Insurance...Co-Pays....and Other Money Stuff

On the WebMD boards, people start off by saying: "I don't have insurance, so I can't go to the doctors, so please help me." Hey....doctors will take money or credit cards, just like the grocery store...or auto repair place. No insurance will pay for mechanical repairs on your car or put food on your table, but yet, people will withhold their own medical treatment over a few bucks.

Every day in my clinic, I am asked to see a patient who does not have a five dollar co-pay, or forgot their wallet with the credit cards, or whatever. Although I will never turn away a sick person for five bucks, it does become annoying as they drive away in their Lexus. And knowing that it costs more than five dollars in employee time to send out a bill for five dollars, it becomes ridiculous. Another clinician in our office told me one day to just say NO...offer to reschedule the appointment when they have their wallet or money in their pocket, so I did it one day, and guess what? The startled man suddenly found some "money" in his car. Miracles.

Have you ever gone to a fast-food place or grocery store and expected to get your purchases without a means to pay? Why can't medical establishments be more like other businesses?

The average cost of an office visit for us is about $75. My car repair place charges $86 per hour; and I rarely leave the grocery store without dropping a hundred dollars or more. And, now with the price of gas, it costs about $50 or more to fill my tank. Everything is expensive.....not just medical care. It costs big bucks to run a medical practice and we take some incredible risks with the health and lives of our patients everyday. Malpractice coverage costs would shock you, and disgruntled people will sue you for about anything, including Acts of God. So, next time that you have an appointment for your doctor, take your wallet....and your insurance card....and the money for the co-pay. If you do not have insurance, bring cash or a credit card and expect to pay that day.....just like the grocery store.

That reminds me....I have an appointment with my OWN doctor in about an hour. I better stop off at the ATM first.

Related Topics: US Healthcare fails women, Malpractice hurts healthcare

Tags: healthcare, copay, health insurance, WebMD

Sleep, Snores and Studies

Yes, I admit it. I snore. I come from a long, proud line of snorers, and although I rarely hear myself doing it, I have been told it is quite impressive. One night, my wife (also a snorer-in-denial) tried to videotape me. I was awakened by her setting up the tripod in a clandestine attempt to document my nighttime throat concert. I remained quiet and pretended to be asleep. After 20 minutes of my baby-like quietness, she turned off the camera and crawled in bed. Minutes later, SHE began to snore. Since the camera was already set up, it was an easy task to get her on tape. She was not happy about it.

Now, sleep apnea is another problem entirely. When you stop breathing for a prolonged period of time during your snoring, this can cause some serious strain on the 'ol heart - a man's second favorite organ. So, after a few years of threats and relentless begging, I finally agreed to a sleep study. I just got home from that experience. After two 12-hour shifts in the pediatric clinic, I was sure I would sleep like a log. Wrong.

I have never had a more uncomfortable night in my life. First, I was wired up like a robot put together by a two-year old. More than a dozen sensors stuck to my head, face, chest, legs, abdomen, up my nose, in front of my mouth; attached to my hairy body and face with gobs of disgusting glue. This stuff is on a man that can't stand wearing a RING to bed.

I was led to my bedroom for the night, a standard hammock-like hospital bed that still had the faint impression of the fat guy from the night before. I was to lie on my back (not the sleeping position that I have been used to for a half a century) and patiently wait about two more hours -- normal sleeping time. I tired of reading, but the wires all over my face annoyed me to no end. I was in multi-sensory overload for sure and very close to going insane. I had a pulse oximetry sensor on my right index finger, the one I would normally use to fish out an occasional rogue booger. Of course, I had one, and it was awkward for my nose to have a strange finger in there. I tried to watch TV, but there is something about a wired-up guy with bad vision and a 14 inch TV screen attached to a wall 20 feet away that was incompatible.

There were three other guys at the Sleep Center that night (in their own rooms, of course) including one very large Mexican fellow in the room next to mine. According to the experienced respiratory therapist, Mexicans are the maestros of snoring. I was able to confirm that observation over the next two more hours as he rattled my wall with the loudest snoring I have ever heard, with apnea pauses so long I thought he had died. I tried to use his snoring as some sort of "count the sheep" exercise, but to no avail. When the staff checked on me to find out why I was still awake at 2 AM, they understood why. The agreed to slap on a CPAP on him, a bizarre mask-like device that forces air into your lungs to stop the snoring and supply some needed oxygen to the brain. He finally quieted down, and I finally feel asleep...on and off, for about three more hours. I woke up at 5 AM, tangled in my wires and seriously needing to urinate. I figured there was no way that I would get back to sleep for the last hour of the test which ended at 6 AM, so I pulled off those damn sensors. Finally. Worst night of my life.

It is going to be a week or so before I get the results of my abbreviated sleep study, but I was told I didn't do that bad (whatever that means); certainly better than my Mexican neighbor who will surely go home with a CPAP. I can't imagine that I will be able to tolerate a CPAP...ever, both from the profound discomfort aspect and the obvious cosmetic effect. Maybe I will just dump my wife and look for a cute deaf woman.

Related Topics: Men's Sleep Apnea Increases Heart Problems, Treating Sleep Apnea Helps Heart Failure

Tags: sleep apnea,snoring,CPAP

Whooping Cough and other horrible diseases

When I was just a little baby boomer, back in the 50's, we had ALL of the diseases that most of today's parents have never seen. My cousin, Danny, got polio; another cousin became deaf after a case of mumps. Now, immunizations have made those serious childhood diseases extremely rare. Some, like smallpox, are completely gone. Others, like polio and measles, are so rare in the U.S. that many medical providers have never seen a live case. However, they are NOT gone from this planet, and the world is becoming smaller and smaller. These diseases and others are less than a plane trip away.

Pertussis is nothing to whoop about. Pertussis, better known as whooping cough, is highly contagious bacterial disease that can kill infants and young children in a flash. In unvaccinated populations pertussis is endemic, and in undeveloped regions of the world infant and childhood mortality rates are high. Improvements in supportive treatment in the United States at the beginning of the twentieth century and the subsequent development of antibiotics reduced mortality rates from pertussis; however, the incidence did not drop until the early 1950s, when the immunization of infants and children became prevalent. Before widespread immunization, the annual incidence in the United States was about 200,000 cases, compared with a recent annual incidence of about 4,000 cases. Treated early and effectively with antibiotics, infant deaths are now rare. If we stopped the pertussis vaccine today, we should expect 9,000 deaths per year.

Interestingly, pertussis is now on the rise again due primarily to an increase in the proportion of unvaccinated individuals in the very young population, but from immigration and non-compliance. A significant number of parents are withholding pertussis vaccine from their children. Do we really need another good 'ol epidemic to get the message out that immunizations SAVE LIVES?

In the early stages, pertussis looks like a common cold - runny nose, red eyes, low-grade fever, sneezing, and of course, a nighttime cough. However, it is this early stage, that pertussis is most contagious. Parents will send these kids to school and day-care. About a week or so later, the cough will worsen. It will be frequent, forceful, and may have that "whoop" that older folks remember, and young parents have never heard. Along with these frequent harsh, spasmodic, coughing attacks, will come cyanosis, sweating, exhaustion, expulsion of copious amounts of thick phlegm, and vomiting - not a pretty picture. At this stage, many will have developed pneumonia, the most serious complication.

The organism that causes pertussis can be cultured from the nose in the early stages, IF your medical provider is suspicious that this is more than "just a cold". Unfortunately, the likelihood of obtaining a positive culture starts to decrease at about the time in the course of the illness when the diagnosis of pertussis becomes obvious.

If diagnosed, antibiotic therapy can stop the progression and spread of the disease if it is given during the incubation period or the early stage. Later, antibiotics will not really affect the course of this disease, but may help prevent complications. Wouldn't it be easier just to PREVENT pertussis in the first place?

Children under 7 years of age should be immunized with pertussis vaccine. Pertussis vaccine is one of the three components in the routine DTaP shot given to infants, combined with diphtheria and tetanus toxoids. Other than a little soreness at the injection site, serious reactions to the vaccine are extremely rare, but unfortunately do happen. Serious allergic reactions occur about 1: 1,000,000, about twice the risk of being struck by lightning. To put that in other relative risk perspectives; the risk of dying in a traffic accident is 1:800, smoking 1/2 pack per day 1:400. Need I say more?

Related Topics: Why Immunize Our Children?, Keeping Catchy Infections Contained

Tags: pertussis, whoopingcough, immunization

Friends and Mentors

It has been nearly six years that my mentor and friend died, but yet it seems like yesterday. When a man continues to have admiration and respect long after his death, he was truly a man to be admired and respected.

My mentor was a benevolent man - a giver of gifts. He once gave me his microwave oven (back when they were expensive and unique) when I mentioned how long it took to cook meals after I came home from work. He said he never used it. Three weeks later, he sent me to pick up a package. It was another microwave oven. Apparently, he used it more than he thought.

My mentor taught me to give. When I was trying to buy my first home, he gave me advice. He talked me out of buying a fixer-upper that years later, slid down the hill. When I couldn't afford the house that he approved, he wrote me a check for the down payment told me to "go get my house". Six years later, I was able to loan that same amount to a young physician, pregnant with her first child, so she could buy her first house. He gave me a lesson on the pleasure of helping others that I have never forgotten. He enjoyed being a "jump-starter" for me and numerous others.

My mentor was my teacher. He used life as his classroom and never missed a teaching opportunity. When I was in a terrible car accident...thrown through the front windshield, he brought his teenage daughter out of her bed to see my bloodied and scarred face and told her, "See why you should always wear seat-belts." I was glad I was there to drive that lesson home.

My mentor made me part of his family. His youngest daughter became my little sister that I took to the zoo and carried on my shoulders. Not being Jewish, I fondly remember my first Seder, sharing this precious, ancient ceremony with his family. One of my proudest moments came years later when I stood as his Best Man when he remarried. My son is getting married next year and I will again remind him of the name that he shares with my mentor. This week, his youngest daughter visited me with three of her six little children, and I saw my mentor's face again...in one of his little grandchildren.

My mentor taught me about trust. He always had something confidential to share with me, even things that were obvious that everyone knew. Regardless of the secret he would share, I never betrayed his trust. As the years went by, we shared many private moments and secrets. I will cherish those even more now, since there will be no more. It is certainly no secret how much I loved this man.

My mentor inspired me to achieve. There was something about him that made you want to try harder...that made you want to please him and earn his approval. Having his approval was equivalent to winning the Congressional Medal of Honor. He would make you feel special and make you proud. In the Preface of my first textbook that I published, I gave tribute to my friend and mentor. When I sent him a copy, he told me how proud he was of me. During the years that we worked together side by side, he would often give me one of his famous notes written on a 3x5 card that told me how much he appreciated my friendship. They were worth more than gold to me.

I talked to my mentor a few days before he died. We had a wonderful conversation and were making plans to get together the following week. I was glad that I told him how much his friendship meant to me, because that was our last conversation. A few days later, I sadly helped carry my mentor's coffin to his final resting place. This was only fitting because of the number of times he helped carry me.

Most men do not like to cry. They think it is a sign of weakness. I think it is a sign of being a man. I am proud to shed tears of respect and admiration for a man that was my mentor... and my friend.

Post a comment and tell me about your mentor, or better yet, make a commitment to mentor others.

Related Topics: Heroes Among Us, Boys 2 Men: A Healthy Transition from Boyhood to Manhood

Tags: volunteer,pledgebank,mentoring,mentor

Health Advice for Santa

Ah, Santa Claus...my hero. He basically works one day per year; has lots of help, smokes a pipe, eats an impressive number of cookies, and drinks a lot of whole milk. He has a red nose (hopefully, not alcohol abuse) and a big belly (truncal obesity). On the other hand, Santa is quite happy, apparently enjoys his job, and has been married for a long as anyone remembers (to the same Mrs. Claus). He has not experienced the stress of divorce, job changes, or relocations.

Statistically, Santa should have had a stroke by now, or at least be taking blood pressure medications. Depending on his overall tobacco use, he could have lung cancer or COPD (chronic obstructive pulmonary disease). His diet is terrible and he most likely has a cholesterol level off the chart, and he is at risk for colon cancer. Due to his apparent inactivity, he should have arthritis / degenerative joint disease and back problems (that heavy pack on one shoulder). These are really nothing to Ho..Ho...Ho about.

There is no mention, ever, of Santa having a complete physical exam. Although he is self-employed, thousands of elves depend on his longevity. It is highly unlikely that Mrs. Claus will take over the family business.

Five things you can do to help Santa?

1. No more cookies and milk. Leave a tossed salad, low-fat dressing and water. Put an alarm on the refrigerator and hide the candy and liquor.
2. Seal up your chimney and make him walk around the house to find a door. Take the steps.
3. Put up some NO SMOKING signs.
4. Make it easy on his back. Ask for small, light things for Christmas. Helium balloons are nice, as are thongs.
5. Put a floor-length mirror and a bathroom scale someplace where he will see himself.

I love Santa. I want him around for my grand-children and great-grandchilden. I don't want to tell them Santa is in the Coronary Care Unit.

Related Topics: 6 Secrets of Successful Weight Loss, Quit Smoking

Technorati Tags: Santa,health,diet,exercise,quit smoking

The BACK is the most important part of the body

When I was a PA student back in the old days, I attended a lecture on back pain. Like the young, diligent medical students we were, we wrote down every word as the elderly (80 years plus) physician shared the wisdom of the ages.

"The back is the most important part of our body," he said. "If it wasn't for our backs, our heads would be sitting on our butts." I have never forgotten those inspiring words, especially now...when I am sitting at home with recurrent back pain.

In the early '70's, I took a sudden and unexpected trip through the front windshield of my car when I was rear-ended in freeway traffic. Years later, I thought that I could commute a few hundred miles per day (about five hours or more in SF/Oakland time) for a teaching position. And, more recently, after moving to a more rural area, I dug over a mile of ditches in order to irrigate my property. These events, and probably more back abuses than I can't recall, has left my head sitting on my butt.

Perhaps I am being punished for not believing all of those drug-seekers, screaming and hunched over coming into my Urgent Care facility. But like most medical providers, it often takes some personal experience to truly appreciate the pure, honest-to-God misery of back pain.

I hate missing work. I think of all of those patients that will be inconvenienced if I stay home to take care of myself. Sure, they may understand on the surface, but deep down, they may be ticked. I think (a little) about my colleagues that will have to see some of my patients that didn't get the phone call in time to cancel their appointments.

I am treating myself, mostly because I know there is not much else that can be done medically. If I whine too much about it, some neurosurgeon will want to take out those degenerative disks that showed up several years ago on an MRI. I do have some radicular pain down my leg and my left big toe is numb, but I am going to try and wait it out...again. Some pain medications, some anti-inflammatories, hot/cold compresses, a few sets in my beloved massage chair, and some Tincture of Time should get me back on my feet in a few more days. When I am not medically sedated, I am terribly bored. My youngest son, an RN, just had back surgery a month ago, so at least I can call him and commiserate.

Related Links: What to Do For Back Pain, Low Back Pain Shouldn't Sideline You

Miracle Cures - Quackery

If it LOOKS like a DUCK, and sounds like a DUCK, then it is probably QUACKERY

There are "enzymes" and herbal remedies to increase penis size, and more recently, a non-drug concoction that will make you taller (if you are under age 25). There are diet pills that give you energy, burn fat while you eat like a pig, and some designed only to lose belly fat. What's next? Fat Ass-away? Who is supposed to be regulating this crap? Because they are not technically drugs, these herbal supplements and homeopathic cure-alls are apparently free from regulation. And, who in their right minds are buying this stuff?

A good friend of mine, an Anthropology professor, invited me to display my lifelong collection of patent medicines and quackery medical devices at the local Skeptics organization. This is a volunteer group that attempts to identify and close down Quacks and quackery practices. At the turn of the last century, there were electric belts to help you lose weight, neon-like wands to grow head hair or shoot sparks up your butt, and thousands of snake-oil medicine that would cure just about everything. I displayed cures for cancer, torpid livers, flagging spirits, consitutional humors, female complaints (whatever those are!), and worms. 2005 is really no different.

In the cabinet behind my desk, I have several hundred of them proudly displayed. I haven't figured out how to post a picture on this site, but when I do...I will show you. I am particularly proud of my award-winning collection of antique laxatives. I won second prize in the Most Bizarre Collection Contest with our local newspaper. I lost first prize to Chinese Fighting Cricket Cages, but my opinion is that laxatives lack a certain public relations appeal. A year later, I again took second prize in national contest of bizarre collectables. Again, I lost to more appealing and tasteful collections. I was very disappointed about losing, since I still think I am the only Antique Laxative Collector in the World. After my disappointing defeat, a local news show did a story about my collection. When they ask me "How did I decide to collect laxatives?". I simply said, "Process of elimination...."

On my WebMD Ear Disorders message board, I get a frequent question about ear candles. Apparently, you can light one of these things in your ear, and the hurricane-like suction pulls disease, infection, and poisons out of your ear, as the candle wax fills your ear. After the wax hardens, you then pull out a disgusting glob of candle wax/ear wax, and perhaps a great deal of your brain, if you had one. Ear candles, according to www.quackwatch.com, were invented by the people of Atlantis, so there is a high level of credibility here. You can tell by my sarcastic tone that I do not think highly of objects being lit in body orifices. There should probably be butt-candles, too, making it easier for college guys to light farts?

Related Topics: Advertising: Miracle Cure, Safety of Herbal Supplements

A Christmas Promise

Somehow, you can always tell when the patient has a hidden agenda. As I was preparing to leave the exam room, my patient asked if I would be interested in helping a worthy organization. Expecting to be hit up for a donation, I reached for my wallet.

"No, she said, I don't want your money...I need your help. I have an organization called A Christmas Promise. We provide gifts to children who would otherwise have an empty holiday. As a school assignment, children in the poorer areas write letters to Santa. The teachers, being aware of children in need, pull their letters and get addresses from the school records. The letters are then posted on the wall of our office, where generous people donate the appropriate gifts. We are a few Santas short...are you interested?" I did have a full white beard and was twenty pounds overweight, so I guess I was made for the job.

On Christmas Eve, my PA wife, Lindsey and I drove to the organization headquarters where I donned my Santa regalia and received my assignments. We were to deliver gifts to two needy families. Volunteers loaded our van with two bicycles and five huge bags worth of specially-wrapped gifts. There were two bags for each family, and in case we encounter some extra children at the homes, an "emergency" bag containing various wrapped packages with little "B's" and "G's" written on them to indicate boy or girl gifts.

After scaling a chain link fence (not easy in a Santa suit), we were greeted by a very surprised couple. Their small home was clean and very sparse, with a little decorated tree in the corner. But, where were the children? Before I could utter this question, three brown, naked children, dripping wet from the bathtub came screaming down the hall yelling, "Santa...Santa!" We distributed two bags of gifts and left for our next delivery.

Street lights being as rare as house numbers, our next address was challenging. Counting down the houses from the last readable house number, we knocked on the door. It was answered by a pleasant woman who informed us that our intended family lived next door. Disappointed that her children would not see Santa, she asked if we would return. She offered to leave some of her gifts on the porch to distribute. Remembering our unused emergency bag of gifts, we told her that Santa would take care of it.

The second house contained some scary-looking adults, drinking beer, smoking something obviously illegal, and playing cards in the kitchen. Lying quietly on a rumpled couch was an ill and feverish two year old child. I sat beside him, but he was too lethargic to even smile at Santa's surprise visit. I asked the adults to please take this little child to the emergency room now. Not wanted to disappoint Santa, they agreed.

We returned to the van, loaded up scores of wrapped gifts from the emergency bag, and returned to the neighbor's house as promised. The door was answered by a very wide-eyed seven year old little boy. "Santa Claus! Please come in", he said. I was ushered into a tidy little room where I was offered the best chair. My PA wife, dressed in elf-like red, helped me carry our overflowing bag of gifts.

"I have something for you, Santa". "What is it, I asked?" Without missing a beat, this little child, dressed in clean, but ragged pajamas, flawlessly recited the entire Night Before Christmas. Perhaps it was just the temperature change from outside, but I discovered that my glasses had completely fogged.

"Now, Santa has some gifts for you." I searched inside my bag for a gift with the "B" designation. I selected a large one and handed it to the boy. Asking permission first, he ripped off the paper, revealing a crochet set. Much to my surprise, he squealed with puzzled delight.

"Do you have a gift for my sister?" Again, I reached into my bag, this time looking for a "G". I pulled out another mystery gift and handed it to a shy three year old. This time, an appropriate little doll emerged from the wrapping and was promptly hugged. I was relieved.

Pointing toward the one-year old sitting on Mom's lap, "Do you have a gift for my baby sister?" Again searching the bag for another "G", I just knew that I would select some age-inappropriate gift for this little girl. Finding another, I handed it to the boy to give to her. He looked directly into my misty eyes and said, "She likes unicorns", as he waited in anticipation.

With God as my witness on this incredible night, that little girl opened this sealed, wrapped gift marked just with a little "G" and out popped a beautiful, white stuffed unicorn. I was absolutely stunned.....and puzzled by the magic of Christmas to this very day.

For me, there will never be a more special Christmas.

Related Topics: Kids at the Holidays, Holiday Parenting Tips, Kindness is Contagious

Ear Infections: EDUCATE...Don't Just MEDICATE

Prior to the mid-1930's, there was no such thing as an antibiotic. First came the sulfa drugs, followed by penicillin in the 1940's. Since then, hundreds of antibiotics have been developed. Right now, there are about two dozen that we can routinely use for the management of ear infections. But, did you know that in children, MOST EAR INFECTIONS WILL RESOLVE ON THEIR OWN WITHOUT ANTIBIOTICS? Knowing that, why do medical providers continue to shell them out, and why to parents continually demand them? Education.

So, what is the answer? Should we withhold antibiotics for childhood ear infections for otherwise healthy, normal U.S. children? Should we medical providers tighten our sphincters and wait 7 days like our European partners?

How about a compromise? Let's wait 3-4 days.....or basically, let's COUNT TO THREE before prescribing or soliciting antibiotics for routine childhood ear infections. If we do that, we may need to use some better pain medications than plain 'ol Tylenol or Motrin. Ear infections hurt like hell, so there is really nothing wrong with giving children stronger pain medication, if they need it. A few days of codeine is certainly not going to turn them in to heroin addicts. Should we use pediatric nasal or oral decongestants as well? Many studies have shown them to be worthless, but they are also safe and could help, so why not? Giving our remarkable immune systems TIME to fight these common infections without the interference of antibiotics will only make us stronger...for those future infections.

Each medical encounter is an opportunity for EDUCATION. Parents need to take a more active role and stop just accepting cafeteria medicine. When your child is diagnosed with a middle ear infection, ASK TO SEE IT. Have the medical provider show you that red and bulging eardrum. Buy your own otoscope (about $30) and look for yourself. Instead of expecting or demanding an antibiotic (most medical provider just assume ALL parents want them), ask if it is appropriate to DELAY using them for a few days. More and more, I am giving the parents this choice. I offer them a written prescription for an appropriate antibiotic just to hold for a few days. If the child is not improving over three or four days (or worsening at any time), then parents can get it filled. You would be surprised how many prescriptions go unfilled. Education.

Related Topics: Antibiotics for Ear Infections, Kids Ear Infection

Parents Using Otoscopes? Isn't That Illegal?

It has been over 25 years since I shocked the local medical community by teaching parents how to use a home otoscope -- a device that can peer into the ear to determine if a child has an ear infection or not. A local pediatrician called to inform me that it was ILLEGAL for parents to possess an otoscope. What a moron! Anyway, over the years, my wife (also a PA) and I have taught well over a thousand parents to use this simple device.

Why learn how to use an otoscope? The eardrum is hidden about an inch or so down a small tunnel of skin. In order to see the eardrum, you need a device that will focus and magnify the eardrum -- an otoscope. They are very easy to use, but they do take some practice. If you have one, your doctor may raise his/her eyebrows when you tell them, but remind them that they had to learn to use this device in the past, too. I remind people on my WebMD Ear Disorders board that ear infections are the second most common reason why children are taken for medical care.

Traditionally, otoscopes were exclusively medical devices costing several hundred dollars a piece, but it didn't take long for some less-expensive consumer models to hit the market. Once I found a good one, I started teaching some classes to my patients. Years later, I saw the need to write a book to accompany the otoscope. My book, "EARS: AN OWNER'S MANUAL" is now in it's second printing and is available through Amazon.com or Notoco - a company that makes one the best and most economical home otoscopes (about $30). So, with co-pays costing nearly the price of an otoscope, it will not take long for this little gem to pay for it's self -- especially if you have children with frequent ear infections and more-frequent "false alarm" visits.

Otoscopes are not illegal. As a matter of fact, they should be part of every home that has people with ear problems, from the kids with ear infections to the older folks with wax problems.

Related Links: Home Ear Exam, Self Care Tools