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The 10 Least Expensive Health Insurance Markets FEBR U A RY 2014 I S S U E
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This ranking is based on the lowest cost of a "silver" plan, the mid-range plan most consumers are choosing.
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Picking Up the Pieces
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MEDICAL NEWS
The 10 Least Expensive Health Insurance Markets By Jordan Rau, Kaiser Health News
eople in much of Minnesota, northwestern Pennsylvania, and Tucson, Ariz., are getting the best bargains from the healthcare law's new insurance marketplaces: premiums half the price or less than what insurers in the country's most expensive places are charging. The 10 regions with the lowest premiums in the nation also include Salt Lake City, all of Hawaii, and eastern Tennessee. This ranking is based on the lowest cost of a "silver" plan, the mid-range plan most consumers are choosing. By contrast, the most expensive insurance markets include towns that are home to Colorado's ski resorts and the Connecticut suburbs outside New York City.
The cheapest cost regions tend to have robust competition between hospitals and doctors, allowing insurers to wangle lower rates. Many doctors work on salary in these regions rather than being paid by procedure, weakening the financial incentive to perform more procedures. Health systems focus on organizing patient care rather than let specialists work detached from each other.
The lowest monthly silver premium in the country is offered in the Minneapolis-St. Paul region, where a 40-year-old will pay $154 a month for a PreferredOne plan. Just across the Wisconsin border, that same level plan -- but with a different insurer and other doctors and
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hospitals -- costs nearly three times as much.
Insurers were able to negotiate low rates with hospitals and doctors in the Twin Cities because they could choose among four major healthcare systems. Both Fairview Health Services, which runs the University of Minnesota Medical Center and is included in the lowest plan's network, and Allina Health, the largest system in the Twin Cities and operator of Abbott Northwestern Hospital, have been in the vanguard of experimenting with more efficient ways to care for patients, such as accountable care organizations and putting doctors on salary, said Stephen Parente, a health economist at the University of Minnesota.
"Minnesota has had years if not decades of experience with managed care," he said.
Most counties in central and northern Minnesota also have premiums that are among the lowest in the nation. Michael Rothman, commissioner of Minnesota's Department of Commerce, which regulates insurers, said the state moved early to enact cost-control measures such as restricting how much insurers can spend on things other than medical care and requiring annual insurance rates to go through state review. Several of the other lowest-cost areas, including the Salt Lake City region and Hawaii, also have major hospitals and health systems that have been at the
Least expensive areas:
$154: minneapolis-St. Paul. Anoka, carver, Dakota, hennepin, Ramsey, Scott, Sherburne and washington counties $164: Pittsburgh and Northwestern Pennsylvania. Allegheny, Armstrong, Beaver, Butler, crawford, Erie, Fayette, greene, Indiana, lawrence, mcKean, mercer, warren, washington, and westmoreland counties $166: middle minnesota. Benton, Stearns, and wright counties $167: Tucson, Ariz. Pima county $171: Northwestern minnesota. clearwater, Kittson, mahnomen, marshall, Norman, Pennington, Polk, and Red lake counties $173: Salt lake city. Davis and Salt lake counties $176: hawaii $180: Knoxville, Tenn. Anderson, Blount, campbell, claiborne, cocke, grainger, hamblen, Jefferson, Knox, loudon, monroe, morgan, Roane, Scott, Sevier, and Union $180: western and North central minnesota. Aitkin, Becker, Beltrami, Big Stone, cass, chippewa, clay, crow wing, Douglas, grant, hubbard, Isanti, Kanabec, Kandiyohi, lac qui Parle, lyon, mcleod, meeker, mille lacs, morrison, Otter Tail, Pine, Pope, Renville, Roseau, Sibley, Stevens, Swift, Todd, Traverse, wadena, wilkin, and Yellow medicine counties. In chisago county, the lowest premium is $162 $181: chattanooga, Tenn. Bledsoe, Bradley, Franklin, grundy, hamilton marion, mcminn, meigs, Polk, Rhea, and Sequatchie counties The rankings stay the same no matter the age or family size. however, Vermont and New York do not allow insurers to charge more to older people and less to young ones. Therefore, some older consumers in those states may find their premiums are less expensive than people of the same age in these cheapest region
forefront of integrated care, in which rules, payment methods and the bureaucracy are designed to foster collaboration among primary care doctors, specialists, and nurses. But people who buy the cheapest Salt Lake City plan will not have access to Intermountain Healthcare, the most prestigious system in the area.
Innovative hospital practices do not guarantee cheap insurance. In Rochester, Minn., the home of the Mayo Clinic in the southeastern portion of the state, the lowest priced silver premium is $305, which is above the national median. Although
Mayo's doctors are salaried and the system practices integrated care, its prices are higher than in Minneapolis, said Dannette Coleman, an executive at Medica, the insurer that offers the lowest priced silver plan in that area. Given Mayo's extensive network of clinics in the region, "you really cannot be in that area in that state if you don't have the Mayo Clinic Health System in your network," she said. Mayo officials did not respond to a request for comment. In eastern Tennessee, cheap premiums are notable because many residents face chronic
health issues. Obesity and smoking are common. "We're the buckle of the stroke belt," said Kevin Spiegel, president of Erlanger Health System, which is included in the network of the least expensive silver plan in Chattanooga. Blue Cross and Blue Shield of Tennessee was able to offer the lowest silver premiums in the Knoxville and Chattanooga regions -- $180 a month for a 40-year-old -- by cutting deals with just one hospital system and their doctors in each region, said Henry Smith, the insurer's chief marketing officer. "There are competing systems within those two regions to price against," Smith said. These lowest premium plans are "the narrowest network we have by far." Likewise, in western Pennsylvania, Highmark was able to offer the low premium -$164 for a 40-year-old -- by omitting nine hospitals and about 3,000 doctors who charge higher prices, according to spokeswoman Kristin Ash. Consumers wanting a wider network will have to pay Highmark 38% more a month.
These competitive markets are quite different than in southwest Georgia, the second most expensive region in the country. Blue Cross Blue Shield of Georgia had no choice but to include in its network the Phoebe Putney Health System, which controls 86% of the market. The lowest premium in southwest Georgia is $461, two and a half times the rate in Chattanooga.
Oral sex could be leading to throat cancer in Chhattisgarh AIPUR: While the country debates on the rights of gays and lesbians and the controversial provisions of the Sec 377 of IPC, which makes unnatural sex, including oral, punishable, there is evidence of an increasing number of youths, even in a retrograde state like Chhattisgarh, could be falling prey to cancer due to indulgence in oral sexual activities.
This may come as a shock for the conservatives, who consider oral
sex as a taboo, the Regional Cancer Centre (RCC) gets 4 to 5 patients every month, including young women, with symptoms of cancer and an history of indulgence in oral sex. Most of these patients are young boys and girls in the age group of 22 to 35 years.
Confirming this, Dr Vivek Choudhary, who heads the RCC, told TOI that they started questioning these young cancer patients about their sexual activities when they found that most of them had no history of
alcohol or tobacco use. "They confirmed indulgence in oral sex, which in the West is a known to cause for throat cancer", he said.
Incidentally, Hollywood star, Michal Douglas, had recently admitted that his throat cancer was caused by HVP transmitted through oral sex.
Dr Choudhary said, "the Human Papilloma Virus or HPV, which is also responsible for cervical cancer, can be transmitted during oral genital sex, leading to cancer". He said though this is
more common in the Western countries, but such cases have started coming in here too in the last few years. He however adds that though HPV is quite high in the general population, but a very small percentage get oral cancer. "Normally, sexual transmission of the HPV leads to cervical cancer in women", he said.
He said though India has more patients with oral cancer than any advanced western countries, it primarily due to tobacco and
alcohol abuse. " We haven't had many HPV-related oral cancer patients but are conducting a study to look into it as strong possibilities exists". He said at present about 5% of oral cancer patients they treat have no history of tobacco or alcohol abuse.
He said the result of the study would be available very soon. Talking about the treatment, he said that since surgery is not always possible, this condition of oral cancer coul be treated by radiation and chemotherapy.
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February 2014
Page 3
HEALTH TRENDS
Picking Up the Pieces missing, poor health may result. On the other hand, if the pieces fall into place properly, longevity is the only force to be reckoned with.
Missing Pieces
I
Dr. Shelley Plumb
t is a beautiful Sunday afternoon and I am watching my son put together a jigsaw puzzle. Frustration flashes across his face as he painstakingly searches for the correct piece. In the next moment, a calm wave of satisfaction comes over him as he puts the troublesome piece in its rightful place. He looks up at me and confidently says, “Now that I have that piece, the rest will be easy!”
Sitting there I realize something. Maintaining a healthy lifestyle can be likened to a metaphorical jigsaw puzzle; A puzzle that has numerous pieces, all of which have to fall into the right place to maintain proper health. If one piece to the healthcare puzzle is
There are many pieces to the lifestyle puzzle; Stress management, healthy relationships, fitness, nutrition. If one healthcare piece is missing or deficient, it can drastically affect the piece next to it bringing the entire system down. Besides the obvious negative physical, psychological, and economical effects, studies show that lack of a pro-active healthy lifestyle can profoundly influence an individual’s selfesteem and feeling of self-worth.
Health Trends in the US today
The question is: Is this nation putting the pieces of the healthcare puzzle together? Although there have been strides made in many areas, the nation still struggles with healthcare issues, many of which can be linked directly to improper lifestyle choices. Let’s take heart disease for example. In a review, the Center for Disease Control found that there are 200,000 deaths each year related to heart disease, many of which can be prevented. How? Proactive lifestyle changes related to smoking,
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exercise, and proper nutrition. http://www.cdc.gov/media/dpk/ 2013/dpk-2013-review.html
Effects self-worth
It seems that putting the healthy lifestyle pieces of the puzzle together are imperative, not just for our physical and emotional well-being, but for our overall feeling of self-worth as well. According to Mel Schwartz, L.C.S.W in his 2013 article “A Shift of Mind” low self-esteem is often misdiagnosed as anxiety, depression, and even ADHD. Perhaps a piece of that metaphorical lifestyle puzzle may be properly placed by “challenging our fundamental beliefs” and reframing “how we see ourselves.” http://www.psychologytoday.co m/blog/shift-mind/201307/lowself-esteem-missed-diagnosis
Overall effect on businesses
How does the lack of focus on a healthy lifestyle affect the bottom line? Let’s take a look at US businesses. Poor lifestyle choices have at least been partially to blame for rising business costs due to absenteeism, burnout/low morale, depression, and illness. In the article “The Causes and Costs of Absenteeism in the Workplace” (forbes.com) chronic medical conditions were responsible for lost productivity
with an annual price tag of $84 billion in lost revenue to US businesses. A healthy individual is a happy individual who will be absent from work far less. What does that mean? Higher levels of productivity mean a bottom line that takes a turn for the black instead of the red. http://www.forbes.com/sites/in vestopedia/2013/07/10/thecauses-and-costs-of-absenteeis m-in-the-workplace/ It is imperative to our health that the pieces of the puzzle are put back in place. How? The key may lie in a renewed focus on well-rounded health programs; programs that address physical, psychological, environmental, and economic health. Perhaps more importantly, programs that take into consideration the balance between work and home life.
Pieces to the puzzle together
As I help my son put the last pieces of his puzzle together it occurs to me; We can work together to get the healthcare
Get back on your Feet!
puzzle pieces in place too. Plato is known to say:
“Human behavior flows from 3 main sources: desire, emotion, and knowledge.”
As a nation we have to want it; we have to crave a healthy lifestyle. The desire must be present. Without desire, the motivation to excel is absent; we set ourselves up for failure from the very beginning.
A strong emotional response can be a driving force that motivates individuals to action. Individuals who are passionate about health are inspiring and can help spread the zest for a healthy lifestyle like wildfire.
The key to success is a concrete knowledge stemming from valid resources. Knowledge and resources are the key; The key to putting the puzzle pieces in place. If one loosens or is missing…no worries. It is important to reach out when assistance is needed. With the proper resources we can, together, put the pieces back one by one.
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February 2014
HEALTHCARE EVENTS
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Place for Hope 2 Annual Health Fair
n January 25, Place of Hope organized their 2nd Annual Health Fair in West Palm Beach. There were a variety of activities for every age which included a conference for adults and kids, blood pressure screening, diabetes screening, blood donation, physician's information booths, food, raffles, and giveaways.
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Rev. Edward Rodriguez and Heidi Oquendo.
Jill Weinstein and Dana Hart.
Brenda Martinez, Carolina Maldonado, Damian Martinez, Destiny Martinez, and Alan Higuera.
Christine Ramos, Alexander Hansen, Dr. Arthur Hansen, Anthony Hansen, Heidi Oquendo, and Dr. Lori Hansen.
Vanessa Palladino and Katelyn Rynkewicz.
Maria Flores, Laura Pfendler and Robert Marking.
Antioxidants speed up lung cancer growth, study shows Antioxidant supplements are often marketed for their disease-preventing potential. Supposedly, they can eliminate free radicals and lower a person’s risk of cancer. But much of the evidence supporting these claims is mixed, and a new study published today in the journal Science Translational Medicine suggests that popular antioxidants may actually speed up a cancerous tumor’s growth.
A team of Swedish researchers experimented on the effects of vitamin E, which has antioxidant properties, and a drug called N-acetylcysteine (NAC). NAC is a popular inhaled treatment for people with chronic obstructive pulmonary disease (COPD) because of its ability to reduce phlegm. Testing their effects in mouse models of lung cancer and in human lung cancer cells, the team discovered that the presence of antioxidants caused a threefold increase in tumor growth, and also caused mice to die twice as fast. The more antioxidants the mice were given, the more quickly they died. When tested on human cancer cells in the laboratory, the cells responded in the same way.
Though researchers only examined the effects of vitamin E and NAC, they cited a body of evidence that suggests that other antioxidants may also fuel cancer cells, not thwart them. According to the National Center for Complimentary and Alternative Medicine (NCCAM), clinical trials of antioxidant supplements have
repeatedly failed to prove claims that they help prevent conditions like heart attacks, strokes, dementia, or cancers.
“If anything, if you look at all of them, antioxidants do not protect against cancer. They may increase the risk,” lead researcher Martin Bergo of the Sahlgrenska Cancer Center told reporters this week.
Antioxidants, which include vitamins, carotenes, and minerals, are found naturally in fruits and vegetables, and act to neutralize free radicals—cells that can damage human DNA. “Because DNA can be damaged by cancer, we expect antioxidants to hurt cancer, but it may actually help it,” researcher Per Lindahl of the Institute of Biomedicine at the University or Gothenburg said.
The researchers say their findings suggest that antioxidant therapy is unsafe for smokers, patients with early-stage lung cancer, and people with COPD. However, they said their study only addressed the impact of antioxidants on tumor progression, not initiation or prevention.
Though the study only looked at lung cancer cells, Bergo said the results are “suggestive it might be applicable to other types of cancer.” He cited one study from 2011 that found that men aged 50 or older had a 17 percent increased risk of prostate cancer if they took selenium and vitamin E supplements.
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February 2014
HEALTHCARE EVENTS
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Jose Villareal, D.O.
Dr. Shelley Plumb and Joanne Duchrow.
Paul David Mendoza, M.D.
Carmen Evangelista, Amanda Calvillo, Liz Botts, and Deanna Miller.
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February 2014
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AROUND TOWN
Upcoming Medical and Fundraising Events February 14 – March 15, 2014 February 17
Palm Beach Habilitation Center Hab-a-Hearts 23rd Annual Luncheon will be held at Mar-a-Lago in Palm Beach. Tickets are $225.00 per person. This event begins at Noon and includes a cocktail reception and silent auction. For additional information, contact Jacquie Nicholson at 561-965-8500, ext. 212 or jnicholson@pbhab.org.
February 20
Easter Seals Florida “A Pair to Remember” will be held at Saks Fifth Avenue in Palm Beach. The event begins at 6:00pm and tickets are $175.00 or $150.00 for a young friend. This includes cocktails, dinner, dancing, auction, and designer shoe showcase. For additional information, visit their website at www.fl.easterseals.com.
February 22
DanaFarber Cancer Institute 23rd Annual Discovery Celebration will be
held at Mar-a-Lago Club in Palm Beach. There are many levels of giving, please visit their website for additional details, www.dana-farber.org.
Center for Child Counseling “Black Ties and French Fries” event will be held at the Borland Center for the Performing Arts in Palm Beach Gardens. Pull out your favorite boa and bowtie and have fun. There is a VIP section for children, finger foods, DJ, and a silent auction. The event begins at 6:00pm and all ages are welcome. Tickets are $50.00 for children and $75.00 for adults. Visit www.centerforchildcounseling. org for information.
February 23
Stand Among Friends – “4th Annual Emb(race)” will be held at Florida Atlantic University in Boca Raton. This event brings people with and without disabilities for a run, walk, and other festivities. The event begins at 6:00am. For additional information, contact Carol at
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“Mimosas & Mallets” will be held at the International Polo Club with proceeds to benefit Hospice of Palm Beach County Foundation. The event begins at 12:30pm. Tickets are $125.00 and include brunch, a silent auction, and a day of polo. For additional information, visit their website at www.hpbcf.org.
February 28
Boys & Girls Club of Palm Beach County 33rd Annual Gala “The Winter Ball” will be held at the Breakers in Palm Beach. The event begins at 7:00pm and has many donation levels so please visit www.bgcpbc.org for additional details.
March 1
Juvenile Diabetes Research Foundation - “Walk to Cure Diabetes” will be held at the
Meyer Amphitheatre in West Palm Beach. Registration begins at 9:00am and the walk begins at 10:00am. For additional information, contact 561-686-7701 or greaterpalmbeach@jdrf.org. You can also visit their website at www.walk.jdrf.org.
March 2
Walk Now for Autism Speaks will be held at Meyer Amphitheatre in West Palm Beach. For additional information, visit their website at www.walknowforautismspeaks.org.
March 6
The H.O.P.E. Foundation for a Better Tomorrow – Wine Tasting event will be held at St. Patrick Parish Center in Palm Beach Gardens. Tickets are $45.00. For additional information, visit their website at www.hopefoundation.us.
March 9
28th Annual JARC Gala Dinner Dance will be held at Boca West Country Club in Boca
Raton. Cocktails begin at 6:00pm and will be followed by dinner, and a silent and live auction. Tickets are $250.00 and jacket and tie are required. For additional information, call: 561-558-2550 or visit their website at www.jarcfl.org.
Hanley Center Foundation Family Picnic will be held at Palm Beach International Equestrian Center in Wellington. Tickets are $195.00 for an adult, $50.00 for a child and free for children six and under. For additional information, call 561-841-1048 or visit their website at: www.hanleycenter.org.
March 14
March of Dimes Palm Beach Gala will be held at Mar-a-Lago Club in Palm Beach. The event begins at 7:00pm. For additional information, contact Jennifer Whitaker at: 561-290-0905.
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T
By Dr. R. Sabates CLS, CME
here have been some exciting advances in fat removal. Liposuction is now faster, cheaper and safer. Non-invasive fat removal techniques are the latest rage. If liposuction is not for you, this article is to help explain and simplify the confusing array of competing systems.
There are basically four competing non-invasive medical techniques that advertise localized fat and cellulite removal. They consist of; laser light, cold exposure, heat with radiofrequency, and cavitation with ultrasound. Don’t get confused with the name brand equipment since they all use the same basic four technologies. The difference is in having a few more bells and whistles (i.e. price). Then there is the equipment imported from China of which has not been approved by the FDA and being sold on the internet. They simply do not work. My story:
For numerous health reasons, I finally decided to lose that unwanted weight that was making me miserable. Under a doctor’s care, I chose to use a controversial quick weight loss method that uses hormone
February 2014
Page 7
MIND & BODY
Cavi-Lipo News
injections and a strict 800 calorie diet. Due to a good bit of desperation and dedication, I lost 37 lbs. in about three months. Surprisingly enough, I did this without going hungry or exercise. I kept the weight off for four months, but couldn’t lose the love handles or lax skin folds - even with exercise.
Liposuction was not for me, so for personal and professional reasons, I decided to study and evaluate the various non-invasive techniques that claimed to magically remove fat deposits without surgical intervention.
After reviewing the techniques, I wanted to share my results and conclusions with you. Here is the short version of a roundtable medical convention that I attended in Orlando which was sponsored by the ASLM. It featured experts within the four technologies. Here were their opinions. 1. Laser light does not work. At least in 80% of patients in one study. It required diet, exercise and vibratory massages.
2. Cold exposure works, but it is expensive, cumbersome, painful, and it doesn’t work on cellulite.
3. Radiofrequency (RF) and ultrasound were rated the best by the panel with about the
same efficacy. RF uses heat from electric currents and had more discomfort with more side effects than ultrasound. Ultrasound uses radio wave is painless and appeared to have more long lasting effects.
4. All manufacturers claimed to have the best machines that give permanent results by damaging the fat cells ability to store fat.
I tried the last two and chose to try Cavitation ultrasound, since I didn’t like the torture.
Ultrasound has only recently been approved by the FDA (2012). Out of all the equipment I have researched, I chose to use a machine called CAVI-LIPO. My decision was based on the good long term reviews from the European and Asian markets.
As you can see from my before and after photos, so far, after
only seven treatments - the results have been dramatic! I spaced my treatments one week apart, did not lose any additional weight and really did not exercise. I was so impressed with the results, that I could not wait to send my family and friends the before and after photos. Now, I am happy to share my good news and photos with you as well. My good fortune can now be your good fortune!
The CAVI-LIPO is currently available in all nine Tropicalaser Centers in South Florida. They specialize in the latest in hair and tattoo removal, facial rejuvenation, and now have added the CAVI-LIPO Body Sculpting as well! Since putting them in all of the centers, the feedback from patients has been 100% positive. The one thing that everyone has noticed and a key element with this procedure
is the immediate measurable results after the first treatment. There is nothing more satisfying than seeing a difference in your appearance after just one visit.
CAVI-LIPO is not a weight-loss formula and is only indicated for patients that have 10-20lbs. left to lose. It’s for those patients that have stored fat in areas that exercise and weight loss just doesn’t seem to touch. Personally, I highly recommend it for that extra fat in the belly, love handles, upper arms, and cellulite of the thighs.
The news for non-invasive painless fat removal is good and it keeps getting better every day.
For additional information about CAVI-LIPO, or any of our other procedures, please visit our website at www.tropicalaser.com or call 561-753-3336.
Page 8
February 2014
SEXUAL HEALTH
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Are You Concerned About Erectile Dysfunction? • Pain disorders – almost exclusively affecting women due to dryness and muscle spasms during intercourse.
Dr. Ishan Gunawardene received his medical degree from St. Georges University. Dr. Gunawardene specializes in internal medicine and adult medicine and believes in providing the utmost in patient care and treatment. General consultations are also available.
By Ishan Gunawardene, MD
Sexual Dysfunction can be defined in many forms and fashions. This often distressful and embarrassing issue can be broken down into four categories:
• Desire disorders – a lack of sexual desire or interest in sex for a period of time.
• Arousal disorders – an inability to become sexually aroused or excited during sexual activity. It also includes failing to achieve and maintain an erection during sexual activity.
• Orgasm disorders – a consistent delay or inability to have an orgasm after normal sexual activity.
I would like to focus on one form covered under arousal disorders, erectile dysfunction or ED. ED is the inability to have and maintain an erection in order to achieve sexual intercourse. Having an occasional problem maintaining an erection is generally not a cause for concern. However, if it becomes a consistent issue, you may very well have ED. While ED is the most common form of sexual dysfunction in men, it can be somewhat embarrassing and thankfully by finding the underlying cause, it is treatable. ED is so common that one in three men will experience it at some point in their lifetime and it is a significant cause of stress in men.
There are many health and psychological issues why someone may experience ED. One of the more common risk factors is advanced age. Thirty percent of men over the age of 70 are affected. Obesity is another cause and because of this, a man that is overweight is at a greater risk of having problems as opposed to a man of normal weight. Diabetes, high blood pressure, high cholesterol, arthritis, heart disease and other cardiovascular disorders, and surgery are among the many reasons that may play a significant role for anyone experiencing ED.
Not only is ED stressful to deal with, stress is also a cause of ED. Since the psychological aspect of one’s life plays a role in their overall health, ED can be a result of stress. Other risk habits include;
a sedentary lifestyle, alcohol, use of substances (anti-depressants, barbiturates, cocaine, smoking – cigarettes, cigars, and marijuana, heroin, and amphetamines), and a variety of medications. As it turns out, about a quarter of all cases of ED are actually caused by taking some sort of medication.
The first step in treating your ED is to attempt to find the underlying cause. Your primary care physician will perform a thorough physical examination which includes taking your complete history, blood pressure, heart rate, genital screening, neurological exam, review of
your lower extremities, and any laboratory tests needed to attain a proper diagnosis.
Erectile dysfunction is often treated by making some sort of lifestyle modification along with the use of medication. In a recent study, one-third of obese men had improved ED symptoms by exercising and losing weight, which can reduce your body mass index (BMI) below 30. Other remedies include; stop smoking, talk with your physician about changing medications associated with ED, and psychosexual therapy performed by a qualified sex therapist can improve ED between 40-80%.
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Imagine hearing a weather forecaster warn that tomorrow could be "colder with a chance of stroke."
As odd as that may seem, researchers have found possible associations between certain weather conditions and the incidence of strokes.
Larger daily temperature variations and higher humidity each were associated with higher stroke hospitalization rates, according to a new study.
The researchers also found that colder average annual temperatures were associated with stroke hospitalizations and death. An average daily temperature change of 5 degrees Fahrenheit was associated with about a 6 percent increase in stroke risk and hospitalization, the researchers said.
The reasons behind the findings are unclear, said study lead author Judith Lichtman. And although the study showed an association between weather and stroke risk, it didn't prove a cause-and-effect relationship.
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"Daily fluctuations in temperature and increased humidity may actually be stressors," said Lichtman, an associate professor of epidemiology at the Yale School of Public Health. "People at risk for stroke may want to avoid being exposed to significant temperature changes and high humidity." How might fluctuating temperatures actually stress the body? When temperatures go down, blood vessels in the skin constrict so the body doesn't
waste a lot of heat, said Dr. Mark Stecker, chairman of the department of neurosciences at Winthrop-University Hospital in Mineola, N.Y. When it's warm outside, the vessels open up to increase heat loss through the skin. Stecker, who was not part of the research team, said the idea that weather can affect health is not new. "People think there should be a relationship," he said. "They often say things like, 'My joints hurt -maybe it's going to rain,' or, 'I got a cold because it's cold outside.'"
There might be something to old wives' tales, he said, but it's extremely difficult to know for sure. The study, which is scheduled for presentation at the American Stroke Association meeting in San Diego, should be considered preliminary until published in a peer-reviewed journal.
www.GlobalHealthTribune.com
February 2014
Page 9
HEALTHCARE NEWS
FDA Advisory Panels Vote Against CV Safety Claim for Naproxen
S
ILVER SPRING, MD — In a two-day meeting of the Food and Drug Administration (FDA) Arthritis Advisory Committee (AAC) and Drug Safety and Risk Management (DSARM) Advisory Committee, just nine panel members said they believed naproxen has a lower risk of cardiovascular thrombotic events than other available nonsteroidal anti-inflammatory drugs (NSAIDs). In contrast, 16 of the advisory panel members felt the data were insufficient to say naproxen was safer than other NSAIDs.
The panel grappled with the available evidence, mainly because the data presented over the two days were indirect or observational. While some members, including Dr Brendan Everett (Brigham and Women's Hospital, Boston, MA) and Dr Peter Kaboli (University of Iowa, Iowa City), said the data were strong enough for them to change their clinical practice, which would see them now select naproxen over other available NSAIDs, others, like
Dr Sanjay Kaul (Cedars Sinai Medical Center, Los Angeles, CA), argued the evidence was inconclusive to say naproxen posed less cardiovascular risks.
For Kaul, observational studies are important for raising clinical questions, not settling them.
Nearly 10 years ago, rofecoxib (Vioxx, Merck) was pulled from the global market because of a heightened cardiovascular-risk profile. This led to a 2005 meeting of the AAC and DSARM, where the FDA concluded that the three
approved COX-2–selective NSAIDs, celecoxib (Celebrex, Pfizer), rofecoxib, and valdecoxib, were associated with an increased risk of serious adverse cardiovascular events compared with placebo. Valdecoxib was eventually withdrawn from the US market and a boxed warning added to all NSAIDs warning of the cardiovascular risk and risk of serious gastrointestinal bleeding. Celecoxib is still approved for the treatment of osteoarthritis and rheumatoid arthritis. The Prospective Randomized
Evaluation of Celecoxib Integrated Safety vs Ibuprofen or Naproxen (PRECISION) trial is currently evaluating the relative safety of celecoxib, ibuprofen, and naproxen. During the twoday meeting, the panel discussed whether PRECISION should continue, as some felt the trial was biased toward a null effect and that the results would not be useful. However, the majority of panelists felt that despite the difficulties with PRECISION, which has been delayed because of slow enrollment, the study should continue, as it could help inform clinical practice. The 16–9 vote against changing the label to highlight a lower cardiovascular risk profile with naproxen than with other drugs in the class runs somewhat counter to an FDA review. As reported by heart wire , the FDA review suggested the evidence might be sufficient to say naproxen did not pose the same cardiovascular risks as other NSAIDs. The FDA review pointed to a 2013 meta-analysis published in the Lancet that showed the risk for cardiovascular events was
present for both nonselective and COX-2–selective NSAIDs, but the risk might be lower for those treated with naproxen.
A slight majority of the AAC and DSARM panel members also felt the weight of clinical evidence supported a reconsideration of the current NSAID labeling. The label implies that cardiovascular thrombotic risk is not "substantial" with short treatment courses, but 14 panel members said this advice should be reconsidered and that there was no latency period with the NSAID class. Eleven panel members did not feel the label needed to be changed, although many of those who voted against the label change said they didn't feel there was any period in which the cardiovascular risks were nonexistent. Finally, the panel also discussed whether or not changes should be made to the label of over-thecounter NSAIDs at currently available doses, to refine the message about cardiovascular risk, but this was a nonvoting question. No consensus was reached given the absence of data.
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Page 10
February 2014
HEALTHCARE NEWS
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EXTRAORDINARY NURSES RECOGNIZED AT Wellington Regional Medical Center
urses at Wellington Regional Medical Center are being honored with the DAISY Award For Extraordinary Nurses on February 4th at 2pm in the Community Center at Wellington Regional Medical Center. The award is part of the DAISY Foundation's program to recognize the super-human efforts nurses perform everyday.
The first award recipient is Towanda Anderson who is being honored for her outstanding effort in providing extraordinary care to patients at Wellington Regional Medical Center.
The not-for-profit DAISY Foundation is based in Glen Ellen, CA, and was established by family members in memory of J. Patrick Barnes. Patrick died at the age of 33 in late 1999 from complications of Idiopathic Thrombocytopenic Purpura (ITP), a little known but not uncommon auto-immune disease. The care Patrick and his family received from nurses while he was ill inspired this unique means of thanking nurses for making a profound difference in the lives of their patients and patient families. Each quarter, a nurse will be selected by Wellington Regional’s Daisy Committee to receive the DAISY Award. At a presentation given in front of the nurse’s colleagues, physicians, patients, and visitors, the honoree will receive a certificate commending her for being an "Extraordinary Nurse." The certificate reads: "In deep appreciation of all you do, who you are, and the incredibly meaningful difference you make in the lives of so many people." The honoree will also be given a beautiful and meaningful sculpture called A Healer’s
Touch, hand-carved by artists of the Shona Tribe in Africa.
One day while Pat was in the hospital, he asked his family to bring him a Cinnabon® cinnamon roll plus enough for all the nurses in his unit. With the help of Cinnabon’s parent company, FOCUS Brands, the DAISY Foundation carries on this tradition by serving Cinnabons to all the nurses in the Award recipient’s unit in thanks for everything they do for their patients and families.
Said Bonnie Barnes, President and CoFounder of The DAISY Foundation, "When Patrick was critically ill, our family experienced first-hand the remarkable skill and care nurses provide patients every day and night. Yet these unsung heroes are seldom recognized for the super-human work they do. The kind of work the nurses at Wellington Regional Medical Center are called on to do every day epitomizes the purpose of the DAISY Award.” Said Chief Nursing Officer Michelle Epps “We are proud to be among the hospitals participating in the DAISY Award program. Nurses are heroes everyday. Given the current national nursing shortage, the DAISY Award could not be launched at a better time. It’s important that our nurses know their work is highly valued, and the DAISY Foundation provides a way for us to do that.” For a complete listing of hospitals currently running the program, please go to www.DAISYfoundation.org
Dear Deborah
seriously thinking about staying up all night just so he doesn’t find out. Do you have any other ideas? - Stay up all night
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DEAR DEBORAH: If you are dating someone that doesn’t accept your Facebook friend request, should you stay with them? - Are we friends?
Dear Are we friends: That is really difficult to answer and there are many more questions than answers. First of all, is it a personal page or strictly for business? How long have you been dating? Although those questions seem trivial, the answers are important. If you have been dating someone for a short period of time, let’s say less than six months, you should not get upset. If you have been dating someone exclusively for over six months and it is their personal page, they should accept your friend request or give you a plausible reason for not doing so. However, if the page is for business, they have every right to exclude you. DEAR DEBORAH: I was invited to accompany a guy I have known for years on a cruise. We have hung out here and there and I have always felt a spark. My concern is that he will find out that I snore and I am
Dear Stay up all night: There is one simple answer – tell him that you snore! It really is not a big deal and for all you know, he does too. DEAR DEBORAH: My former boyfriend of three years never told me that he had herpes and unfortunately, he passed them on to me almost immediately. Do people need to get a clean bill of health before having sex? - Giving a bit too much!
Dear Giving a bit too much: I am very sorry that you were given a gift that no one would willingly accept. First of all, you need to be honest with any future partners and tell them of your condition. Regardless of whether or not you have breakouts, they need to know that there is a chance that they can become infected. If you think it’s possible that your ex. does not know he has herpes, you need to tell him as well. He needs to know so he doesn’t infect any other future partners. You also need to practice safe sex by ALWAYS using condoms. I personally feel that it is a smart idea to ask someone to get tested prior to being intimate. Again, whatever you decide, please make sure that you also get tested and disclose your illness to anyone that you will be intimate with in the future.
Dear Deborah is a monthly advice column written by Deborah Lynn with a common sense approach to dating. If you have any questions or comments, please forward them to: questions@globalhealthtribune.com as we would love to help.
www.GlobalHealthTribune.com
February 2014
Page 11
CHIROPRACTIC & WELLNESS
Disc Herniations: Not All are Equal a herniated disc, but there’s a lot of misinformation about the condition and what to do to get it treated. Today’s article is going to deal with the most common misconceptions. Misconception #1 Hernia = Herniated Disc:
Dr. Jonathan Chung is a Doctor of Chiropractic who focuses on Structural Correction and is primarily concerned with Structural Shifts of the spine. He graduated from the University of Central Florida with a B.S. in Microbiology and Molecular Biology. Dr. Chung then went on and received his doctorate from Life University's College of Chiropractic. Dr. Chung is certified in pediatrics from the International Chiropractic Pediatric Association, and is a Structural Chiropractic Researcher who has been published in scientific peerreviewed journals.
N
eck pain and back pain are two of the most common reasons for visits to a doctor’s office. One of the most notorious causes of neck and back pain are caused by herniated discs in the spine. Most people have heard of
First of all, a herniated disc and a hernia are not the same thing. A hernia is a condition that typically involves parts of your internal organs poking out of the body and can lead to parts of the organ to become ischemic and die. Many people use these terms interchangeably, and believe me when I say that it’s never good for the chiropractor or the patient to have a person with a hernia in the office. Those people belong in the ER.
A herniated disc involves a part of the intervertebral disc poking out of the normal barriers of the spine. They are often called slipped disc or ruptured discs. When someone has a herniated disc, the common threat is that of a pinched nerve causing pain or dysfunction to spine or the extremities. Misconception #2 Herniated Discs Require Surgery:
The truth is that herniated discs range widely in magnitude and severity. They are generally categorized into 3 different types
in order of severity: disc prolapse, disc extrusion, and disc sequestration. A prolapse is when the disc begins to push out of its normal barrier. An extrusion is when parts of the disc have visibly entered the spinal canal. Sequestrations are when the disc material begins to break off the main disc and separate into the spinal canal.
Most of you reading this probably have a prolapse and don’t even know it. Research shows that as many as 60% of disc herniations show no pain or symptoms. Protrusions and
smaller extrusions that cause pain can typically be managed conservatively without surgery. Larger extrusions and full sequestrations can affect the spinal cord, cause muscular weakness, and even affect organ function which certainly becomes a surgical issue.
Misconception #3 Chiropractic is unsafe for people with disc herniations: I’m often confronted with this misconception when someone introduces me to a friend or family member with a spine
problem. Even though as many as 60% of my patients are people who are coming to me for relief from disc herniations, I’m often told that their spine has herniations and that chiropractic is not safe. While this may have been true for some of chiropractic’s olden days where people only used a heavy handed and rough style of manipulating the spine, we live in a time where multiple techniques can be applied that are gentle and effective in helping people with disc problems.
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Page 12
February 2014
PRACTICE TRENDS
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Medical Screening at 40 and Beyond
Y
Shekhar V. Sharma, M.D. Board Certified in Internal Medicine
ou wake up in the morning and it’s your 40th birthday. That certainly snuck up on you and you suddenly feel like you’re over the hill!
non-cancerous. Occasionally, these extra tests are patient directed, and other times, these tests are ordered by a physician.
If you are a woman, you should think about having a mammogram at the age of 40, as this is the recommendation by both the United States Preventive Services Task Force and the American Cancer Society (ACS). The ACS also recommends that women should have an MRI if they are at a higher risk of developing breast cancer. Part of the downside of annual mammograms is identification and testing of suspicious lumps and masses that end up being
If you are a male, you would definitely want to have a Prostate Surface Antigen Test or PSA Screening. Men who want to be screened for prostate cancer should also have a digital rectal examination once a year.
After the age of 40, you may want to consider taking up running, jogging, or brisk
walking to maintain and improve your cardiovascular health. As long as you have a strong heart it is never too late to start an exercise program. As we age, our muscle fiber shrinks in number and size. This may result in a decrease in cardiovascular endurance, strength, balance, and coordination. Most athletes also experience a decline around the age of 40.
If you are female and beyond 40 and have been experiencing symptoms of early menopause,
have a family history of osteoporosis, and you have had a fracture in your adult years, I would strongly recommend a Bone Mineral Density Test (BMD). The U.S. Preventive Services Task Force recommends a BMD for everyone over 65 years of age at least once a year. At 50, a lot of people are not aware that this is an age you should have a colonoscopy screening to rule out colon cancer. Annual physicals are also a must; this entails drawing
blood for lab tests. These lab tests should screen for diabetes mellitus, hypercholesterolemia, kidney and liver diseases, and anemia. Tests for various other ailments that match your complaints can be done by your primary care physician. An annual physical exam will also screen for hypertension. Remember, your primary care physician is the captain of your health and will guide and direct you to having a healthy and hopefully happy life.
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February 2014
Page 13
EVENTS
Keystone Chiropractic ribbon cutting
T
Dr. Chung circulating the room.
hankfully, the rain did not deter family, friends, local business owners, and patients from coming out to join Tony Zapata from the Central Palm Beach Chamber of Commerce welcome new member, Dr. Johnathan Chung, owner of Keystone Chiropractic, into the chamber with the symbolic ribbon cutting ceremony to commemorate the occasion.
The anticipation is building for Dr. Chung to cut the ribbon.
M
Brittany, Dr. Jonathan Chung, and Tony Zapata.
The weather did not keep people from coming out for the ribbon cutting.
Medical Marijuana – Will You Vote For or Against? different. Some people may experience dizziness, rapid heartbeat, depression, hallucinations, muscle relaxation and therefore, a slower reaction time, and it may have an impact on your lungs over time.
By Deborah Lynn
any Florida residents are rejoicing with the Florida Supreme Court’s decision on January 27, 2014 to include medical marijuana on the November ballot.
However, even with the required 683,149 verified signatures (although they had collected 786,368), it still faced a hurdle when Florida Attorney General Pam Bondi challenged the validity of the initiative which was brought forth by the organization, People United for Medical Marijuana.
In the Supreme Court’s 4-3 decision, it was determined that the voters would have fair notice in order to understand the scope and purpose of the proposed amendment which is for the restricted use of medical marijuana for debilitating medical conditions. In their opinion, the Justices felt the proposed amendment was not misleading and conveyed its purpose – the limited use of marijuana as determined and prescribed by a physician licensed in the state of Florida.
There are currently 20 states and the District of Columbia that have legalized medical
According to a study performed by the University of Southern California (USC), there is a link between the recreational use of marijuana and an increased risk of developing subtypes of testicular cancer. Testicular cancer is the most common type of cancer among men between 15-45 years-of-age.
marijuana. However, that may change if New York goes through with its plan to legalize medical marijuana on a trial basis within a year and if voters decide to legalize the plant in Florida.
It is classified as Schedule I under controlled substances and under federal law, it is illegal to use, sell, and possess cannabis in the United States. Although individual states have legalized marijuana for one purpose or another, it will be quite some time before the federal government legalizes marijuana – if it ever does.
With the words medical or
medicinal marijuana being thrown around so often, we’ve decided to break it down a bit so it would be easier to understand. Marijuana, cannabis, or “pot” has been around for thousands of years and has been used for medicinal purposes within many cultures. Cannabis produces a compound called cannabinoids. Since cannabinoids have an effect on the immune system and central nervous system, it has been useful in treating the side effects associated with cancer and cancer-related therapies.
According to the National Cancer Institute, studies show that use of cannabis helps to relieve pain, nausea, and
vomiting. Therefore, due to its pain relieving qualities, it has been helpful in treating the side effects from cancer therapies and it has been beneficial in relieving pain associated with debilitating diseases. Because of the lack of research at this time, it is not known whether it is better to eat or smell the plant in order to help with pain. There are many forms in which people have used medical marijuana, those include; eating it by incorporating it in food, smoking it, using a marijuana vaporizer, tonic or drops, mouth spray, topically, and in pill form. With any drug, there are side effects and marijuana is no
Since the plant has been illegal for so long, there have not been sufficient studies to determine exactly what the risks are with long term use. The fact is, there needs to be additional research in order to make an educated decision on the benefits and risks associated with the long term use of marijuana. If you would like to view the decision made by the Florida Supreme Court, you can visit their website at www.floridasupremecourt.org. You can also view the proposed constitutional amendments that will be on the November ballot by visiting the Florida Department of State Division of Elections at http://election.dos.state.fl.us.
Page 14
February 2014
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AROUND TOWN
T
Susan G. Komen Race for the Cure
he 25th of January proved to be a picture perfect day for those participating in the 23rd Annual Susan G. Komen Race for the Cure. Participants and spectators quickly filled Flagler Drive and the grounds of the Meyer Amphitheatre for a morning full of activities while raising money for such a worthy cause, breast cancer. If you would like to learn more about Susan G. Komen South Florida, visit www.komensouthflorida.org.
Chairman and CEO of Universal Health Services (UHS), Alan B. Miller, with Wellington Regional Medical Center's Director of Marketing, Helen Rengepis.
The team from Good Samaritan Memorial Center were kind enough to pose for a photo.
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Bethesda Health was just one of the many booths at the event.
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www.GlobalHealthTribune.com
February 2014
Page 15
HEALTHCARE NEWS
Select Specialty Hospital Do you have a success story?
Mike Corvaia has been in healthcare administration for over ten years and is currently the Director of Business Development for Select Specialty hospital in Palm Beach. he holds a Bachelor’s degree from the University of Florida and is completing his master’s Degree this year in Business Administration, with an emphasis on healthcare Administration.
Please feel free to send any healthcare related questions to mcorvaia@selectmedical.com
Ventilator Care
Judy Barth was working in her yard when she experienced what she thought was heartburn. The pain increased to the point that she called for help. The last thing she remembers is
scrambling for her insurance cards and passing out. Her next memory is one month later when she woke up at Select Specialty Hospital- North Knoxville. Judy had gone into cardiac arrest and was admitted to the local medical center where she was treated and stabilized. Doctors were concerned that a lack of oxygen might have affected her brain. Judy had spent almost a month unconscious and on a ventilator in the ICU when she was referred to Select Specialty Hospital to get her off the ventilator and functioning again. During her two week stay at Select Specialty Hospital, Judy woke up, got off the ventilator and beat the odds by discharging home. She has since returned to work and walks one to two miles every day.
Wound Care
Eugene Harris and his wife Jerlean were working on his antique truck, trying to get it to start. He was working with the carburetor when it blew up. Eugene was sent to the burn unit in Memphis in critical condition with twenty-four percent of his body burned. His family was told he might not survive. A month and a half later, still
unconscious and having survived several life-threatening infections, Eugene was transferred to Select Specialty Hospital in Memphis. He was on a ventilator with pneumonia and required dialysis. Eugene was with Select for nearly two months, his wife by his side every day. While he was at Select, he weaned from the ventilator and saw his kidney injuries resolved. He no longer needed dialysis. His burns continued to heal and he was discharged to a rehab facility with the goal of returning home as soon as possible. Almost four months after the accident, Eugene returned home. He says now he plans to enjoy the
comforts of home with his wife of 46 years.
Cardiac Care
Thirty eight year old Myrtle Mason had been struggling for breath for about a month. Her body was swollen from fluid retention due to congestive heart failure and she had been sleeping upright in a chair so she could breathe at night. When she could no longer take it, Myrtle sought the help of a physician. She was admitted to the local medical center with acute respiratory failure and was placed on a ventilator. Doctors told her family that getting off the ventilator would be a long shot
and she might not survive. Then, Myrtle was transferred to Select Specialty Hospital- Fort Smith. At Select, the team got her up and moving again. Her congestive heart disease, diabetes and blood pressure were brought under control and she was weaned from the ventilator. Myrtle was originally scheduled to go to rehab, but she surprised everyone by walking out of the hospital on her own and discharging home. It was her son’s 18th birthday. Myrtle feels like she has learned the importance of taking care of herself and is grateful for a second chance. “They gave me my life back. They were there for me.”
Phoebe’s daddy has big dreams for her.
St. Jude patient Phoebe: Daddy’s Princess
B But ut aatt this m moment, oment, sh she’s e’s fi fighting ghting ccancer. ancer er.. esearch H ospital® sspends pends eevery very momen hanging That’s Children’s en’ss R Research Hospital® momentt cchanging T hat’s why why SSt. t. JJude ude Childr en’ way world orld tr treats eats cchildren hildren – with with pioneering pioneering research research and exceptional exceptional ccare. are. the w ay the w ude for an ything. Don’t Don’t wait. wait. Join Join SSt.t. JJude ude in finding finding And no famil ver pays pays SSt.t. JJude familyy eever anything. children like like Phoebe. Phoebe. Because Because at at this moment, moment, she should should be be home ccures ures and saving saving children enjoying story story time hugs from from d addy and pl ay dates dates in the p ark. enjoying time,, hugs daddy play park.
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