Today's Health Headline

The headline on front page news today features the logos of the twelve teams that will be playing for the superbowl.

A more important, newsworthy headline was buried in the evening news and went something like this - "Many Americans Unable to Afford Medicine"...and medical care.

To be continued....

Healthy, Wealthy and Wise

Prevention and wellness.
Transform America to a wellness society.
Wellness and prevention are missing...make them a centerpiece of healthcare reform.
Promote wellness and prevent disease.
Transition from sick care to a true health care system.
Preventing illness and staying well are as important as curing illness.

These are key words and phrases from Senator Tom Harkin's speech in Congress today. We are on the right path to the Healthy People 2010, the nation's health promotion and disease prevention program.

Wellness, health maintenance, prevention and early detection will make you healthier, wealthier, and wiser!

Library News & Donations

Dear Librarians,

A FREE copy of Patient Handbook to Medical Care: Your Personal Health Guide will be donated to your library upon request until November 30th, 2008.

Bend of the River Books is proud to announce that Patient Handbook to Medical Care is now in 56 libraries throughout the United States. Our goal is to ensure that everyone has free public access to read and learn the importance of health maintenance, prevention, and wellness. This expert's guide to personal health care is the ideal book "to inform and educate patients about medical care".

Thank you for all your support. It is so appreciated.

Best,
Dr. Richardson

www.mypatienthandbook.com
info@mypatienthandbook.com

"Patient Handbook" Exhibits at Sharjah World Book Fair in UAE

"Patient Handbook to Medical Care: Your Personal Health Guide" by J. L. Richardson, M.D. (Bend of the River Books, Miami, FL), will be on exhibit at the at the Sharjah World Book Fair in the United Arab Emirates October 29th to November 7th. This Writer’s Digest International Self-Published Book Awards winner in the Reference Books category will be on display with The Combined Book Exhibit, a world leader in book shows and expos for seventy-five years. The title was recently on exhibit at the 60th Frankfurt International Book Fair, the largest book fair in the world, for the second consecutive year from October 15th to October 19th in Frankfurt, Germany.

Considered an expert’s guide to personal health care, "Patient Handbook to Medical Care" provides readers with essential information for getting the care they deserve and need. Dr. Richardson, a family medicine physician, offers an overview of health care from an insider’s perspective. This 112-page reader-friendly book covers topics such as complete physical exams, medical tests, medical specialists, preventive screening guidelines, and health coverage.

Same Health Plan as Yours, Please: Part 2

Many have been waiting to hear details for a health care plan. It is in writing, but has yet to be discussed openly like during the debates and on the campaign trail. Even the mainstream media has yet to pick it up. Obviously, the economy and presidential candidates’ every appearance are more newsworthy.

The Obama-Biden health plan is “to provide affordable, accessible health care to all”. It is presented in nine pages (includes one and a half pages of references) on their campaign website. The new National Health Insurance Exchange is one of the highlights of the plan. The creation of this entity will help everyone, “Americans and businesses”, obtain private health insurance.

Insurance companies will be required to cover pre-existing conditions at affordable prices through the National Health Insurance Exchange, or through private health plans. The Exchange will provide comprehensive care like the health plan that covers Congress.

The FEHBP, Federal Employees Health Benefits Program, is their health plan and that of many federal employees (wonder if that includes the president). Medicare, Medicaid, and SCHIP (children’s health plan) government funded health plans would continue to exist. In fact, Medicaid and SCHIP will be expanded. All children will be required to have health care coverage.

It is unclear to me (as I pointed out in my previous blog), why the Exchange is necessary if it is to be like the FEHBP. It seems highly logical to expand the FEHBP. Medicare, Medicaid, and SCHIP are being expanded. Will they be expanded to be as inclusive and comprehensive as the FEHBP? Furthermore, will the disparities implicated by being a Medicaid recipient be dismissed?

It sounds doubtful as mention of private insurance is still part of the plan. It would seem even more logical to make the National Health Insurance Exchange the FEHBP, or vice-versa. Members of Congress have been talking about making the FEHBP, their health plan, the health plan for the American people for many years.

“So close, yet so far away.”


Dr. J.L. Richardson is the author of the research paper, Building an American Health System, and the award winning Patient Handbook to Medical Care: Your Personal Health Guide.

Presidential Health Plans - Same As Yours, Please

Health Care Plan Talk: Show Me the Plan
By J.L. Richardson, M.D.

Why are the candidates continuing to talk about health care plans? They along with their colleagues in Congress have repeatedly proposed the insurance they have is what the American public should have. So why are they failing to move in that direction. Congress has been talking about it for years. Is this another political re-election tactic?

Senator Obama reiterated this in the debate - again. He explained in more detail the cost savings from being in a purchasing pool such as Congress. I applaud his vigor in this matter. I feel like he really wants us to have the best affordable health care like the lawmakers of the land. I want to see a plan, some details. I believe it will work.

He also wants us to be able to keep our same doctors and health plans no matter who we work for if we are working. That was part of HIPPA law passed some years ago. Okay, let's reinforce that. Somehow the pre-existing condition part got overlooked. It would be nice for our insurance companies to do the same. Medicare does. So that must become effective immediately. If not, in spite of the patient privacy part of HIPPA, one may be asked - actually "grilled" - about your current health problems and unhealthy habits by a total stranger over the phone. Ten, more like twenty, years ago you could get insurance without telling your pre-existing health conditions.

Senator McCain wants to tax insurance premiums, and pay that to the insurance companies. Where is one going to get that extra money when their premium has almost doubled over three years and are currently unemployed? Maybe that will be from the tax cut refund check he is promising. He’s looking out for us, too. Even if is to be paid for by the savings from the continuing health disparities - by age, gender, disability, chronic medical diseases, job and so on. Healthy people would be exempt, that is, until they became sick.

Both senators think health care should be run by the government which already funds almost 50% of the American health system. That must be good. Medicare seems to be working. The premiums have been rising. Payments to doctors are less. Private insurers usually charge more, but get paid the Medicare rate. That must count for something. Medicare is the gold standard for health insurance. Coverage is provided for all over 65. If totally disabled beyond employment at poverty level, you might qualify after the rigorous application and approval process.

They saved the best for last. After months of remaining generically redundant on America’s health care, they finally talked in more generic detail about their health care platforms. This was pretty much what they have already said and put on their websites.

I vote for caps on insurance premiums, retroactive to at least five years ago when insurance premiums started going through the roof. This fits better than a tax credit. There are wage caps in effect. This makes good sense. It is time for shareholders and company executives to put patients on the forefront.

I vote for the omission of pre-existing conditions immediately. Prevention, wellness and health maintenance would be a primary focus. Management of pre-existing conditions and chronic disease are prevention in action. Baseline body scans sound like a good idea for looking into your health (pun intended). Early detection may save your life, and some money. The American health system teaches doctors to treat you after you get sick. Which costs more? Which is better for you? Would you like to know what you have and decide how to manage it?

I vote for and agree with the senators on downsizing the US Department of Health and Human Services. There are agencies that appear to overlap. They could be combined with new initials. Talk about alphabet soup. Put ODPHP with NCCDPHP and USPSTF under OIG monitored by AHRQ and CDC. Mmm…mmm…good.

All in all, it appears that the presidential candidates want what they would want for themselves and their families. That remains to be seen instead of heard. After all they have shared their medical history with us through the media – Senator Obama’s one page note from his doctor, and Senator McCain’s thousands of pages in three hours. Senator McCain allowed questions to his doctors for about an hour, while Senator Obama is sticking with his note. Speaking as an expert, both are unacceptable and unrealistic medical record reviews for health assessment. Remember HIPPA.

Actions do speak louder than words. Show me the plan.

Dr. Richardson is author of the award winning reference book, Patient Handbook to Medical Care: Your Personal Health Guide, and Building an American Health System health care proposal.

http://www.mypatienthandbook.com/
www.twitter.com/MD4U
www.blogtalkradio.com/drjfpmd

Financial Medical Tips

Here are some financial medical tips to help you during this financial crisis the world is facing.

1) Keep your health insurance coverage. This is as important as your home and food. Cut expenses elsewhere to keep it in your budget. Let your doctor know if you do not have insurance coverage. Many offer discounts to the uninsured as do other health providers like hospitals and diagnostic centers. Pay for what you need instead of relying on insurance.

2) If you lose your job, get COBRA through your employer. You will have at least 18 months of coverage. You will have to pay for it. It is worth it.

3) Be sure you are up to date on your health maintenance. Get in now for your physical and preventive tests (mammogram, blood tests, eye exam, shots, etc.).

4) Check your medication, prescription and non-prescription. Review these with your doctor to discontinue any you really do not need, and/or can't afford. Let your doctor know if you are unable to afford any of your medication, so other options can be discussed such as drug assistance programs. Research them yourself on the Internet, and by calling or writing the drug company that makes your medication. Remember to include your non prescription meds in your budget (like cough medicine, stool enhancers, pain relievers, etc.). Talk with your pharmacist.

5) Discontinue unhealthy habits like smoking and excessive drinking.
These items cost money and your health.

Remember that YOU are your most important asset. Great health is true wealth.

Dr. Richardson is the author of the award winning, Patient Handbook to Medical Care: Your Personal Health Guide, and Building an American Health System.

http://www.mypatienthandbook.com/

Cap Insurance Premiums

Dear Senator Obama and Senator McCain,

As part of your spending cuts, put a scalpel to insurance premiums. Cut and cap. It is preposterous to think that someone on a limited income (like seniors, retirees, disabled folks), or those whose salaries have flat lined can continue to afford increases of 25% or more per year. With the average annual cost of living increase of 3 to 5% it is simply unaffordable. For many this can be as much as 10%or more of their income.

For the past three years many insurance premiums have risen as much as total of 25% per year for the past few years! Meanwhile your insurance rates in Congress were recently reported as an 8% increase last year to a hefty 12% this year. Give us the same. After all you do work for us. You and your colleagues keep saying we should have the same health insurance opportunities as Congress. Act on it and stop the private insurance sector from hemorrhaging us to code blue.

Start by putting a cap on insurance premiums. Make this retroactive for the unfair cost increases over the past five years. Let the insurance companies apply this instead of a tax credit to our insurance.

It is time that patients instead of shareholders and company executives reap the benefits of decent health care. Shift the focus on preventive care to preserve your health and save your life as opposed to waiting until you get sick and die.

Do the right thing and the best thing for your country. Keep insurance premiums affordable. Keep your country's health from failing. Invest in prevention, health maintenance, wellness, and health preservation. Make the insurance companies accountable for this, too. Disease management is good, but if it is prevented or detected early it's even better.

Information technology such as electronic medical records are great, too. Be realistic. We are behind here and trying to catch up. Take care of patients first and do this as you go. Most doctors' office are still trying to figure out how they are going to afford it.

Consolidate some of the government health agencies that overlap. As I waded through the Health and Human Services department, I drowned in an alphabet soup of agencies that do similar things. It looks like a lot of money being spent for those most in need; however, the disparities in health care continue in despair.

Keep our country's vital signs stable. Resuscitate. Perform CPR STAT. Open the airway, breathe in fresh air, and circulate the proper health care to all Americans. It is our birth right. It is our privilege. Make it our asset.

Best regards,
Dr. Richardson

P.S. On a personal note - my insurance company increased my premium another 25% this year from $700 to $882. Pre-existing conditions have prevented me from getting affordable continuous coverage elsewhere, or from getting into less expensive plans in the company. My years of employment with this company have amounted to nil.

Patient Grievance

You arrive at your doctor's office for an appointment. You arrive at the scheduled time. You make your co-payment. You wait for 45 minutes before you are taken into the exam room. The doctor enters in a frenzied panic about 15 minutes later. He tells you that you must reschedule because there is not enough time for him to see you. After persistent banter back and forth, your "official" doctor visit begins.

Once the visit starts, there are multiple interruptions from the staff. The doctor does not have the results of your tests. He fumbles persistently through the chart ignoring your presence. You look over your list and move on to the second item while test results are being located. Another interruption puts these results in your doctor's hands. Since you have not heard about these tests done a month ago, you assume all is okay. You assume wrong again.

As the doctor comes to his senses and recoups his professional demeanor, you continue with your list of items to discuss. After 30 minutes you have it all together - copies of test results, prescriptions, and a plan for follow-up on all that is necessary. You are asked to schedule your next appointment in one month at the doctor's convenience. There is no one at the front desk to give you an appointment.

Doctor visits like this are far too common to ignore. In this instance, the patient had an abnormal test that would have been ignored for a longer time. The unprofessional encounter amplified the patient's stress and blood pressure. It may have been easier for the doctor for the patient to reschedule, but would it have been the right thing to do, and the best thing to do?

Doctors would you?
1) keep arguing with the patient until blood pressure reaches 160/120
2) blame the patient for waiting one hour to be seen
3) see the patient
4) see the 2 drug reps and make the patient reschedule
5) apologize for unprofessional rudeness.

Patients would you?
1) reschedule appointment
2) let the doctor know you were on time - deal with it
3) continue talking with doctor instead of wasting time
4) stand up for your rights
5) file patient grievance with insurance company, state medical board.

Filing a patient grievance/complaint is a smart thing to do. A grievance is a request for an investigation of a complaint about a possible risk to the health, safety, or well-being of a patient; or a situation where the patient is unnecessarily at high risk. Check with with your health insurance provider to find out the details for reporting unacceptable medical services that may threaten your life. In addition, it may save other lives as well since about 15% of JCAHO sentinel events reported are from responsible patients who speak up.

by J. L. Richardson, M.D., family physician, patient advocate (specializing in grievenace process and medical record review), patient, and author of Patient Handbook to Medical Care: Your Personal Health Guide, and upcoming Patient Handbook to Surgery: Surviving Your Operation.

Second Opinion, Third Opinion

Dr. Oz has spoken again. On today's "Oprah" he made it crystal clear that second opinions, even third, are "patriotic" and show you care about your doctor. He said physicians should not be offended if a patient gets another opinion. Instead physicians should embrace the opportunity and respect their patients. He further stated that that this is an opportunity for doctors to learn.

Most doctors do get a terrible attitude if they know you are getting other opinions. They must feel threatened in some way. Is it an ego thing? As a physician, I fail to see why other opinions are so hard for my colleagues to embrace and suggest. As a patient, I fail to see why patients fail to trust their instincts about seeking other opinions.

Whenever, I have felt that another opinion was needed for my health, I did so. I told my primary doctor - after the fact. I brought in the other doctor's notes and recommendations, and I expected them to be followed. I found that when doctors don't know about a new test or treatment they tend to discourage you and get you out of their office quickly. Instead they should be yearning to know more about it, and what you have found out about it.


Unfortunately, I have had to seek other opinions on more than one medical condition I have had. Each time it was the best decision and the right thing for me. Then my doctors embraced it. Being a physician patient does not get you better care as most think.

It is good to trust physician, but you must be cautious. Trusting someone else is far from enough when it comes to your health and well being. You must help yourself - Help, Empower, Lift, Prepare.

Get another opinion if you need to it. And another, until you have the best. That's the way Lance Armstrong did it.

Bravo again, Dr. Oz! Thank you and Ms. Winfrey.

Follow UP!

A news story on colon cancer follow up revealed that if you are older, a minority, or have other health problems you may be receiving less screening for colon cancer follow up. Many that have colon cancer, about 60%, are failing to get proper tests for follow up of their cancer. This is unacceptable. Why are so many being neglected? Do our doctors care, or do they really not know what to do? The article actually suggests the latter may be true!

The deputy chief medical officer of the American Cancer Society said that he was not surprised by these findings. He felt that the doctors' ability to give the proper care was under par. Now this is truly a sad situation. The person you trust with your health may be less qualified than you think.

It is up to you to be on top of your own health care. Follow up is so important. Make the choice to call your doctor, and to make your appointments. More importantly, make it your business to know all you can about your health - what you have, what you need. Follow UP!

Stand Up To Cancer

"Stand Up To Cancer" is the best medical TV event ever! Broadcast simultaneously on the three major broadcast networks at 8 P.M. tonight, this event was magnificently powerful! Much information on cancer cause, early detection, treatment and more was provided throughout the hour. This also included written information in large letters at the bottom of the screen.

TV is a powerful information source, yet used the least for providing basic medical information and news. Hopefully this TV event will set the precedent for more real medical productions, maybe even a commercial free, 24-7 medical channel.

Stand up to cancer! Do your self breast exam. Do your scrotal exam. Do your preventive screening tests ordered by your health care providers. Do it routinely. "Just do it!"

A thorough medical history and physical exam includes the basic cancer screening. Some tests considered for routine cancer screening are:
-mammogram, MRI, sonogram - breast cancer
-PSA (prostate specific antigen) - prostate cancer
-colonoscopy - colon cancer
-stool blood check - colon cancer
-PAP smear - cervical cancer
-complete blood count - blood cancer
-CT or MRI scan - lung cancer, brain cancer, pancreatic cancer
and cancer in other body areas being scanned
-pelvic sonogram - ovarian cancer
-body scan (neck to buttocks and in between) - checks
body for cancer and other medical conditions.

Screening exams and tests save lives. Talk to your doctor. Be sure your doctor goes over the test results with you and explains EVERYTHING! Leave with your questions answered! Be sure to follow up to prevent any delays.

Stand up for cancer!

Healthy Aging Month

During National Preparedness Month the nation prepares for emergencies. September is also Healthy Aging Month. This is the ideal time to get the nation prepared for healthy aging. Healthy aging includes lifestyle modifications such as proper diet and regular exercise. These we hear a lot about. Often ignored is the lifestyle modification of routine doctor visits for physical exams, blood tests, preventive screening tests, and more.

The physical exam and patient medical history (including family history) are important in determining what tests are needed for each person. That is why regular doctor visits are an important lifestyle modification to every one's health maintenance and wellness plan. As we age our bodies tend to acquire medical conditions that require treatment by a doctor or other health care provider.

Healthy aging. We might as well do it gracefully. See the web page www.healthyaging.net for more information.

"Patient Handbook to Medical Care: Your Personal Health Guide" by J. L. Richardson, M.D. is the ideal resource to help you. Preview actual pages at http://www.books.google.com/. Check out the book at http://www.mypatienthandbook.com/.

Add your healthy aging comments to the blog. Free copies of "Patient Handbook to Medical Care" will be available to the first 10 bloggers each week during Healthy Aging Month.

National Preparedness Month

As Hurricane Gustav fizzles out, and Hurricane Hanna (with Ike and Josephine on her tails) approaches the southeast US, it is time to be sure you are prepared for any emergency. Safety and health are more important than ever during an emergency situation. Being prepared is a real-time, year round activity.

September is National Preparedness Month which is sponsored by the Department of Homeland Security (DHS). This program helps us prepare for emergencies. It encourages us to "get a kit, make a plan, be informed, get involved".

While it is important to prepare yourself, it is also important to help prepare your community. The Citizens Corp, "uniting communities, preparing the nation", encourages you to start with personal preparedness as well as volunteering to help in community preparedness.

Citizens Corps programs include the Medical Reserve Corps (MRC), Community Emergency Response Team (CERT), Fire Corps, Volunteers in Police Service (VIPS), and USA on Watch (National Neighborhood on Watch). Learn more about these programs at www.citizenscorp.gov. Get involved. If you are already involved, call on others to do their part.

Preparedness begins at home. Be ready, stay ready. Be informed and check out National Preparedness Month at www.ready.gov.

Medical Record Retrieval

Today I reorganized my medical records. I started getting copies of them when I was in college. It was at this time that I was diagnosed with a medical condition that required surgery for a cure. That is pretty shocking. I decided that after several years of doctors’ testing and untimely diagnosis I must see what is being written about me.

By getting a copy my medical record from that doctor, I was more informed. Thereafter I continued to get copies of my medical records including blood tests and all other tests as well as surgery notes. I also started doing it for my parents and my whole family. Your medical record is the cornerstone and foundation of your medical care. It is the most important communication aside from direct patient to doctor conversation.

It sure would be nice to write it all down. The doctor writes, types, or dictates as much as possible. This important conversation including what is found on the physical exam, the diagnosis/ diagnoses, an assessment of tests done, and a plan for treatment is documented by writing, typing, or dictating. That is a lot of information to document. Accuracy is of utmost importance. The medical record is the communication tool used by all your health care providers.

It is only right that you should be able to see your medical record about you. Checking for accuracy and information in your records is important. It is empowering. It makes you want to take the best care of yourself, and be able to talk more openly to your doctor about it. I have found this to be true amongst patients that keep their medical records. I have seen medical errors avoided. I have learned more from patients about their own medical conditions because they read about them.

The best way to obtain your medical record is to obtain a record release form. Your doctors’ office should have this document. Ask for it. After completion return it to the person in charge of medical records at the office, hospital, or other medical care facility via mail, fax, or in person. A copy of the medical record is sent directly from the office, or it may be sent from a company that sends out medical records. How this is done is beyond me especially when the company is in another state. Getting the record directly from the health care provider seems easiest for the patient.

Sadly, you may have to pay for your records. It is best to get copies from your doctor at the time of your visit. Most doctors have it finished by the time you leave. When tests are ordered, the results can be faxed or mailed after your doctor talks to you about the results. This may avoid costs, and help ensure timely follow-up. I have found some doctors’ offices automatically give you this information. How nice!

Medical record retrieval can be challenging, but rewarding. Keeping current with your health is your job. You are your most important asset.
Information on obtaining a medical record release form can be found at http://www.mypatienthandbook.com/ under “Patient Tools”. Then reconnect to the blog spot. Happy blogging!

Prevention Guideline Changes

Should we follow preventive guidelines recommended by a single source, or by our individual medical history? I heard on the news this week that the USPTF (United States Preventive Task Force) no longer recommends screening for prostate cancer with the PSA (prostate specific antigen) blood test in men aged over 75. I was shocked to hear that a few years ago it discontinued monthly self breast exams (SBE).

These are easy, cheap ways to screen for cancer. The breast exam you can even do yourself. For those who are unable to get mammogram the self breast exam can be helpful. As for the PSA it is felt that men usually don’t live much longer than 10 years after turning 75. In addition, it is felt that the cancer grows so slowly that the cause of death will be from something else. Then there are the side effects of cancer treatment in someone over 70.

This type of age discrimination in health care occurs much earlier, in the 60s. If you get too many illnesses too young in life, health discrimination may be seen earlier. Women have faced this forever. We are guesstimated to live longer lives these days, into the hundreds. Why stop screening for age, sex, or chronic illness? When we choose to do so, will the system allow this without extra cost to us for life saving tests that are so cheap? Bottom line – human individuality deserves custom made prevention plans based on personal and family medical history.

See the previous blog here (5/14/07) entitled “Missed Diagnosis”. Cancer is the most missed diagnosis! Cancer prevention tests are outlined in this blog. Decide what’s best for you and discuss it openly with your health care providers. Ask them what they would do for themselves. It is very important for us to learn as much as possible about wellness, disease prevention, and disease management.

Preventive Testing Lifestyle Change

Do lifestyle changes (like proper diet, low weight, exercise, avoidance of tobacco, etc.) really keep the hypertension and high cholesterol under control if it runs in your family? Genetic disposition to diseases is tough to beat. My own health issues that have been inherited have been resistant to my ongoing 30 year regimen of proper health recommendations - and new ones are popping up earlier than in my ancestors. My cholesterol remains high, and now high blood pressure is staring me in the face. Medication has been required as I continue to do all the other right things. Has this happened to you? Please blog with me about it.

As a physician in training I recognized that prevention also includes routine checkups , and screening tests. When you get a heart scan that shows heart disease, or a self breast exam that turns up a lump, or a prostate blood test that shows cancer, you usually get more testing and treatment. It seems as if checking yourself routinely before disease that you know runs in your family is the best and right thing to do. Is it? What if something that doesn't run in the family shows up? Early detection can very critical. You can be cured and your quality of life can be better.

If you are at risk for some disease whether or not it is inherited, why not check for it early? This brings to mind the recent news about the rise of AIDS and HIV in the world. I think everyone should be checked for it. After all most routine blood tests include a syphilis test. Society has made individuals "afraid" to be HIV positive; therefore, the secrecy surrounding this makes people less likely to talk about it let alone be honest about it.

Wake up world! Get checked for everything you possibly can that is available. It's your life. To those lifestyle changes like weight control, exercise, proper diet, etc., add routine total body checkups.

Ideally, your health care provider should be helping you. Help yourself and your health care provider by reading "Patient Handbook to Medical Care: Your Personal "112 page" Health Guide". www.mypatienthandbook.com. Preview pages at www.books.google.com. Information on routine physical exams, and preventive tests are detailed. Make this another lifestyle change to improve your life.

Great health is true wealth! Best health, Dr. Joan

Heart Disease Screening

EKG? Stress test? Echocardiogram? Nuclear stress test? Angiogram? CT scan? Which test is the best for checking for heart disease, also known as coronary artery disease (CAD)? The best way to look at the heart is directly. Short of an autopsy, there is no other way. So what do you do?

Thanks to modern medical technology a electron-beam computed tomography (EBCT) scan (also called fast CT) of the heart is able to show heart vessels coronary artery calcium (CAC), hard plaque that causes blockage. An angiogram/ cardiac catherization shows actual blockages. This is invasive requiring injection of dye into a main artery to view the coronary arteries, and is the gold standard for detecting CAD. The heart scans are noninvasive, and give a rather good look at CAC (hard plaque) in heart vessels which can also be a predict cardiac events like heart attacks.

The most current consensus document (2007) from the American
College of Cardiology Foundation and American Heart Association does not recommend the scan for asymptomatic people with a high risk of coronary artery disease, or for those at low risk, nor as a screening tool. It is considered reasonable in the asymptomatic with intermediate risk, and for the symptomatic person prior to an angiogram for definitive diagnosis.

The document also cites studies that compare fast CT with EKG stress test, nuclear perfusion scan, stress echocardiogram and angiogram. "The accuracy of fast CT was significantly higher than either treadmill testing or technetium stress in the diagnosis of obstructive CAD." Other studies included angiography (the gold standard), fast CT, EKG, and nuclear (with thallium and technetium) exercise stress testing. The fast CT correlated closer with the angiogram than the other tests especially if the CAC score from the fast CT was over 100. If arteries are occluded more than 50%, this will likely show on the fast CT. "Three studies have documented that CAC is a rapid and efficient screening tool for patients admitted to the emergency department with chest pain and nonspecific electrocardiograms."


So why are cardiologists continuing to pass on recommending the fast CT? Is it because it is more convenient for the doctor to do the other tests because they are more "readily available" like in the doctor's office or nearby hospital? It seems like a fast CT could be just as "readily available". Do they get paid more for these other tests that may yield less information like the specific areas where CAD may be localized?

The fast CT sounds too good to be true. Is it? Does it give more accurate information about heart vessel blockage in 10 minutes than the other tests mentioned, excluding the angiogram? I have been watching my vessels with fast CT for about 5 years now. I felt that my family history of heart disease and my risk factors warranted more than an EKG or stress test which have also been done. Both failed to correlate with the findings of the fast CT.

Tips for Medication While Traveling

When you prepare for a trip, one of the most important things to pack is your medication. Here are some tips for getting your medication organized and ready. Start at least two weeks before your trip.

1) Put all of your medication in front of you. This should include your prescribed and over the counter medications.

2) Check each prescription medication for number of refills.

3) Contact your pharmacy. Call the medication in that have refills, or fill them at the pharmacy's website. Pick up these medications, and any over the counter medications you need.

4) Contact your doctor for those that need refills. If you have not seen your doctor in three or four months, it is likely that you may have to make an appointment to see your doctor to get your refills. Your doctor's office will let you know when you call them. Make sure they have the correct phone number for your pharmacy.

5) Make a list of your medication. A medication list form can be found at www.mypatienthandbook.com under "Patient Tools".

• You can write your medication list on paper, or type on the computer and print.
• Include the name of the medicine, strength, and how many times a day you take it.
• Take a copy of this with you on your doctor visits.
• Update it monthly, and when you have medication changes.
  
  6) Buy pill reminder boxes with the days of the week on them, or use clear resealble plastic bags (sandwich size). You can buy weekly or monthly boxes. Some have midday dose sections. The easiest to use is weekly.
• Get a different color for morning, noon, and night. If different colors are hard to find, buy what is available.
• You will be able to make a label for the times of day and put on each weekly pillbox or bag.
• Make a label for "morning", "noon", and "night".
• Use adhesive labels, or write labels on piece of paper, cut out and tape to bag or pillbox.
  
  7) Put all of your most recent medication bottles from the pharmacy that are in original bottles in a plastic container with a top. This is your master pill box supply.
  
  8) Fill your weekly pillbox containers by morning, noon and evening once a week on Sunday. Put this set of pillboxes in a bag that seals. This will make it easier to see your pillboxes. They may also be packed in your special travel bag for your medical needs. Pack in the piece of luggage you will have closest access to such as purse, overnight bag, etc.
  
  9) Take your master pillbox with the original medication bottles in your luggage with your clothing, or where you choose to be the safest and most easy to get to for use.
  
  10) If you have empty used bottles from the present year that you are currently taking, put these in another master pillbox. Store this in a safe place in your home. It may be prudent to keep at least a week's supply in these bottles. This box should match the contents of your other master pillbox for travel.

By following these organization techniques, you will find that keeping up with your medication when traveling, or faced with emergency situations will be much easier.

Enjoy your trips! Great health is true wealth!

Post your comments and suggestions below.

Overmedication and Illness

You just had that coronary heart bypass, and you have been prescribed several new medication pertaining to that and other conditions that popped up during your hospitalization for the surgery. You go to see specialists for these new diagnoses, and you get more medication. So you have over ten different medications to take now. You thought you would be getting along much better by now, but something is just not right. Are your conditions getting worse?

You may think that you are getting worse from the illness, but could it be the medicine? You decide to get out the Physician's Desk Reference (PDR) and research the medication you are taking. Upon discharge from the hospital you received information sheets about each medicine, but the information seems so scanty. Sure enough, you are right.

The PDR gives details about side effects and drug interactions you had no idea could occur. You wonder why the doctor didn't tell you one of the drugs could cause blindness, fatal lung disease, hepatitis, hyper- and hypothyroidism, loss of appetite, anorexia, constipation, worsening of the condition for which it has been given, etc., etc. As you read further you find this drug should not be used with two other medications you have been prescribed.

You no longer have to wonder why your recovery has been slower than expected, and why you feel so bad. You have been overmedicated! Here you were thinking you were getting sicker from your diagnoses and surgery.

Take the time to read about medicines you are prescribed. You may find that you are not as sick as you thought you were. Overmedication can easily mimic as well as bring on symptoms of many disease conditions, and make you feel worse than that for which you are being treated.

Patient Educate Thyself

You are a patient. You are the most important "link in the health care chain". You, patient, keep your health care chain strong. You are the strongest link. Stay up to date on your medical conditions through your health care providers, and through yourself.

Patient education is part of your job. It is up to you to seek out information and knowledge about staying well, preventing disease, and managing disease you currently live with daily. Make a list of your medical conditions, and all medicines you take. Make a list of medical conditions that run in the family. Study your lists.

Read about your medical conditions and those that run in the family. On your next doctor appointment ask your doctor for more information especially in writing. Talk with your doctor. Discuss any tests that you feel would help you in detecting and managing your conditions.

Know all you can know, patient, so you can "be all you can be".