Health Care and Medicaid

One of the most difficult health care issues facing America today is Medicaid, the state run public healthcare assistance program for people who are poor. The technical description of Medicaid is that is a federal program that provides health coverage to nearly 60 million children, families, pregnant women, the elderly, and people with disabilities, and it is administered at the state level. Medicaid covers US citizens and eligible immigrants.

All States provide Medicaid to infants and children under age 6 with family incomes up to 133% of the federal poverty level, or FPL. Medicaid is available in every state for children under age 19 with family incomes up to 100% of the FPL. For a family or household of 4 persons living in one of the 48 contiguous states or the District of Columbia, the poverty guideline for 2015 is $33,465 if your state is expanding Medicaid. Separate poverty guideline figures are developed for Alaska and Hawaii, and different guidelines may apply to the Territories.

Medicaid pays for a full set of services for children, including preventive care, immunizations, screening and treatment of health conditions, doctor and hospital visits, and vision and dental care. In most cases, these services are provided at no cost to families.

Medicaid is the largest source of funding for medical and health-related services for people with low income in the United States. It is a means-tested program that is jointly funded by the state and federal governments and managed by the states, with each state currently having broad leeway to determine who is eligible for its implementation of the program, according to CMS, the Centers for Medicare and Medicaid Services.

States are not required to participate in the program, although all currently do. Medicaid recipients must be U.S. citizens or legal permanent residents, and may include low-income adults, their children, and people with certain disabilities. Poverty alone does not necessarily qualify someone for Medicaid.

The Patient Protection and Affordable Care Act significantly expanded both eligibility for and federal funding of Medicaid. Under the law as written, all U.S. citizens and legal residents with income up to 133% of the poverty line, including adults without dependent children, would qualify for coverage in any state that participated in the Medicaid program.

However, the United States Supreme Court ruled in National Federation of Independent Business v. Sebelius that states do not have to agree to this expansion in order to continue to receive previously established levels of Medicaid funding, and many states have chosen to continue with pre-ACA funding levels and eligibility standards.

According to the Kaiser Family Foundation (KFF), Medicaid is the nation’s main public health insurance program for people with low income and the single largest source of public health coverage in the U.S. covering nearly 70 million Americans. States design and administer their own Medicaid programs within federal requirements, and states and the federal government finance the program jointly. Medicaid plays many roles in our health care system.

Medicaid coverage facilitates access to care for beneficiaries, covering a wide range of benefits and tightly limiting out-of-pocket costs for care. As a major payer, Medicaid is a core source of financing for safety-net hospitals and health centers that serve low-income communities, including many of the uninsured. It is also the main source of coverage and financing for both nursing home and community-based long-term care. Altogether, Medicaid finances 16% of total personal health spending in the U.S.

There are, of course, a number of arguments against expanding Medicaid, according to the Atlantic Magazine. While the federal government would pick up much of the immediate cost of the new enrollees, it sticks states with 10 percent of the tab after 2020. A 2014 study found that people use emergency rooms more, not less, once they enroll in Medicaid, somewhat undermining the argument that the expansion would funnel more people toward cheaper primary-care doctors. (Though it’s worth noting that people tend to use all sorts of healthcare more — not just ERs —once they get insured.) And physicians are indeed reluctant to accept Medicaid: Its lower reimbursement rates mean that more than a third of doctors won’t see new Medicaid patients, a shortage that is especially acute among specialists.

Studies on Medicaid’s health benefits show mixed results. One Urban Institute paper found that Medicaid provides its beneficiaries with similar access to care as employer-sponsored insurance, except at a lower cost for the individual. For example, patients would spend more than four times as much on out-of-pocket medical expenses if they were uninsured, and three times as much if they had employer insurance, as they do with Medicaid.

Meanwhile, another New England Journal of Medicine (NEJM) study that looked at Oregon residents who won a Medicaid lottery found that getting coverage generated no significant improvements in cholesterol or hypertension in the first two years. It did, however, encourage people to go to the doctor more, raised their rates of diabetes detection and management, lowered rates of depression, and reduced financial strain. A NEJM study also found that states that had previously expanded Medicaid saw a 6.1 percent reduction in the death rate among adults younger than 65. While critics of Medicaid point out the program’s spotty record of saving money or alleviating certain health conditions, its proponents say that many of its shortcomings apply to Medicare and private insurance as well.

According to KFF, as of March 2015, 22 states were not expanding their programs. Medicaid eligibility for adults in states not expanding their programs is quite limited: the median income limit for parents in 2015 is just 44% of poverty, or an annual income of $8,840 a year for a family of three, and in nearly all states not expanding, childless adults will remain ineligible.

Further, because the ACA envisioned low-income people receiving coverage through Medicaid, it does not provide financial assistance to people below poverty for other coverage options. As a result, in states that do not expand Medicaid, many adults will fall into a “coverage gap” of having incomes above Medicaid eligibility limits but below the lower limit for Marketplace premium tax credits.

Nationally, nearly four million poor uninsured adults fall into the “coverage gap” that results from state decisions not to expand Medicaid, meaning their income is above current Medicaid eligibility but below the lower limit for Marketplace premium tax credits. These individuals would have been newly-eligible for Medicaid had their state chosen to expand coverage. Nationally, 43% of uninsured adults in the coverage gap are White non-Hispanics, 24% are Hispanic, and 27% are Black.

The ACA Medicaid expansion was designed to address the high uninsured rates among adults living below poverty, providing a coverage option for people who had limited access to employer coverage and limited income to purchase coverage on their own. However, with many states opting not to implement the Medicaid expansion, millions of adults will remain outside the reach of the ACA and continue to have limited, if any, options for health coverage: they are ineligible for publicly-financed coverage in their state, most do not have access to employer-based coverage through a job, and all have limited income available to purchase coverage on their own. A significant amount of info on Medicaid can be found at this site: http://kff.org/health-reform/issue-brief/the-coverage-gap-uninsured-poor-adults-in-states-that-do-not-expand-medicaid-an-update/.

Medicaid is a very expensive program to maintain and administer. And, at some future date, there is a tipping point where it won’t be sustainable or a viable option for states or the federal government. Not to mention, physician drop out in Medicaid is increasing at a greater rate since the Affordable Care Act negotiated reimbursements in the past few years.

What are the options? Charitable organizations are one option, and they are going to need to increase their work in communities affected by the lack of income based families who can afford insurance. Another option would be to engage individuals in financial counseling and income opportunities. States should develop programs to assist those adults capable of working to find better employment options, and educational programs should be developed in partnership with community organizations to provide job skills and training.

Although Medicaid is a way to help families and individuals receive a limited form of health care, it is not the end all answer. More work needs to be done by all stakeholders to improve the financial wellness of those with limited incomes to move beyond the FPL, and to encourage the health care community to lessen access the restrictions to all types of medical care. Certainly, Medicaid should be seen more as a stop gap measure versus the lifestyle it perpetuates.

Until next time. 

Healthcare and Prescription Adherence

Individuals who take medications, especially seniors or those with chronic health issues, are supposed to be taking their prescriptions on regularly scheduled intervals. One of the most critical issues that health plans and medical providers face is the lack of prescription adherence. 

Taking your medications as prescribed is very important to your overall health regimen. Doctors are constantly dealing with patients who either refuse or forget to stay on track. As a consequence, many people suffer from problems related to the lack of consistency with their medications.

Prescription adherence is especially severe with anyone who has a maintenance medication, and does not maintain their adherence due to various reasons—cost, memory, fear, and other excuses. Medication adherence usually refers to whether patients take their medications as prescribed (eg, twice daily), as well as whether they continue to take a prescribed medication.

Medication non-adherence is a growing concern to clinicians, healthcare systems, and other stakeholders (eg, payers) because of mounting evidence that it is prevalent and associated with adverse outcomes and higher costs of care, according to the American Heart Association. It’s very important in cardiovascular care. For more details, read material at this website: http://circ.ahajournals.org/content/119/23/3028.full .

People do not realize the real damage or consequences of non-adherence, according to the American Heart Association. When patients with chronic conditions such as cardiovascular disease do not take medication as directed, the repercussions can be severe. For instance, not keeping blood pressure in check can lead to heart disease, stroke, and kidney failure.

In sum, poor medication adherence takes the lives of 125,000 Americans annually, and costs the health care system nearly $300 billion a year in additional doctor visits, emergency department visits and hospitalizations. There are many reasons why people are not able to take their medication as directed.

·         They may forget.

·         They may not be convinced of the medication’s effectiveness or be unsure that it is working.

·         They may fear the side effects or have difficulty taking the medication (especially with injections or inhalers).

And we all know that the rising cost of prescription medications is a barrier for many.

Some may face a combination of these reasons for not taking their medications. One person may face different barriers at different times as he or she manages his or her condition. Whatever the reason, you could miss out on potential benefits, quality of life improvements, and could lose protection against future illness or serious health complications. Much more detailed material on this subject can be located at this site: http://www.heart.org/HEARTORG/Conditions/More/ConsumerHealthCare/Medication-Adherence---Taking-Your-Meds-as-Directed_UCM_453329_Article.jsp

According to the American College of Preventive Medicine (ACPM), poor adherence to prescribed medication is associated with reduced treatment benefits and can obscure the clinician’s assessment of therapeutic effectiveness. Non-adherence is thought to account for 30% to 50% of treatment failures. Non-adherence leads to worse medical treatment outcomes, higher and avoidable hospitalization rates, institutionalization for the frail elderly, and increased healthcare costs.

Physicians play an integral role in medication adherence. Patients who trust their physicians have better two-way communication with their physician. Trust and communication are two elements critical in optimizing adherence. Numerous studies show that physician trust is more important than treatment satisfaction in predicting adherence to prescribed therapy and overall satisfaction with care. Physician trust correlates positively with acceptance of new medications, intention to follow physician instructions, perceived effectiveness of care, and improvements in self-reported health status.

A recent meta-analysis of physician communication and patient adherence to treatment found that there is a 19% higher risk of non-adherence among patients whose physician communicates poorly than among patients whose physician communicates well, according to the ACPM. Statistically, the odds of patient adherence are 2.26 times higher if a physician communicates well. This translates into more than 183 million medical visits that need not take place if strong interpersonal physician/patient communication occurs.

Communication contributes to a patient’s understanding of illness and the risks and benefits of treatment. Hence, the major challenge is to improve:

• Verbal and nonverbal communication (patient-centered care)
• Interviewing skills (improved competency)
• Discussions and provide greater transmission of information (task-oriented behavior)
• Continuous expressions of empathy and concern (psychosocial behavior)
• Partnerships and participatory decision-making (patient-centered care)

Among significantly more detailed information and additional statistics located at this website:  http://www.acpm.org/?MedAdherTT_ClinRef, a challenge to improve adherence is clearly stated. Poor adherence to medical treatment is widespread and well recognized, as are its consequences of poor health outcomes and increased healthcare costs. Lack of prescription adherence is estimated to annually cause 125,000 deaths. Consider these other statistics:

• Overall, about 20% to 50% of patients are non-adherent to medical therapy.
• People with chronic conditions only take about half of their prescribed medicine. 
• Adherence to treatment regimens for high blood pressures is estimated to be between 50 and 70 percent. 
• 1 in 5 patients started on warfarin therapy for atrial fibrillation discontinue therapy within 1 year.
• Underuse of anticoagulant therapy for prevention of thromboembolism is attributed to the risk factors of younger age, male gender, low overall stroke risk, poor cognitive function, homelessness, higher educational attainment, employment and reluctant receptivity of medical information.
• Rates of adherence have not changed much in the last 3 decades, despite WHO and Institute of Medicine (IOM) improvement goals.
• Overall satisfaction of care is not typically a determining factor in medication adherence
• Adherence drops when there are long waiting times at clinics or long time lapses between appointments.
• Patients with psychiatric disabilities are less likely to be compliant.

According to a new national poll by Greenberg Quinlan Rosner Research and Public Opinion Strategies, 40 percent of American adults suffer from some form of chronic illness, ranging from diabetes and cancer to heart disease and high blood pressure. In recent years, however, lack of regular adherence to medications has resulted in higher health care costs and an increase in the prevalence of chronic conditions that directly impact patient health. In fact, nine out of ten patients who adhere to their prescription medications describe their health as “good” or “excellent,” while two thirds of patients with poor adherence report the same.

A growing body of evidence suggests that medication adherence programs have the potential to reduce health spending and, in the process, generate significant savings for taxpayers. Policies to promote medication adherence have the potential to improve health and significantly reduce health spending, according to this organization: http://adhereforhealth.org/who-we-are/medication-adherence/.

There are some tools that can help remind people to take prescriptions. This particular website includes ways to keep track of your medicines, how-to videos about taking your medicine, and tips to help you talk with your doctor or pharmacist about your health problem and your medicine. For more information, go to this site: http://www.scriptyourfuture.org/tools/.

The average adherence rate (the degree to which patients correctly follow prescription instructions) for medicines taken only once daily is nearly 80%, compared to about 50% for treatments that must be taken 4 times a day. As many as 75% of patients and 50% of chronically ill patients fail to adhere to or comply with physician prescribed treatment regimens.

In a poll (Med Ad News 02/2010) of U.S. individuals 65 years old and older who use medications, researchers found that 51% take at least five different prescription drugs regularly, and one in four take between 10 and 19 pills each day. 57% of those polled admit that they forget to take their medications. Among those using five or more medications, 63% say they forget doses, compared to 51% among those who take fewer medicines.This website offers solutions for products to assist with prescription adherence: http://www.epill.com/statistics.html.

Remembering to take your medicine is the key to compliance. Medicine will be effective only when taken as prescribed by your physician. If you are a caregiver for someone who needs prescriptions taken on a daily basis, your responsibility to help them follow their regimen is especially important. According to the Rosalynn Carter Institute of Georgia Southwestern College, there are 25 million non-professional caregivers in the U.S., and 80% of those are women. Between 80% and 90% of people taking medications receive them from a family member. That’s why it is critical to be adherent to medication therapies.

Prescription adherence is such a huge health care issue in America that Congress is considering ways to mandate options to make it happen better. Organizations that promote adherence are all about education and awareness for the public to know how important the issue is relative to the population at large and the overwhelming costs to the economy. All stakeholders in the medical community--doctors, clinics, hospitals, health plans, pharmacists, etc--are in full stress mode to monitor and maintain the highest degrees of medication adherence.

If you are on regular prescriptions for maintenance medications, keep your schedule intact as much as possible and follow the instructions of your doctor and pharmacist. Even if your medication need is temporary, such as an antibiotic or other short term prescription, follow the directions.  Not only does this help you, but it provides safety and comfort to those around you. Plus, it reduces the possibility of a recurring illness or relapse.

Until next time.

Health Care and Meth Addiction

Drug abuse is a huge problem, not only in the US but also around the world. One of the most abusive drugs is methamphetamine, or “meth.” Crystal meth is short for crystal methamphetamine. It is just one form of the drug methamphetamine. Methamphetamine is a white, odorless, bitter-tasting crystalline powder that easily dissolves in water or alcohol.

In comparison to similar stimulants, much higher levels of methamphetamine enter the brain, making it a more potent stimulant drug. It also has longer lasting and more harmful effects on the central nervous system. Methamphetamine has many street names, such as speed, meth, and chalk. Methamphetamine hydrochloride, the crystal form inhaled by smoking, is referred to as ice, crystal, glass, and tina.

According to the Foundation for a Drug Free World, methamphetamine is a white crystalline drug that people take by snorting it (inhaling through the nose), smoking it or injecting it with a needle. Some even take it orally, but all develop a strong desire to continue using it because the drug creates a false sense of happiness and well-being—a rush (strong feeling) of confidence, hyperactivity, and energy.

Users also experience decreased appetite. These drug effects generally last from six to eight hours, but can last up to twenty-four hours. The first experience might involve some pleasure, but from the start, methamphetamine begins to destroy the user’s life. More details about Meth abuse is at this website: http://www.drugfreeworld.org/drugfacts/crystalmeth.html .

There are many warning signs that a person may be addicted to methamphetamine. The physical appearance of a person using methamphetamines may provide several key clues:

·         Skin picking: methamphetamine addicts are known to obsessively pick at their skin. The marks left by this picking may look similar to an extreme case of acne, often leaving open sores on the face.

·         Skin crawling: meth addicts also often complain about having crawling skin, a disorder known as formication.

·         Tooth decay: Another common sign is tooth loss or tooth decay, referred to as meth mouth.

·         Hair loss: due to the lack of nutrients in an addict's body as well as the dangerous chemicals they ingest, hair breakage frequently occurs as well.

Crystal meth has become more popular because it is easily produced in home labs using store-bought materials. It is highly volatile in the production stage. Symptoms of meth abuse include:

·         increased attention and decreased fatigue

·         increased activity and wakefulness

·         increased talkativeness

·         decreased appetite

·         euphoria and experiencing a rush

·         increased respiration

·         rapid/irregular heartbeat

·         hyperthermia

Once ingested, it creates fierce cravings, so physical dependence can start immediately. When you are physically dependent on a drug, it’s extremely difficult to voluntarily stop using. Entering an accredited drug treatment center that specializes in this type of drug addiction is the best way to succeed at sobriety. Some symptoms of withdrawal may include:

·         Paranoia

·         Tingling sensations on the skin

·         Confusion

·         Insomnia

·         Moodiness

·         Agitation

·         Fatigue

Methamphetamine affects the brain and can create feelings of pleasure, increase energy and elevate mood. Methamphetamines give someone the ability to stay awake and do continuous activity with less need for sleep. Methamphetamines, like regular amphetamines, also suppress a person's appetite and are sometimes used by people trying to lose weight quickly, according to this website: http://www.timberlineknolls.com/drug-addiction/meth/signs-effects.

Most of the pleasurable effects of methamphetamine are believed to result from the release of very high levels of the neurotransmitter dopamine. Dopamine is involved in motivation, the experience of pleasure, and motor function. Methamphetamine releases approximately twelve times the dopamine that food, sex or other pleasurable activities release. The elevated release of dopamine produced by meth is also thought to contribute to the drug's harmful effects on nerve terminals in the brain.

Meth addiction and dependency is a serious disease that is extremely difficult to address. Timberline Knolls Residential Treatment Center is a leading rehab and recovery facility for women suffering from methamphetamine addiction as well as other co-occurring disorders such as anorexia and bulimia.

According to research gathered in 2009 by the National Survey on Drug Use and Health, 1.2 million Americans ages 12 and over had abused methamphetamine in the previous year. Methamphetamine use is a national problem, and many families are looking for the right treatment for their loved ones who are suffering from an addiction to crystal meth. Finding the right program begins with knowing what questions to ask and what signs to look for. All addicts deserve proper care, and finding the right program takes careful consideration.

In addition to medical detoxification programs caring for individuals while they come off the drug, these programs can also provide ongoing care as needed during residential stays, according to this website: http://www.recovery.org/topics/crystal-meth-recovery/. This care may include medical care for physical problems associated with crystal meth abuse such as infected skin sores, or care for diseases that may have been contracted through the use of the drug, such as hepatitis B.

You should call any facility you are considering and ask about its on-site detox and healthcare amenities. Some facilities may even allow you or your family member to tour the center before committing to a stay. One of the most important questions to ask a crystal meth addiction treatment center is what aftercare options they offer. While an inpatient stay is a step in the right direction, ongoing care after rehab keeps a user focused on remaining sober. Some facilities offer their own outpatient programs to those who have completed an inpatient stay, while others may redirect care to another center.

Aftercare is important because it helps you acclimate to the new world of temptations outside of the safety of inpatient care. In essence, it is a guiding light in a world that may look a bit dark as meth addicts continue towards recovery. Many of the effects of crystal meth abuse are psychological. These effects can sometimes be worse than physical effects, as the suffering often goes unnoticed because the scars and pain cannot be seen with the naked eye.

You or a family member or friend may suffer from anxiety or psychosis as a result of abusing the drug, and the results can be life-altering. The best facilities also treat these mental effects and can keep them from spiraling out of control with counseling or medications, depending on your diagnosis.

Another benefit of seeking out centers that have mental health services is that they can care for any existing disorders you may have. According to the National Institute on Drug Abuse, a high proportion of addicts suffer from both addiction and mental illness at the same time, with 40 percent of drug users suffering from some type of mood disorder as well. Mental health facilities can also diagnose underlying conditions that someone addicted to methamphetamine may not even realize they have.

Addiction to methamphetamine in any form can be deadly. Your life is in jeopardy as soon as you start experimenting with this drug. No short term high is worth putting your life in danger. For treatment, see a professional health care provider who can assist with helping to prevent long term addiction, or worse.

Until next time. 

Health Care and Asthmatic Symptoms

Millions of people suffer from asthma or asthmatic symptoms, and the condition is characterized by inflammation of the bronchial tubes with increased production of sticky secretions inside the tubes. People with asthma experience symptoms when the airways tighten, inflame, or fill with mucus. 

In the United States asthma affects an estimated 26 million people including children, teens, and adults — many of whom aren’t aware that they have it, especially if their symptoms are not severe. Asthma does not discriminate against age, race, or sex.

Asthma causes a variety of symptoms that can worsen at any time, making breathing difficult. Asthma is a disease that cannot be cured, but it can be managed. Some days you may not have symptoms, but this doesn’t mean your asthma has gone away. Asthma doesn't have to slow you down.

You may still need to pay attention to how your asthma makes you feel, even when you don't have many symptoms. The more severe the inflammation and constriction become, and the longer they go untreated, the worse your asthma symptoms may be and the harder they may be to control. You may need to monitor your asthma symptoms every day, because the disease is always with you.

According to the American College of Allergy, Asthma, and Immunology (ACAAI), the most common symptoms are:

·         Coughing, especially at night, during exercise or when laughing

·         Shortness of breath

·         Chest tightness

·         Wheezing (a whistling or squeaky sound in your chest when you breathe, especially when exhaling)

Any asthma symptom is serious and can become deadly if left untreated. Symptoms may be triggered by exposure to an allergen (such as ragweed, pollen, pet hair or dander, or dust mites), irritants in the air (such as smoke, chemical fumes or strong odors) or extreme weather conditions. Illness — particularly a respiratory illness or the flu — and exercise can also make you more susceptible.

A physical display of strong emotion that affects normal breathing patterns — such as shouting, crying or laughing — may also contribute to an asthma attack. Panic can prevent a person with asthma from relaxing and following instructions, which is essential during an attack. Scientists have found that rapid breathing associated with strong emotions can cause bronchial tubes to constrict, possibly provoking or worsening an attack.

Like any chronic condition, asthma can cause emotional strain. As a leading cause of work and school absences, it can have a significant effect on livelihood, education and emotional well-being. Depression may set in when people diagnosed with asthma believe that they are unable to participate in normal activities.

Asthma symptoms can happen at any time. Mild episodes may last only a few minutes and may be resolved spontaneously or with medication; more severe episodes can last from hours to days. For more details about the ACAAI and asthma, visit this site: http://acaai.org/asthma/symptoms.

However, not every person with asthma has the same symptoms in the same way. You may not have all of these symptoms, or you may have different symptoms at different times. Your asthma symptoms may also vary from one asthma attack to the next, being mild during one and severe during another. Some people with asthma may go for extended periods without having any symptoms, interrupted by periodic worsening of their symptoms. Others might have asthma symptoms every day. One good aspect is that the disease is not contagious.

In addition, some people may only have asthma during periods of exercise, or asthma with viral infections like colds. Mild asthma attacks are generally more common. Usually, the airways open up within a few minutes to a few hours. Severe attacks are less common but last longer and require immediate medical help. It is important to recognize and treat even mild asthma symptoms to help you prevent severe episodes and keep asthma under better control.

Also, recent research by the Asthma and Allergy Foundation of America showed that 97% of allergists consider a pest-free home to be vital to avoid the symptoms related to asthma and allergies. Despite this fact, many consumers are unaware of the implications of the common dust mite and many other pests have on their health.

Making matters worse, many bugs and pests are hidden from people and encouraged by the reduced cleaning caused by increasingly busy lives. For more information about this topic, visit this website: http://aardvarkpestmgmt.com/household-pests-a-leading-trigger-for-childhood-asthma-and-allergies/ 

Asthma is especially tough on kids. To control asthma, partner with your doctor to manage your asthma or your child's asthma. Children aged 10 or older—and younger children who are able—should take an active role in their asthma care, according to the National Institutes for Health (NIH). . Taking an active role to control your asthma involves:

·         Working with your doctor to treat other conditions that can interfere with asthma management.

·         Avoiding things that worsen your asthma (asthma triggers). However, one trigger you should not avoid is physical activity. Physical activity is an important part of a healthy lifestyle. Talk with your doctor about medicines that can help you stay active.

·         Working with your doctor and other health care providers to create and follow an asthma action plan.

An asthma action plan gives guidance on taking your medicines properly, avoiding asthma triggers (except physical activity), tracking your level of asthma control, responding to worsening symptoms, and seeking emergency care when needed.

Asthma is treated with two types of medicines: long-term control and quick-relief medicines. Long-term control medicines help reduce airway inflammation and prevent asthma symptoms. Quick-relief, or "rescue," medicines relieve asthma symptoms that may flare up. Your initial treatment will depend on the severity of your asthma. Follow up asthma treatment will depend on how well your asthma action plan is controlling your symptoms and preventing asthma attacks.

Your level of asthma control can vary over time and with changes in your home, school, or work environments. These changes can alter how often you're exposed to the factors that can worsen your asthma. Your doctor may need to increase your medicine if your asthma doesn't stay under control. On the other hand, if your asthma is well controlled for several months, your doctor may decrease your medicine. These adjustments to your medicine will help you maintain the best control possible with the least amount of medicine necessary.

Asthma treatment for certain groups of people—such as children, pregnant women, or those for whom exercise brings on asthma symptoms—will be adjusted to meet their special needs. For much more information, visit this website: http://www.nhlbi.nih.gov/health/health-topics/topics/asthma.

If you have asthma, you may have developed ways of coping with your symptoms that you may think are working quite well, according to this website: www.asthma.org . However, you may not be controlling your asthma symptoms. Work with your healthcare provider to develop your personalized asthma management goals. Here are some examples:

·         Few, if any, asthma symptoms

·         Few, if any, awakenings during the night caused by asthma symptoms

·         Little or no time off from school or work due to asthma symptoms

·         No limits on your participation in physical activities

·         No asthma-related emergency department visits

·         No asthma-related hospital stays

Unfortunately, asthma to date has no cure. But, it can be managed. Your family doctor or health care provider can help diagnose the symptoms and create a treatment plan for you or someone in your family that has been diagnosed with asthma or who has asthmatic symptoms. Don’t self-diagnose. See your health care practitioner. Ignoring the symptoms can be catastrophic.

Until next time.

Health Care and Angioplasty

Millions of Americans suffer from various forms of heart disease—ischemic, rheumatic, hypertensive, inflammatory, congenital, and cerebrovascular. According to the World Heart Federation, there are multiple reasons for each of these medical diagnoses. The heart is a critical organ and is responsible for pumping life giving blood throughout your body from birth until death. Your heart is the size of your fist and the strongest muscle in your body.

Your heart started beating about three weeks after you were conceived. If you live to be 70 your heart will have beat 2.5 billion times. Each heartbeat pumps blood around the body, pushing it from the left heart chambers, through arteries of ever-decreasing size, finally reaching the capillaries in all parts of the body. Once your body has taken oxygen and nutrients from the blood, it is returned to the heart via the veins to the right chambers of the heart. On its way back, the blood passes through the liver and waste products are removed.

As marvelous as this system is, it is very vulnerable to damage from the things we do to it, like smoking, eating an unhealthy diet or putting it under stress. Or you may be born with a heart condition. When your heart’s functions become compromised, this is known as cardiovascular disease, a broad term that covers any disorder to the system that has the heart at its center. For much more detailed information about heart disease in general, visit this site: http://www.world-heart-federation.org/cardiovascular-health/heart-disease/.

One way to help improve some types of heart disease, and to help prevent heart attacks, is through a medical procedure called angioplasty--a term describing a procedure used to widenvessels narrowed by stenoses or occlusions, according to the FreeDictionary.com. There arevarious types of theseprocedures and theirnames are associatedwith the typeof vessel entry andequipment used.

For example, percutaneoustransluminal angioplasty (PTA) describes entrythrough the skin(percutaneous) and navigates to the areaof the vessel of interestthrough the samevessel or one thatcommunicates with it (transluminal). In the caseof a procedure involving the coronary arteries,the point of entrycould be the femoralartery in the groinand the catheter/guidewiresystem is passed throughthe aorta to theheart and theorigin of the coronaryarteries at the baseof the aorta justoutside the aorticvalve. For more technical aspects of angioplasty, visit this website: http://medical-dictionary.thefreedictionary.com/Angioplasty.

According to the National Institutes of Health (NIH), you have angioplasty in a hospital. The doctor threads a thin tube through a blood vessel in the arm or groin up to the involved site in the artery. The tube has a tiny balloon on the end. When the tube is in place, the doctor inflates the balloon to push the plaque outward against the wall of the artery. This widens the artery and restores blood flow.

Doctors may use angioplasty to reduce chest pain caused by reduced blood flow to the heart and to minimize damage to heart muscle from a heart attack. Many people go home the day after angioplasty, and are able to return to work within a week of coming home. More details are located at this website for your research: http://www.nlm.nih.gov/medlineplus/angioplasty.html.

Angioplasty with or without vascular stenting is commonly used to treat conditions that involve a narrowing or blockage of arteries or veins throughout the body. When undergoing this procedure, there are definitely benefits and risks to be considered for angioplasty. Angioplasty should be considered with your physician, cardiologist, or medical heart specialist. Not to be taken lightly, the procedure saves lives, but is not without risk. Consulting your health care team for this event is critical for your long term survival if you suffer from any heart disease. A significant amount of detailed information concerning angioplasty can be found at this website: http://www.radiologyinfo.org/en/info.cfm?pg=angioplasty.

According to this website, http://www.ptca.org/heart_attack/, if cardiologists can reopen blocked blood vessels with an angioplasty balloon within a couple of hours after a heart attack begins, blood flow can be restored and heart damage prevented. Time from arriving at the hospital to receiving angioplasty is called “door-to-balloon time” and in the past few years many hospitals have made significant strides in shortening “D2B” time, often treating patients with angioplasty within an hour.

Angioplasty within 90 minutes of arriving at the emergency department is the gold standard of treatment for heart attack, recommended by all the major medical societies. If you or a member of your family is at risk for heart attack (have coronary artery disease, a family history of heart disease, or risk factors such as high cholesterol or high blood pressure), it makes sense to educate yourself ahead of time, and make a heart attack emergency plan as noted below from www.ptca.org :

1)    Learn the Symptoms: Listen to Your Body. Familiarize yourself with the range of heart attack symptoms. Heart attacks can involve slow and subtle warning signs; people rarely collapse to the floor clenching their chest as in the movies. Pay attention to your body and what it is telling you -- no one wants to be a hypochondriac, but when it comes to heart attack, it’s way better to be safe than sorry. Most heart attack victims wait hours before going to the hospital, greatly decreasing their chance to benefit from angioplasty. For angioplasty to be most effective, the quicker you get to the hospital to get checked out the better.

2)    Call an Ambulance: Know the number to call an ambulance and don’t be embarrassed to use it; don’t drive yourself or have a family member drive you unless it’s your only option. Ambulances are usually equipped to begin administering tests and emergency care en route, saving you precious time. And, you will be attended to more quickly when you get to the ER if you arrive by ambulance. Time is muscle; you don’t want to be delayed by traffic or bureaucracy. While you wait for the ambulance, take an aspirin, which can help thin your blood and discourage clotting.

 

3)  Plan Ahead to get the Best Care: Do some research ahead of time to determine which hospital in your area offers the best heart attack treatment. It’s good to know what your options are. In some parts of the country, sophisticated systems have been set up to transfer heart attack victims from community hospitals to regional centers that have cath labs. You want to go to the closest ER that has a catheterization lab, or if there are no cath labs in your area, go to a community hospital that has an effective system for quickly diagnosing and then transferring heart attack victims to a facility that offers angioplasty services.

Angioplasty when performed in a timely basis can save your life. Living with heart disease isn't simple. But it's something millions of people manage to do. Knowing your body, and your family heart history definitely helps with learning the warning signs and developing an action plan.

Until next time.

Health Care and Sickle Cell Anemia

One very unique  health care disorder that affects primarily people whose families come from Africa, South or Central America (especially Panama), Caribbean islands, Mediterranean countries (such as Turkey, Greece, and Italy), India, and Saudi Arabia, according to the National Institutes for Health (NIH).

In the United States, it's estimated that sickle cell anemia affects 70,000–100,000 people, mainly African Americans. The disease occurs in about 1 out of every 500 African American births. Sickle cell anemia also affects Hispanic Americans. The disease occurs in more than 1 out of every 36,000 Hispanic American births. More than 2 million Americans have sickle cell trait. The condition occurs in about 1 in 12 African Americans.

According to the NIH, it is the most common form of sickle cell disease (SCD). SCD is a serious disorder in which the body makes sickle-shaped red blood cells. “Sickle-shaped” means that the red blood cells are shaped like a crescent.

Normal red blood cells are disc-shaped and look like doughnuts without holes in the center. They move easily through your blood vessels. Red blood cells contain an iron-rich protein called hemoglobin. This protein carries oxygen from the lungs to the rest of the body.

Sickle cells contain abnormal hemoglobin called sickle hemoglobin or hemoglobin S. Sickle hemoglobin causes the cells to develop a sickle, or crescent, shape. Sickle cells are stiff and sticky. They tend to block blood flow in the blood vessels of the limbs and organs. Blocked blood flow can cause pain and organ damage which can also raise the risk for infection. Much more detailed information can be found at this website: http://www.nhlbi.nih.gov/health/health-topics/topics/sca.

According to the Sickle Cell Disease Association of America (SCDAA), sickle cell conditions are inherited from parents in much the same way as blood type, hair color and texture, eye color and other physical traits. The types of hemoglobin a person makes in the red blood cells depend upon what hemoglobin genes the person inherits from his or her parents.

Examples:

--If one parent has Sickle Cell Anemia and the other is Normal, all of the children will have sickle cell trait.

--If one parent has Sickle Cell Anemia and the other has Sickle Cell Trait, there is a 50% chance (or 1 out of 2) of having a baby with either sickle cell disease or sickle cell trait with each pregnancy.

--When both parents have Sickle Cell Trait, they have a 25% chance (1 of 4) of having a baby with sickle cell disease with each pregnancy.

A simple blood test followed by a laboratory technique called Hemoglobin Electrophoresis will determine the type of hemoglobin you have. When you pass an electric charge through a solution of hemoglobin, distinct hemoglobins move different distances, depending on their composition.

The SCDAA reports that sickle cells are destroyed rapidly in the body of people with the disease causing anemia, jaundice and the formation of gallstones. The sickle cells also block the flow of blood through vessels resulting in lung tissue damage (acute chest syndrome), pain episodes (arms, legs, chest and abdomen), stroke and priapism (painful prolonged erection).

 

It also causes damage to most organs including the spleen, kidneys and liver. Damage to the spleen makes sickle cell disease patients, especially young children, easily overwhelmed by certain bacterial infections.

Health maintenance for patients with sickle cell disease starts with early diagnosis, preferably in the newborn period and includes penicillin prophylaxis, vaccination against pneumococcus bacteria and folic acid supplementation. Treatment of complications often includes antibiotics, pain management, intravenous fluids, blood transfusion and surgery all backed by psychosocial support. Like all patients with chronic disease patients are best managed in a comprehensive multi-disciplinary program of care.

Blood transfusions help benefit sickle cell disease patients by reducing recurrent pain crises, risk of stroke and other complications. Because red blood cells contain iron, and there is no natural way for the body to eliminate it, patients who receive repeated blood transfusions can accumulate iron in the body until it reaches toxic levels.

It is important to remove excess iron from the body, because it can gather in the heart, liver, and other organs and may lead to organ damage. Treatments are available to eliminate iron overload. Much more detailed material about this disease can be found at this website: http://www.sicklecelldisease.org/index.cfm?page=about-scd.

Scientists are constantly researching ways to help people with sickle cell anemia, according to this website:  http://kidshealth.org/teen/diseases_conditions/blood/sickle_cell_anemia.html.

Several new treatments, such as the drug hydroxyurea, have helped reduce painful crises and episodes of acute chest syndrome for adults and kids with sickle cell. Bone marrow transplant, a complex and risky procedure, is the only cure for sickle cell anemia. This disease is especially tough on children and adolescents.

Scientists are also studying gene therapy as a treatment for sickle cell anemia. One day, it's hoped that doctors may be able to stop the disease by changing or replacing the abnormal gene that causes it. With the right precautions, children and teens with sickle cell disease can do most of the stuff other kids do. To stay as healthy as possible, take these steps:

--Eat a balanced, healthy diet.

--Take medications, including folic acid supplements, as prescribed.

--Drink plenty of fluids to prevent dehydration.

--Avoid extreme cold or heat.

--Exercise regularly, but in moderation. Exercise is important for staying healthy, but overdoing it can trigger a crisis in some people, particularly if they become dehydrated, overheated, or exhausted.

--Get plenty of rest.

--Avoid alcohol, drugs, and smoking which can aggravate sickle cell disease and its symptoms. Some people with sickle cell disease are prone to lung problems, so smoking is particularly risky and must be avoided.

--Avoid places low in oxygen. (For example, it's not a good idea to go hiking at high altitudes or spend lots of time swimming under water.)

--Prevent serious infections by contacting your doctor as soon as illness symptoms start. Be sure to get any immunizations (such as pneumonia and flu vaccines) that the doctor recommends, and always call your doctor if you have a high fever (over 101°F, 38°C).

--Learn as much as you can about the disease and see your doctor regularly to help prevent complications.

For a tremendous human interest story about a family’s inspirational fight against sickle cell anemia, visit this website: http://sports.espn.go.com/espn/eticket/story?page=boozers

Sickle cell anemia is a disease that can be deadly and debilitating. If you or someone you know are suffering from symptoms, see your doctor. Follow the guidance provided by specialists and support groups. Work hard at staying healthy. Know that the disease can be managed.

Until next time.