar with the disease only
• 25% of black women are
• 19% of latino women are
• 17% of Asian women are familiar with osteoporosis and behaviors that help maintain bone mass.
• 
  
• 
  
• Black women are twice as likely to die within the first year after a hip fracture and more than 1.5 times more likely to die while hospitalized for a hip fracture.
  What people do not realize is that after a hip fracture, previously healthy people tend to deteriorate mentally and physically. Blood pressure falls due to blood loss and there is a need for blood transfusions.
  
• 
  
• Osteoporosis is a silent disease - but it can be prevented. Get regular exercise. Get a bone density test.
  
• If you have relatives who have been diagnosed with the disease or have history of fractures - you may have a higher risk factor.
  
• omen are at greater risk for osteoporosis.
  
• Post-menopausal women have an even greater risk.
  
• People who smoke have increased risk
• People who abuse alcohol have increased risk

Walking vigorously, low impact aerobics, taking vitamin D, calcium supplements and some medications all help prevent osteoporosis.

Thank you radiant.baby for use of photo.

Labels: health disparities, minority health, osteoporosis

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Global Healthbeat: Folic Acid Lowers Blood Arsenic Levels in Bangladesh

Arsenic contaminated drinking water is a major public health concern in 70 countries, including the US. 100 million people world wide are thought to be affected. Chronic arsenic poisoning due to long-term exposure in drinking water causes cancer of the skin, lungs, bladder and kidney as well as other skin changes like hyperkeratosis according to the World Health Organization (WHO).

A new study conducted in Bangladesh has found that folic acid supplements dramatically reduces the blood arsenic levels in exposed individuals. The study was funded by the National Institute of Environmental Health Sciences (NIEHS) at the National Institutes of Health (NIH). Researchers found that treatment with 400 mcg. of folic acid reduced blood arsenic levels by 14%. Folate is a B vitamin found in leafy vegetables, citrus fruits, beans and whole grains. Researchers found that folic acid supplementation decreased the detoxification of arsenic to a form that could be more readily excreted in urine.

Effected countries include Argentina, Australia, Bangladesh, Chile, China, Hungary, India, Mexico, Peru, Thailand and the USA (mostly western states). On a related note, a different group of researchers has discovered that ferns, specifically the fronds Pteris vittata
remove arsenic from soil and water, soaking it up through their roots and absorbing it through their fronds. These pretty ferns are available through Edenspace at $4.95 a piece, are easy to grow and tolerate sunlight.

Thank you Ahron de Leeuw for use of Dhaka steamers (Bangladesh) photo.

Labels: arsenic contamination, folate, folic acid

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Dr.'s Got a Brand New Bag - Smartphones replacing the "black bag"

The percentage of active physicians using Internet-enabled smartphones is expected to increase from 49% in 2006 to 70% in 2011 according to a report by The Diffusion Group. Doctors report that the mobile eMarket is application-driven with solutions developed by physicians themselves.

TDG Research describes the health care industry as "a space in which mobile hardware and software innovations are embraced and rapidly developing." Consumers are driving the mobile eHealth application market. Carriers see the "mobile health ecosystem as a space rich in opportunities" and the yet there remains a lack of awareness of other applications. The needs of doctors are well suited for mobile devices and applications because they work in data-intensive environments with daunting work-flow problems. Physicians are mobile workers, traveling between medical practice facilities, hospitals and making rounds. They also require comprehensive up-to-date medical information.

Examples of these products are Epocrates, real clinical doc-in-a-box tool kits, including mobile continuing medical education (CME) opportunities. These applications, made to use with PDA's, have become portable reference manuals. Vendors see the healthcare marketplace as an area where under-utilization prevails. Adoption of new technologies is seen as a way to improve patient care and outcomes - because decisions will be based on up-to-date reference material.












Thank you Toasty Ken for use of photo Getting Smart.

Labels: doctors, eHealth, mobile eMarket, smartphone

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Understanding Medicare Part D: Prescription Plans

The six-week enrollment period for the Medicare prescription drug plan is coming up soon - enrollment begins November 15 through December 31, 2007 for the 2008 plans. Medicare's drug plans are subsidized by the US federal government and offered through private insurers. In January, 2006 Medicare enacted Part D as a supplemental insurance plan for seniors to offset the costs of increasingly expensive prescription medications. Part D is an optional plan in which the insured (consumers) pay a premium each month and Medicare pays for prescriptions. If you decide not to enroll in Part D when you are eligible, you may be charged a penalty for enrolling later on. The initial enrollment period (as of this writing) is the period three months prior to and three months after your 65th birthday. If you are disabled you may enroll three months before through three months after your 25th month of disability. This is called the Initial Enrollment Period. If you opt out of the Initial Enrollment Period and choose to enroll later, you may calculate your penalty by 1% of the national average premium for the year you choose to join and multiply it by the number of months you were eligible to join but didn't. Try explaining this to your grandkids when they ask why they need to learn math.

Insurance is confusing, and government subsidized insurance even more so. The Centers for Medicare and Medicaid Services has a 116 page publication (available online or you can request it by mail by calling 1-800-633-4227) entitled Medicare & You 2007. If you have prescription drug coverage through your or your spouse's employer or union, check with the benefits administrator before enrolling in any Medicare Plans as it may impact your coverage. If you drop your employer or union group coverage, you may not be able to get it back. If you have prescription drug benefits through the VA, Tricare or the Federal Employee Health Benefits Program (FEHBP) you may not need Part D, although if you choose to enroll, it could offset your costs and copayments. A list of the stand-alone Medicare Prescription D plans may be found here.

Plans are regional and it is important to compare Medicare drug plans offered in your area before enrolling. The cheapest premium does not always mean your lowest cost option. Look over each plan and the specific drug coverage rules for filling prescriptions (formulary). Compare your list of prescriptions against monthly premiums, deductibles, copayments and coinsurance. (And you thought you were retiring?). What about the convenience factor? Does the plan you want work with your pharmacy of choice, or send your medications through the mail? If you spend your winters in a different place, will the plan you choose accommodate that? If you move out of your Medicare plan's coverage area, you may enroll in a new plan as early as the first day of the month before you move.

Be aware of certain rules that your plan may follow - prior authorization, limited quantities of refills (important to pre-plan if you are going on vacation or out of the country for any length of time) and step therapy (lower cost medications must be tried first unless Medicare grants you an exception). The premium for your Part D prescription plan can be deducted from your Social Security benefits, from a savings or checking account, or you can opt to receive a monthly bill in the mail. Medicare.gov has a Medicare Prescription Drug Plan Finder to help you find the plan that is best for you. Review your plan now and enroll early to take advantage of your best options.

Thank you Bekah stargazing for use of photo.

Labels: enrollment, Medicare Part D, prescription drug plans

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Dr. Rob, in the style of Dr. Suess, hosts Grand Rounds

Do not miss this edition of Grand Rounds. Written in the style of a Dr. Suess book, he offers plenty of great medical reading in an entertaining format. Some of the more interesting posts are from diabetic patients who come clean about being non-compliant. He included my post Canyon Ranch - Be Your Best Self At Any Age! Thank you Dr. Rob. You made my day!

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Lifestyle changes could prevent 1 in 10 cases of breast cancer by 2024

Cancer Research UK wants women everywhere to know that some simple lifestyle changes will reduce incidence of breast cancer cases. What can you do to prevent breast cancer?

• maintain a healthy body weight
• exercise more
• reduce use of hormone replacement therapy (HRT)

The risk of breast cancer in postmenopausal women is 25% higher for those who are obese compared to those with normal weight.

• New studies show that even small amounts of alcohol increase the risk of breast cancer so keep your alcohol intake to one drink per day.
  
• Breastfeeding for six months reduces the risk of the disease

The message is clear - stop smoking, stay active and in shape. Limit alcohol and eat a healthy diet with plenty of fruits and vegetables and decrease your fat and sugar consumption. Protect yourself from the sun. Do regular breast exams and follow through with all screenings with your doctor.

Thank you Alexandra Moss for Women Exercising in Guanshan Park- Fuyang photo.

Labels: breast cancer, lifestyle

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