Tag illness

Doctor, Heal Thyself

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One thing I never thought about before I went to medical school was how much I would be exposed to various illnesses as a physician. I guess you could say it’s an occupational hazard, but it can be downright frightening when you are exposed to some of the most virulent microbes which circulate in communities and in hospital environments. You’re bound to catch something at intervals.

Most people think of hospitals as disease-riddled, and they’re pretty much correct. But there are other places which have the potential to make you too weak to whip a gnat.

One of the worst environments is the pediatric setting, in which walking Petri dishes, also known as children, traipse into the clinic and somehow fling their nasty germs onto you. Before you know it, you are struck with a horrific infection that require an army of medications before you begin to feel human again. I remember spending the majority of my time in every single pediatrics rotation I completed, whether it was as a student, intern, or resident, so ill that I spent my days feeling like I had been hit by a truck, with a pressure cooker for a noggin, fuzzy-brained and miserable from whatever pathogen those little brats had brought to me.

Another microbe-filled gathering place is urgent care, a setting in which I have worked regularly over the past couple of years. Last year, when I was working more shifts than ever, I contracted three upper respiratory infections which progressed to bronchitis, and developed acute gastroenteritis (stomach flu) twice. Thank goodness I always get a flu shot every fall, otherwise I am sure I would have been hit with influenza as well. I see patients who are so sick that they can barely stay awake during their exams, people who have no business being out in public.

I recently saw a young female patient with a 103 degree fever who looked very ill, so I tested her for strep throat and influenza A&B. The nurse on staff asked if I wanted both, to which I replied, “Absolutely. I wouldn’t be surprised if both tests lit up like Christmas trees.” And they did. She actually had both influenza A and streptococcal pharyngitis. Poor girl.

It’s my duty as a physician to care for others, and I take it very seriously. But I will admit that my attitude towards my own illnesses is similar to the attitude of the Black Knight. My attitude is that it’s “only a flesh wound”, or “just a scratch” when I am ill or injured, so when I finally break down and admit that I am ill or injured, I am definitely in a bad place physically.

I suspect this attitude is similar to that of other physicians. So keep that in mind when you see that your provider is under the weather. We are only human as well.

Disrespect

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Last month, while working an urgent care shift, I caught a bug from one of my patients which progressed very quickly from a viral upper respiratory illness to a bacterial infection. Because I was so congested, the infection also seeded in my upper airways, and I developed bronchitis. Whenever bronchitis sets in, I am in for a world of hurt, because the coughing jags are so violent that I almost pass out from them since I can’t get a breath in.

In an effort to keep social media world happy, I posted my health status just so people would know why I sort of backed off from social interaction during that time. I felt horrible, and my voice was reduced to a strange, congested baritone mumble.

What irritated me was that several people jumped onto social media with health advice. I understand that people were concerned and trying to be helpful. However, there were two facts which kept floating through my head, and which left me scratching my head over how people thought it was appropriate to post advice.

FACT #1: I never asked for any advice from anyone. I was merely posting facts about my condition.

FACT #2: I am a board-certified family practice physician who works regularly in the urgent care setting. Don’t you think I would KNOW how to take care of myself? Why would anyone offer unsolicited health advice to a physician?

I couldn’t help but be bothered by the influx of posts suggesting things like, “drink tea with honey”, or “take zinc”. As an urgent care doctor, I am just as likely to give general, common sense advice about upper respiratory infections as I am to give prescriptions for medications and order in-office nebulizer treatments. I know all about zinc, tea with honey, vitamin C, salt water gargles, etc.

Besides, I ended up needing a course of antibiotics, two prescription inhalers, two prescription cough medications, and three over-the-counter decongestants. No amount of tea with honey, zinc, or salt gargles would have fought off the infection and reactive bronchitis I had developed. One person on Facebook hounded me via Messenger, and when I said I couldn’t chat, sent me a bizarre set of instructions for a concoction which included red wine. I became irritated and berated him for giving me health advice, whereupon he took the opportunity to insult me for no good reason. His disrespect was so blatant that I blocked him. I don’t need that kind of hostility in my life.

Sorry, but I think it is presumptuous and insulting to attempt to give health advice to doctors. In the age of Google, so many people fall under the assumption that they are suddenly experts when it comes to just about everything. Don’t trust everything you read on Google!

When I really think about it, I doubt that people would give automotive advice to an auto mechanic, or financial advice to their CPA’s. So why insult someone with 7 years of medical training and 14 years of experience as a practicing physician?

I believe I have made my point.

Understanding The Costs Of Diabetes Treatment And Planning For The Future

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Original post can be found at:
https://www.thesimpledollar.com/understanding-the-costs-of-diabetes-treatment-and-planning-for-the-future/


by DeVonne Goode
Updated on 06.05.18

Diabetes is a prevalent disease. However, it can still take many by surprise, and leave them struggling to pay medical bills.
With the complexities of the condition and the wide range of costs involved with treatment, having a financing plan is necessary. Health insurance is obviously one of the primary methods of assistance. But not everyone has the adequate coverage to cover
the costs – let alone the out-of-pocket cash to put on the counter every time out.

Opening a savings account, particularly one with high interest, could be a worthwhile investment toward consistently managing the disease today and into the future.

Diabetes at a glance
Type 1 Diabetes

A condition that keeps the body from producing enough insulin. Insulin shots are used to control blood glucose levels. Most diagnosis occur among children and young adults, which is why it is also referred to as juvenile diabetes.

Type 2 Diabetes

The most common form of the condition where the body doesn’t properly use insulin to convert sugar, starches and other food into energy.

Gestational Diabetes

Occurs when women experience high blood glucose levels during pregnancy. It’s usually easily managed and goes away after pregnancy.
Prediabetes

When blood glucose levels are higher than normal, but not high enough to be diagnosed as Type 2 diabetes. A large number of Americans are living with prediabetes (1 out of 3 adults). But taking early action to manage glucose levels can prevent diabetes from forming.

People who have diabetes are at higher risk of developing the following health conditions:
Blindness
Heart disease
Stroke
Kidney failure
Blindness
Loss of lower appendages (toes, feet, or legs)

Keep in mind – these conditions occur in the case of severe complications with the disease. With consistent attention to diet and other medical treatments (like most living with type 1 or type 2 diabetes undergo), these conditions are avoidable.
Diabetes by the numbers

According to a recent report from the Centers for Disease Control and Prevention (CDC), more than 100 million U.S. adults are now living with diabetes or prediabetes. Of that, only 12% were aware that they had it. And with approximately 1.5 million new cases being diagnosed every year, the need for education and financial support is clear.

Prevalence
Infogram
Rates of diagnosis for the following ethnic groups
7.4% of non-Hispanic whites
8.0% of Asian Americans
12.1% of Hispanics
12.7% of non-Hispanic blacks
15.1% of American Indians/Alaskan Natives
Breakdown among Asian Americans:
4.3% diagnosed were Chinese
8.9% diagnosed were Filipinos
11.2% diagnosed were Asian Indians
8.5% diagnosed were identified as other Asian Americans
Breakdown among Hispanic adults:
8.5% diagnosed were Central and South Americans
9.0% diagnosed were Cubans
13.8% diagnosed were Mexican Americans
12.0% diagnosed were Puerto Ricans

Underreported deaths due to diabetes

Diabetes is one of the leading causes of death in the United States (seventh as of 2015). However, studies have found that it is also among the most underreported. According to the American Diabetes Association®, only 35% of people who died with diabetes had the disease listed on their death certificate. And of that number, only 10% had diabetes identified as the cause of death.

Underreported Deaths
Infogram

There are a number of possible reasons for the underreported rate. But a lot points to the lack of ability to pay for adequate diagnosis and proper medical treatment.

What specific costs will someone with diabetes have to address?

If you or your child are diagnosed with diabetes, or you’re told that you have prediabetes, management and prevention take center stage. While a lot involves diet and exercise, medication will inevitably have an effect on your finances as well.

According to the American Diabetes Association® (ADA), medical costs for a person with diabetes averages out to $16,750 per year (a total of $327 billion nationwide in 2017). Of that amount, $9,601 is attributed to treatment specifically for diabetes. That’s more than twice the medical cost for people without diabetes.

Of the $327 billion nationally, $237 billion was attributed to direct diabetes medical costs and $90 billion was attributed to indirect costs – absenteeism and reduced productivity at work. Understanding the different forms of diabetes treatment, as well as the direct and indirect costs, is important for wrapping your head around plans for financing.


Type
Treatments

Type 1 Diabetes
Diet
Exercise
Insulin therapy
Regular blood glucose tests/monitoring

Type 2 Diabetes
Diet
Exercise
Insulin therapy
Other medication
Gestational Diabetes
Diet
Exercise
Monitoring sugar intake
Monitoring the baby
Direct Medical Costs ($9,601/year)
Indirect Medical Costs ($90 billion nationally)
Prescription medication (30% of total cost)
Loss of productivity due to mortality ($20 billion nationally)
Hospital care (30% of total cost)
Inability to work as a result of diabetes ($40 billion nationally)
Routine doctor’s office visits (15% of total cost)
Reduced productivity while at work ($30 billion)
Other medications and supplies (25% of total cost)
Reduced productivity due to increased absences and loss of employment from diabetes ($6 billion)

Insulin

Insulin injections are one of the primary forms of medical treatment used to manage diabetes. Especially for those living with type 1 diabetes, who can’t produce insulin of their own, these types of injections are vital for survival. However, the cost for insulin has skyrocketed in recent years, leaving many in the position of having to choose between going into debt or cutting back on medication.

Average cost for insulin as of 2015: $100-$200 per month
Average cost for insulin as of 2018: $400-$500 per month

WIDELY USED INSULIN BRANDS AND INSULIN INJECTION TOOLS
Insulin
Apidra, Humulin, Lantuo, Lente, Levemin, Novolog, Novolin, NPH Insulin, Regular Iletin, Regular Insulin, Velosulin
Insulin Syringes
BD Ultrafine, Levemir®, Monoject, NovoFine®, Ulticare, UniFine, UltiGaurd
Insulin Pumps
Animas, Deltec, Medtronic

Diabetes screenings and other medications

Along with your normal doctor’s visits, diabetes screenings are an important part of the process for identifying the disease. Specifically, if you have been diagnosed, testing your blood glucose levels will become a regular part of your life. Much of the costs for medications involved should be covered by your health insurance. And there are a number of home testing devices you can invest in to help make things more convenient and cost-effective.


WIDELY USED DIABETES TESTING BRANDS AND OTHER MEDICATIONS
Blood Glucose Test Meters and Test Strips
Abbott Freestyle®, Abbott Flash, Accu-Chek Compact®, Ascensia Elite, Ascencia Breeze, Ascensia Contour, Lifescan One-Touch©, Prestige
Injectable Medications
Byetta (Exenatide) injection and Symlin (Pramlintide Acetate) injection, Victoza (lLiraglutide- rDNA origin) injection
Oral Medications
Acarbose, Avandia, Chlorpropamide, Diabinese, Glipizide, Glucophage, Glucotrol, Gylset, Meglitol, Metformin, Prandin, Precose, Repaglinide, Rosiglitazone (These drugs act in different ways to lower blood glucose levels and may be prescribed in combination with other medication.)


Diabetes health expenditures according to group

Depending on whether you or your child has type 1 or type 2 diabetes, total expenditures can vary. Those who manage their condition at home, through diet, exercise, and home testing will have different averages than those needing regular appointments with specialists. According to the American Diabetes Association®, average total healthcare expenditures for diabetes treatment differ according to gender, race, and states with the highest populations of people diagnosed.

Gender
Men: $10,060
Women: $9,110

Race
Hispanics: $8,050
Non-hispanic Blacks: $10,470
Non-hispanic Whites: $9,800
States with highest population of people with diabetes
New York: $21 billion in healthcare expenditures
Florida: $24 billion in healthcare expenditures
Texas $25 billion in healthcare expenditures
California: $39 billion in healthcare expenditures

Options for diabetes treatment financing

In a recent online survey of 500 adults with diabetes, more than half of the participants acknowledged the medical costs involved has had a negative impact on their finances. Many also admitted to going to “extreme lengths” to cover the costs. These lengths include accruing credit card debt, borrowing money from family or friends, and tapping into a savings or retirement account. Many may feel the need to take some extra financial risks because they don’t feel as supported as they’d like. Understanding your options will help you make the most informed choices.

Insurance

Government insurance, such as Medicare and Medicaid provides most of the financial assistance for diabetes care. The military also takes care of a good amount of costs for veterans. The remainder of the cost is covered by private insurance or out-of-pocket cash. According to the National Conference of State Legislatures, 46 states mandate that diabetes be covered under state insurance.

Diabetes Health Insurance Coverage
Infogram

These states require coverage for diabetes treatment as well as equipment and supplies for home use (insulin, pumps, syringes, test meters). Four states do not have that same insurance mandate, however – Ohio, Alabama, North Dakota, and Idaho. Anyone with diabetes who live in any of those four states will most likely need to deal with a private insurer or explore other methods of financing.

Coverage from private insurers usually come through employer-sponsored group plans or individual health plans. Advisors would suggest going with employer-sponsored plans, because they offer higher protections due to being subsidized. On the other hand, if you are unemployed and venturing into the individual market, it may be difficult to find affordable coverage. The reason is that diabetes is considered a “high risk” disease. Insurance companies anticipate a high amount of claims, especially from those with pre-existing conditions. So it will be reflected in the pricing.

HSA

People who have diabetes but don’t have coverage that’s comprehensible enough for their needs may utilize a health savings account (HSA). An HSA is primarily useful for people with high deductibles (at least $1,350 individually, or $2,700 for family). Also, those who are a part of low-income families or don’t live in a “mandate state” may see this as a helpful tool. One big benefit of an HSA is that you take the money with you. There’s no “use it or lose it” policy like some other savings plans. Being able to set aside pre-taxed dollars to help pay for medical expenses can go along way when trying to manage diabetes.

FSA

Another way to set aside dollars for medical expenses is through a flexible spending account (FSA). An FSA is provided through your employer with a $2,650 limit. You can also use it to cover medical expenses for your spouse and dependents. One thing to keep in mind with FSA’s is that they do have an expiration period. You’re generally required to use the funds within your plan year. But your employer may offer extensions at their choosing. The benefit is, it can be used with any type of health plan. And diabetic supplies are eligible to be paid through FSA’s.

High interest savings account

If you’re not interested in dealing with your employer for coverage or a flexible spending account, a high interest savings account could be a good option to explore. It’s just like any other savings account, only with fewer restrictions. Not only are you saving for your medical needs, but your money is also making money. High interest savings accounts are opened through online banks – which means they don’t have to worry about maintaining branches all over the country. They can offer you higher interest rates, with the benefit of accessing your money whenever you want.

Unlike an HSA, a high interest savings account isn’t tied to a high deductible health plan with a dollar limit. And unlike an FSA, there’s no expiration date on when you can use your money. It removes any additional stress so you can concentrate on managing your condition properly. And as you earn interest, you can still take advantage of a number of outreach resources available for people with diabetes.

This condition can be a tough one to get a handle on, but it’s not insurmountable. Let your understanding of diabetes, your knowledge of its treatments, and your strategy for tackling costs work in your favor.

Your Health Is Everything

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health-is-everything

You’ve probably heard the saying, “If you haven’t got your health, then you haven’t got anything”, and it’s so true. Even something as benign as the common cold can flatten you out, robbing you of energy and motivation. So imagine if you had to contend with something more ominous, like heart disease, diabetes, or cancer. Illness can rob you of everything which you hold dear in your life.

There are some folks who will snicker when someone like me admonishes them for their unhealthy habits. They’ll sometimes even indicate that they welcome any insults to their health, and essentially dare fate to touch them with illness. That attitude quickly disappears when one of these people gets a health scare, or worse yet, a devastating medical diagnosis. If you are throwing caution to the wind, thinking that your unhealthy habits won’t catch up to you, you need to wake up. It’s that kind of attitude which can doom you to a great deal of suffering and an earlier death than you had anticipated.

Look seriously at all your unhealthy habits, and resolve to abandon them.

If you smoke, then quit.
If you are in the habit of drinking alcohol every night, dial down your consumption.
If you consume sugary treats, processed foods, and fast food, replace those selections with clean, whole foods.
If you rarely get adequate sleep each night, make sure to re-pattern your nighttime regimen so that you go to sleep at a decent hour.
If you deal with a lot of stress, then incorporate stress-reducing activities like meditation into your life.

Your health is no laughing matter. Don’t be in denial about it!

My Weekly Calls

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When my mother’s aneurysm rupture occurred in August of 2004, I immediately thought of two elderly ladies whom I considered surrogate mothers: one was my mother’s sister Jean, and the other was a dear friend of my mother’s and mine, whom everyone referred to as Frenchie. With my mother hovering over the edge of death, I made a sudden realization that I needed to reach out to these surrogate mothers more regularly. Anything could happen in an instant and forever change the lives of these women whom I adored.

My mother was in the Neurosurgical ICU at UCLA for two weeks, then spent another week on the med-surg floor recovering from two coil embolization procedures. Shortly after my mother was released from the hospital, I decided to call my aunt Jean and Frenchie every week to say hello and to check up on them. With only a few stark exceptions (such as trips out of the country), I was able to keep my promise to myself and to them over the years. To this day I still call Frenchie every week to chat.

Sadly, my aunt alienated the majority of the family four years ago and refused to speak to me for a year. Once she allowed me to contact her again, things weren’t the same, and what further complicated the situation was that she developed amyotropic lateral sclerosis (ALS, or Lou Gehrig’s Disease) in early 2016. ALS eventually robbed my aunt of her ability to speak, and she eventually passed away on December 20, 2016.

For any of you who keep pushing off contacting old friends or relatives, I implore you to contact them NOW. If you wait, it might be too late when you finally get around to it.

The Last Essay By Dr. Oliver Sacks

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Dr. Sacks on porch

http://www.newyorker.com/magazine/2015/09/14/filter-fish

Filter Fish
At life’s end, rediscovering the joys of a childhood favorite

Gefilte fish is not an everyday dish; it is to be eaten mainly on the Jewish Sabbath in Orthodox households, when cooking is not allowed. When I was growing up, my mother would take off from her surgical duties early on Friday afternoon and devote her time, before the coming of Shabbat, to preparing gefilte fish and other Sabbath dishes.

Our gefilte fish was basically carp, to which pike, whitefish, and sometimes perch or mullet would be added. (The fishmonger delivered the fish alive, swimming in a pail of water.) The fish had to be skinned, boned, and fed into a grinder—we had a massive metal grinder attached to the kitchen table, and my mother would sometimes let me turn the handle. She would then mix the ground fish with raw eggs, matzo meal, and pepper and sugar. (Litvak gefilte fish, I was told, used more pepper, which is how she made it—my father was a Litvak, born in Lithuania.)

My mother would fashion the mixture into balls about two inches in diameter—two to three pounds of fish would allow a dozen or more substantial fish balls—and then poach these gently with a few slices of carrot. As the gefilte fish cooled, a jelly of an extraordinarily delicate sort coalesced, and, as a child, I had a passion for the fish balls and their rich jelly, along with the obligatory khreyn (Yiddish for horseradish).

I thought I would never taste anything like my mother’s gefilte fish again, but in my forties I found a housekeeper, Helen Jones, with a veritable genius for cooking. Helen improvised everything, nothing was by the book, and, learning my tastes, she decided to try her hand at gefilte fish.

When she arrived each Thursday morning, we would set out for the Bronx to do some shopping together, our first stop being a fish shop on Lydig Avenue run by two Sicilian brothers who were as like as twins. The fishmongers were happy to give us carp, whitefish, and pike, but I had no idea how Helen, African-American, a good, churchgoing Christian, would manage with making such a Jewish delicacy. But her powers of improvisation were formidable, and she made magnificent gefilte fish (she called it “filter fish”), which, I had to acknowledge, was as good as my mother’s. Helen refined her filter fish each time she made it, and my friends and neighbors got a taste for it, too. So did Helen’s church friends; I loved to think of her fellow-Baptists gorging on gefilte fish at their church socials.

For my fiftieth birthday, in 1983, she made a gigantic bowl of it—enough for the fifty birthday guests. Among them was Bob Silvers, the editor of The New York Review of Books, who was so enamored of Helen’s gefilte fish that he wondered if she could make it for his entire staff.

When Helen died, after seventeen years of working for me, I mourned her deeply—and I lost my taste for gefilte fish. Commercially made, bottled gefilte fish, sold in supermarkets, I found detestable compared to Helen’s ambrosia.

But now, in what are (barring a miracle) my last weeks of life—so queasy that I am averse to almost every food, with difficulty swallowing anything except liquids or jellylike solids—I have rediscovered the joys of gefilte fish. I cannot eat more than two or three ounces at a time, but an aliquot of gefilte fish every waking hour nourishes me with much needed protein. (Gefilte-fish jelly, like calf’s-foot jelly, was always valued as an invalid’s food.)

Deliveries now arrive daily from one shop or another: Murray’s on Broadway, Russ & Daughters, Sable’s, Zabar’s, Barney Greengrass, the 2nd Ave Deli—they all make their own gefilte fish, and I like it all (though none compares to my mother’s or Helen’s).

While I have conscious memories of gefilte fish from about the age of four, I suspect that I acquired my taste for it even earlier, for, with its abundant, nutritious jelly, it was often given to infants in Orthodox households as they moved from baby foods to solid food. Gefilte fish will usher me out of this life, as it ushered me into it, eighty-two years ago. ♦

Mercury Retrograde, Solar Flares, Full Moon? Yikes!

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mercurygodThe past week has been extremely difficult, fraught with high emotion, malfunctioning electronic devices, and illness. I returned home on Sunday June 8th after driving 400 miles from Sacramento with rock bottom placings at the Nor Cal, only to meet with emotional anguish from a couple of sources. The emotional roller coaster continued throuughout the entire week, and midway through the week, I ended up contracting the flu, getting so beaten down by illness that I was literally incapacitated for three days from it. It’s a big deal when I refrain from training, so when I tell you that I had to forgo training two days in a row, that is a clear sign of how sick I was. I literally could not budge from bed due to severe body aches, sore throat, cough, headache, dizziness, chills, and gut issues. I also had to take a day off from work which is also unheard of in my busy world.

I am not alone in what I experienced this past week. Emotions ran high with many people, probably largely due to the retrograde position of Mercury and the Full Moon on Thursday. Many individuals were also struck with the flu, which is unusual for this time of year. The strain which has been striking people is incredibly strong and will literally slam you so hard that you will feel like you got hit by a Mack truck. You will be so sore that even moving a limb while in bed is agonizing. It’s truly awful.

full moonAnother thing which I have been dealing with is a Smartphone which has given me ongoing grief for the past few weeks. My phone restarts spontaneously, switches to airplane mode, and for whatever bizarre reason is chewing up memory to the point where my next bill will be close to twice what it usually is. Thing is, I am not going to pay for additional charges when my phone wasn’t even functioning for the majority of the last two weeks! I am sure this has everything to do with Mercury retrograde and the nasty solar flares which interfere with electronics. There is nothing like the frustration of a phone which does not function and constant emails notifying me that I am being charged another $15 for 1 gigabyte of storage. I was charged $15 in the span of TWO days, during which time I barely even used my phone and had it turned OFF to conserve battery power because the phone was acting so strangely. How’s that for the wonders of technology?

Thank goodness a new week and fresh slate have arrived!