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Wednesday, January 20, 2010

Closing the divide in the Health Care Debate

Congress has begun the pain staking process of interfacing the Senate's health care proposal with it's counterpart written by the House of Representatives. It seems as though those involved in the development of the bill truly do believe that it cannot fail.


California's 15th District Representative - Mike Honda recently posted on the
Huffington Post explaining and commending the Health Care bill currently under review - below you can read what he had to say or you can:

Skip to the good stuff - what's this bill about? |   Skip to the author's comments CMARWSQMDTHF

"This month, as Congress begins to reconcile two very different health care reform bills in the Senate and House, it is worth taking perspective on the significance of this moment. It is an understatement to say that the road to health reform has been long and difficult. The most recent attempt, in 1994, failed through a combination of scare tactics by opponents and intense opposition from entrenched and wealthy interests. Since then, the health insurance industry has staved off the threat of real reform by pledging to control costs and make health insurance affordable. They have failed to deliver, however, and do not deserve another chance to play with the lives and pocketbooks of the American people.

Meaningful health reform must deliver accessible, affordable, high quality health care. Passage of reform is critical to the economic health of our nation and for millions of chronically ill and low income Americans. It is the goal of the thousands of chronically ill Americans who come to Capitol Hill every year, and the millions unable to make the trip, who share their stories of struggling with insurance company bureaucracy, medically related personal bankruptcies, deaths, and financial ruin that result from our broken health care system. It is the goal of county and local health officials who struggle to deliver the services their communities need as the public health system across our nation struggles under the weight of the uninsured and underinsured. These voices are not the fringe of America; they are from the heart of our nation and represent the reality of our broken health care system.

Businesses small and large, their employees, the self-employed, and the self-insured all find themselves increasingly unable to bear the cost of premiums that climb 8, 10, 15, or as much as 25% per year, every year. Our bill in the House -- America's Affordable Health Choices Act, H.R. 3962 -- was specifically designed to address the needs of small businesses, middle and low-income workers, and families to expand access and quality, while creating transparency and accountability in the health care industry.

The bill allows small businesses to access, for the first time, large group provider rates through the mechanism of the health insurance exchange. It provides substantial tax credits for small businesses to provide health care for their workers. Subsidies are made available to American families from 150% up to 400% of the federal poverty line so they can afford to purchase the health insurance plan of their choice. For the very poorest families in our communities, HR-3962 expands Medicaid to 150% of the federal poverty line, and it does so without substantially burdening the states. In fact, for the first three years, the expansion is fully funded by the Federal government and thereafter, states shoulder only 10% of the expansion.

Our bill in the House ends the insurance industry practice of capping annual and lifetime payments for health care. In two years, pre-existing conditions will no longer be able to be used as the basis for coverage denials. Insurance companies will have to report and justify their rate increases and spend at least 85% of the premium dollars they collect directly on patient care rather than administrative costs. We invest heavily in preventative services because we know that chronic health conditions either prevented or caught early cost less to the system and less to the patient than only responding to acute health needs.

HR-3962 institutes basic consumer protections and requires plans to provide information and outreach in plain language, increasing consumer knowledge and power. Finally, because so much of our focus is on strengthening prevention and coordination of patient care (more efficient, cost effective, and results in better health outcomes), the House bill contains a much stronger investment in primary care physician training and education than the current Senate bill. In fact, I recently joined several of my colleagues in sending a letter to the President and Congressional leaders supporting the House language over the Senate language because of this concern.

As Congress calls upon its constituents to weigh in on health care reform during this final phase, I encourage all who are interested in health reform to visit my website and the websites of the Speaker of the House of Representatives and the Committee on Energy and Commerce to read the bill yourself, access summaries and fact sheets about the bill and its effects on different groups, and educate yourself about the substance of the bill."
- Rep. Mike Honda represents California's 15th district and serves on the House Appropriations Subcommittee on Labor & Health and Human Services


It strikes me as ironic that Medicare, Medicaid and every HMO out there has been trying to make the health care system more efficient and emphasize the importance of preventative medicine for a few decades now. Usually they claim to aim for the exact same standards outlined in Mr. Honda's speech - however consider this:

[caption id="attachment_163" align="alignright" width="300" caption="Number (in Millions) of Civilian/Noninstitutionalized Persons with Diagnosed Diabetes, United States, 1980–2006"]Number (in Millions) of Civilian/Noninstitutionalized Persons with Diagnosed Diabetes, United States, 1980–2006[/caption]

Diabetes is one of the biggest problems in America and possibly even the world, 7.8% of the U.S. population is diagnosed with diabetes. Of those - 5-10%  have

Type I or 'juvenille' diabetes - for which a cause has not yet been discovered. The other 90% have type II diabetes - which is directly linked to obesity and

inactivity and can controlled with diet, frequent light exercise and preventative medicine. The battle to fight diabetes with preventative medicine has been going on since it became a concern around the 1970's and 80's - and yet if you look at the data collected by places like the CDC's - Division of Diabetes HERE or HERE it becomes crystal clear that preventative medicine - hasn't done anything at all to slow the trend - so what makes anyone think that if government tries to do the same thing, it'll actually work?!


Saturday, January 9, 2010

Thirteen percent of poison exposure calls related to painkillers

U.S. poison centers answered more than 4.3 million calls in 2008, including nearly 2.5 million calls about human exposures to poison, according to the American Association of Poison Control Centers -- up from 4.2 million calls in 2007. About 13 percent of all poison exposure calls poison centers received in 2008 were related to analgesics, or painkillers.

The National Poison Data System also documented 1,756 deaths reported to poison centers in 2008. Most of these fatalities involved exposure to drugs including sedatives, antipsychotics, antidepressants and cardiovascular drugs. And most poison-related fatalities occurred among adults between the ages of 20 and 59.

Friday, January 8, 2010

2009 Hospital Report

According to Press Ganey Associates’ 2009 Hospital Pulse Report, the Physician Perspectives on American Hospitals found physicians’ overall satisfaction with fully functioning electronic medical records (EMRs) is on a downhill slope. Many physicians actually consider the increasingly common technology to be very time-consuming. Some fear that it may compromise patient safety and the security of their information. 

The report also finds that, for the third year in a row, physicians’ number one complaint is a gap in the physician-administration relationship. Physicians continue to stress a need for a much better line of communication between administrators and medical staff.

The 2009 Physician Pulse Report surveyed the experiences of 27,328 physicians practicing at nearly 300 hospitals and facilities across the country. Some other significant findings detailed in the report include:
  • Physicians who work in government-owned hospitals are reporting a lower satisfaction with their hospitals than peers in community-owned and teaching hospitals. The difference in the score is 6.3 points – a significant variance.
  • Physicians practicing in psychiatry, pediatrics and emergency medicine are those most highly satisfied within their practice when grouped by specialty. Those least satisfied include physicians dealing with cardiovascular disease, anesthesiologists, and general and orthopedic surgeons.
  • Physicians who have been practicing for less than five years, and those who have been practicing for over 20 years are the most satisfied.
  • Although many physicians would like to see improvements in EMRs, most are satisfied with their facilities’ ability to provide up-to-date medical equipment.
  • One of the top concerns of physicians is their confidence in hospital administration to carry out its duties and responsibilities.


“Open communication between administrators and physicians is vital not only to their relationship, but also to the bottom-line of the hospital,”
said Deirdre Mylod, PhD, vice president of hospital services, Press Ganey.
“So much of a hospital’s business is based on physician referrals, and competition among hospitals and surgical facilities continues to heat up. If administrators and physicians can improve communication, the effects will trickle down and lead to more satisfied patients and a better bottom-line.”
Findings of the survey show that physicians satisfaction level improves when hospitals put targeted programs in place, such as a monthly newsletter from the CEO, a 1-800 number for physicians to call with concerns (and a 48 hour return call guarantee), and a commitment to take simple steps like keeping physicians in updated on important issues such as hospital finances.

You can download a full copy of the report here.

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Friday, January 1, 2010

Medical Miracle? or Moral Abomination?

"In California, voters authorized spending $3 billion over 10 years for embryonic stem cell research. A bipartisan Congress voted to ease federal restrictions, legislation which Bush vetoed. And opponents continued to push for a total ban on the research."



There is no question that embryonic stem cells have remarkable properties. They can grow indefinitely in the lab, and they can turn into any cell type in the body. But to obtain them, a human embryo must be destroyed.
Scientists first showed that it was possible to grow embryonic stem cells in 1998. 

The line has been drawn on a million planes, and still the world is torn apart on this subject - why?


Happy New Year! May 2010 bring wisdom to the masses!

Happy news years and may 2010 bring wisdom to all!


And boy are we going to need it! With all the backwards decisions being made, and all the craziness that 2009 embodied that is now (thankfully) in the past - what will 2010 bring?

Will health care reform actually get passed into legislation?
or
Will it rob this country blind of all it's worked for?

Will even one corrupt politician feel the slightest bit of guilt when selling us out to the highest bidder?
or
Will the cycle continue?

How many more celebrities are going to die?


Whatever it brings 2010 is sure to be a very interesting year - well all know how 2009 went, and personally I'd say it was the worst year in quite awhile. Common sense would tell us that it's almost got to be better - or can it get even worse?

Guess time will tell, I'll be paying attention that's for sure!

My New Years Resolution: To be more social, get out more, have more fun, meet more people, live my life more! 
-Whats Yours?


*** UPDATE: IMPORTANT ***

This blog is being migrated to HealthCareNut.com it's own registered domain powered by WordPress! The next few months will be double posted and when all traffic stops here this URL will be permanently redirected to the new domain.

Thursday, December 24, 2009

Obama's christmas gift - Health Care reform gets through the Senate

President Obama got his Christmas gift a little early as the Senate voted through the health care legislation in it's third and final procedural 'test run'

- Republican senators sought to frame the bill as a tarnished product of backroom deals, with some going so far as to declare it illegal. Despite strong opposition in the Senate and from a large part of the American citizens - Democrats were able to scrape together the 60 votes needed to "win" the vote, while not a single Republican supported the bill.
With final approval of the bill all but certain, Republicans on Wednesday focused on diminishing it in the eyes of the public. In particular, GOP senators questioned a deal struck by Sen. Ben Nelson (Nebraska) - who agreed to support the legislation in part because a provision was added exempting his state from paying part of the cost of expanding the Medicaid program. 

Thursday, December 17, 2009

Health Care reform may have been defeated by the Drug Companies

Senators may have been paid off


Nobody on Capitol Hill takes kindly to a spreadsheet that lines up their campaign contributions with their floor votes. But that's what Maplight.org, a nonprofit database operation, has just done, producing a mashup with the tally from the Senate's vote Monday on drug importation and 6 1/2 years of campaign finance data. 

SENATOR
PARTY
PHARMA. $$
VOTE
Max Baucus, MT
Democrat
$261,020
NO
Richard Burr, NC
Republican
$301,898
NO
Orrin Hatch, UT
Republican
$262,950
NO
Joe Lieberman, CT
Independant
$199,540
NO
Mitch McConnell, KY
Republican
$225,900
YES
Arlen Specter, PA
Democrat
$353,550
YES


Monday, December 14, 2009

Studies show that Physicians are happy with Medicare

Physicians may not be enamored of Medicare, but they like it much better than private insurance plans

according to a survey by the Medical Group Management Association (MGMA).
The association’s Payer Performance Study of more than 1,700 group practices showed that physician groups ranked Medicare Part B well ahead of six of the largest private insurance companies in terms of overall satisfaction, based on data released at the MGMA’s annual meeting.

The survey asked participants, all of whom were MGMA members, to rank seven of the largest payers--Medicare Part B, UnitedHealthcare, Aetna, Cigna, Humana, Coventry, and Anthem--on parameters including payer communications, provider credentialing, contract negotiation, payment processing, systems transparency, and overall satisfaction.

Medicare led the pack with a mean aggregate satisfaction score of 3.59 on a 6-point scale (1 = totally dissatisfied, 6 = completely satisfied). Aetna took second place with a score of 3.14.


The big loser? UnitedHealthcare, with a score of 2.45.


Obama Health Care plan turns into Medicare extension?!

Obama announces: Public option - dead, new plan - Medicare extension!


Wednesday December 9th,

President Barrack Obama's health care reform plan that originally involved a 'public option' that would have potentially covered all citizens of the U.S. went out the window.

Instead of the so called 'public option' Obama intends to change the eligible age of Medicare beneficiaries.

The U.S. Senate is now weighing the option of expanding the program to people aged 55 to 64. But many may not be eligible, and those who are probably won't get as great a bargain as seniors enjoy currently, after all - expanding the over fed hog that is government spending can't do anything but raise the cost to the taxpayers!

The idea of expanding Medicare has been a sleeper throughout this entire health care argument. It emerged Tuesday as part of a compromise plan to pacify liberals who wanted a government-run public option as part of reform. President Obama embraced the new plan Wednesday.

Wednesday, December 9, 2009

Senate Rejects Abortion Ban

Senate Rejects Abortion Ban



The Associated Press reported yesterday that by a vote of 54-45 the U.S. Senate actually rejected an amendment by Democratic Sen. Ben Nelson of Nebraska and Republican Sen. Orrin Hatch of Utah that would ban insurance plans funded by taxpayer dollars from offering coverage for abortions.



As it stands currently the proposed legislation calls for insurance plans that would receive any federal subsidies in a new insurance marketplace to strictly separate all public funds from private dollars that to be used to pay for coverage of an abortion. However the current proposal does not ba coverage of abortions. In essence instead of flat out denial of coverage the legislation would only mandate where the funds to cover an abortion would have to come from. 


The Senate vote is taken as a victory by abortion rights supporters, however it could complicate prospects for President Obama's health care overhaul plan in the long run.



Personally this comes as a bit of a shock; I was beginning to believe this country had been completely consumed by religion and frankly expected anything covering abortion to be prohibitted almost wihout question. Maybe the corruption in the U.S. hasn't completely taken over yet!

Monday, December 7, 2009

Why Obama is right about health care

Sicko

I am not a movie critic therefore it is out of character for me to recommend you sit down and watch a movie for any purpose other than entertainment but here I will make an exception - no matter how much I disagree with Michael Moore on any of his other views, in Sicko he makes a great point.

Take a good look at some of the stories of health insurance horror and fiscal nightmares brought about by our current health care system.



Even though it came it a little over 2 years ago, I still recommend everyone watch Sicko.

Whether you are; young, old, rich, poor, democratic, republican, liberal or conservative – it makes no difference at all, we all need health care and this movie will open anyone’s eyes to some of the problems with our healthcare system.

To be honest I am not generally a fan of Michael Moore at all!! I find him to be quite obnoxious at times as a matter of fact, but this movie was done well. This particular creation of his is a very good representation of the big issues that Obama is attempting to solve with his reform plan.

I am also not a huge fan of president Obama, I find it hard to trust in any of his plans, efforts or promises thus far and he has made so many in his brief period in office I don't believe I will ever find any sort of faith in his leadership -  BUT  I do agree with the general idea that this country's health care system is in desperate need of reform; if we do not face it soon - it will drag this country to the ground eventually.

On a separate note

Here is a very well put together blog post about Obama’s plan I found earlier today.
p.s. - his plan is not all that impressive or ingenious 

Friday, December 4, 2009

What do specialists think of the Senate Health Legislation?

 Twenty surgical organizations, led by the American College of Surgeons, sent a letter to the United States Senate in November stating that they are prepared to oppose the Senate’s health care reform bill because it will threaten patient access and harm quality. Surgeons state that as the legislation currently stands, it fails to address some of the fundamental problems that plague the health care system.

We strongly support health care reform that will expand access to quality surgical and medical care to as many Americans as possible, but we cannot support legislation that puts at risk both quality of care and patient access

Our system is badly in need of reform but if the legislation does not address these concerns, it will do little to fix its underlying problems and may make it worse.

  • A. Brent Eastman, MD, FACS
    chair of the American College of Surgeons’ Board of Regents and chief medical officer, Scripps Health.


The surgical groups said they plan to oppose the Senate health care reform bill if a number of provisions that were included in the Senate Finance bill are retained. In addition to failing to permanently fix Medicare’s broken physician payment system and to include any meaningful proven medical liability reforms, the surgical community opposes a number of the bill’s provisions including:
  • The legislation establishes a Medicare Commission that would shift the responsibility for making difficult Medicare payment and coverage decisions to an unelected Executive branch agency without appropriate checks and balances.
  • The legislation includes mandatory participation in the seriously flawed Physician Quality Reporting Initiative (PQRI) – a program through which CMS is still attempting to address systemic problems dating back to 2007.
  • The legislation attempts to improve patient access to certain physician services through reimbursement changes, but funds these changes through payment cuts to all other physicians – thereby exacerbating workforce shortages, including general surgeons.

The result of these serious deficiencies will make it more difficult for the American people to receive the surgical care they will need in the future. We will work with the Senate to improve the legislation, but if these shortcomings remain in the final Senate bill, we will have no choice but to urge Senators to vote no



  • A. Brent Eastman, MD, FACS



The American College of Surgeons met with policymakers over the past year to educate them about programs that would improve quality, reduce costs and increase patient access. One such program, the ACS National Surgical Quality Improvement Program (ACS NSQIP), is helping to prevent thousands of surgical complications each year. Each hospital in the program, on average, is seeing 250 to 500 fewer complications and thus an annual reduction of $3 million in costs. Nine of the top 10 private hospitals in the nation, along with more than 240 additional hospitals, use ACS NSQIP. The ACS believes that these types of quality programs, if supported by Congress, could save the health care system a minimum of tens of billions of dollars over the next decade.


There are ways to improve quality, cut costs and increase patient access – but the Senate isn’t hearing those of us who are closest to the patient and work in the system every day 



  • A. Brent Eastman, MD, FACS




The surgical groups that signed the letter include:


  • American College of Surgeons


  • American Academy of Facial Plastic and Reconstructive Surgery


  • American Academy of Ophthalmology


  • American Academy of Otolaryngology-Head and Neck Surgery


  • American Association of Neurological Surgeons


  • American Association of Orthopedic Surgeons


  • American College of Obstetricians and Gynecologists


  • American College of Osteopathic Surgeons


  • American Osteopathic Academy of Orthopedics


  • American Society of Anesthesiologists


  • American Society of Breast Surgeons


  • American Society of Cataract and Refractive Surgery


  • American Society of Colon and Rectal Surgeons


  • American Society for Metabolic & Bariatric Surgery


  • American Society of Plastic Surgeons


  • American Urological Association


  • Congress of Neurological Surgeons


  • Society for Vascular Surgery


  • Society of American Gastroitestinal and Endoscopic Surgeons


  • Society of Gynecologic Oncologists

Monday, November 30, 2009

Health Care Reform - A new idea

Do we really have a right to health coverage?


Think about it - why do people believe they have some right to free health care? No body else pays for our cars, our houses, or our groceries. Why is it any different when it comes to medical care? Maybe if we cared about the cost involved we as a society would actually care about what it all cost, maybe we would actually look into alternatives and conservative treatments for our problems rather than rushing into the most expensive tests possible at the slightest hint of a cough.

If we all paid for our health care and insurance didn't cover anything but emergency services, providers would have to lower prices and compete like any other business. This is one way to make sure that not only the prices are kept in check but also that the quality is also maintained.

As it stands today in America, no one ever really questions the prices of any medical care unless they are paying out of pocket with their own money. The mutual thought process among providers and patients alike is essentially -

'Why do I care - the insurance is picking up the tab?'


That kind of mentality is the reason we are in the situation we are in right now with health care. The insurance companies have tightened down on spending, increased premiums and run the system through the ringer because of the over spending on medical care that is not medically necessary and yet thousands of us throw caution to the wind on a daily basis because someone else is paying the bill.

That mentality hasn't gotten us anywhere so far...maybe that is what needs to change.

Add to Google

Friday, November 27, 2009

Baritatric Surgery - Weighing the risks

Bariatric Surgery


- It's the newest craze in surgery today. Some surgeons net up to $16,000 each for the Lap Band procedure and other surgical weight loss options, most of which take only a few hours to complete. The staggering demand for these procedures has led to abuse of the system - patients eager to jump straight to surgery without going through the proper channels and greedy surgeons hounding after patients who are willing to pay cash like blood thirsty animals will tell them anything they want to hear if they think it will convince the patients to go under the knife.

If you or anyone you know is undergoing preparation for bariatric surgery - take a real look at the medical guideline criteria that is supposed to be met before surgical steps are taken. The reason the guidelines exist is to ensure that before a patient goes into any surgery that he or she has exhausted ALL other realistic options and the surgery is merely the final resort to achieve a healthy weight. By the way – weight watchers does NOT count!

1. The Risks -


The risks are one of the first things your surgeon should discuss with you, in fact if they were truly responsible – they wouldn’t even discuss bariatric surgery without discussing the risks first. As with any abdominal surgery the risk for post operative complications like incisional hernias, infection, or non-healing wounds is very high. Specific to bariatric surgery; other post-operative risks include:

  • Peptic ulcer
  • Esophageal stricture
  • Kidney stones
  • Anemia
  • Chronic dehydration
  • Gastric dumping syndrome
  • Malabsorption of nutrients
  • Severe depression
  • Vitamin B12 deficiencies
  • Neurologic complications
  • Other personality disorders

The intra-operative risks are even more severe. Intra-operative risks in any abdominal surgery (whether laparoscopic or open) apply here.

  • The surgeon could nick the intestine, then a bowel resection would be necessary possibly leaving the patient with a permanent colostomy.
  • Open abdominal operations lead to a very high risk of leaving instruments or surgical sponges inside patients (forgotten instruments)
  • Improper handling of laparoscopic instruments can damage any number of organs within the abdomen.


2. The Planning -

When going by clinic guidelines agreed upon by both the American Medical Association and The American Society for Metabolic and Bariatric Surgery your pre-operative workup would generally require at least 6 months of planning and that is a conservative figure, some patients need up to 1 year of pre-operative workups and dieting before they meet guidelines for bariatric surgery (if they meet the requirements at all).
The following is typically required pre-operatively of anyone below a Body-Mass Index (BMI) of 49.0:

  • Psychiatric evaluation
  • 6 months of physician supervised weight loss counseling/therapy
  • Documented evidence of treatments tried/failed for any and all co-morbidities related to your planned surgery – meaning if you have arthritis due to morbid obesity you need documentation of failed treatments for the arthritis, if you have obstructive sleep apnea secondary to your obesity you need a documented sleep study and documentation of failed treatments for the sleep apnea.

Understand that bariatric surgery is not going to solve your weight problem in and of itself. The surgery is a pre-cursor to the extremely strict diet, and strictly controlled exercise program that is a necessity to maintain for up to 15 years after your surgery.  You will also be required to be closely followed by your psychiatrist to make certain you are not showing signs of suicidal thoughts or depression.

Your surgeon will (should) require regular follow ups at least once a year sometimes for the rest of your life to track and follow you progress, and if you have a Lap Band you will at some point require a saline injection or “fill” to make sure the band has not loosened up over time.




3. The Reasons -


With the heavy advertising done by up and coming bariatric surgery clinics and even the suppliers of the Lap Band system – it is of no surprise that a large portion of people suffering from obesity are clamoring into surgeons offices by the thousands to talk about bariatric surgery options. I would warn you that this is only good for the surgeons and not you as a patient. Your surgeon is sure to be a great talker – he could probably convince you of anything (as most doctors can after so many years) but you should do your homework before hand as regardless of what the surgeon said – you may need to try more conservative options before considering any surgery to help you lose weight!

Bariatric surgery is clinically indicated for the following situations:


Patients with a BMI >35 **

At least one of the following *



  • Type II diabetes






  • Dyslipidemia






  • Poorly controlled hypertension (must be documented)






  • Significant cardiopulmonary disorder (e.g. coronary artery disease, cardiomyopathy, pulmonary hypertension)






  • Obstructive sleep apnea (must be documented)






  • Severe arthropathy of weight-bearing joints (treatable but for the obesity)






  • Pseudotumor cerebri






  • Severe venous stasis disease (e.g. with lymphedema of morbid obesity)






  • Obesity related hypoventilation






  • Non-alcoholic liver disease or steatohepatitis





  • AND

    • Attempted and failed at least 4-6 months of physician supervised weight loss counseling and therapy
    • Been alcohol and drug free for at least 1 year

    *Depending on your insurance you may need to have 2 or even 3 co-morbidities related to morbid obesity to qualify for coverage

    **Some insurance will not cover bariatric surgery for patients with a BMI under 40.0

    Note: Not all insurance companies cover bariatric surgery

    I urge you – take a step back and look at the situation objectively (for real). Bariatric surgery is a relatively new concept and as such it should be utilized only in severe cases where patients have put forth a very determined and focused effort to lose weight and it truly has failed. If one is considering bariatric surgery – do your research first and be honest about it’s applicability to yourself – and do not take it lightly!



    4. The after care -


    As previously stated – surgery is not the end of your journey. There is extensive aftercare and follow up needed if you actually expect bariatric surgery to help you lose that weight.

    Post-operative Diet


    Nothing about your diet after surgery will be pleasant, flexible, or negotiable! You will fail in every aspect if you do not follow the diet assigned to you after surgery.

    You will be eating nothing solid for upwards of 4-6 weeks after your surgery. For the first 4 weeks you will likely be gradually moving from clear liquids only to light juices and protein drinks.

    You will more than likely be slowly moved to semi-solid foods like apple-sauce etc. and then you will be eating blenderized foods almost exclusively for a period of time. Some doctors standard post-op diet plans even include blenderized fish, pizza, and hot dogs! You honestly NEED to be prepared for this – it is not pleasant at first (if at all) almost anyone who has at any point in life needed to eat blenderized fish or meat will tell you so.

    You will be moved to solid foods (obviously in small portions) eventually.

    It is typical for your dietician or nutritionist to recommend that you eat very very small portions every hour or two as opposed to the normal 3 meal a day diet most of us are used to. Fluid intake is recommended in small portions – in some cases, every 30 minutes.

    Your diet will almost always include a set minimum amount of protein (your choice of powders, drinks etc.) that you must intake every day.


    Follow Up visits

    Every member of your bariatric team needs to be someone you are comfortable with because you are going to be following up regularly with all of them – in many cases you will for the rest of your life.

    Your psychiatric follow ups in some cases are not necessary after a few years, however in the case that you develop depression or other psychiatric problems after your surgery – the follow ups will continue until you are cured of them.



    5. The Doctor -


    As I have stated in previous posts – there are a lot of doctors out there so hell bent on getting patients to agree to surgery that they will tell them whatever sounds good. NOT ALL DOCTORS but there are many of them out there. If after considering and discussing the options and risks you decide to not jump to surgery right away – do not let them try and convince you other wise. In fact if they do continue to try and cite reasons you should go ahead with it after you stated you did not want to – I would recommend you not go with that doctor at all. It may be a hassle to find another doctor, it may have cost you a co-pay but do you really think a doctor who wants to operate on you after you said “no” is worthy of your trust?

    I really hate to stereotype anyone however there is a big trend among the newest generation of surgeons (like the ones who just got out of residency and are really energetic and enthusiastic) to be way too quick to jump straight to surgery. A lot of them tend to boast about how they were trained on robotic surgery and they love the latest technology and so on, or how many hundreds of surgeries they did in their residency etc. As a general rule I would recommend you lean away from any surgeon who brags about anything – most of the truly skilled surgeons (or any doctor really) won’t feel a need to brag about anything. If you specifically asked them about their previous experience they would usually offer up the information gladly.

    Doctors in general and surgeons in particular are as human as everyone else. As such they are subject to the same mental tendencies as the rest of us. For example when it comes to bariatric surgery – many surgeons who are not directly involved in the field of surgical weight loss will recommend against it at all costs because of the risks involved. Whereas many who specialize in bariatric surgery exclusively will recommend it to (literally) 9/10 patients they see. Some have even falsified their own records in order to facilitate payment for surgery where the patient did not actually meet the criteria.

    In short – be aware that some doctors become better at making money than making medical recommendations after awhile. Read between the lines on that one!

    The doctor you chose may also have influence over whether or not your insurance company will pay on your surgeons claim. Almost all insurance companies base their policies on Medicare Guidelines, the fair majority use parts of it word for word. Medicare guidelines state: “Coverage is provided only if the bariatric surgery is performed at a medical center designated a Center of Excellence by the American Society for Bariatric Surgery (ASBS) or certified a Level 1 Bariatric Surgery Center by the American College of Surgeons.”

    If the surgeon who is to perform your bariatric surgery is not affiliated with such a facility then obviously he or she won’t be performing the surgery at an approved facility – which in turn will most likely end up in the claim being denied leaving you stuck with the bill; and it will be a very large bill.



    You can to some degree avoid this by making sure you are going to a Medicare approved bariatric facility. Even if your insurance is one that does not require that the facility meet those guidelines – it is still a good idea to go with with one anyways as they have gone through proper measures to prove that bariatric surgery was successfully preformed their before.


    Conclusion


    As a patient you may be inclined to believe that you absolutely need bariatric surgery – but you need to take your time considering the real world risks and truly huge commitment necessary for a good result. If you have tried your hardest (and really REALLY tried) and have failed at losing weight, and it’s effecting your medical well being – then by all means, talk to your doctor and make sure you are choosing the right one.


    DISCLAIMER


    This article is not intended to be the only basis on which anyone bases a decision to have surgery. I am in no way saying you should or shouldn’t have or consider having surgery – I am merely warning of some of the risks you may or may not be taking. Some of the content within this article is based on my personal experience in working with doctors and surgeons.



    References



    ASMBS – Post-operative concerns

    ASMBS – General guidelines for surgical weight loss

    ASMBS – Patient Resources

    Medicare – Bariatric surgery criteria

    Medicare - Approved bariatric facility Search



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    Thursday, November 26, 2009

    Vascular Surgery

    Just finished the Vascular Surgery Knol 

    Check it out and let me know what you think! Most especially if you just so happen to be a vascular surgeon reading this post...but then again I doubt that would happen.

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    Wednesday, November 25, 2009

    Don't let him fool you



    Don't let his teleprompter fool you, President Obama is spreading a very clear message in this video but in the end his actions were opposite his very own words. It's beginning to become clear what his push for health care reform is really all about - money, and not the kind he claims to want to save the patients either.

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    Sunday, November 22, 2009

    Health Care Bill moves forward 60-39

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    Republicans, eager to defeat Obama were handed a punishing defeat of their own last night. The health care bill was passed with a vote of 60 for the bill to 39 against. This has cleared the way for a monumental, full-scale debate set to begin after Thanksgiving on the legislation. The bill is designed to extend coverage to the 31 million Americans who lack it, crack down on insurance company practices that deny or dilute benefits and curtail the growth of spending on medical care nationally.

    Whether or not any of the goals are achieved if and when the bill passes legislation and takes effect is anyone's guess. In recent years the trend of inconsistencies and misjudgments on the governments behalf would point to a grim road lying ahead if in fact it does pass legislation.

    I have said it before - I will say it yet again: Reform is absolutely essential - but this may not be the way to do it. Handing over control of anything to the government has not exactly turned out well in the past.


    Video - Senator Reid's remarks shortly after the bill passed the vote.


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    Mitchell Bard: It's Too Early to Celebrate the Senate Health Care Vote

    Mitchell Bard of the Huffington Post shared these thoughts on health care

    Mitchell Bard: It's Too Early to Celebrate the Senate Health Care Vote:

    I swear, I find no no joy in being Debbie Downer. I really wish I could celebrate the Senate's 60-39 vote to begin the debate on health care legislation, narrowly holding off the blocking tactic of the Republicans. I am 100 percent in favor of health care reform (I'm a fan of Rep. Anthony Weiner's proposal to extend Medicare to everyone). But a realistic view of what happened (and what has happened leading up to the vote) reveals far more things to be concerned about than to cheer for.


    For starters, to get to an up-or-down vote on the final bill in the Senate, this 60-vote procedural hurdle will have to be jumped over again to close debate, and Sen. Joe Lieberman has already promised to join the Republicans in filibustering any bill that contains a public option. There are also several other centrist Democrats in the Senate who may not vote for cloture if there is a public option in the bill. Since the Democrats were only able to secure the minimum 60 votes to get past the Republicans this time, without Lieberman's vote (and all of the centrists'), if no Republican jumps ship, a bill containing a public option cannot get to the floor.


    Also, it is easy to forget that a health care bill only barely made it through the House (220-215), and did so only after Democrats agreed to pass the bill despite the inclusion of the anti-abortion Stupak Amendment, which wouldn't just prevent the government from funding abortions, but would actually have the effect of making it harder for many women to exercise their constitutional right to choose under health care reform than it is today. True, the Senate's version has a less onerous anti-abortion provision, but if the House anti-choice Democrats stand firm again, even if a bill gets through the Senate, when it comes out of conference, the House will have two options, neither of which is good: pass the bill with the odious Stupak Amendment intact, or watch the bill go down to defeat at the hands of the anti-choice Democrats.


    So what am I supposed to celebrate, exactly? That a health care bill will be debated? Even though, to get past a 60-vote cloture motion, it will have to be gutted even beyond the shadow of a bill it is now (the current bill has a weak public option, no other mechanism to really cut costs, and hands billions of dollars to the insurance companies who are a big part of the original problem)? I'm not saying I don't support this weak bill (it's better than nothing), but if it gets any weaker and cuts into the constitutional right of women to choose, really, does the good still outweigh the bad?


    And the whole notion that there will be a debate is really hard to take seriously. There has been no honest health care debate up to this point. There has be a flood of outright lies from the right (two words for you: 'death panels'), and if you think it's getting any better, as the vote neared, Sen. Kit Bond compared health care reform to one of the biggest Ponzi schemes ever: 'Move over, Bernie Madoff. Tip your hat to a trillion-dollar scheme.' This is the level of debate. Paranoid ramblings about government takeovers and hidden agendas of doing the bidding for insurance companies, hospitals and pharmaceutical companies that line the pockets of those opposing reform. The nonpartisan Congressional Budget Office can report that the Senate health care bill will cut the deficit by $130 billion over the next ten years without raising taxes on the middle class, but Republicans will still scream about expanding deficits and massive tax increases. Some debate.


    You know, there is one thing I really like about the health care legislation that will now be debated in the Senate, and, oddly enough, it's something that most of my fellow progressives oppose: the ability of states to opt out of the public option. Honestly, I think this part of the bill is spectacularly brilliant. Why? It's simple, actually. It's democracy at work.


    Consider that in the last months since the health care debate took off, we have been treated to the following:


    - Rep. Joe Wilson of South Carolina screamed 'You lie!' during President Obama's health care address to a joint session of Congress.


    - Sen. Mitch McConnell of Kentucky said that passing health care reform with a public option could 'cost you your life.'


    - Rep. Paul Broun of Georgia, who, by the way, is a physician, said that health care reform with a public option 'is gonna kill people.'


    - Sen. James Inhofe of Oklahoma said, regarding the health care bill: 'I don't have to read it or know what's in it. I'm going to oppose it anyways.'


    - Sen. Richard Shelby wrote to one of his constituents that health care legislation would 'directly subsidize abortion-on-demand,' 'rations health care so that our citizens are withheld important and potentially life-saving treatments,' and 'requires taxpayer dollars to fund health benefits for illegal immigrants,' all scare tactics that he knew (or, as a U.S. senator, should have known) is patently false.


    Unfortunately, I could go on a lot longer, but you get the point. All of these politicians have many things in common, but there are two I would like to point out here: 1) They represent states that would likely opt out of a public option, and 2) they were duly elected by their constituents to serve in Congress.


    Item 2 is really something important to remember. These men did not stage coups d'etat. No, they were elected by the majority of the voters of their states or districts. They were chosen by their constituents in democratic elections. And now it's time for democracy to do its job, so that the citizens of these states get exactly what they voted for. Why should we, as a country, spend taxpayer money to improve the health care of citizens who would send to Congress men capable of uttering baldfaced lies, all in the name of politics (trying to prevent the president from getting a 'win') or protecting the special interests that fill their campaign accounts? And if they are telling their lies in defense of some kind of pure ideology that abhors the government's involvement in anything (except the bedrooms of its citizens, of course, but that's another issue for another day ...), well, then, let's give their constituents what they want. Hell, Shelby went after Medicare in his constituent letter, so I would be happy to let the states opt out of Medicare and Medicaid, too


    In Shelby's state, Blue Cross Blue Shield controls 83 percent of the health insurance market, with more than 600,000 people living without health insurance and another more than 175,000 who cannot obtain group coverage and are forced to buy insurance on their own. Under health care reform, most would have access to health care, more than 400,000 Alabama residents would be eligible for government subsidies to help pay for health insurance, and the 175,000 plus not on group plans could get more affordable insurance. But these people also voted for Shelby. I respect the democratic process, and the people of the good state of Alabama should be free to get exactly what they voted for. I wouldn't dream of stjanding in their way. And the same can be said for the folks in South Carolina, Kentucky, Georgia, Oklahoma and all the other states who have sent representatives to Washington to obstruct health care reform.


    This is the country in which we live now. This is what passes for debate. So you will forgive me if I am not optimistic that a worthwhile health care reform bill will make its way past another cloture vote in the Senate, past an up-down vote in Senate, through a post-conference vote in the House, through yet another cloture vote in the Senate, and finally through a final up-down vote in the Senate, all while the Stupaks, Liebermans, and Lincolns of the world are standing in the way, not to mention the stop-at-nothing lies and scare tactics employed by the right. I am sorry, but I am firmly in I'll-believe-it-when-I-see-it mode.


    The bottom line is that I don't want to be the messenger of doom. I would love to celebrate a health care reform victory. And when a real one arrives, I will.

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    Saturday, November 21, 2009

    Swine flu clinic set for Simpson Center in Hemet

    Swine flu clinic set for Simpson Center in Hemet:
    An H1N1 flu vaccine clinic is scheduled from 2 to 7 p.m. Monday at the Simpson Center, 305 E. Devonshire Ave. in Hemet.
    Riverside County Department of Public Health officials said the nasal spray and injections will be available to about 2,000 people in the following groups: children 6 months to 12 years, caregivers of infants, pregnant women, people who work in health care or emergency medical services and adults ages 25 to 64 with chronic medical conditions.

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    Thursday, November 19, 2009

    House Passes Bill To Create EHR Loan Program for Physicians

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    Yesterday - Wednesday the 18th of November, the House of Representatives approved HR 3014, a bill that was designed to help health care providers purchase electronic health record systems and other health information technology tools, the Rutherford Daily News Journal reports.

    The Small Business Health IT Financing Act would authorize the Small Business Administration to oversee a loan program for health care providers seeking to purchase health information systems. However many electronic medical records vendors are using the bill as a marketing tool - boldly claiming to practices nation wide that the government will 'pay in full for your EMR' when in fact it is more of a loan than a blank check as they would have their customers believe.

    Kathy Dahlkemper (D-Pa.), chair of the House Small Business Regulations and Healthcare Subcommittee, introduced the measure
    http://thomas.loc.gov/cgi-bin/bdquery/z?d111:h.r.3014:
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