Fever and Malaise: Flu or New Disease

Fever. Chills.  Malaise. Myalgia. Loss of appetite.  Cough.  These symptoms are consistent with the flu syndromes such as influenza.  They may also be signs of new inflammatory disease like infection in the body. Cancer and rheumatological disorders that include connective tissue diseases and arthritis may also present in similar fashion. Flu symptoms usually resovle in about ten days to two weeks.  Complications from the flu like pneumonia are likely to cause worsening of symptoms accompanied by new symptoms.

Flu precautions include:

• frequent hand washing especially after contact with others
• avoid those who have flu-like symptoms
• cover your mouth when you cough
• eat nutritious foods especially those that are specific for immunity and healing
• stay well hydrated
• get flu shot before flu season starts
  

These preventive measures are important for staying well and healing.  If your symptoms persist or worsen in any way follow-up with your healthcare provider that initially diagnosed you. Telemedicine health visits help contact avoidance while getting appropriate medical care for you.  Healthy self care, prevention, and avoidance are primary. Best health!

Medicare Healthcare Scare

As health costs rise so do Medicare prices at a faster rate than cost of living increases can contain. During your retirement years good healthcare is as important as ever.  Medicare is primary health insurance during this time yet the cost may be too high.  Medicare is a health plan for the elderly and disabled. Much of this specifc population is on a limited income which is usually only Social Security.  The average Social Security monthly payment for 2019 is $1461.  The average amount for Medicare can be up to one third of this average leaving less for food, rent, and other necessary living needs.

The standard part A premium for inpatient care may range from $240 to $437 and depends on the amount of Medicare taxes you have paid. If you have paid less than 7.5 years in Medicare taxes, the higher price is the premium price.  The deductible for Part A hospital coverage is $1,364 for each benefit period.  Coinsurance is $0 for first 60 days, $341 for next 30 days, and $682 for each "lifetime reserve day" (up to 60 days over your lifetime).  The patient is responsible for all costs after lifetime reserve depleted. 

The standard part B premium for outpatient care starts at $135.50 and is higher depending on income.  The deductible for this part is $185 per year.  After this has been met, payment for services is 20% of Medicare approved prices.  This can be covered with extra insurance coverage through a Medicare Advantage Plan offered by commercial health insurance companies.  If you fail to buy during the eligible enrollment periods, the premium may go up 10%. 

Regardless of who is paid for what, the result is the same.  Prices continue to increase and cover less.  For example, many home health care costs are excluded.  Home health care is important for those that are homebound or disabled.  This cost should hardly be extra on a limited income.  

Then there is Medicare part C (Medicare Advantage) and Medicare part D prescription coverage offered by regular insurance plans for an extra fee of course.  The deductibles, copayments and coinsurance are part of this as well.  Each insurere has their own plans and rates that add to your health maintenance if you can afford it.  Payment for part A and B is too much for many; therefore, medication may be omitted especially if the choice is food or medicine.

The Medicare healthcare scare is real.  What began as a "free" low cost comprehensive health program for the elderly has become a high cost less inclusive health plan for limited income retirees and peopele with disabilities.  Medicare solvency concerns have led to predictions it will be in debt within the next fifty years or so.  In the meantime, price increases with less coverage seems to be the answer for over 60 million people in their retirement years.  Best health!

Medicare:  Will It Be There When You Need It? 

http://bit.ly/bhloV2

Know Your Medical History

One of the first things your doctors and healthcare providers want to know is why you made your appointment. Once you answer this question (hopefully before interruption) there will be questions about your general health and wellness, as well as more information about your reason for the visit. For specific concerns you may be asked:

• How long has this been going on?
• What have you done for it?
• Have you had it before?
• Where does it bother you?
• How often does it occur?
• What makes it better or worse?
• Are there any other symptoms?

You will be asked about how the other parts of the body are working, such as your eyes, ears, heart, breathing, and so on. This is called the “review of systems” (ROS). If there are any problems not related to your main problem, now is the time to let the doctor know.
This will be followed by your past medical history (PMH), which includes:

1. Diseases you have (high blood pressure, sugar diabetes, arthritis, cancer, depression,
   etc.), or have had that are better or gone (including childhood diseases such as
   measles, mumps, and inherited disease)
2. Operations and times you were in the hospital (including accidents)
3. Medication, including prescription, over-the counter (don’t forget about vitamins),
   natural (garlic, aloe), and herbal
4. Allergies and reactions to anything and what it did to you (for example: breaking out in a
   rash, swelling, itching, upset stomach, etc.)
5. Smoking, alcohol, drug use (how much, how often)
6. Shots (childhood, flu, last tetanus, etc.)
7. Sexual (active, using protection, number of partners, diseases)—in females this will also
   include menstrual period, pregnancy, last mammogram, and Pap test
8. Family history (conditions that run in family
   such as cancer, high blood pressure, etc.)
9. Social history—your job or jobs; family; marital status; living arrangement (house,
   apartment, alone, etc.); transportation (drive self, public transport, walk); ambulation
   (use walker, wheelchair); disability (deaf, blind, amputee, etc.); religion, ethnic customs, and traditions

If there is anything left out or that you feel the doctor should know, now is the time to speak up. It is sometimes hard to get someone’s full attention, so take advantage of it while you have it. Some doctors’ offices will have you fill out forms asking the above questions or will ask you the questions and fill out the form for you. This is not a substitute for the doctor’s personal interview and questions.
Writing or typing this information is a sure way to keep all of your PMH http://bit.ly/f8FZ55 . Make a copy for your doctor. While talking you both can refer to this vital source of health information.
Best health!

Overmedication Can Cause New Symptoms

Have you noticed how different you feel with the new medication you just filled?  Then you thought it was just you and something new?  The different feelings like forgetfulness, dizziness, sleepiness are getting worse after one week.  Then you think maybe it could be the five medicines your primary care provider added to the other five you were supposed to be taking. How will you be able to tell which one it could be that is dropping your blood pressure so low you are dizzy and near syncope?  It could have been the one that causes arrhythmias which is the one you were given for the dizziness which only occurred after taking the one for diabetes causing hypoglycemia.  What a constant cacophony conundrum!  When you decide to look over the drug information that came with each prescription, you find that all the medication can cause this and some of the other new symptoms you acquired.

Overmedication is one of the biggest unnoticed culprits of new symptoms in many people regardless of age.  Those over fifty are most susceptible to the effects of too many medication.  Treatment such as proper diet, exercise, and other complimentary therapies are often overlooked as part of first line treatment with or without medication. Accuracy of diagnosis is very important before, after, and during treatment.  Treatment of symptoms may or may not help, and lead to more medical maladies. Overmedication accounts for more hospitalizations and primary care provider/ specialist visits than many chronic diseases, but is hardly noted.  Rather than implement a medication as the cause, another is prescribed to treat new diagnoses.

Overmedication should be included in differential diagnosis of many conditions.  Patients are often non-compliant once they feel a medication may be making them feel bad.  This is usually unknown by the primary care provider for patient fear of being labeled "non-compliant".  Then more medication is added.  Know what medication you are taking, why you are taking it, and the side effects it may cause. Best health!

Medicine Disease Effect
https://mypatienthandbook.blogspot.com/2017/05/the-medicine-disease-effect.html

Mobile Healthcare:Telemedicine Telehealth

If you could visit your doctor 24/7 how much money and time could you save?  Telemedicine healthcare makes this possible.  Telemedicine makes virtual reality a reality as real as visiting your doctor in the office.  Through your smart phone, tablet or computer you can make a doctor visit.  No travel time. No wait time. Just quality doctor time.

Telemedicine is a billion dollar business that is becoming a trend in our connected world of convenience and crucial time management.  It entails the use of electronic communications to monitor and improve a patient’s health status.  In addition to saving money for patients and all providers (including insurance companies, hospitals, clinics), there is better access for everyone. Studies have shown that overall quality of care improves as patients are given more of the attention they deserve to make their healthcare experience more beneficial. .  It is helpful for patients in remote areas with limited or no transportation and those with chronic conditions that limit their ability to make an in person office visit.   

As telehealth develops, doctors and patients will find even greater access with connectivity via personal electronic health devices and applications (apps, for short).  Telemonitoring allows patient and doctor to check and follow together such parameters as blood pressure, blood sugar, and much more in real time together.  If that noon time blood sugar is too high, your doctor can be aware and advise accordingly at the time of occurrence instead of on the next appointment in 2 weeks.  This alone saves the patient’s health as well as travel time, office visit wait time, and the money to do all of this.  It potentially avoids an emergency room visit and hospital admission. 

In addition to patient care, doctors are able to communicate in a more timely, efficient manner with other doctors and health facilities.  The CT scan you had this morning is can be viewed by your doctor within minutes after completion instead of days after. Mobile collaboration allows your doctor to discuss your health case with other healthcare professionals like specialists (in the same or different locations) to determine the plan for your care.  This can actually happen the same day a test is done!  This eliminates delays in care that could be life threatening to a patient. 

As costs for telemedicine access decrease and more insurance companies/plans reimburse, it will become the portal of choice for many patients, doctors, and other healthcare providers.  Your doctor visit time can be more about you at your convenience in your home.  Best health!

Family Health: Abuse Awareness

Family and domestic violence affects many millions of women, children and men worldwide.  More females and children are affected than men.  In 2011 statistics revealed that over 1.5 million women and 800,000 men were involved in intimate partner violence (IPV) in the United States alone.  Studies estimate the lifetime risk for women is an astounding 1 in 4. 

As more accounts of domestic violence are made public, one would think contact for help would be more prevalent as well.  It is in the real world.  Repeated public disclosure (video, discussion of incidents, etc.) with negative implications is less than desirable for anyone especially victims and their families. This lends to more harm than help possibly generating ideas for potential new and recurring events.

Doctors in Florida are required to complete domestic violence course to maintain licensure.  This ensures that anyone who is faced with this situation will get proper guidance and assistance.  Many doctors include questions about this on routine wellness exams.  Help and prevention of further occurrences from qualified medical professionals is of utmost importance.

Domestic violence is a very sensitive issue that affects health and well being.  It is a private matter regardless of those involved. Seeking help is of utmost importance.  Prevention, intervention and early detection are essential.  This can start in the primary care doctor’s office before it escalates to family violence and ER visits. 

Patient safety is a primary concern as is developing a safety plan. Referral to appropriate health care professionals and community-based programs helps patients with the psychological, emotional, and physical aspects of family violence.  Other resources can be found by phone or Internet as follows:

·       National Domestic Violence Hotline

        1-800-799- SAFE (7233)
          www.thehotline.org

·       National Sex Assault Online Helpline

         1-800-656-HOPE (4673)
www.rainn.org/get-help/national-sexual-assault-online-hotline

·       Institute of Safe Families

          www.instituteforsafefamilies.org

·       National Coalition Against Domestic Violence
    www.ncadv.org

·       Academy on Violence & Abuse

          www.avahealth.org

·       American Bar Association

    http://apps.americanbar.org/tips/publicservice/safetipseng.html


Keep you and your family healthy and aware that IPV and family violence is avoidable.  Educate and inform seeking help when it is needed. Abuse be it verbal or physical is harmful and unhealthy.

Medicare & You: Will It Be There When You Need It

If you are in your near retirement years, I am sure you are getting ready for Medicare to take over your health care. Will it be there? By 2030 there will be about 100 million persons receiving Medicare. This is twice as many as 2008. This comes at a time when the growing demand for doctors is at a critical point. Their numbers are dwindling, especially those that accept Medicare payments for services.

Medicare is a health program that is publicly funded by the government to care for persons over 65 who have been legal residents for five years.It is a single payor program. Medicare eligibility starts at 65 years of age. If you are a person with disability, end stage kidney disease (i.e. requiring dialysis or kidney transplant), or Lou Gehrig's disease you will get benefits before age 65.

For the past few years Medicare payments to doctors have been cut by as much as 21% in 2010, while Medicare premium payments by patients have risen (along with the cost of health care!)an average of 10% per year. In addition, Medicare taxes are being prepaid through every working persons' paycheck - 2.9% of your wages to be exact (more if you make over $200,000). It would make sense that doctors and health care providers would receive increases instead of sharp cuts (pun intended). Instead doctors are quitting and looking for second careers unrelated to clinical medicine. Hospitals are closing (the small reserves for hospitals may exhausted by 2017). Clinics are downsizing and closing.

Predictions abound that Medicare will be bankrupt by 2020 to 2030, . "The latest report on the solvency of the Social Security and Medicare trust funds reveals that these entitlement programs will likely run out of money sooner than expected." (reference: Brookings Institute, 2009) Medicare alone was 13% of the federal budget (almost $400 billion) in 2009. It is projected to be near the same in 2010 with a higher cost near $500 billion! The amount spent on Medicare is likely to exceed the payroll taxes collected from your hard earned wages. Astounding data! In spite of the fact that doctors must now accept what Medicare pays them versus what they charge (traditional from 1960 to 1980), this program will be in the red.

Health care rationing may become part of the plan to cut costs and be sure all get health care. Those over 60 and those with multiple chronic conditions many of which occur just because you get old like arthritis, high blood pressure, decreased vision with cataracts, decreased hearing will be put in the long line near the end. As we live longer more health care is needed especially if we inherited the family genes for certain things like diabetes, cancer, and heart disease. Add this to the "old age" diseases and you have the equation of a Medicare patient. Of course old age is much kinder to some than others, but it happens to everyone.

Where will you go for health and medical needs when you reach 65? Medicare was supposed to be there. You worked and paid for it. So you must look after it. First and foremost, you must realize that your health is everything. Loss of function of an arm or leg, your speech or vision almost renders you dependent until you "overcome" it, if you do.

Health maintenance and wellness are vital. You must be your best health advocate by taking the time to prevent as much as possible. Routine checkups by you and your healthcare providers are very important. Early detection will prove a lifesaver if some illness is discovered. This will help you get through the Medicare years. You will be able to see your premium payments and hard work pay off, just with less Medicare and more of your money out of your pocket.

Bottom line: cut Medicare benefits or increase payroll taxes? This is truly a "beast and burden" that needs taming.

by J. L. Richardson, M.D.

Dr. Richardson is a family medicine physician, independent medical record reviewer, and author of Patient Handbook to Medical Care: Your Personal Health Guide. This book provides 112 pages (large print) of health information that will tell you what your doctor should be asking you, telling you, and doing for you - as taught in medical school and used since Hippocrates.