August 19th, 2009 by Gwenn Schurgin O'Keeffe, M.D. in Better Health Network, Health Tips
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If you are a family with kids and have grandparents or great grandparents alive, you likely enjoy visiting with your relatives from time to time. While your small children may not always get much out of these visits, especially while very young, they do wonders for our older relatives who so enjoy visits from family and delight in seeing us become parents and expand our families.
I remember vividly visiting my grandparents as they aged, as a child, a teen, a young adult and when I became a parent with my own infants and toddlers. I recall well their delight…and the vivid images of their aging lives: durable medical equipment like canes and walkers in the corner of the room. And, the kitchen counter with rows of medication bottles that made the counter appear like the pharmacist’s counter at the local pharmacy. Given all of my grandparents had arthritis towards the end of their lives, none of those bottles had child-resistant tops.
Whether at home, an assisted care facility or a nursing home, the issue I worry about with small kids are floors and medications. Even if someone is handing an older person their medication, a pill can fall to the floor without being noticed and later found by a toddling child who mistakes it for a piece of candy. That’s what happened last week when 15 month old boy found a shiny pink pill on the floor of his grandmother’s house and didn’t think twice about tossing it in his mouth. Thankfully, it was bitter so he spit most of it out but it was a blood pressure medication so we had to given him activated charcoal, a lot of it, and then observe him in the emergency room for 6 hours.
This story had a happy ending but could have been a disaster had it been a different type of pill or a higher dose, or a group of pills. It’s very, very important that we all take a moment to think about the pill safety of our older relatives – for their sake and the sake of the small children in their lives. In addition to products that can help dispense pills more safely, making sure floors are clean before visits and supervising kids during visits are essential.
As an aside, the moral to this story can be extended to hotels and homes we may visit that we are not as familiar with. Pills can easily fall out of pockets, purses and luggage. When traveling anywhere with small kids, get on the ground and look under beds, chairs, sofas, pillows and be sure there are not any pills or other small items that we wouldn’t want our small children, or even older children, to touch, or worse – eat!
BTW, can you find the pill in this picture? Hint: it’s blue.
See On The Edge Of Something blog for the “before” shots showing the pill in a spoon on the floor.
Not so easy, huh? Unless, of course, you are a very small child with the eye sight of a falcon and live close to the ground routinely. Now do you get the point?
*This blog post was originally published at Dr. Gwenn Is In*
August 19th, 2009 by Nancy Brown, Ph.D. in Better Health Network, Opinion
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Teens living with a depressed parent need information and support. The inclination of most people living with someone who is depressed is to take on responsibility for the ill parent and other family members.
Life is difficult for anyone living with a depressed parent. The daily home life is complex – with little consistency, irregular habits, plans made at the last minute, little consideration for each person’s wishes or desires, and there is usually a huge decrease in communication. The depressed parent withdraws from the family and the teens are left to manage on their own, creating feelings of loneliness.
Teens are not likely to realize how much their life has changed, or how serious the depression is and need adults who see the changes to bring them to the attention of the family, medical and emotional professionals. Even if the depression lifts for a period, everyone in the family will likely be anxious about when it will returns.
I believe that all health care professionals are ethically responsible to help teens avoid the responsibility and loneliness associated with living with a depressed parent. As mentioned in a previous post, there are also many resources for those parents who are willing to admit the depression, as well.
This post, Teens Who Live With A Depressed Parent, was originally published on
Healthine.com by Nancy Brown, Ph.D..
August 19th, 2009 by Toni Brayer, M.D. in Better Health Network, Opinion, True Stories
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Dear President Obama,
I am in favor of Health Care Reform and I agree with you that universal coverage and eliminating the abuses that both patients and doctors have suffered at the whim of the for-profit insurance industry must be curtailed.
But I also want you to fix Medicare. Medicare is so bureaucratic that expanding it in its current form would be the death knell for primary care physicians and many community hospitals. The arcane methods of reimbursement, the ever expanding diagnosis codes, the excessive documentation rules and the poor payment to “cognitive, diagnosing, talking” physicians makes the idea of expansion untenable.
May I give you one small example, Mr. President? I moved my medical office in April. Six weeks before the move I notified Medicare of my pending change of address and filled out 22 pages of forms. Yes, Mr. Commander in Chief…22 pages for a change of address. It is now mid-August and I still do not have the “approval” for my address change.
I continue to care for my Medicare patients and they are a handful. Older folks have quite a number of medical issues, you see, and sometimes it takes 1/2 hour just to go over their medications and try to understand how their condition has changed. That is before I even begin to examine them and explain tests, treatment and coordinate their care. Despite the fact that I care for these patients, according the Medicare rules, I cannot submit a bill to Medicare because they have not approved my change of office address.
I have spent countless hours on the phone with Medicare and have sent additional documentation that they requested. I send the forms and information “overnight, registered” because a documented trail is needed to avoid having to start over at the beginning again and again. I was even required to send a signature from my “bank officer” and a utility bill from the office. Mr President, I don’t have a close relationship with a bank officer so this required a bank visit and took time away from caring for patients…but I certainly did comply.
I am still waiting to hear from Medicare. At my last call they said they had not received yet another document, but when I gave them the post office tracking number, they said it was received after all. They could not tell me when or if they will accept my address change.
I have bills stacking up since April and I just found out that they will not accept them if they are over 30 days old. I have cared for patients for 5 months and will not receive any reimbursement from Medicare. The rules state I cannot bill the patient or their supplemental Medicare insurance either.
Believe me, Mr. President, I commend you for taking on such a huge task. Please also know that Medicare reform is needed along with health care reform.
A loyal American ,
Internal Medicine (aka: primary care) physician
*This blog post was originally published at EverythingHealth*
August 19th, 2009 by SteveSimmonsMD in Health Policy, Primary Care Wednesdays
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On Saturday, Breitbart.com posted an article about President Obama’s most recent town hall meetings and closed with the following paragraph: “Obama is yet to reveal a detailed plan, but promises to expand coverage, control spiraling healthcare costs, rein in insurance companies and prioritize preventative care.”
I’ve been looking for an actual plan since Health Care Reform was seriously proposed. In July, Rahm Emanuel, Obama’s Chief of Staff, was quoted in the Washington Post, stating that the Administration had decided against having an actual plan for Reform since it would expose the administration to criticism. Yet, I remained optimistic about Reform, and relished the chance to debate the facts as our Nation turned its focus upon a topic I have long been passionate about.
Unfortunately, my optimism waned as an honest and forthright debate about how to implement Reform has become ever-elusive. Disappointed in the turns this debate has taken on its journey through our national consciousness, I am leery of the simplistic viewpoint portrayed so often… “You are with Obama or against him” …. “You’re a Republican or a Democrat” … “You are for Reform or against it …”
Determined to find Obama’s plan, I began my search by reading his speech to the AMA, surfing the White House website, watching his ABC infomercial all the way through Nightline, and observing a number of town hall meetings. I went on to plaster the walls of my home office, to the amusement of my wife, with everything the President had said, color-coded on poster boards.
By July, as I looked around my office I realized that I was surrounded, not by a plan, but by a group of wishes, beliefs, hopes and ideals. I love the way it sounds when I say “prioritize preventative care” and I long for a day when the $100 million salaries of insurance company CEOs has been “reined in.” However, I am not naïve enough to expect this to happen without a coherent plan.
I used to believe the White House would propose a bona-fide plan. Instead they are implementing a strategy that combines the president’s rhetoric with the defensive tactic of refuting critics of Congressional plans or the President’s zeal.
Even after the House passed their Reform bill (the first actual HC plan to come out of Washington), I can’t make myself take down all of those poster boards leaving me surrounded by inspiring and hypnotizing ideals. Yet I fail to see how the House bill will transform these beautiful ideals into reality as it creates multiple new government agencies and burdens doctors’ offices with more clerical responsibilities — new for the busy doctors of tomorrow: the physician quality reporting initiative, cultural and linguistic competence training, financial disclosure reports between providers and suppliers, and national priorities for performance improvement.
John Mackey, CEO of the Fortune 500 company Whole Foods, wrote an op-ed piece about HC reform for the August 11 Wall Street Journal. His editorial includes understandable plans, worthy of intelligent debate while being based in large part on the health care benefits Whole Foods currently has in place for 36,000 of its employees, and includes the following recommendations:
1. Promote high-deductible health insurance plans and HSAs by removing legal obstacles.
2. Equalize the tax laws so those buying individual insurance can enjoy the exact same tax break employer related insurance customers receive.
3. Encourage competition by allowing insurance companies to compete across state lines.
4. Enact tort reform since insurance costs, frequently over $100,000 per doctor, are passed back to all of us in the form of higher prices for health care.
5. Make costs transparent so we can all understand what health care treatments cost.
6. Enact Medicare Reform.
7. Whatever reforms are enacted it is essential that they be financially responsible.
Three days later, instead of arguing the merits or demerits of Mackey’s plan, an ABC News story focused on the controversy his editorial had stirred up after briefly touching on some of his ideas. Spcifically, the ABC story focused on the boycott by many of his customers with one expressing the following belief, “I think a CEO should take care that if he speaks about politics, that his beliefs reflect at least the majority of his clients.” Another described Mr. Mackey’s position as a slap in the face to millions of progressive-minded consumers. The author quoted four customers pledging to not buy their food at Whole Foods anymore and added them to the implied masses gathering on Twitter and Facebook.
Fortunately, one customer, Frank Federer, was quoted as saying, “At a time when most folks are more inclined toward rancor than discussion of facts, I applaud John Mackey.”
So do I.
A realistic map showing us how to get from point A to point B is missing in the Health Care Reform debate. Facts are one thing in short supply to plot a course on this map. While the main ingredient in the fertilizer used to grow Whole Foods produce is in abundance, there’s just not enough for some of Mr. Mackey’s customers.
August 18th, 2009 by Paul Auerbach, M.D. in Better Health Network
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I’m often asked about technologies that are amenable to research applied in outdoor or wilderness settings. A company called Cantimer has developed and made available one of these technologies.
Cantimer is a privately–held, development–stage company commercializing a patented, proprietary, sensor technology platform based on a convergence of micro electromechanical systems (MEMS) technology and advanced polymer science. According to the website, the Company’s first commercial product will be an innovative, hand–held device for non-invasive measurement and monitoring of human hydration status from the osmolality of saliva.
This past October (2008), there was a press release issued by the Company. To paraphrase:
“Cantimer, Inc. Delivers First Alpha Instruments for Real-Time, Non-Invasive, Incident-Scene Assessment of Dehydration in Firefighters
Devices to be used for field testing in structural fire environments and search and rescue operations.
Cantimer, Inc. announced that it has shipped ten alpha instruments for real-time, non-invasive assessment of human hydration to the U.S. Government’s Technical Support Working Group (TSWG). The units will be used for incident-scene assessment of dehydration in firefighters. Dr. Christina Baxter, from TSWG, commented, ‘The focus over the last several months has been on laboratory work that adds to the body of knowledge regarding salivary osmolality as a useful measure of human hydration or dehydration status. That work has gone very well. We are now looking forward to using these new devices for actual field testing in structural firefighting or search and rescue operations – with more of an emphasis on implementation, ergonomics and the user experience.’
Maintaining an optimal level of hydration is a major health concern for firefighters and other emergency scene first responders. Progressive acute dehydration associated with physical exertion in heat-stressed environments significantly increases the risks of temperature-related health problems, with resulting losses of productivity and, in some cases, death. It has been shown that fluid losses of as little as 2% of total body weight (3.5 pounds in a normally 175 pound individual) can lead to noticeable compromises in physical and cognitive performance.
Dehydration and resulting temperature-related health problems among firefighters are preventable through adequate on-scene hydration management. Cantimer’s devices, incorporating the Company’s proprietary sensing technology, enable convenient, field-deployable, real-time measurement, and therefore management, of hydration status from an easily-obtained sample of saliva.
Although easy to treat if identified early, dehydration is a pervasive condition that contributes to a large number of preventable hospitalizations in the U.S. every year. Cantimer believes that the availability of a hand-held device that aims to make it as easy to determine a person’s state of hydration as it is to take their body temperature will have significant benefits, not only for the health and safety of firefighters and other first-responders, but for military personnel, athletes at all levels, the elderly, the very young and those suffering from a wide range of medical conditions.”
The wilderness and outdoor medicine literature is replete with opinions and arguments about conditions predisposing to dehydration and the determination of hydration status. We presume dehydration in the field by clinical diagnosis (e.g., signs and symptoms), but do not generally deploy an actual quantifiable measurement to determine its presence. So, with the advent of the technology espoused by Cantimer, we may finally have a convenient tool with which to begin to diagnose, as opposed to predict, dehydration, during virtually any activity for which the physical environment will allow its use. This will hopefully also allow us to test different hydration/rehydration strategies, including various fluids, electrolyte concentrations, and so forth.
This post, Spit Test To Determine Hydration Status, was originally published on
Healthine.com by Paul Auerbach, M.D..
