RSVP Health | Summer 2011 by RSVP Health, LLC

Bridging The Gap Between Patients And Providers

Summer 2011 | Volume 2, Issue 3 www.rsvphealth.com

The Interview Series... Interviews with health care professionals and people who deal with health issues in their everyday life.

Isaiahâ&#x20AC;&#x2122;s story

(autism and aspergers awareness)

Get educated on health insurance

A front row seat for the birth of gerontology

Too much to do.

Too LiTTLe Time.

We can help!

As parents age, their needs change. You soon discover that your time is filled with “have to do” instead of “get to do.” Our services vary from doing chores to companionship to personal care. Let us be the caregiver, so you can spend your time being family.

Reclaim the time you spend with loved ones. Call today. 314.446.2519

LSSInHomeServices.org Home Health Private Duty Outreach Social Services Living Safe Technologies Hospice Care

Credits Publisher RSVP Health, LLC Executive Editors Benjamin A. Moss Rodney D. Gross, Ph.D. Kevin Russell

RSVP Health is a focused group of individuals, interested in bringing consistent and understandable health care, health and wellness education and services. It is who we are that dictates what we do. What we do: Health Care Business Development Strategic Business Planning Executive Health Care Management Practice Management Policy and Procedures Protocols Speaking Engagements Health Care Reimbursements Patient Satisfaction Practice/Office Patient Flow Designs Patient and Senior Care Advocacy RSVP Health 888-415-8759 www.rsvphealth.com twitter.com/rsvphealth facebook.com/rsvphealth

Creative Director Production Manager Benjamin A. Moss Designer Kristen Martin Writers Rodney D. Gross, Ph.D. Dr. Charles Willey, M.D. Lola AuBuchon Gross Dr. Arturo C, Taca, FABAM, FABPN Molly Burns Rita Martin Cindy Presnell Sally Droege Catherine T. Ramirez Jeff Browning Benjamin A. Moss Production Coordinator Kevin Russell For advertising information, please contact us at: RSVP Health 124 N. Jackson St., Farmington, MO 63640 888-415-8759 info@rsvphealth.com

RSVP Health is provided for information and education purposes and is in no way to take the place of a health care professionalâ&#x20AC;&#x2122;s advice. Please consult a health care professional with any health related questions. Not all information within is the opinion of RSVP Marketing Group or RSVP Health. RSVP Health is not liable for any decisions made as a result of information received from the RSVP Health Magazine. www.rsvphealth.com www.rsvpmarketinggroup.com

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RSVP Health | Community Health Care and Wellness Resource Guide

Many of you flooded us with questions and requests for this next issue. It makes it so exciting and fulfilling for us to receive the overwhelming responses and reiterates, why RSVP Health exists and our vision of simple relevancy.

always believed in “questions equal results” and in health and wellness, particularly your health, it has to be necessary. It is your or your family’s health and wellness, do not be afraid to educate yourself, ask questions and ask for answers/results.

Gathering these requests, the things most requested were: Real Life Stories, Interviews and Definitions (new and repeated ones). Inside the pages of this issue, you will find personal stories of struggles, awareness, navigating health care specialties and achievement. Furthermore, you will read a detailed interview, that was done live, between one of the most respected Insurance Brokers in the St. Louis region and me around Health Insurance and Health Care Reform. Additionally, you will read an interview, again done live, with a mother, her family’s and son’s journey through a particular diagnosis. Last but not least, your requests for health care and wellness definitions, which includes those titles at the end of individual’s names.

One last thing, we were contacted by a dear friend asking us if we would be willing to utilize all of our media outlets (Publication, Radio Shows, Website, Facebook, Live Events, Personal Appearances, etc), to help make awareness of an individual with three small children that has been missing in the region. Without hesitation, we agreed and as of the printing of this issue, the individual is still missing. Please reference the page inside this issue and if you have any information, please contact the listed individual/organizations.

This past year as RSVP Health continues to grow, we have expanded our vision to include the one on one interviews with individuals, patients, organizations, health and wellness experts, government, etc. This helps in what you are accustomed to hearing me say, “keeping it relevant”. Our vision has also included keeping individuals like you updated with information on our Facebook page and our website. The weekly radio show continues to grow in listenership and even the set up of live-recorded shows with audience questions in and at communities and organizations all around. We want to continue to hear from all of you like we did for this issue. If you have a story to share, come do a show in your community or at your organization, this is why we exist. I have

As always, I would like to thank all health care and wellness entities and contributors that have participated in this guide and for seeing the importance to educate and communicate to you. In addition, I would like to thank my other partners who make up RSVP Health LLC and their support on the importance of healthcare and wellness education, communication and awareness. In closing, RSVP Health LLC will strive to bring healthcare and wellness education, awareness and access to you with one goal in mind, your well-being. Rodney D. Gross, Ph.D.

Have a story you would like to share with us and everyone else? Contact us at 888-415-8759 or www.rsvphealth.com/contact

RSVP Health | www.rsvphealth.com 5

Health coverage as individual as your family. Don’t put your family at risk by trying to get by without health care coverage. Get reliable benefits that match your busy life. We can help you choose a plan that makes good sense for your health, and your wallet.

Diana Harte

Authorized Independent Agent

314-727-5522 x107 dharte@mrctbp.com 230 S. Bemiston Ave., Ste 900 Clayton, MO 63105

Health. Join In. Diana Harte isHealth an independent authorized agent in Missouri for Anthem Blue Cross and Blue Shield. 6 RSVP | www.rsvphealth.com

In Missouri (excluding 30 counties in the Kansas City area): Anthem Blue Cross and Blue Shield is the trade name for RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. Life and Disability products underwritten by Anthem Life Insurance Company. Independent licensees of the Blue Cross and Blue Shield Association. ®ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association.

Table of Contents | RSVP Health

You Have More Power Than You Think.

The Grandparent Scam. Are you vunerable?

Page 8

Page 14 Marion’s “Happily Ever After”

Page 28 Whole Body Vibration.

Page 54 Page 12 Isaiah’s Story

Page 24 Get Educated on Health Insurance

Page 36 Autism and Communication

Page 16 One Doctors Prescription to Cut Health Care Costs

Page 31 A Front Row Seat for the Birth of Gerontology.

Page 40 & 60 INSynergy and the Growth in Addiction Medicine (2 part)

Page 32 Bringing Noah Home

Getting Healthy & Staying Healthy - Page 44; Is Your Parent Waiving a Red Flag - Page 48; Facts About Trama and Shock - Page 53; Dairy Dilemma - Page 58;

Page 19 Animals Are Good Medicine Pages 21 Kidz Care to End Alzheimer’s

Page 35 Giving Garrett Hope RSVP Health | www.rsvphealth.com 7

Part 3 By Dr. Rodney Gross, Ph.D.

Titles:

The Doctors? D.C. D.O. D.P.M. M.D. O.D. Ph.D.

Other Titles & Acronyms L.C.S.W. M.H.A. M.P.H. M.S.N. M.S.W.

Become Your Own Health and Wellness Expert

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Titles & Acronyms

“Titles and Acronyms”! We trust individuals and organizations that have “Titles and Acronyms” just because that is what we were taught throughout the years and additionally taught not to question. Do we even know what they mean? Most of us do not know what they mean and as I said at the beginning of this issue, this is something that all of you requested in large numbers. Obviously, the “You Have More Power Than You Think” is empowering many of you.

The Doctors? What and who is a “Doctor”? Speaking from the health side, I have listed some common initials that you will see behind someone’s name that you address as “Doctor”. D.C. – (Doctor of Chiropractic) - “Focuses on the relationship between the body’s main structures – the skeleton, the muscles and the nerves – and the patient’s health. Chiropractors believe that health can be improved and preserved by making adjustments to these structures, particularly to the spinal column.” – Association of Chiropractic Colleges D.O. – (Doctor of Osteopathy) – Please reference the RSVP Health Publication Summer 2010 edition on our website for a detailed definition and comparison to a Doctor of Medicine (M.D.). D.P.M. - (Doctor of Podiatric Medicine) – Focuses on the medical treatment and diagnosis of disorders of the foot. M.D. – (Doctor of Medicine) – Please reference the RSVP Health Publication Summer 2010 edition on our website for a detailed definition. O.D. – (Doctor of Optometry) – “Doctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye. Doctors of Optometry prescribe medications, low vision rehabilitation, vision therapy, spectacle lenses, contact lenses, and perform certain surgical procedures.

I will attempt to put as many of the titles and acronyms requested and add some that I think is relevant to your wellbeing. I may have described some of the definitions in previous issues and I will reference which issue you can find further detail on our website under the media tab. I will use some of my own definitions and quote some of the others, with the goal of all of us having a better understanding of who is involved with “our” health and wellness.

Ask questions, research the web, go to the library, spend a day at the bookstore, most of these costs little to nothing in return for the knowledge you will receive. Your health and wellness is your “Return on Investment”.

Optometrists counsel their patients regarding surgical and non-surgical options that meet their visual needs related to their occupations, avocations, and lifestyle. An optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete an optional residency in a specific area of practice. Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system.” – American Optometric Association I will add, because you asked, they are not to be confused with Ophthalmologists. Ophthalmologists are M.D.s, Doctors of Medicine. Ph.D. – (Doctor of Philosophy) - is a degree a person gets from finishing a doctorate program normally after completing a Master’s Degree program in the related field as the Doctorate program. In many areas of study, the Ph.D. is the highest degree that a person can earn and normally takes three to six years to complete after the Master’s Degree program. I like to say that for me, it is the quest and contribution of knowledge. Other Titles and Acronyms Next are some of the most requested ones that all of you asked about.

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L.C.S.W. – (Licensed Clinical Social Worker) - Are trained in psychotherapy and social work principles to help individuals, families and groups. Before becoming an L.C.S.W., they earn their Master’s in Social Work (M.S.W).

“with all the “Titles and Acronyms” you may encounter, the one that is the most important is “Y.O.U.!”

M.H.A. – (Master of Health Administration or Master’s of Healthcare Administration) – Course of study involving the management of hospitals and other health services organizations. Course work may include health policy, healthcare economics, healthcare marketing, human resource management statistical analysis and much more. M.P.H. – (Master’s of Public Health) – Primary focus is on some of the following core areas of public health: Health Education, Nutrition, Child Health, Maternal Health, Policy, Statistics and more. M.S.N. – (Master of Science in Nursing) – an advanced-level postgraduate degree for Registered Nurses (R.N.s).

Become Your Own Health and Wellness Expert “Titles and Acronyms” are abundant throughout the health and wellness world. I hope this helps give you a simplified and brief explanation of “some” of the titles and acronyms you have and may encountered. Never let all those “Titles and Acronyms” intimidate you in anyway. The individuals who hold these titles are professionals, they have earned their title. However, as I have witnessed throughout my years in the health and wellness profession, most of us forget to explain what our titles are and what they mean to our patients/customers. One last thing, even with all the “Titles and Acronyms” you may encounter, the one that is the most important is “Y.O.U.! Empower yourself, ask questions, demand communication and know RSVP Health. You have more power than you think!

M.S.W. – (Master’s Degree in Social Work or Social Welfare) – Advanced degree in the field of Social Work, you usually see them working as family counselors, support group facilitators, school counselors and more.

Origin of “Doctor”

Doctor, as a title, originates from the Latin word of the same spelling and meaning.[1] The word is originally an agentive noun of the Latin verb docere, ‘to teach’. The Ph.D. entered widespread use in the 19th century at the Friedrich Wilhelm University in Berlin as a degree to be granted to someone who had undertaken original research in the sciences or humanities. From there it spread to the United States, arriving at Yale University in 1861, and then to the United Kingdom in 1921.[2]

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1. William Whitaker. “William Whitaker’s Words - Doctor”. University of Notre Dame. 2. British Medical Association. 2007. Becoming a Doctor: Entry in 2008

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Isaiah’s Story: An Interview with Amy Dugal | RSVP Health Interview Series

Dr. Rodney Gross and Rita Martin, with RSVP Health spoke with Amy Dugal, a registered nurse, wife and mother of two, one with Asperger’s Disease, a form of Autism. Rita: Amy, what made you wonder about Isaiah’s development? Amy: His gross motor skills, as he did not crawl until eleven months, or walk until seventeen months. He did not babble, though he did make sounds. Even though he could not speak we could communicate. We could ask, ‘Which one on this page is the blue square?’ And he would point to it. He had sensory issues such as he didn’t like to walk barefoot in the grass or mud. He was very picky, eating only lukewarm food or bathing

Or he is not talking and they would say, ‘Oh, it’s okay, he’s a boy. They do that later.’ They said he probably just chose not to speak. I read The Strong-Willed Child by James Dobson, thinking this kid is stubborn. The Autism thing was way out there. It was in the back of my mind, but I thought no, he is just really strong-willed. I read that book, I tried some of that, and I was like why is it not working? That kind of got the ball rolling. People I worked with had a family member recently diagnosed with Asperger’s. So I researched it online. The pediatrician still said no. I was tired of that pediatrician so we decided to switch. Rodney: You make a valid point there. The medical

Isaiah’s Story An Interview with Amy Dugal RSVP Health Interview Series

With: Amy Dugal, Dr. Rodney Gross and Rita Martin

in lukewarm water. Auditory problems were noticed when he would hold his ears when I was using the microwave. By three he had still not spoken a word but the pediatrician had said it was nothing to worry about, he would talk when he was ready. Then one day while in the car driving I heard, ‘Mom, I’m thirsty. I want some milk.’ I nearly pulled off the road. Thinking, who said that! He repeated it and I turned around and said. ‘You can talk!’ I realized that I always knew he was smart. When we got home that day, I sat a book down expecting him to say, ‘The blue square is there.’ Instead, he read the words on the page. I thought, [he has] memorized this book, so we went to the library and got ten new books. He read them all. Rodney: That is extraordinary. Amy: He was only three. This is when I became more aware of the auditory. I took him to the pediatrician with these concern and of course they blew it all off saying “He is fine.” I would always bring up questions at his well-child checkups at the pediatrician. “He is not walking.” They would say, ‘Oh, it is okay, he will.’ 12 RSVP Health | www.rsvphealth.com

community does not want people going on the web and diagnosing themselves. Though there is a difference between diagnosing and educating. After the education, what changed? Amy: The parents as teachers advocate in our former school district said there was nothing wrong with him and that he did not qualify for the early childhood program. So we moved to another school district. We met with a child educator within a week or so of the transfer. She watched him and agreed with me totally. She put me in touch with W.L. Johns of the Early Childhood Center of Farmington, where Isaiah qualified for SPED, special EDI. After a sixty-day observation class we found out that our three and a half year old was reading at a sixth grade level. They said it was probably higher, but he became board with the tests. These test results led us to the Thompson Autism Center in Columbia. They interviewed me for four hours while Isaiah was evaluated in another room. Based on their assessment he was diagnosis with Classic Autism.

Isaiah’s Story: An Interview with Amy Dugal | RSVP Health Interview Series

He started the early childhood program with an IEP in place so that his needs would be taken care of. That same year his little sister, Isabelle was born. We thought there might be some problems with regression but really, there was not. Autistic kids are kind of in their own little world. Isaiah’s major issues are in socialization and self-help skills like bathing and dressing. Emotionally, he was disconnected, so it did not matter to him that he had a sister. Now he loves her, they play and stuff, but we’ve come a long way over the last couple of years. He did wonderful in school, improving leaps and bounds. It was like every day it was something new. However, Isaiah developed some behavioral issues. After further testing we found out that he has ODD, Oppositional Defiant Disorder. Rather than trying medication we attempted using positive behavior intervention. So we tried that for a while. He and I actually wrote up a contract that he could not use the words dead, dying, killing, because he was using them all the time and I was like, ‘What is the deal?’ And they said that was just a part of ODD. So I called the pediatrician in Columbia and I said this is the deal, and she said, ‘Okay, do you want to start medicine?’ And I said yes. I really, really did not want this, but I cannot have my six-year-old thinking thoughts like that. Rodney: So you started to phase in the medications? Amy: There is not really any medication for Asperger’s, any medication would be for a symptom, like the ODD or an accompanying problem. So we started the medication and within a few weeks, he was a totally different child. He would hold the door open for me and do these normal things. He no longer tried to push his sister down the stairs; he told me that he loved me; I had never had that before. He would come up and hug me and it was just like, wow! So that is kind of, where we are now.

we kind of got the ball rolling. We work to gain community support and spread awareness through different projects. One of our current projects is to build a playground with access for the developmentally disabled. We expanded from just Autism to include all developmental disabilities, such as Cerebral Palsy and Down’s. Rita: What advice would you give parents in a similar situation? Amy: Have your child screened by a pediatrician early on. Trust your instincts, you are your child’s best advocate. Do not take no for answer, but do not be aggressive. This only pushes people away. Rita: To kind of sum up Isaiah’s story, what do you think he thinks? Amy: He knows he has Asperger’s. I just explained to him that, “You are a normal kid, but your brain works a little differently, and that is why you feel this way or that way about certain things” And he was like, ‘Okay mom.’ Rodney: How has Isaiah changed the family dynamic? Amy: He has definitely made us stronger. Josh and I keep each other balanced, we work very well together. You have to realize that you cannot do it by yourself—it is all about communicating, teamwork, and support. Editors Note: This interview was edited for length by RSVP Health, to read the entire interview, go to www.rsvphealth.com/articles and search for “Isaiah’s Story.”

Rodney: Are there support groups? Amy: We heard of a group called Autism Connections. My husband and I went, there were five people there. It was more like a gripe session. We thought it would be better if we had a goal. The group dissolved a bit, but we joined another couple, the Brocks, and created the kind of group we were looking for. Together we formed PADD (Parent’s Advocating Developmental Disabilities Inc.). The name is registered; we are now a 501(c)3, so

Isaiah Dugal, playing in a stream. Autism hasn’t stopped him from enjoying his childhood.

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The Grandparent Scam | By Sally Droege, LSS

The phone rang at Gloria Tremane’s house around 11:30. “Grandma, it’s Sara,” said the voice on the other end of the line. “I’m sorry to call so late, but ... I’m in trouble.”

unsure of, don’t let them rush you or pressure you. Think about the situation analytically—is this how the grandchild you know would speak and act?”

Maybe it was because it was so late and Gloria was beginning to drift off to sleep, or maybe it was because she so rarely spoke to Sara on the phone, but she could be forgiven for mistaking the voice of a stranger for the voice of her granddaughter. After all, the caller seemed to know things about Sara’s friends. And who else would be calling her so late at night asking for money for help in an emergency?

2. Apply the Parent Trap. The modus operandi of this particular scam seems to be the claim that the “grandchild” doesn’t want to call his or her parents because they don’t want to get in trouble. “That should be your first tip that something’s wrong,” Sally says. “Even if you think they have a good cause for not wanting to get their parents involved, it’s a good tip to stop and really examine the situation.”

“Off the top of my head, I’d say it was probably someone with not the best of intentions who was friends with Sara on a website like Facebook,” says Sally Droege, program manager for Lutheran Senior Services’ (LSS) Volunteer Money Management program. “The grandkids don’t always think about the things they post online. People who try to pull off the Grandparent Scam often go through the grandkids’ postings to pull out little bits of information to make them sound authentic.”

3. Ask for details. Check them by asking for detailed personal information, the likes of which probably won’t be found in online forums. The name of a family pet, or an event that happened long ago. “If they start fudging the details,” Sally says, “hang up.”

The so-called “Grandparent Scam” is becoming increasingly prevalent in all corners of the country. In June, a San Diego couple wired more than $12,000 to scammers after a caller claiming to be their grandson pleaded with them for help in bailing him out of a Mexican prison. While this is a more extreme case, similar incidents cost seniors lesser amounts with shocking frequency. So what can seniors do to safeguard themselves? Sally offers five tips. 1. Stop and Think. “The Grandparents Scam preys on that initial gut reaction to the thought of a loved one in trouble or in danger,” Sally says. “If you get a call from someone whose identity you’re

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4. Call your grandchild directly. Make up an excuse to hang up (“There’s static on the line, dear,”) and call them back on their direct phone line. If you cannot reach them, call a relative to confirm the situation. 5. Think about working with a money manager. “Agencies like LSS Volunteer Money Management are a good check against scammers,” Sally says. “For example, our volunteers know about currently circulating scams and other irregularities. And it’s always a good idea to have someone in your corner you can check with on these kinds of matters – a cool head in a hot situation.” For more information on scams or working with a money manager, contact Sally Droege and the LSS Volunteer Money Management team by visiting LSSMoneyManagement.org.

The Grandparent Scam:

Are YOU Vulnerable? By Sally Droege, LSS

“We have some seniors and some volunteers who have been together for a while. The volunteers become confidants, closer to family members than advisors. And they’re so passionate about what they do. It’s amazing to see the heart they put into their work. It’s a win-win for everyone.” – Sally Droege

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One Doctor’s Prescription To Cut Health Care Costs | Dr. Charles Willey

One Doctor’s Prescription To Cut Health Care Costs By Dr. Charles Willey

Health care reform starts and ends in the exam room. For most of my 27 years as an internist, I have structured my medical practice to align the financial incentives (for both patient and doctor) with patient wellness and lower costs. When we lower health care costs, all our health care woes — the uninsured, the skyrocketing premiums, Medicare insolvency — disappear. But more importantly, we can offer high-quality health care to all Americans. We can begin to instill this novel thinking with a simple accounting change in regular Medicare by allowing individuals to keep the Medicare Part B Tax in their own Health Savings Account (HSA). This simple change will spill over to transform all of American health care. The government deducts on average $98 a month from seniors' Social Security checks to pay into the insurance pool for Part B (doctors' office services). This is cash outof-pocket for seniors. If we instead structure the $98 as an HSA, unspent dollars would roll over year to year. I know from experience that, overnight, Medicare beneficiaries would become eager partners with me to improve their own health and make judicious health decisions. Ask any doctor how patients change behavior when their own money is at risk. The relationship between quality of patient care and health care spending is part financial and part psychological. Fischer and Wennberg at Dartmouth famously demonstrated that in Medicare, increasing spending on care is inversely proportional to quality of care. Another of their uncomfortable findings: Half of our health costs result from unhealthy behavior. I experienced this trend in my practice. We designed our own Medicare Advantage plan so that our patients can afford the care necessary for long-term health with zero premium and affordable but meaningful co-payments. It even pays for their membership to fitness centers. My

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One Doctor’s Prescription To Cut Health Care Costs | Dr. Charles Willey

patients save money by becoming healthy and avoid waste by spending their own money wisely. Patients who act instead as customers (as Medicare beneficiaries would, with their new Part B HSAs) are more cautious, less wasteful and more collaborative about health decisions. In health care, the price elasticity of demand curve is very steep. Patients with low personal costs, and anxiety fueled by incomplete Internet information, are more likely to demand MRIs for a tension headache or a CT scan for three weeks of coughing. Attention to spending, even in a Medicare Part B HSA, incentivizes patients to keep their costs low by improving their health, which improves their quality of care. This will spill over to Part A (hospital and other expensive services) affecting all costs in Medicare. As the Medicare patient's daughter observes the efficacy of careful health care shopping for mom, she'll use those acquired skills for her own family's health. This simple change in the Medicare Part B tax would ripple through the entire culture of American health care. Health would improve, costs would go down and nothing is "cut." My current plan also rewards doctors for keeping their membership happy and healthy. We preside over fewer chronic disease complications and hospitalizations. Healthier patients save money. My total cost of care is half of the area average. In addition to clinical responsibility, our physicians take the health insurance risk which, combined with a 10- to 15-year relationship with our patients, motivates us to invest in our Medicare patients' long-term health. We are well-paid for early intervention and spending time to encourage patient participation in better "cost of care" decisions. Preserving the "donut hole," for example, motivates the patient to choose Pravastatin 40mg at $40/year instead of equally effective Lipitor 10mg at $1,240/year. With a 20% co-payment and my coaching, patients with wet macular degeneration ask retinologists for Avastin at $40/injection instead of Lucentis at $2,000/injection. With money saved, the patient can now afford other essential expensive medications, such as insulin. We take the time, for example, to diagnose toothache that's really impending heart attack.

We celebrate $30,000 for bypass surgery that saves our patient's life, a far better outcome than resuscitation and spending six miserable weeks in ICU at approximately $300,000. The woefully underpaid fee-for-service doctor simply cannot afford time for in depth diagnostic history-taking, teaching, and motivating and following up. With substantial savings in the program, doctors instead are paid for value (including responsibility for their insurance risk), provide the richest health benefit for seniors in our market and invest heavily in information technology at lower cost, which also improves outcome. Medicare Part B as HSA will drive change in the culture of our health care delivery system to provide value instead of fee-for-service transactions.

“The relationship between quality of patient care and health care spending is part financial and part psychological.” Structurally, the short-term decrement in the general Medicare Part B fund created by the HSA will recover through substantial savings in Part B and Part A in the short term. Accumulated HSA funds will be restricted for Medicare-covered services, and passed on to the beneficiaries' heirs. Medicare should simply return accountability for cost and care to the doctor and patient by aligning each party's incentives. Aligned incentives are working for us for 20 years running, and it can work for everyone. A survey of my patients shows they love the idea. Changing the culture of health care starting with this simple Medicare Part B modification enables the doctor and patient to jump-start the most useful and locally effective market-based health care reform. Dr. Charles Willey, founder of a physician-owned Medicare Advantage plan, practices with three advanced nurse practitioners as Innovare Health Advocates in St. Louis.

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Health Care the Way It Ought to Be Remember the good old days when your family doctor really spent time with you? Wouldn’t it be great to have that same level of service now from your primary care physician as your healthcare needs increase? Dr. Charles Willey, MD As heard on RSVP Health radio & Bob Hardcastle’s Money Talk TV and radio

At Innovare Health Advocates, we practice “Old School” Internal Medicine that means we spend Quality Care all the time necessary to help you enjoy a healthier life. Speaks for Itself “Old School” medicine means you receive the most 91% of Patients Are up-to-date medical treatment available while getting all the time you deserve from our top medical team. Satisfied & Happy We are your coach and advocate, and wherever you with Our Healthcare go in the healthcare system, we’re with you every Practices* step of the way. We work closely with you to educate, motivate and lead you to better long term health. “Old School” means truly responsive Internal Medicine that delivers high quality patient care with specific attention to low cost for you. We appreciate the two Medicare Advantage plans in which we participate, Essence Healthcare and Gold Advantage, that truly enable Old School Internal Medicine. Ask for us when you call Essence 866-597-9560 or TTY:711 or Gold Advantage 800-533-0362 (both plans Mon-Fri from 9 am to 5 pm). The Innovare style of medicine is Healthcare the Way It Ought to Be. Come see us soon and experience the difference. Dr. Charles Willey, MD; Terry McQuaide, APRN-BC; Barbara Menke, APRN-BC; and Christine Grissum, APRN-BC

Call Dr. Charles Willey and the team at Innovare Health Advocates for an appointment. Our offices are in: South St. Louis County—314-843-4794 Jefferson County—636-931-5112 18 RSVP Health | www.rsvphealth.com

Visit us online at www.innovarehealth.com.

Animals Are Good Medicine By Lola AuBuchon Gross

Throughout ancient times to present day we have shared our lives with companion animals, however the human-animal bond can be a healing force mentally and physically. On a personal level, I experience the “good medicine” that my furry friends bring to me mentally and physically daily. Whether it is walking the trails with my lab-retriever mix Golden, or grooming and riding my paint horse Chero, it is not hard to recognize all the physical benefits I receive. As far as the mental aspect goes, there is nothing greater than coming home to my dog’s smiling face and the horses running with the mini ponies whinnying! How could I be sad or stressed with that kind of welcome? Here I had thought I was taking care of them, but could it be the other way around? The healing power of animals is being accepted more and more as a complementary therapy to the physically and mentally challenged, children, adults, and seniors as well as healthy people everywhere. For children, having and caring for a pet teaches them responsibility as they acquire a greater respect for all living things. Animal assisted therapy for a child suffering from an ailment greatly enhances their chances for improvement from a treatment. For example, equine assisted therapy in children with autism benefits their social and motor skills as well as communication skills. Concentrating on the task at hand, such as riding, helps them focus better instead of doing everything at once. They become better communicators by having to give verbal commands to the horse to walk or stop and steering the reins in the direction they want to go. Improvement in relaxation and response to internal and external stimuli has been observed in autistic children. Kids in general have a lower frequency of asthma and allergies if exposed to pets the first year of life. According to The Delta Society, having a therapy dog present during an exam at a doctor’s office lowers procedure related distress in children.

blood pressure. The mental aspect is less stress, loneliness, and behavior that is more outgoing for seniors with pets. In nursing home facilities in Missouri, Texas, and New York, medication costs dropped from on average $3.80 per patient per day to $1.18 per patient per day that had animals and plants as part of the environment. (Montague, 1995) Hmmm, I have not heard any politicians mention this topic as a way to cut health care costs! For those of us adults who give from the heart to nurturing and loving our pets, turns out our pets are doing the same for our hearts. Keeping our “furry friends” around may decrease heart attack mortality by 3% saving 30,000 lives annually. (Friedman 1980) By lowering blood pressure and reducing mental stress, patients with congestive heart disease have less anxiety and have a better chance at recovery by having a companion animal around. Cancer patients have been observed having more drive to recover to get home to their pets. According to Dr. Edward Creagan, Oncologist at Mayo Clinic, Rochester, MN, “A pet is a medication without side effects that has so many benefits. I cannot always explain it myself, but for years now, I have seen how instances of having a pet are like an effective drug. It really does help people.” By staying more active, such as walking the dog, we are also fighting obesity, one of the factors contributing to illness and rising health care costs in America. So whether it is a service, therapy or companion animal we would all be a little healthier and happier utilizing the “good medicine” that animals bring.

Seniors do not have to give up the health benefits of animals because of age. As long as they are paired with a calm animal, the rewards are numerous. Seniors with dogs have less doctor’s visits for minor issues and have lower levels of cholesterol as well as RSVP Health | www.rsvphealth.com 19

THE TEAM LEADER WHO SAW A DISEASE STEAL HER MOTHER’S PAST AND IS DETERMINED NOT TO LET IT TAKE HER DAUGHTER’S FUTURE. BE A PART OF THE MOVEMENT TO RECLAIM THE FUTURE. START A TEAM. JOIN A TEAM

alz.org /stl 800.272.3900

Kidz Care to End Alzheimer’s By Molly Burns

I stood in the office kitchen and read a flyer that had been posted on the refrigerator. “Talent Show” was printed at the top with a list of candy and their prices: Tootsie rolls- 15 cents, cookies- 25 cents, lemonade- 10 cents. No date, no time and no location. All I could think was “wow where is this place with the cheap candy, I want to go.” Little did I know that Kailyn Timme had more planned than an economy friendly concession stand. The “The Kidz Care Too” Talent Show debuted on Friday, July 29, in the Timme’s backyard of their St. Charles, Mo., home. The show was put together and hosted by Kailyn Timme, 12, and her friend Sydney to raise money for their first Alzheimer’s Association Walk to End Alzheimer’s on Oct. 1, at T.R. Hughes Ballpark in St. Charles. The Alzheimer’s Association Walk to End Alzheimer’s is the nation’s largest event to raise awareness and funds for Alzheimer’s care, support and research. Alzheimer’s disease is the sixth- leading cause of death in the nation, and the only one in the top ten without a way to prevent, cure or even slow its progression. Kailyn and her friends formed a Walk team appropriately named, “Kidz Care Too.” The team will walk in honor of Kailyn’s great grandmother, who passed away from Alzheimer’s, and two of her team members’ grandfather, who is living with the disease today. The talent show was the team’s big fundraiser, raising $215. “I got the idea from my grandma, she said she used to put them on when she was little,” Kailyn said about the inspiration for the talent show. Once the idea was in her head, Kailyn set forth on making the talent show happen. She went door to door asking neighborhood kids and adults to perform or attend the night of festivities. Kailyn rounded up 10 acts, with the talent ranging in age from 4 to 40.

Mr. Wilson, 40, was cheered on stage by the audience and other performers to share his nosy talent with everyone. He commenced his performance with an anatomy lesson. “Did you know why you can’t taste food when you pinch your nose closed? Because the mouth and nose are connected,” he said with a mischievous smile. Shouts of shock, awe and opposition arose from the audience and onlookers. Mr. Wilson looked at the audience, reassured them it was true, and to prove his point extracted a string from his pocket and said, “I’ll show you.” Mr. Wilson proceeded to sniff the string into his right nostril, reached into his mouth and pulled out the string. Screams of laughter and terror filled the backyard while Mr. Wilson showed off the string running in his nose and out his mouth. He eventually removed the string from his nose and took a bow. The show brought in profits via their concession stand selling soda, lemonade, candy and cookies-- “lots and lots of cookies”. While the show did not charge admission, Kailyn did take a moment to address the issue at hand and pass around a donation basket. “5.4 million Americans are currently battling Alzheimer’s disease and someone new develops the disease every 69 seconds. If you have enjoyed the show so far, please make a donation to our Walk team (The Kidz Care Too Team) and help us reclaim the future for millions,” Kailyn announced before the kids, and Mr. Wilson, took their final bows.

The concession stand was a homemade booth placed on a wagon to cart around during the show. It was equipped with a menu and a purple donation box provided by the Alzheimer’s Association. A concrete patio served as the stage for the performers while the theater was five rows of fold out and patio chairs on the grass with an aisle down the middle. Neighbors, parents and friends filled the seats for a night of entertainment. “Almost all of the seats were full in the backyard,” said Kailyn. The full house enjoyed instrumental performances, including the recorder and trumpet, singing, dancing and various other talents. And, just in case the audience forgot to give an act their proper due, there was always a bright yellow sign politely requesting their applause. One daring Border Collie, Hazel, climbed the ladder to the backyard jungle gym and flawlessly executed her descent down the 10 foot yellow slide. Another stand out performance was delivered by a young man by the name of Ian. Ian, 5, has a bright future as a professional dancer. Ian’s break dance routine to “Dynamite” would make Chris Brown and Usher Raymond stop and stare in amazement and envy. Kailyn’s cousin, innocent eyed Nora, 4, sang her “Angel Song” with her own choreography she learned at summer camp. Nora fluttered her angel wings and placed her imaginary halo atop her head twice that evening, because one performance of her song and dance just wasn’t enough. The show ended with a bang and a warning from Kailyn that “the faint hearted should turn away now.”

The Kidz Care Too Team If you would like to donate to Kailyn’s Walk team or start your own team, visit www.alz.org/stl and or call 800.272.3900.

Walk Information

Washington City Pavilion Washington, Mo. Saturday, Sept. 10, 2011 Busch Stadium St. Louis, Mo. Saturday, Sept. 17, 2011 Cape County Park Cape Girardeau, Mo. Saturday, Sept. 17, 2011 SIUE Edwardsville, Ill. Saturday, Sept. 24, 2011 Mineral Area College Park Hills, Mo. Saturday, Sept. 24, 2011 T.R. Hughes Ballpark O’Fallon, Mo. Saturday, Oct. 1, 2011

RSVP Health | www.rsvphealth.com 21

22 RSVP Health | www.rsvphealth.com

Sleep. Sleep is essential to good health. However, over 40 million Americans suffer from some type of sleep disorder that prevents them from having a good night’s sleep. Often, the symptoms of a sleep disorder go unrecognized and untreated. Without help, an individual’s quality of life can suffer, possibly leading to other medical conditions such as heart attack, stroke or an injury. Skaggzzz Sleep Institute is composed of registered sleep technologists with years of experience in the field of sleep disorders. Come see our Board Certified Specialists at no cost to discuss your sleep problems and see if a sleep test is the answer. Here are some sleep disorders and symptoms. SLEEP APNEA Sleep apnea is a serious medical disorder in which breathing is repeatedly obstructed for periods of time. Symptoms: Habitual snoring, daytime sleepiness and irritability.

NARCOLEPSY Narcolepsy is a disorder of the central nervous system that causes excessive daytime sleepiness, cataplexy (sudden muscle weakness) or sleep paralysis when falling asleep or awakening from sleep.

RESTLESS LEG SYNDROME Restless legs syndrome involves a “creepy crawly” sensation in the legs resulting in a frequent need to move the legs for comfort.

PERIODIC LIMB MOVEMENT DISORDER Periodic limb movement disorder is the rhythmic moving or kicking of the limbs while asleep.

Skagzzz Sleep Institute 1269 Doctors Dr. Farmington, MO 63640 573-760-1501 Find us on Facebook

INSOMNIA Insomnia is a condition characterized by difficulty falling asleep or maintaining sleep.

Get Educated on Health Insurance: An Interview with Vincent K. Blair

This is part one of a four part radio interview between Dr. Rodney Gross, Ph.D. and Vincent Blair of the Vincent K. Blair insurance agency who specializes in Health Insurance. Rodney: I welcome Vincent Blair of the Vincent K. Blair agency. Glad to see you this morning Vincent, it’s always a pleasure coming up to visit with you. A couple months ago I came up and visited with you and talked about some topics we were going to be covering under the radio show today. One of them being the perception of health care from your standpoint as an insurance broker, one of the most respected brokers in the region, and myself being an old hospital CEO practice. We both agree that a lot of the problems out there with health care and the health care reform, things like that, is the lack of knowledge, meaning the cost of health care, who to trust to get your information

side the choices you make in your everyday life affects the type of care, the cost of the care which all ends up filtering down back to you anyway. Vincent: Through the premiums, and that is the work that I have done and the education I’ve tried to provide my clients for all of these years, for over a couple of decades now. Unfortunately, I think the cost of health care that the public knows just comes out in the premiums and that’s all that they see. I sure wish that could be different. I really and truly believe that the public somehow perceives that the profit in an insurance company is thirty to forty percent or fifty percent and I’m serious, I really wonder if that’s what they think it is. When in reality, it’s like three of four percent. It’s a very narrow margin that they’re working with. But, in the system that we’ve always had in the past, especially when they had an employer paying most of the

Get Educated on Health Insurance: RSVP Health Interview Series

An Interview with Vincent K. Blair With: Rodney Gross Ph.D.

from, and then obviously the education. Vincent: Rodney thanks for having me on. Yes, when you were here and you and I met, you have such a unique perspective of what you were doing. We hear the politicians talk about health care and that but you were really drilling down on the cost and for the last twenty-five years for me as a broker and working at this, that’s what I’ve really concentrated on. So I welcome being here. Rodney: Yeah, and that’s what was so exciting with being with you and having the relationship with Anthem Blue Cross and Blue Shield because you have individuals, as ourselves and as Anthem, that are on the front line of educating people and talking to them through shows like this, through their online sites, through our RSVP health publication talking about the actual cost and how everybody involved, a lot of times in a medical field we talked about continuity of care and usually that just encompassed patients and providers but continuity of care is all of us. It’s the patient, the provider, and the carrier because everybody needs to have some skin in the game, per say, and understand on the patient side, the individual 24 RSVP Health | www.rsvphealth.com

premiums and that starting to change of course and your listeners will start to see that but they’re starting to see the actual reflection. One of the misconceptions, and I don’t care if I’m talking to a laborer or a retired engineer out of a major corporation, when they call me for individual health insurance they would have a common theme that I would give them a premium and they would say, ‘Well, I never paid more than $150 a month or $200 a month out of my check.’ Not realizing at all that those corporations’ premiums were probably twelve or thirteen hundred dollars a month. That’s unfortunate because it’s the premiums the people are starting to see and they think that’s the cost of health care. What they’re seeing are the people like Anthem, Blue Cross, and Shield paying those bills. We just see the premium and we don’t see the high cost of the prescription uses, you know the prescriptions that we use, the emergency room costs, and the surgeries. I recently went through a simple surgery myself, I was probably under about 17 minutes and the bill, by the doctor and the facility, was about $15,000 for a real common meniscus repair that listeners will be familiar with. Now, it gets reduced and negotiated through the networks, but where

Get Educated on Health Insurance: An Interview with Vincent K. Blair

does that bill even originate? Who thinks that bill up? That’s kind of the cost I’m referring to. Rodney: There’s a perfect example there you mentioned: emergency rooms. In one of the previous publications of the RSVP health publication, we did an article talking about the cost between utilizing the emergency room versus an urgent care and understanding when you should go to one or the other. But it was understanding the cost and I think you find companies like what we have at RSVP health, organizations like Anthem, Blue Cross, and Shield helping you understand if you have a policy from them, the types of things you should possibly look at to go to an urgent care versus going to an emergency room to help control some of those costs and actually to help get you seen sooner. There’s a whole lot of variables under there besides the cost and just the access of going to an urgent care. Vincent: Well, you know, such an incredible point you just brought up and that’s what I was so impressed with when you came into my office. When we were first introduced I didn’t even know what you were doing. Why couldn’t you have that dialogue national? That is the most relevant conversation this country can have. Another quick example to join in on that one is prescription uses. When people do call my office and they are used to a corporate plan, they have a small co-pay on a prescription. They might be paying fifteen or twenty dollars or something for a co-pay on a prescription. When they realize that the cost of that prescription may be a hundred and fifty dollars for an antacid that they can buy over the counter. Either that may get excluded in underwriting or perhaps it raises the premiums because they are already currently on a medicine that costs a hundred and fifty dollars a month. When you tell them that they say, ‘Well, oh heck with that! I’ll just buy it over the counter!’ Well, while they’re on a corporate plan and they’re paying twenty dollars, or perhaps they’re on a medicine that’s on the higher co-pay, but because the doctor recommended it they’ll pay for instance the sixty dollar co-pay. Once they have a higher deductible perhaps, and they realize what the cost is, they start looking at the cost and they say, ‘Well, I can buy that same basic prescription for twenty-five dollars over the counter.’ Look what happens when that happens. The person not only stops paying sixty dollars themselves they pay twenty-five or thirty dollars for the over the counter drug and the insurance company pays nothing. So, look at the cost savings. Just with that little minor education, as you talk about the emergency room,

now we’re talking thousands of dollars. We’re talking about eleven hundred dollars. I had someone tell me the other day that her daughter had a piece of sand in her eye or a piece of glass in her eye or something, they were on a vacation, and they were out of the network and so the hospital demanded they pay the bill. Eleven hundred dollars. The emergency room was so crowded they never even got into a room or sat on one of those gurneys. A nurse practitioner came out, washed her eye out sitting in one of those plastic chairs, and her bill was eleven hundred dollars. Rodney: Now that is true. One of my most common complaints when I was a hospital CEO actually came from the emergency rooms. A lot of people would come in and say we had to wait four to six hours, we can’t believe our bill to have that piece of sand taken out of my eye in the waiting room was eight or nine thousand dollars. Once I explain to them the cost of providing that health care, number one the liability cost, my liability insurance, the cost of the staff, the doctors, and all the equipment that you have to have in an ER, they usually understood. They always thought well, the hospital doesn’t want you to go to their urgent care down the street because they’re going to lose money. Believe me, which is not true. Those ERs are set up for particular reasons and they are for your true emergencies. Individuals like me, though there might be some out there that disagree with me, welcome the Urgent Cares because it takes a load off our ERs. The true Urgent Cares are open twenty-four hours a day and when people sit and listen or read these articles and understand that hey, I could have went down the street and had that piece of sand taken out of my eye and been seen within twenty or thirty minutes, the light bulb comes on and they really start getting it. Like you said, it should be a national conversation. We try to keep everything very relevant on this show, a lot of people know me by now, you know, very relevant and to the point, but this is a subject that no matter what state, what political party you are, this is a relevant statement when it comes to health care and how the future of health care will be. Vincent: Well, again I agree with that and in the work that I have done for all these years , it has always been my point of view to have a very outstanding insurance company, no name brand, if you will, and writing their best policies. Now, initially that may sound expensive because I literally write the best policies of whatever these companies do, but we control the cost through RSVP Health | www.rsvphealth.com 25

Peace of mind right from the start. Different families need different health plans. Select from our plans designed to fit you and your family.

Get the quality health care coverage you need, without the expense you might expect. Anthem Blue Cross and Blue Shield has plans that provide protection at a rate that’s probably less than you expect.

VINCENT K. BLAIR

Authorized Independent Agency

(314) 961-7777

20 North Gore, Suite 100 Webster Groves, MO 63119 http://www.vincentkblair.com

Vincent K. Blair with Vincent K. Blair Agency is an independent authorized agent in Missouri for Anthem Blue Cross and Blue Shield. In Missouri (excluding 30 counties in the Kansas City area): Anthem Blue Cross and Blue Shield is the trade name for RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. Independent licensees of the Blue Cross and Blue Shield Association. ® ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association.

Get Educated on Health Insurance: An Interview with Vincent K. Blair

the deductible. So, if I was to ask an auditorium of a thousand people what is your best policy, we could sit there for thirty minutes and people would talk about this co-pay and that co-pay and this co-pay and prescriptions and if a take my three year old to the doctor and this co-pay. We would hear nothing about the upper end limits and the upper end care, in case that three year old gets leukemia, or in case someone needs a hip replacement. We would never hear that. It would all be about the small bills and everybody that I speak with, again it could be just a working person, or it can be an attorney. Literally the president of the United States before the health care reform was passed, there was a luncheon with the republicans and one of the republicans, I believe it was Eric Canter, had asked him what he had against HSA’s. I do not pick on the president, this is not my point, and my point is this is everything from the person working to a muffler repair shop to the president of the United States. He said, ‘What do you have against HSA’s?’ The president literally sneered. You could go back and find the tape. He literally sneered and said, ‘Well, we would like to have a real policy enforced when people needed it.’ And of course you’re sitting at your desk or in your living room on the couch and you just want to jump through the screen and say, ‘Do you think this is free?’ What I mean by that is we are covered, we cover our clients extremely well, and you have to be covered. But, for instance, a deductible of five hundred to twentyfive hundred is a difference of two thousand dollars and very often you’ll see that whatever risk you accept, you will save anywhere about a hundred percent of that risk. It depends on the age, it depends on the family make up, but you may very well see somebody save, of those extra thousand dollars, you may see a savings of eight hundred, you may see a savings of twelve to fourteen hundred. So, you just want to jump off your couch and say I wish I could be at that meeting. Why don’t the knowledgeable people, Eric Canter is a pretty knowledgeable person and is on the forefront, why can’t they ask a follow-up question and say, ‘Mr. President, you said that the problem is that we’re all one step away from bankruptcy if we lose our job we lose our healthcare. Well then [why] don’t we have a twenty-five hundred dollar or five thousand dollar deductible? That certainly would prevent bankruptcy. It literally reduces the cost in half of the premiums and now we all have equity in our health care.

Rodney: I think you’re right. We want to believe that those making those decisions are well informed themselves and well educated. What we find out is that that’s not necessarily true. The whole purpose of RSVP Health was our slogan, ‘You have more power than you think.’ Educating individuals, because individuals are the ones who do elect these people that are in public office and you need to hold them responsible to make sure that they have researched your needs and your wants but also understand when they vote for something like health care, you know, what does that mean? And what does the future mean of health care? We talked about it before, all of us research cars, cell phones, things like that, but we don’t research our own health. We don’t find out our own health and we should because it’s our own body. What better return on investment does one have than their body? And on that body, being your person, you have your purse or pocketbook so you are ultimately responsible for your own well- being and your own finances. Vincent: Well, you keep going to what you’re doing as far as this health care cost because as you were talking, and you were talking about the emergency room and urgent care and I can see a thousand dollar bill going into an urgent care. I took my son to an urgent care facility, I was glad it was open one day, it was open from eight in the morning to eight at night and very nice and good service. The bill was about a hundred and eighty dollars for a urinary tract infection. So obviously, that was a dramatically lower cost. I had my own personal experience where I needed some sort of ear infection type thing and walked into one of the facilities at the drug store. The person literally that saw me looked at me and said I didn’t have an ear infection and I said, ‘How much do I owe you?’ And she said ‘Nothing. I’m not going to charge you for a consultation to tell you that you don’t have an ear infection.’ So, look at that cost right there. Look at a thousand, down to a hundred and eighty, down to I think the typical cost at one of those facilities is about thirty-five, forty, or fifty dollars. Just a little bit of knowledge for the prescription uses and the urgent cares versus the emergency room make dramatic differences and we control our costs and ultimately the premiums. This interview was edited by RSVP Health for content length, you can get the full content at www.rsvphealth. com/articles.

RSVP Health | www.rsvphealth.com 27

Marion’s “Happily Ever After” How Geriatric Care Management Can Help You

Late one afternoon, social worker Jennifer Ronzio got word of a letter sent from one of the families she served. Carol, her supervisor, suggested Jennifer sit down before reading it. “I am writing,” began the letter from Wayne, “to express the most sincere appreciation for the assistance our family has received from your agency. My mom, Marion, moved to Laclede Groves (a Webster Groves retirement community) on Oct. 20 and seems to be thriving in the environment there.” But it was the next part that made Jennifer catch her breath. “The highlight of our family’s experience has been Jennifer Ronzio. She has shown a level of care, knowledge, and professionalism that must be recognized. Her energy and capabilities have helped our family turn an unbelievably stressful situation into a survivable one.” Jennifer had been working with Wayne for some time, helping him arrange in-home health care and private duty visits for his mother. “Marion loved being at home,” Jennifer remembers, “but she needed 24/7 care.” Soon, she was assisting Marion as she moved into her new home at Laclede Groves. “Oh, it’s just lovely here,” Marion says. “The staff are fun – they ALL are. I just love it here.” Jennifer served Marion’s family as a Geriatric Care Manager (GCM), a member of a relatively young career field that incorporates aspects of social work, detailed research, advocacy, and care management. The goal is to streamline seniors’ search for assistance, and to provide ongoing oversight to ensure all of the client’s needs are being met. As Carol Melka, Jennifer’s supervisor at Lutheran Senior Services’ (LSS) Outreach Social Services agency, explained, “Geriatric Care Management means seniors and their families count on you to make recommendations regarding personal, medical, and financial decisions. Aging in America today is getting increasingly complicated; having someone on your side to help you navigate the in’s and out’s of all the different systems seniors face at any given time can be an enormous help.” GCMs are especially useful for most anyone: families who live in a different area from their aging loved one, individuals who need to explore and link to local services, those who have a hard time understanding the complexities of available benefits like Medicare or Medicaid, or seniors without an existing support network of family members to assist them. Starting with an assessment of needs (usually conducted in the home), a relationship with a GCM can involve the development of a comprehensive care plan, arranging housing options, coordinating appointments and transportation, and helping clients apply for various types of benefits. They also serve as a go-to resource for a client’s doctors, attorneys, trust officers, and financial planners to help carry out the family’s wishes. That attention to detail made all the difference for Marion. Today, Jennifer Ronzio keeps a copy of Wayne’s letter on the wall of her office. It concludes, “The facilities and staff at Mom’s community offer our family a dramatically improved situation, support for her continued recovery, and peace of mind.” Jennifer taps the glass on the framed letter approvingly. “And they all lived happily ever after,” she says. To learn more about Geriatric Care Management, contact Carol Melka and the rest of the LSS Outreach Social Services team at LSSOutreach.org

28 RSVP Health | www.rsvphealth.com

Marion’s “Happily Ever After” | By LSS Outreach Social Services

“Oh, it’s just lovely here.”

RSVP Health | www.rsvphealth.com 29

Your situation is unique. Your care should be too.

Each member of the LSS Hospice Care team believes wholeheartedly in touching lives and making a difference during a personâ&#x20AC;&#x2122;s remaining days. Each family we serve becomes our family, and by working together we make life and loss as bearable as possible. ÂŽ

314.446.2539 < LSSHospiceCare.org

A Front Row Seat for the Birth of Gerontology: An Interview with Retired Nurse Jean Plesko

The household model of care reflects a maturing of the field of gerontology — the study of the medical effects of aging. Gerontology as a discipline only dates back to the 1940s, and it didn’t begin to gain traction in the U.S. until the 1960s and 1970s. Jean Plesko, RN, MSN, who began a career in nursing in 1951 Chicago, had a front row seat for the birth of the field, earning a master’s degree in the subject and devoting the better part of her career to advancing medical care for older adults. RSVP: You’ve seen a lot of changes in the field of long-term senior care in the last 60 years. Jean Plesko (JP): I remember in the 1970s, clinicians in England began doing research on what the normal aging process was. That was a first. Up until that point, nurses were trained to treat all adults, 18 to 80, in much the same way. That was the beginning of a real shift in the way we look at the aging process. RSVP: How did you see that shift playing out? JP: First and foremost, it was a change in the perception of what aging is. For so long, people assumed that illness was just a normal part of the aging process. The idea almost seemed to be that age itself was a disease rather than a normal part of life. If you were an older person and you complained about being sick, the attitude of the time was almost just “Well, what do you expect? You’re old!” It seems simple now, but the idea that aging is all a part of God’s plan was a pretty radical idea once upon a time. As you age, you’re going to see some changes. We don’t always like them, we don’t

always want them, but they’re there. Gerontology is all about figuring out those changes and what we can do about them. RSVP: How do you see Gerontology evolving today? JP: Rapidly, and almost completely for the better. You have to understand that we’re in the middle of demographic shift in this country. The population is getting older, and that means the importance of

A Front Row Seat for the Birth of Gerontology: An Interview with Retired Nurse Jean Plesko By: Jean Plesko and Rodney Gross Ph.D.

gerontology is only going to grow. And the more the demand rises, the more gerontologists get trained. And the more gerontologists get trained, the richer and more dynamic the industry becomes. RSVP: So the future’s looking bright? JP: Absolutely. Health care used to be a one-symptom, one-pill sort of affair. But there’s so much more to a person than a single medical issue. I like to say, “When you age, you are what you are, but even more so.” Each person is unique, and the older you get the more unique you become. Now, medical professionals are geared toward catering to that uniqueness.

RSVP Health | www.rsvphealth.com 31

Bringing

Noah

Home By Rita Martin

P.A.D.D. Inc. is a group of parents, friends, and teachers of individuals with developmental disabilities coming together to lend support, help educate themselves, and the community, and advocate for their loved ones. P.A.D.D, Inc meetings are held the 3rd Tuesday of every month at 6:30 PM at the St Francois Co. Board for the Developmentally Disabled, 2068 N Washington, Farmington, MO 63640. You can learn more about the support and work of PADD, Inc by logging on to www.paddgroup. com. Be sure to check out the links to other sites.

For the most recent gathering of P.A.D.D. Inc, Jessica Harmon spoke about the new addition to her family. It is a working service dog for her son Garrett Gann who is diagnosed with Classic Autism. Noah is a Standard Goldendoodle, a hybrid of Golden Retriever and Standard Poodle. The story really began two years ago. The family found Wilderwood Service Dogs of Tennessee that could supply the service dog that Garrett so desperately needed. Through community supported fundraising they were able to secure Noah and start the process of Wilderwood training him for Garrett’s specific needs. Classic Autism is a developmental disability limiting Garrett’s ability to live independently within his age group. Garrett isn’t a danger to others. The constant supervision is for Garrett’s safety. His attention span, self-direction, self care, receptive and expressive language (for the most part non-verbal), learning and understanding limits are all hard for him to process. With Noah’s help he will eventually be allowed more freedom to be a child with the added focus of learning more about his world. As a beloved family member, Noah has the ability to be a calming effect in constant attendance and aware of Garrett’s every move. He is being trained to nudge or paw as a 32 RSVP Health | www.rsvphealth.com

gentle reminder to Garrett to stay on task. While harnessed and working outside the home, they are attached by leads that help them to respond and walk together. Even when out of his harness, Noah remains on alert and will respond to Garrett’s needs. Noah went through months of intensive training at Wilderwood. Now that he is in the Gann Harmon home, his training is left to Jessica as the “alpha” family member and Cindy Presnell, a local consultant in the transference of service animals. When Noah has his harness on, Garrett will be tethered to it in all public places. At this time, they are not to be harnessed in public without the presence of their dedicated trainers. This will be a long and arduous process as both canines and Garrett learn in the “now”. They will be working through many trips to public places and different scenarios before they will be allowed more freedom. After a strong bond is formed over the next 6-9 months, Noah will be able to support Garrett without being commanded. As the bond continues and Garrett learns how to handle Noah in public places, he will begin taking the lead with his dog. Garrett’s brother Morgan is also Autistic though higher functioning and more social. His interaction with Noah has already improved the boys’ relationship with each other. Noah is already turning things around for the boys and their family, this has been an answer to prayer and a dream come true for Jessica and the boy’s father Jerry Gann.

Jacque Waller

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Bridging the Gap Between Patients and Providers.

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34 RSVP Health | www.rsvphealth.com

Giving Garrett Hope | By Cindy Presnell

This is why I see a lot of hope. The science and success stories of service and therapy dogs had intrigued me for some time. Over the past year, that interest turned into a passion of finding ways to facilitate the successes in both schools and communities. When Garrett Gann first got his service dog Noah, I attended training with Garrett and his mother Jessica at the Wilderwood Service Dog Center. Wilderwood specializes in training dogs for individuals with disabilities. To qualify for a service dog, a prescription that a service dog was medically necessary for Garrett was required from a Neurologist . Over the course of the past year, Noah had been trained for his service dog job and the last several months specifically trained for Garrett’s needs. Information and videos from Jessica and school were provided to give insight to the center’s director that was used to design Noah’s training. Our training focused on Jessica and me becoming licensed handlers for Noah. To assist the successful integration of Noah into Garrett’s world, we have focused on communication with parents and children and taught appropriate interaction with a service dog and his person. The children have been great at daycare, church and summer school. They are excited for Garrett, take great care in their interaction with Noah, ask good questions and then go about their own routines. Within Garrett’s community, it will be important that businesses and organizations also be aware of their responsibilities with service dogs. During my 32 years of working in public schools as a teacher of students with special needs, special education director, principal and assistant superintendent, I have seen a lot of great and powerful things in the education of developmentally disabled

children. Now working with Garrett and Noah, I am amazed. Positive growth in Garrett’s socialization, communication of needs and emotions, on-task behavior, wait tolerance and stress relief has already been seen. This is just the beginning of the teamwork between Garrett and Noah. As their bond grows, Noah will anticipate Garrett’s needs without command prompting and Garrett’s independence will continue to thrive. It is hard not to be excited and hopeful.

GIVING GARRETT HOPE By: Cindy Presnell

Trained, tested and certified through Wilderwood Service Dogs Center; Ms. Presnell’s involvement with service and therapy dogs continues as a consultant for schools, businesses and organizations in their responsibilities and opportunities for onsite visits and sessions, as well as her continued work with the Wilderwood organization. Contact her at 4PawsAtWork@gmail.com To learn more about service dogs and their effect on disabled childeren: http://www.autismspeaks.org/ http://www.wilderwood.org/ http://www.autism-society.org/

RSVP Health | www.rsvphealth.com 35

Autism and Communication

What is autism?

How does autism affect communication?

Autism is one of the autism spectrum disorders, a group of conditions that vary in their severity and the age at which a child first may show symptoms. Autism spectrum disorders fall under a broader category known as pervasive developmental disorders (PDDs). PDDs cause delays in many areas of childhood development, such as the development of skills to communicate and interact socially. Autism typically is diagnosed during a child’s second year and is lifelong, although symptoms may lessen over time. There is no cure for autism, but appropriate treatments can help a child develop life skills to function more independently.

The word “autism” has its origin in the Greek word “autos,” which means “self.” Children with autism often are self-absorbed and seem to exist in a private world where they are unable to successfully communicate and interact with others. Children with autism may have difficulty developing language skills and understanding what others say to them. They also may have difficulty communicating nonverbally, such as through hand gestures, eye contact, and facial expressions.

Who is affected by autism? Autism is one of the most common developmental disabilities. It affects people of every race, ethnic group, and socioeconomic background. Boys are four times more likely to have autism than are girls. According to a study by the Centers for Disease Control and Prevention (CDC), autism spectrum disorders were found to affect as many as one out of every 150 8-year-old children.

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Not every child with an autism spectrum disorder will have a language problem. A child’s ability to communicate will vary, depending upon his or her intellectual and social development. Some children with autism may be unable to speak. Others may have rich vocabularies and be able to talk about specific subjects in great detail. Most children with autism have little or no problem pronouncing words. The majority, however, have difficulty using language effectively, especially when they talk to other people. Many have problems with the meaning and rhythm of words and sentences. They also may be unable to understand body language and the nuances of vocal tones.

Autism and Communication | By National Institute of Health

Below are some patterns of language use and behaviors that are often found in children with autism.

their feelings and needs known. They may act out their frustrations through vocal outbursts or other inappropriate behaviors.

Repetitive or rigid language. Often, children with autism who can speak will say things that have no meaning or that seem out of context in conversations with others. For example, a child may count from one to five repeatedly. Or a child may continuously repeat words he or she has heard, a condition called echolalia. Immediate echolalia occurs when the child repeats words someone has just said. For example, the child may respond to a question by asking the same question. In delayed echolalia, the child will repeat words heard at an earlier time. The child may say “Do you want something to drink?” whenever he or she asks for a drink. Some children with autism speak in a highpitched or singsong voice or use robot-like speech. Other children with autism may use stock phrases to start a conversation. For example, a child may say “My name is Tom,” even when he talks with friends or family. Still others may repeat what they hear on television programs or commercials.

How are the speech and language problems of autism treated?

Narrow interests and exceptional abilities. Some children may be able to deliver an in-depth monologue about a topic that holds their interest, even though they may not be able to carry on a two-way conversation about the same topic. Others have musical talents or an advanced ability to count and do math calculations. Approximately 10 percent of children with autism show “savant” skills, or extremely high abilities in specific areas, such as calendar calculation, music, or math. Uneven language development. Many children with autism develop some speech and language skills, but not to a normal level of ability, and their progress is usually uneven. For example, they may develop a strong vocabulary in a particular area of interest very quickly. Many children have good memories for information just heard or seen. Some children may be able to read words before 5 years of age, but they may not comprehend what they have read. They often do not respond to the speech of others and may not respond to their own names. As a result, children with autism sometimes are mistakenly thought to have a hearing problem.

If a doctor suspects a child has autism or another developmental disability, he or she usually will refer the child to a variety of specialists, including a speech-language pathologist. This is a health professional trained to treat individuals with voice, speech, and language disorders. The speech-language pathologist will perform a comprehensive evaluation of the child’s ability to communicate and design an appropriate treatment program. In addition, the pathologist might make a referral for audiological testing to make sure the child’s hearing is normal. Teaching children with autism how to communicate is essential in helping them reach their full potential. There are many different approaches to improve communication skills in a child with autism. The best treatment program begins early, during the preschool years, and is tailored to the child’s age and interests. It also will address both the child’s behavior and communication skills and offer regular reinforcement of positive actions. Most children with autism respond well to highly structured, specialized programs. Parents or primary caregivers as well as other family members should be involved in the treatment program so it will become part of the child’s daily life. For some younger children, improving verbal communication is a realistic goal of treatment. Parents and caregivers can increase a child’s chance of reaching this goal by paying attention to his

Poor nonverbal conversation skills. Children with autism often are unable to use gestures—such as pointing to an object— to give meaning to their speech. They often avoid eye contact, which can make them seem rude, uninterested, or inattentive. Without meaningful gestures or the language to communicate, many children with autism become frustrated in their attempts to make RSVP Health | www.rsvphealth.com 37

“Most children with autism respond well to highly structured, specialized programs.”

or her language development early on. Just as toddlers learn to crawl before they walk, children first develop pre-language skills before they begin to use words. These skills include using eye contact, gestures, body movements, and babbling and other vocalizations to help them communicate. Children who lack these skills may be evaluated and treated by a speechlanguage pathologist to prevent further developmental delays. For slightly older children with autism, basic communication training often emphasizes the functional use of language, such as learning to hold a conversation with another person, which includes staying on topic and taking turns speaking. Experts estimate that as many as 25 percent of all children with autism may never develop verbal language skills. For some of these children, the goal may be to acquire gestured communication, such as the use of sign language. For others, the goal may be to communicate by means of a symbol system in which pictures are used to convey thoughts. Symbol systems can range from picture boards or cards to sophisticated electronic devices that generate speech through the use of buttons that represent common items or actions. What research is being conducted to improve communication in children with autism?

38 RSVP Health | www.rsvphealth.com

The federal government’s Combating Autism Act of 2006 brought attention to the need to expand research and improve coordination among all of the components of the National Institutes of Health (NIH) that fund autism research. These include the National Institute of Mental Health (NIMH), which is the principal institute for autism research at the NIH, along with the National Institute on Deafness and Other Communication Disorders (NIDCD), the Eunice Kennedy Shriver National Institute on Child Health and Human Development (NICHD), the National Institute of Environmental Health Sciences (NIEHS), and the National Institute of Neurological Disorders and Stroke (NINDS). Together, these five institutes have established the Autism Centers of Excellence (ACE), a program of research centers and networks at universities across the country. Here, scientists study a broad range of topics, from basic science investigations that explore the molecular and genetic components of autism to translational research studies that test new types of behavioral interventions. Some of these studies, which could be testing new treatments or interventions, might be of interest to parents of children with autism. Go to http://clinicaltrials.gov and search on “autism” for information about current trials, their locations, and who may participate. The NIDCD supports additional research to improve the lives of people with autism and their families. Recently, a group of NIDCD-

Autism and Communication | By National Institute of Health funded researchers developed recommendations calling for a standardized approach to evaluate language skills in young children with autism spectrum disorders. The new benchmarks will make it easier, and more accurate, to compare the effectiveness of different intervention strategies. NIDCD-funded researchers in universities and organizations across the country are also looking at: Better ways to predict early in infancy if a child is at risk for an autism spectrum disorder. Whether or not treatment interventions for at-risk infants can influence the development of speech perception and speech preferences. How infants with autism spectrum disorders “visually” scan their environment during their earliest social interactions and how this influences their development of language and

communication skills. How genes and other potential factors predispose individuals to autism spectrum disorders. Where can I get additional information? Additional information from other centers and institutes at the NIH that participate in autism research is available at http://health.nih. gov/topic/Autism. In addition, the NIDCD maintains a directory of organizations that provide information on the normal and disordered processes of hearing, balance, smell, taste, voice, speech, and language. Please see the list of organizations at www.nidcd.nih.gov/directory. Use the following keywords to help you search for organizations that can answer questions and provide printed or electronic information on autism: Autism, Speech-language development, Learning disabilities

Autism Speaks

The NIDCD Information Clearinghouse

St. Louis Office 1121 Olivette, Exec Pkwy St. Louis, MO 63132 stlouis@autismspeaks.org Ph: 314.989.1003 TF: 888-777-6227

1 Communication Avenue Bethesda, MD 20892-3456 Toll-free Voice: (800) 241-1044 Toll-free TTY: (800) 241-1055 Fax: (301) 770-8977 E-mail: nidcdinfo@nidcd.nih.gov NIH Pub. No. 09-4315 Updated July 2009 For more information, contact the NIDCD Information Clearinghouse.

RSVP Health | www.rsvphealth.com 39

INSynergy and the Growth in Addiction Medicine | Dr. Arturo Taca

Dr. Rodney Gross discusses addiction medicine and treatment with the founder of INSynergy, Dr. Arturo Taca. Rodney: Dr. Taca. You are a Diplomat of the American Board of Addiction Medicine, American Board of Psychiatry, and American Board of Neurology. Dr. Taca: That’s right. Our field of addiction medicine is growing by leaps and bounds. Rodney: That’s a broad field, Dr. Taca. A lot of people are just used to seeing their family doctor and some of the specialists they refer them to, so it excites me, as a person in health corps, to see all of these board certifications. Dr. Taca: Actually, that’s true and I’m very pleased that the science of addiction medicine is getting more respected. There are ten new addiction medicine programs that are

lack an enzyme called alcohol dehydrenates which breaks down alcohol. So for example, when I drink it’s not very pleasurable. I sweat, I have complications, my face gets very bright red, and it’s not very pleasurable. So that’s how, at least in my case and people who lack this enzyme, are protected from, at least the alcohol illness. Rodney: Reading over your material, it seems like you bullet several things: the convenience, the privacy factor, the non-disrupting one’s personal life, the cost effectiveness, etc. Could you elaborate on some of those bullets? Dr. Taca: Yes, of course. Traditionally, when somebody wanted to get treatment for alcohol or drugs, the choices were you had to go somewhere for 28 days and disappear. You had to go inpatient. You had to be detoxed in a hospital. We now understand that with new advancements and new discoveries to addiction medicine, all of those could

INSynergy and the Growth in Addiction Medicine: Part 1 RSVP Health Interview Series

An Interview with Dr. Arturo Taca With: Dr. Rodney Gross

going to be put in place around the country, which tells me that the field is growing and becoming more respected as an independent medical field. Rodney: That’s great. Diving right into it, Dr. Taca, why the name INSynergy? Dr. Taca: Well, as the name suggests, there’s synergistic forces that are involved in addictive behavior. We’ve always known in the past that addictive behaviors, or addiction, have run in families. There are a lot of things that contribute to addictive behavior, including the force of genetics, the role of psychiatric and psychological conditions such as depression, bipolar depression, and ADHD. A lot of these things increase the risk for impulsive behaviors and addictive behaviors. There are a lot of things that contribute to the act of being addicted. It’s not just one thing that causes someone to be addicted to alcohol. It may be that one has an exaggerated effect from drinking that may not allow someone to stop as easy as compared to me. I actually have, there’s a gene that does not allow me to become addicted to alcohol. 30% of the Asian population will 40 RSVP Health | www.rsvphealth.com

be achieved as an outpatient. We do it on a daily basis. The people we treat have very busy lives. They may be addicted to alcohol or opiates, pain pills, even heroin. We can safely detox each one of those addictions as an outpatient if everything is in place. Now, if my staff determines that they require inpatient, then we would recommend the appropriate medical treatment options. However, most people could be safely treated as an outpatient. No one has to know. It’s very confidential. There’s minimal disruption. That’s why we’re having such success with our treatment program. Rodney: Everyone is going to want to know out there, including myself, what drives Dr. Taca? What drives you? Why this field? Why this vision? Dr. Taca: Well I don’t know if there’s anybody who’s protected from having a friend or a close family member who’s personally struggling with drugs and alcohol. My personal friends growing up, many of my family members, uncles, and aunts, and grandfathers; everybody has this disease. So I would like to say, the people around me are

INSynergy and the Growth in Addiction Medicine | Dr. Arturo Taca

who are driving my desire. But what really fascinates me is the growth of the field. When I get somebody who comes to me with a story of several failed treatment rehabs, spending dozens of thousands of dollars with these inpatient rehabs that keep them sober for a little bit. Then when they come into our clinic and after our sixth month program, the family comes to me and they say they’ve never seen so much improvement in the client’s quality of life. Their relationships are better; they’re functioning at a higher level. Sometimes they don’t even talk about their sobriety because their sobriety will come, it’s the other stuff that improves: their relationships, their functioning, and that’s what keeps me going. These people get better. There is hope; I see it on a daily basis. I don’t promise a cure like a lot of people will do. They promise a cure for this or that, and we know in the field that there is no cure for drinking or drugs. However, there are fantastic medications that eliminate, in a lot of cases, the craving that is really the biggest problem that these people are struggling with. It’s the craving of using or drinking. At least now we have better tools and better medications and we have a better approach of looking at this.

was growing up. New government data shows that more teenagers are using opiates for the first time as their gateway drug rather than marijuana. That’s disturbing because the opiate has the potential to get somebody quickly addicted. Within six months, they could be addicted to opiate pain pills and then the script quickly goes from pain pills to heroin. Heroin now is different from heroin when I was growing up in the 80’s. It’s not dirty back heroin that we thought that only bums would use, but it’s called China white and its powder. They can snort it, they can smoke it, they can inhale it, and when they quickly get addicted to it, they end up injecting it. This can happen quickly. So I want to warn this is an epidemic and prescription drug abuse is growing to a point where it’s becoming a nationwide problem.

Rodney: I think you’re so right on, and I think, there again, quoting some of your sayings from your website and things like that, the future of addiction medicine, I think you’ve hit it right on the head. It’s eliminating the cravings instead of just trying to nail down an absolute cure, if that makes sense. It’s like you said. Is that the future of addiction medicine, instead of trying to do the hard cure?

Dr. Taca: I think it’s everybody’s fault. I mean, the patients who go to the doctors wanting instant relief, there are pain specialists who believe that no one deserves to be in any type of pain. They do great work with great medications, however, a lot of people will get addicted to these medications. We have good doctors trying to practice good medicine, however, sometimes the addictive potential of some of these powerful pain medications can override that and sometimes it’s a recipe for disaster. You mix these pain medications with your typical Benzodiazepines, there’s a lot of problems with Benzos in and of themselves, Xanax or Alprazolam is one of the most prescribed drugs in all of medicine. If you mix those two together, you can stop breathing and die. That’s usually a common cocktail found in overdose deaths. The combination of Benzodiazepines and opiate drugs.

Dr. Taca: Yeah well, the future is now we’re seeing we’re eliminating cravings on a daily basis. We have great medications such as Naltrexone and Vivitrol, which is an injection of Naltrexone. Things for heroin like Suboxone and Buprenorphine that are FDA approved to eliminate the cravings for alcohol and opiates. So, I’d like to refer to the future as being right now, but the future is very exciting for the field. There are things in research that for example, in the next few years their thinking that there may be a vaccine for cocaine. That will be exciting because right now there’s nothing FDA approved for treatment of cocaine. There’s a lot of literature that points to certain compounds. There are a lot of things that have been used like antidepressants or mood stabilizers, even stimulants. But right now there is nothing for the treatment of cocaine. So this vaccine, I’m keeping a close eye on it because it can be something special in the next couple years. Rodney: You’re correct. That is very exciting. On addiction, what’s some of the common forms and types of addiction that you see at your practice? Dr. Taca: Well, we see about 95% of the people who come for treatment are split right down the middle with alcohol and opiates. The opiates are kind of divided into pain pills and heroin. Heroin has become a middle class drug. If parents are listening, I’d like to reach out to you and warn you that heroin is like the pot of when I

Rodney: With prescription drug abuse, we see this all the time. We see it on the news; we see it in our medical correspondence. Is it the pharmacies? Is it some of the doctors writing too much medicine? Is it the people becoming too dependent? Where do you think the problem is there?

Rodney: That’s some scary stuff. Speaking of addiction, a lot of the questions out there in the field are, is it social issues? Can it be the economy? Unemployment? Or are some people just predetermined to have like, genetic markers that they’re going to become addicted, or have that in their DNA, per say, that have that genetic marker to be that addicted person? Dr. Taca: That’s a great question, and I think our field is trying to determine whether there is a genetic link specifically for certain addictions. We’re beginning to understand, at least for the alcohol model and the opiate model, that there is a relationship with somebody getting quickly addicted to at least alcohol or opiates. We know that alcohol has run in families, and we know that some of these alcoholics will do best when you block an opiate receptor. What that suggests is that some people who drink alcohol may have an opiate like effect, which means not only will they get intoxicated from the alcohol, but they’ll have an added opiate like RSVP Health | www.rsvphealth.com 41

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INSynergy and the Growth in Addiction Medicine | Dr. Arturo Taca

feeling which makes them feel very high. That is a little different than if I would use alcohol and I would get a little disinhibited and maybe kind of dizzy. The people who really cannot stop drinking alcohol really feel high and they will tell you, ‘I feel like I’m floating. I can’t stop drinking. I feel euphoric.’ Many times this is why they black out because they cannot say no and they drink, drink, and drink until they do pass out. The good thing about this type of alcoholic is they do best, believe it or not, when you block that opiate receptor and the craving goes away. So I tell my clients that come in with a very bad history of heavy drinking that they [might] be the one that responded the best to medication management. That gives them hope.

a diplomat of the American Board of Psychiatry, diplomat of American Board of Neurology. Their physical address is 11477 Olde Cabin Road, Suite 210, Creve Coeur, MO 63141. Their telephone number is 314-997-2296. Their website is www.insynergystl.com You can find them on Facebook. One last thing Dr. Taca, I guess congratulation goes out. We’ve seen that you’ve been voted one of the best doctors in America in the field of psychiatry. I understand that’s by some of your peers. Dr. Taca: Yes, I’m deeply honored that my peers have recognized the leaders in each specialty and I do feel honored being included on this list. It’s a pleasure to be even recognized in the same orbit as many of the people on that list.

Rodney: My guest is Dr. Arturo Taca of INSynergy. He is the medical director; he’s a diplomat American Board of Addiction Medicine,

Healthy Connections 1. Can Addiction be treated effectively? Yes. Addiction is a treatable disease. Discoveries in the science of addiction have led to advances in drug abuse treatment that help people stop abusing drugs and resume their productive lives. 2. Can Addiction Be Cured? Addiction need not be a life sentence. Like other chronic diseases, addiction can be managed successfully. 3. What is INSynergy? INSynergy provides an innovative, alternative to traditional 12- step and AA treatment models, and guided by evidencebased treatments. Our novel program is a 6 month, completely outpatient, model that incorporates an effective combination of FDA approved medications for addiction management with effective counseling. The type of therapy that INSynergy provides is called Cognitive Behavioral Therapy. 4.What’s different about INSynergy compared to other substance about programs? Only 23% of publicly funded addiction treatment programs use any of the FDA-approved medications for managing addiction. INSynergy provides an alternative approach to traditional 12- step

Top 10 questions that INSynergy receives regarding addiction medicine.

and AA treatment, and guided by evidencebased treatments. 5. Is INSynergy against the 12 Step or AA programs? No, INSynergy supports the fundamental messages of the 12 Step programs. However, Cognitive Behavioral Therapy is the type of therapy that is the focus while in the program. 6. Do I have to go to a hospital to get detoxed? Most of the time detox can be achieved safely as an outpatient however INSynergy has relationships with medical stabilization hospital programs that will detox our clients in a hospital setting and then discharged to our program directly. 7. Is this program confidential? This program protects the reputations of its clients. Many of our clients are high profile persons with public personalities. Our program assists them without a disruption in their professional lives. 8. What kinds of medications does INSynergy use? The FDA has approved many medications for addictive disorders such as Vivitrol and Suboxone, however, there are many

psychotropics that are being studied that hopefully in the future will give us more choices. When there are other medical or psychiatric conditions, INSynergy will recommend appropriate medications under the supervision of the psychiatrist. Medications are also commonly used during detox from alcohol or benzodiazepine addictions. 9. Does Vivitrol™ work for heroin and opiate pain pills? Yes, Vivitrol™ was just recently approved by the FDA in treating opiate addiction. Before this, Vivitrol and Naltrexone had FDA approval for treating alcoholism by reducing the cravings for drinking. The physician will evaluate your condition and prescribe the most effective treatment for your recovery. 10. What is Suboxone? Suboxone is an effective, safe medication approved by the FDA for use in the treatment of opioid addiction. Suboxone can be used as a detoxification or maintenance medication however we encourage a slow taper that may go beyond the time here at INSynergy. This will decrease risk of early relapse.

RSVP Health | www.rsvphealth.com 43

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Age 40 $191.87 $154.57 $126.64 $100.24

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You should know: • Maternity benefits are not available with this plan. • Your Lumenos HSA Plus plan has a policy-level deductible and out-of-pocket maximum. Once any combination of covered members on the policy meet these amounts, the plan pays 100% of covered expenses. It’s that simple. Prescription Drug Coverage Lumenos HSA Plus not only puts you in charge of your health care dollars, it can help you use those dollars for generic and brand name prescription drugs in the way that best suits you. Once your deductible is met, there is a coinsurance, if applicable, for covered prescription drugs. But even while you are meeting your deductible, you benefit from lower negotiated rates on prescription drugs at network pharmacies nationwide. There’s no need to have a different deductible or copayment for prescriptions; it all works as one. And since you decide how to spend it, your Health Savings Account dollars can be used to pay for prescription drugs -- while you are meeting your deductible. How to Customize your Lumenos HSA Plus Plan Choose your deductible: You can usually lower your premium by choosing a higher deductible. Simply choose the deductible and premium combination that works best for you. Remember, any covered member can contribute to some or all of the policy deductible and coinsurance if applicable, whether the policy covers one member or the entire family. Use your Health Savings Account the way you want: Your HSA, if you choose to open one, is funded by you. So, it is yours to use for qualified health care expenses covered by the plan, or those not covered at all, like contact lenses. Your HSA is also yours to keep if you ever leave the plan; you won’t lose those dollars if they’re not used. In fact, the carryover from year to year can help you save for future financial needs. Other Optional Coverage: You can add more protection for you and your family by purchasing optional dental benefits or life insurance.

Female Age 50 $243.79 $190.25 $153.35 $121.09

Age 60 $319.19 $253.74 $206.38 $162.47

In Missouri (excluding 30 counties in the Kansas City area) Anthem Blue Cross and Blue Shield is the trade name for RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. Independent licensees of the Blue Cross and Blue Shield Association. ®ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross Blue Shield Association. Additional information about Anthem Blue Cross and Blue Shield in Missouri is available at anthem.com.

RSVP Health | www.rsvphealth.com 45

Taking Care of What Matters Most, even when it’s inconvenient.

COMPREHENSIVE • COMPASSIONATE • CONVENIENT COMPLETE • COST EFFECTIVE 573-747-1510

508 W. Pine St., Farmington, MO

| www.midwestconvenientcare.com

Midwest Health Group Commitment to Community Midwest Health Group is proud to announce our brand new lab. It is be a Quest and Labcorp draw station and offers: - PadNet testing for peripheral artery disease and or poor circulation. - Nerve testing to help diagnose disorders of the spine and carpal tunnel syndrome - Lung testing (pulmonary function testing [PFTâ&#x20AC;&#x2122;s]) - 24 hour glucose monitoring - Saturday hours 8:00 AM - 12:00 PM (noon) - Drive up location All of these tests and services can be provided no matter where your primary physician or provider is located and the results will be forwarded to them.

Dr. Paul Moniz D.O. and Dr. Guy Roberts D.O.

Midwest Health Group and Midwest Health Group Convenient Care is proud to spotlight our nurse practitioners: Midwest Health Group Josie Savage, N.P., Christina Klinesorge-Rariden, FNP, Gina Herberlie FNP and Missy Radosevich FNP Midwest Health Group Convenient Care Angelica Lappe FNP

573-747-1510 508 W. Pine St., Farmington, MO www.midwestconvenientcare.com

Is Your Parent Waving a Red Flag? By: Jeff Browning, LSS

For some people, it can be one of the most daunting conversations they’ll ever have — bringing up the possibility that their parents might need long-term help. They may need in-home health care, they may need a nonmedical private duty caregiver, or they may need assistance with managing their care and finances. Whatever the solution, changing the status quo can be a thorny issue. But, with the average lifespan getting longer each year, many people will need additional care in their lifetimes. The question becomes “When?” And, more impor tantly, “How will I know when it’s time?” The truth is, there is no one defining sign that means steps should be taken. It is a gradual process that can be difficult to notice right away, especially for those of

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us who are predisposed to want to only see the positive. Our parents have always been strong and independent, so it is difficult to accept that they may not be able to take care of themselves anymore. So how does one determine when an aging family member needs some extra assistance around the house? Here is a list of warning signs that can help you identify when it is time to talk to your parents about their options. Is the mail piling up? Reading becomes difficult as we age, so reading the mail can become quite a chore. For this reason, seniors can begin to neglect their mail, resulting in bills and letters going unread.

Is Your Parent Waving a Red Flag? | By LSS Outreach Social Services

Seven Warning Signs That It’s Time For In-Home Care

Can’t take two steps in the house? Household chores can often fall by the wayside as it becomes harder to lift and carr y things. This can create a hazardous living environment, as it makes threatening falls more likely. You should also take note of environmental damage such as dents in the car and burnt cookware. These signs can hint at confusion or mobility problems. Is the fridge full of expired cartons? If you notice a significant weight loss in your loved one, tr y checking the fridge. If there is spoiled food, this should raise a red flag. Cooking can be confusing or challenging, and trips to the grocer y store might be impossible, so some seniors eat only what they have to, or skip meals all together. This increases the likelihood for illnesses and poor nutrition. Has personal hygiene become optional? Personal hygiene can become more physically challenging to keep up, meaning cleanliness and health can decline. Many seniors are afraid of slipping and falling in the tub or shower, making these tasks seem like daunting endeavors.

Do they have injuries hidden up their sleeves? Many seniors want to remain independent, so they will tr y to cover up whatever trauma they might have encountered at home, such as bruises or scrapes. This suggests a hazardous living environment, and should be handled seriously. Do they seem confused? You don’t have to be a doctor to know when your parents are acting out of the ordinar y. Missing appointments, skipping medications, and wearing the same clothes ever y day are all signs that suggest your parent may need extra care. Do they seem blue? Depression in older adults is often overlooked, but it is just as serious. Many seniors begin to feel isolated, and they withdraw from social activities they once loved. It is hard to be objective with the ones we love. We want our parents to live long, healthy, independent lives – something we want for ourselves when we grow older. Exper ts in the field agree, though, that broaching the conversation sooner is always better than later. Knowing these signs can give you concrete examples to use when talking with your parents about how much you want to see them in a safe and happy place. And that can make that most daunting conversation a lot less stressful.

For more tips on how to talk to your aging loved ones about in-home services for older adults, call on the experts at Lutheran Senior Services (LSS). With a wide range of programs serving the St. Louis area, LSS’ In-Home Services are dedicated to helping seniors live life to the fullest, wherever they call home. To learn more, visit LSSInHomeServices.org.

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ONE EASY STEP™

In addition to the cost difference between the Easy Step™ and walk-in tubs, homeowners and caregivers should be aware of the significant amount of water and the time required for filling and emptying a walk-in tub while the user sits waiting in the tub.

to a Safer Bathroom!

Terry Kavanaugh Miracle Method When installing the Easy Step™, the Miracle Method technician can also install safety grab bars, hand o room poses a greater safety threat for the held shower nozzles, curved shower rods and slip elderly than the bathroom. Slip and fall resistant tub surfaces. All provide greater safety and accidents, particularly when entering and convenience,” according to Kavanaugh. exiting the bathtub, account for nearly 25 percent of “Many of our the hospital admissions for people age 65 customers and older. also have us For you or for someone you care for, refinish their Miracle Method can install an Easy Step™ d i ffi c u l t - t o tub to shower conversion that can greatly clean tub and improve bathing safety. The Easy Step™ tile surround creates a 24” by 9” opening in the tub, at the same allowing the user to step through, not time as the over, the side of the tub.

Choose either an Easy Step™ tub to shower conversion or the new Easy Step™ door option to maintain the use of the bathtub for yourself or other household members.

EASY STEP™ AFTER

“It’s not uncommon for elderly people to lose their balance when getting in or out of the bathtub,” states Terry Kavanaugh, owner of Miracle Method of St. Louis and “An Easy Step™ installation can greatly reduce the risk of slip and fall accidents,” continues Kavanaugh.

“I gave my mother an EASY STEP™...it gives us both peace of mind.”

Costing a fraction of the price of walk-in bathtubs, the Easy Step™ conversion is an affordable solution that can be installed in just one day. Removing walls, tearing out the old tub or doing extensive plumbing modifications are completely unnecessary with Easy Step™, but are the norm with walk-in tubs.

EASY STEP™ B EFORE

Easy Step™ installation, states Kavanaugh. “Having all the work done at once allows us to offer a cost savings to the homeowner.” Miracle Method installs Easy Step™ tub to shower conversions in homes, apartments, and senior living facilities. “Easy Step owners as well as care givers appreciate Easy Step’s affordability, improved safety and the speed in which we can make the installation,” says Kavanaugh. For more information on EasyStep from Mirale Method, visit www.miraclemethod.com/EasyStep or call us at 314-293-0074 or 573-358-7228 for a free in-home estimate. We are veteran owned and operated.

Trama and Shock Facts Sheet | By National Institute of General Medical Sciences

What is physical trauma? Physical trauma is a serious injury to the body.

sweaty skin, weak but rapid pulse, irregular breathing, dry mouth, dilated pupils and reduced urine flow.

Blunt force trauma occurs when the body is struck with an object or force, causing concussions, lacerations or fractures. Penetrating trauma occurs when an object pierces the skin or body, usually creating an open wound.

What causes shock? Shock can be caused by internal or external bleeding (hypovolemic shock), dehydration, burns or severe vomiting and/or diarrhea. All of these involve the loss of large amounts of body fluids.

Trauma also results from “controlled injury,” such as that caused by surgery.

What are the different types of shock? Septic shock is caused by microorganisms in the bloodstream.

What is psychological trauma? Psychological trauma is an emotional or psychological injury, usually resulting from an extremely stressful or life-threatening situation. For more information on psychological trauma, visit the National Institute on Mental Health’s Coping with Traumatic Events. How many people die from physical trauma each year in the United States? According to the Centers for Disease Control and Prevention (CDC), unintentional injury kills more people between the ages of 1 and 44 than any other disease or illness. Trauma (including accidental and deliberate injuries) causes: • 35 percent of all deaths from ages 1-4 • 38 percent of all deaths from ages 5-9 • 74 percent of all deaths from ages 10-24* • 56 percent of all deaths from ages 25-34* • 31 percent of all deaths from ages 35-44* * includes suicides and homicides What is shock? Shock often accompanies trauma. Also known as “circulatory collapse,” shock can occur when the blood pressure in a person’s arteries is too low to maintain an adequate supply of blood to organs and tissues. What are the symptoms of shock? The symptoms of shock include cold and

Anaphylactic shock is caused by a severe allergic reaction.

Facts About Trama and Shock Cardiogenic shock is caused by the inability of the heart to pump blood effectively. Neurogenic shock is caused by extreme emotional upset due to personal tragedy or disaster. Where can I find more information and statistics about trauma and shock? The CDC’s Injury Topics and Fact Sheets provide information about general injury and acute care, unintentional injury, and injury caused by violence. The CDC’s National Center for Injury Prevention and Control has a searchable database for leading causes of death among all age groups. From the National Institute of General Medical Sciences

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Whole Body Vibration By Catherine T. Ramirez

Mike Hitschler, President 314-775-9017 www.advancedhealthworks.com

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Whole body vibration therapy (WBV) has become a popular device among the general public, professional athletic teams, beauty and therapeutic spas. Recently physical and occupational therapist, chiropractors and physicians who often specialize in bone & joint disorders, pain management and age related diseases, especially involving degenerative nature are appreciating the clinical efficacy and outcomes for their patients. History of WBV WBV can be traced back to ancient Greece where it is reported that healers applied mechanical vibration to a body part that was not functioning properly. In the late 1800’s a noted medical researcher, Dr. John Harvey Kellogg utilized various forms of WBV on his patients in his sanitarium and while various applications were consistently utilized in medicine it wasn’t until the 1960’s when Dr. Biermann of East Germany published his findings with vibration therapies which he termed Rhythmic Neuromuscular Stimulation (RNS). Dr. Nazarov, a Russian scientist at the time paralleled Dr. Biermann’s work that is published as Biomechanical Stimulation (BMS), which was a localized vibration, designed to produce a substantial increase in muscular strength, flexibility and bone density, especially in athletes. Favorable clinical findings led to further studies with the scientists of the Russian cosmonaut program, the Russian Space Institute (RSI), the European Space Agency and NASA aimed at introducing a WBV to inhibit muscle atrophy and bone loss during prolonged space flights. Many of these studies were kept secret until the fall of Communism when the information was openly shared and free enterprise realized the market share of interest and profit. Application & Function WBV can be achieved when exercises are performed while the person stands or sits on a vibrating platform. Vibrations are produced by electric motors under the platform, which in turn transmit the vibrations to the person standing on the platform. As the platform vibrates, the muscles are forced to react to the vibration (energy). Many different WBV’s are manufactured and sold today and vary in quality as well as clinical performance. The function of each WBV is determined by the specific effect or outcome produced by the moderator (platform). Most machines today vibrate in three planes or directions, front and backward, sideways, up, and down. The sideways motion produce a seesaw type of motion that is similar to a walking gait where one foot is moving upwards while the other is moving downwards. Some machines combine the sideways motion with up/down and oscillating action at the same time, thus eliciting a cycle of activity. Several inherent effects reported in recent clinical studies support results from WBV. • Boost bone mineral density • Improve muscle strength in elderly adults • Improve balance, gait function & ambulatory strength • Enhance peripheral circulation • Reduce healing time from fractures, sprains-strains • Reduce recovery time in post-surgical implant patients

It is well understood that WBV is a “low-load” exercise device that aids many patients who are unable to perform static exercises and/or perform strenuous movements primarily due to the mechanical traction that will cause the muscles to lengthen and the subconscious contraction effects on the muscles are greater than conscious, voluntary movements. WBV enhances circulatory function due to the rapid pumping action that affects the relaxation of a muscle bundle, blood vessels and lymphatic fluid movement. There are four main categories that determine the result and/or outcome of the therapy performed. Specific application will dictate the type of unit you consider. 1. Pivotal platforms producing only a low vibration • This type of machine typically offers little if any therapeutic value. 2. Lineal platforms producing a low to medium vibration • This type of machine is generally limited in clinical value for osteoporosis prevention, blood circulatory management and flexibility as well as limited exercise or fitness value. 3. Lineal platforms producing a medium to high vibration • This type of machine directs a lineal/upward motion, producing a strong stretch-reflex contraction of the muscles and is usually a commercial /industrial grade unit. 4. Pivotal platform produce a teeter-totter movement and medium vibration • This type of machine is ideal for exercising at higher speed and used for physical therapy at lower speeds. The human body can absorb vertical vibrations better due to gravitational forces so in order to produce a therapeutic stretch reflex in a muscle, a WBV machine must be able to deliver two functions: 1. Hz – which is the frequency - Muscle frequency varies from person to person 2. Up and down movement along with the oscillating lineal motion is the desired movement. Clinical Efficacy WBV is demonstrated to be effective in a vast number of conditions involving degenerative, post-traumatic, post-surgical, acute and chronic neuro-muscular, bone & joint, vestibular, circulatory and lymphatic health issues. It does not seem to replace static, aerobic, and cardiovascular exercising, but is helpful in burning calories simply because of the effects on the muscles during the vibratory activity. WBV is also a therapy of choice for weight management or morbidly obese persons due to their inability to perform routine exercises. Another broad market for WBV is the geriatric patient who often presents with one or a combination of conditions involving the body systems. It has also demonstrated significant application with the institutionalized, aged patient due to the influence on muscle performance, balance, flexibility and mobility that WBV can present.

RSVP Health | www.rsvphealth.com 55

Often the geriatric patient avoids activity due to pain, fatigue, lack of interest or fear of injury. WBV can be instituted because it can overcome these resistance factors that make it attractive for institutionalized, home bound and persons who need to increase functional activity. Clinical Contraindications As with any form of exercise, any person should consult a physician, health care provider or physical therapist prior to engaging usage with WBV in order to qualify their health status. Equally as important to the wide range of clinical conditions, it is recommended that WBV be considered with some precaution for people who currently and/ or who may have or have had in the past: • Thrombosis or blood clots of any nature (lung / pulmonary / arterial) • Epilepsy and/or any type of seizure disorder • Certain / specific severe neurological disorders • Head Injuries / amnesia / cognitive memory loss • Recent post-operative joint replacement (Foot, Knee, Hip) • Nephrolithiasis • Acute hernia, • Spinal discopathy or spondylosis • Advanced arthrosis, arthropathy and/or acute RA • Retinal condition and/or detachment • Cancer (tumors) • Cardiovascular disease, pacemaker, or cardioverter / defibrillator • Diabetes (severe type I) • Wounds (non-healing for any reason) • Acute infections and/or inflammatory conditions (non-healing) • Recently implanted IUD’s, metal pins, plates or hardware • Pregnancy or difficulties in pregnancy in the past

Clinically placed machines should be monitored by a physician, therapist or trained technician who is prepared to act appropriately for any pain, vertigo, loss of balance, chest discomfort and/or shortness of breath. How Whole Body Vibration Works. The vibrations are created by a mechanically vibrating platform and transferred to the body through the feet or hands that are in contact with the vibrating plate. By standing on the plate, the vibration generates systematic involuntary muscle contraction throughout the body, which not only increases your flexibility but also challenges balance and coordination, burns fat by increasing your metabolism while it improves your circulation and provides your cells with ideal oxygen and nutrient delivery to slow the degenerative process. The body automatically adjusts to these mechanical stimuli by responding with what is called a “stretch reflex”. This is similar to the knee jerk reaction that occurs when the knee is tapped in a doctor’s office. The body responds with a strong involuntary muscle contraction, leading to your leg ‘kicking out’. The vibration platform works in a very similar way. The stretch reflex is actually a reflexive adjustment that is occurring in the brain. Consequently, WBV causes the brain to train in a way that induces a neurological effect. In other words, the brain is trained; releases brain derived neurotropic factor and functions in a healthier state.

Whole Body Vibration Therapy Now available at Skaggzzz Sleep Institute. 573-760-1501 www.skaggzzz.com

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Accidents Happen. And when they do, the best way to summon help is The Button, part of the personal emergency response system offered by Lutheran Senior Services. Itâ&#x20AC;&#x2122;s safety, security, and peace of mind for people who live on their own. Call 314.446.2421 to learn more.

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Dairy Dilemma Are You Getting Enough Calcium?

You may be avoiding dairy products because of lactose intolerance. Or you might have other reasons. But dairy products are a major source of calcium, vitamin D and other nutrients that are important for your body. If you’re avoiding dairy products, you need to take special care to make sure you’re getting enough of these nutrients. Our heart, muscles and nerves need calcium to work properly. Our bones need it to grow and stay strong. The body also needs vitamin D to absorb calcium. Nutrition surveys have shown that most people in the U.S. aren’t getting the calcium they need. If you’re avoiding milk and dairy products, you may be missing out on important sources of calcium and vitamin D. One of the major reasons people avoid dairy products is lactose intolerance. Lactose is a natural sugar found in milk and other dairy products. You become lactose intolerant if your body doesn’t have enough lactase—an enzyme produced in the small intestine that you need to digest lactose. Undigested lactose can cause stomach cramps, gas and diarrhea within 30 minutes to 2 hours after eating something with lactose. Lactose intolerance isn’t common in young children, but many people gradually lose their ability to digest lactose after childhood. That happens more often in some ethnic groups, such as African Americans, Native Americans, Hispanics and Asians. Most people who don’t completely digest lactose have no symptoms and are entirely healthy, but some people do get those uncomfortable symptoms.

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Complicating things, some people mistake the symptoms of intestinal disorders, such as irritable bowel syndrome and inflammatory bowel disease, for lactose intolerance. NIH recently convened a “consensus development” conference to review the scientific evidence and develop objective statements about treating lactose intolerance. The panel concluded that there isn’t enough scientific evidence to answer many questions about lactose intolerance, including how many people have it, whether it causes serious health effects or how these effects should be treated. More research will be needed to answer these questions. If you think you or your children are lactose intolerant, studies suggest you may not need to completely eliminate milk or dairy products from your diet. There are several strategies you can try to ensure you get the nutrients you need. These include spreading your dairy intake throughout the day, combining it with other foods, taking nutritional supplements and choosing reducedlactose or non-dairy foods rich in the nutrients found in dairy products. How much calcium and vitamin D you need depends on your age and other factors. If you’re avoiding dairy products, talk to your doctor to make sure you meet your nutrient requirements. You can also check out the Dietary Guidelines for Americans for recommendations about dietary intake, including dairy or calcium-rich foods. NIH News in Health

“Many people gradually lose their ability to digest lactose after childhood.”

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INSynergy and the Growth in Addiction Medicine | Dr. Arturo Taca

Part 2 of Dr. Rodney Gross’ interview with Dr. Arturo Taca, consists of a question and answer session with Ed Mayuga as the moderator. Rodney: I’d like to welcome everybody back to the RSVP Health show. Our guest is Dr. Taca. Ed, have you gathered the questions from our panel? Ed: Yes I have. The first question is from Raymond in St. Charles. “Is your treatment the twelve-step program?” Dr. Taca: Our program is not based on the twelve-step program. However, we do encourage it if they find that helpful. The twelve-step and AA fellowship is, as you know, widely available. We don’t want to repeat that in our program. We do a different type of therapy called cognitive behavioral therapy. It’s a little bit more sophisticated. We talk about feelings and belief systems in more depth that they find more helpful than the twelve steps. However,

Ed: The next question comes from Joyce from Cairo, Illinois. She wants to know, “Is marijuana addictive?” Dr. Taca: Well, if you ask people who smoke marijuana, ‘is it addictive?’ Most of them would say, ‘No, I can stop at any time.’ However, when I tell them, ‘Well, humor me. Try to stop.’ They come back and say, ‘You know doc, I really can’t stop. It helps me with anxiety or my appetite or sleep.’ We know now and we’re getting a better understanding of the actual cannabinoid system in our brain. This system in our brain has always been there. We use it, most of us, to regulate anxiety and sleep and depression and appetite. Some people depend on exogenous forms of cannabinoid peptides that actually give them a therapeutic response from smoking. If you took that away, they may end up more anxious or unable to sleep. So it’s quite addicting .We describe a syndrome where when people stop cannabis, they get more anxious, they’re craving for it. They’re very mild, but there is a syndrome that’s being described in

INSynergy and the Growth in Addiction Medicine: Part 2 RSVP Health Interview Series

An Interview with Dr. Arturo Taca With: Dr. Rodney Gross

we’re not anti-twelve step or AA. Actually, we encourage it because it’s very widely available and many people get a lot from its teachings. Ed: Okay, next question. This is from Susan in Farmington. “I’ve heard a lot about bath salts. What’s the danger?” Dr. Taca: Well, when you hear about bath salts, it’s not the bath salts; it’s not the Calgon of bath salts. It’s not the ones you can get in the beauty supply stores. They’re nicknamed bath salts and they’re very dangerous synthetic stimulants. I’ve recently had a handful of people admitted to the psychiatric hospital from violent psychosis. It’s different from your psychosis that we see from other drugs. I find it more dangerous, the psychosis is more violent, and it does respond to anti-psychosis medications. It reminds me how PCP was described in the 70’s where there’s lots of rage and violence. It’s a very dangerous designer drug that’s actually quite popular these days. The FDA and the DEA are now fast on the track of these people who are synthesizing these bath salts in the lab. Watch out for this new drug. It’s very dangerous. 60 RSVP Health | www.rsvphealth.com

literature and we’re changing our opinion about cannabis. So yes, it is addicting. People look for cannabis or marijuana when they quickly run out of their supply. It promotes a drug seeking behavior so yes, it is considered addictive. Ed: Okay, the next question is from Samuel from Fenton. He wants to know, “How long is the INSynergy treatment program?” Dr. Taca: Well, our program is a little different. My hope is that this may one day become the standard because we know the traditional twenty-eight day inpatient programs usually don’t promote long lasting sobriety. We know that the brain changes and you have to wait for those changes to happen over time. So twenty-eight days is way too short to expect the brain to change. Our program, at least, it gives us time to understand personality structure. That’s when the therapy, the group therapy, the marriage counseling, all is very important because we learn more about the patient over time, rather than a quick detox and discharge.

INSynergy and the Growth in Addiction Medicine | Dr. Arturo Taca

Ed: Francis from Webster Groves asks, “What do we do about methamphetamine?” Dr. Taca: Well here in Missouri, methamphetamine, as you know, I don’t know if we should be proud of it, but we’re number one in manufacturing methamphetamine in the country. Right now there’s nothing that’s FDA approved for the treatment of methamphetamine. But I want to let your listeners know that methamphetamine is a type of stimulant that’s very dangerous. It works differently than cocaine. Cocaine, how it works is, it inhibits the reuptake of brain chemical called dopamine. Dopamine makes you feel good. That’s why people like using cocaine. What happens in the meth user is dopamine is literally squeezed out of the brain cell and what you’re left with is a brain cell that kind of looks like a sponge. Or, over time, methamphetamine users’ brains will shrink and will look like squished cheese. So there’s brain damage with heavy methamphetamine use over time. We don’t see that with cocaine. We see other things with cocaine. However, specifically the changes of the brain in methamphetamine use are pretty obvious. If you see a before and after picture of a methamphetamine user, the changes are quite disturbing. They look ragged, their hygiene becomes poor, their dentition is terrible, they have this characteristic meth mouth where they develop cavities and that’s from smoking the meth. When you smoke meth, the saliva disappears and you need saliva to battle bacteria. Well, if you smoke a lot of meth, that bacteria fighting saliva isn’t there and a lot of cavities grow. So you really end up looking like a gargoyle, a starving gargoyle, after years of meth use. Ed: John from Edwardsville, Illinois asks, “What qualifications do the INSynergy staff and you have?” Dr. Taca: Well, at least in our program, we like to take pride in recruiting the leaders in the field. I myself am board certified in addiction medicine. We have therapists who are at least master level therapists who have extensive experience in treating addiction. Some have additional advanced training, at least, for opiate use and Suboxone training. We also have PhD therapists specifically trained in marriage and couple’s counseling. We find this a very important component in our program because everybody in the family unit struggles. So when my job is done with the cravings and stabilizing the mood, a lot of times the work is done in the family with individual therapy, group counseling, and what the participants enjoy the most is access to a PhD marriage counselor. Ed: Our next question comes from Carrie in Bonne Terre. “What are the medical advances in alcohol treatment?” Dr. Taca: With alcohol treatment, there have always been choices out there, since the 60’s and the 80’s. The three medications that are FDA approved are, at this time, Antabuse, it’s the medicine that makes you ill or nauseas when you drink. It’s not very popular, but some people will still request it. Naltrexone has been around since

the 60’s and actually got the FDA approval for treating alcoholism in the 80’s. It’s one month depot formulization called Vivitrol has been approved for alcoholism in 2006, and recently got the FDA indication to treat opiates. So it’s this monthly injection of Vivitrol that can treat the cravings of alcohol and be very effective for people addicted to heroin and pain pills because it blocks the opiate receptor in the brain. So there are new advancements. There are things that have been studied in the lab that do not have indications such as Topiramate, Zofran, and Baclofen. These are generic compounds that have lots of clinical trials to suggest they may be effective in different alcohol dependents. There was one other medication called Acamprosate, or Campral, that’s also been recently approved by the FDA to treat alcoholism. Ed: Now Kristen from Moscow Mills asks, “What’s the role of mental illness in addiction?” Dr. Taca: That’s a very important concept because if you don’t treat the mental illness, you’re not really treating the addiction. Addiction and mental illness go hand-in-hand. If you are practicing addictionology, you’ll really have to dig deep to figure out what is really causing the drug seeking behavior or the self-medicating behaviors. The highest conditions that are associated with drinking and drugging are bipolar disorder, if you can imagine someone who has mania, feeling very energized, very grandiose, at times very reckless, and very impulsive; they are at high risk to do drugs and alcohol. The opposite pole of bipolar illness is the depress pole, and if you can imagine somebody reaching out to help the field better. Bipolars, as a group, 60% have association with drinking or drugging. ADHD is also a condition that is often times overlooked, that’s also highly associated with drinking and drugging. Mainly because of impulsive behaviors, not doing well in life and school, getting depressed about this and drinking your sorrows away, or promoting that kind of drug seeking behavior. Simple anxiety and PTSD are also associated. But, if one is treating addiction, you really have to be focused on if there is a mental illness going on at the same time. Ed: Now we have a question from Jill in Sunset Hills. She asks, “Dr. Taca, what kinds of therapy do you use in treating addiction?” Dr. Taca: Throughout time there have been different approaches and different therapy types that have specifically been addressed in addiction as a whole. We do something called cognitive behavioral therapy. This is a type of simple but sophisticated type of therapy which most therapists are skilled at. It addresses belief systems, it addresses cognitive distortions, and it addresses negative thinking. So as you can imagine, all of that can also lead to frustration if there is a distorted belief system, and persistent negative thoughts can also lead to drinking and drugging. So we often times when we do therapy, don’t talk or focus on the drug addiction itself, but the solid principles or belief systems that the clients may be bringing in to us. These types of approaches are more long lasting. That’s RSVP Health | www.rsvphealth.com 61

INSynergy and the Growth in Addiction Medicine | Dr. Arturo Taca

why we like to use a prolonged style for six months so we can have time to reprogram the software with the client. It gives us a better understanding what they bring to the table, how they behave, and also gives the client enough time to readjust their thinking. Ed: Our final question comes from Tony in Cape Girardeau. He wants to know, “After going through the program, what support care is available afterwards?” Dr. Taca: At INSynergy, I would say 70 to 80 percent of our clients continue what we call phase two, or our form of aftercare. We understand that addiction and mental illness is a lifelong battle. And so when our clients see the robust effects of our system, they don’t want to stop, most of them. They enjoy the groups, and often times they become leaders in group discussions and help the new people who come in understand a better way of thinking about their addiction, and a different way of thinking about their addiction. A lot of times they’re shameful and guilty of relapsing. We know that this is a chronic relapse illness just like diabetes or hypertension, high blood pressure, and the idea is, over time, drinking and drugging becomes a little less intense. Some people call this the harm reduction method. A lot of people have strong opinions about this method because there may be some relapses. However, we understand as a field that there is no cure. So people in my field are okay with, over time, reducing intake with the hope of completely eliminating the addictive behavior and stabilizing the mood. This is a process that can’t be rushed. Rodney: Ed, thank you for gathering all those questions. I want to thank the listeners and the audience for submitting those questions. Dr. Taca, to kind of wrap things up in this segment, what would you want the audience and the listeners to take away from these sessions with yourself and INSynergy?

be the standard of care. There are wonderful, new FDA approved medications that are safe and available. Many of these medications you don’t need to see a specially trained addictionologist, you can just ask your doctor. “Hey, I heard about this injection for drinking. Can you order it for me?” Maybe it’s time to educate your own primary care physicians about the wonderful, new options out there and spread the word because there is hope. I treat the ones that have lost hope and we’ve got amazing results. Rodney: Dr. Taca, we both have seen in our medical profession and medical careers, that a lot of times it’s the communication and the trust factor. The people need to know it’s okay to talk to their physician or call you and your staff directly to start confronting these problems. It’s not something to keep locked up inside of you. That just builds on the problem. Dr. Taca: Absolutely. We have to start educating the community. Part of my job is educating my colleagues who are uncomfortable in treating the people struggling with drinking and drugging. So it takes a unified force to really get the message out because there’s too much suffering right now and people don’t need to suffer. We’ve got great new discoveries and great new advancements in the field. Rodney: Our guest has been Dr. Arturo Taca of INSynergy. You can find further information on his website at www. insynergystl.com Their office number is (314) 997-2296. You can also find Dr. Taca and INSynergy in the current issue of RSVP Health publication. If you haven’t gotten a copy yet, please go to our website are www.rsvphealth.com Click on the current publication. You’ll find information on articles written by Dr. Taca and be able to see some visuals that he’s talked about before. I can’t thank you enough Dr. Taca for being on the show. Dr. Taca: Thank you, Rodney. It’s been a pleasure.

Dr. Taca: I think most of the people who come to me have come with a feeling of being hopeless. Most of them have failed several treatment options including inpatient, inpatient detox; a lot of them have never been offered medications. There was one statistic that showed that only 23% of addiction programs in the United States offer medications for the cravings. At least, this shouldn’t

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INSynergy and the Growth in Addiction Medicine

Lap Band Surgery at Mineral Area Regional Medical Center

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Protect your skin. You wouldn’t consider going out into a blizzard without a coat, right? So why go out in the sun without the right protection, too?

This information is intended for educational purposes only, and should not be interpreted as medical advice. Please consult your doctor for advice about changes that may affect your health. Source: National Cancer Institute at the National Institutes of Health, cancer.com, accessed July 8, 2011. In Missouri, (excluding 30 counties in the Kansas City area) Anthem Blue Cross and Blue Shield is the trade name of RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates

administer|non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. Independent licensees of the Blue 66 RSVP Health www.rsvphealth.com

22613MOMENABS 7/1

Cross and Blue Shield Association. ® ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association.

Sure the sun feels good, but when you expose your unprotected skin to its rays, you increase your chance of getting skin cancer. Not convinced? According to the National Institutes of Health, skin cancer is the most common cancer in the United States. And anyone can get skin cancer. Even people who don’t burn are at risk. The good news: It’s easy to protect yourself from this potentially deadly disease. Check out these quick tips for staying safe in the sun: 

Wear sunscreen — Apply sunscreen with an SPF of 15 or higher at least 30 minutes before you head outside.



Lather up — For good coverage, you need to use at least an ounce of sunscreen – about a shot glass full – and reapply every two hours.



Seek shade — Try to avoid direct sun between 10 a.m. and 4 p.m.



Suit up — Wear sunglasses, a hat and clothing made from tightly woven fabrics to avoid additional exposure.

While protecting your skin is important, recognizing and seeking treatment for skin cancer can save your life. Examine your skin regularly and look for the following early warning signs:

A B C D E

Asymmetry: Common moles are round while skin cancers are often asymmetrical. Border: Skin cancers often have uneven borders. Color: Watch for varied shades of brown, tan, black, red, white and blue. Diameter: If a spot is larger than a pencil eraser, it could be trouble. Evolving: The mole has changed over the past few weeks or months. No one wants to get skin cancer, and no one has to. Protect your skin. Look for early warning signs. Talk with your doctor if you suspect a problem.

When it comes to being healthy, your choices can make a difference.

RSVP Health | www.rsvphealth.com 67

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