Thursday, May 26, 2016

Health Care and Lithotripsy

When a kidney stone gets too big to pass in the urinary tract system, trying to migrate from the kidney to the bladder, your doctor or urologist may suggest a procedure known as a lithotripsy. Surgery was the only method to remove stones too large to pass until lithotripsy was developed and replaced it as the most frequent treatment beginning in the 1980s.

The introduction of lithotripsy in the early 1980s revolutionized the treatment of patients with kidney stone disease, according to Johns Hopkins Medicine. Patients who once required major surgery to remove their stones could be treated with lithotripsy, and not even require an incision. As such, lithotripsy is the only non-invasive treatment for kidney stones, meaning no incision or internal telescopic device is required. More information is available at this website: http://www.hopkinsmedicine.org/healthlibrary/test_procedures/urology/lithotripsy_92,p07720/ .

Kidney stones occur when minerals and other substances in the blood crystallize in the kidneys, forming solid masses (stones). Stones may consist of small, sharp-edged crystals, or smoother, heavier formations that resemble polished river rocks. They usually exit the body naturally during urination, according to Healthline.

However, sometimes the body can’t pass larger formations through urination. This can lead to kidney damage. People with kidney stones may experience bleeding, severe pain, or urinary tract infections. When stones begin to cause these types of problems, your doctor may suggest lithotripsy. More info about lithotripsy is located at this site: http://www.healthline.com/health/lithotripsy#Overview1 .

According to the National Kidney Foundation, extracorporeal shock wave lithotripsy (ESWL) is a technique for treating stones in the kidney and ureter that does not require surgery. Instead, high energy shock waves are passed through the body and used to break stones into pieces as small as grains of sand. Because of their small size, these pieces can pass more easily from the body along with the urine.

There are two ways to remove stones using shock wave treatment. In one method, the patient is placed in a tub of lukewarm water. Using x-rays or ultrasound to pinpoint the location of the stones, the body is positioned so that the stones are targeted precisely. In the second, more common method, the patient lies on top of a soft cushion or membrane through which the waves pass. About 1-2 thousand shock waves are needed to crush the stones. The complete treatment takes about 45 to 60 minutes. Much more detail about this process is located at this website: https://www.kidney.org/atoz/content/lithotripsy .

ESWL is usually an outpatient procedure, according to Healthwise. You go home after the treatment and do not have to spend a night in the hospital. After ESWL, stone fragments usually pass in the urine for a few days and cause mild pain. If you have a larger stone, you may need more ESWL or other treatments. ESWL may be used on a person who has a kidney stone that is causing pain or blocking the flow of urine.

Stones that are between 4 mm (0.16 in.) and 2 cm (0.8 in.) in diameter are most likely to be treated with ESWL. ESWL may work best for kidney stones in the kidney or in the part of the ureter close to the kidney. Your surgeon may try to push the stone back into the kidney with a small instrument (ureteroscope) and then use ESWL. More info is available at this site: http://www.webmd.com/kidney-stones/extracorporeal-shock-wave-lithotripsy-eswl-for-kidney-stones .

As with any medical procedure, there are always inherent risks to patients. According to the American Urological Association, although manifestations of chronic injury have been identified, it seems likely that the full spectrum of long-term injury—the form and severity of chronic adverse effects—has yet to be determined. It is intuitive that chronic effects derive from acute tissue damage, but very little is known about the progression of tissue changes that link the two.

There is also limited information about treatment dose and the development of chronic effects and whether specific risk factors exist that predispose an individual to long-term effects. Much more clinical data and research is available at this site: https://www.auanet.org/education/guidelines/shock-wave-lithotripsy.cfm .

According to the University of Florida Medical Center, here are some post surgery symptoms you may experience after going through lithotripsy:

·         Flank Pain: Most patients experience some degree of discomfort for a day or two after ESWL. The pain is usually described as a dull ache or soreness over the kidney or flank area, and is typically at its worst the evening following surgery. The pain lessens over the following days.

·         Blood in Urine: It is normal to see visible blood in the urine for days to several weeks after surgery. It is important during this time of bleeding that you avoid strenuous activity, blood thinning medications, and drink plenty of fluid.

·         Fevers: Low grade fevers are not uncommon following any surgical procedure and anesthesia. If you have fevers >101o F, please notify your surgeon and ask to be connected to the urologist on call.

There are some patients who are not suited to undergo lithotripsy. Patients who are pregnant, have active urinary infection, obstruction of the kidney or are on blood thinning medications that cannot be discontinued are not ideal candidates for ESWL treatment. Patients with particular known stone composition including cystine and certain types of calcium phosphate stones are not ideal candidates as these stone types may not fragment well with ESWL due to their dense nature. Much more detailed material is available at this website: http://urology.ufl.edu/patient-care/stone-disease/procedures/extracorporeal-shock-wave-lithotripsy-eswl/ .

If your child needs this procedure, follow the directions of your child’s doctor and nurse for caring for your child at home after the treatment. According to AboutKidsHealth, they will usually instruct that your child:
·         Drink plenty of fluids, especially water.
·         Change their diet, if needed.
·         Take medication to manage pain and nausea.
·         Get plenty of rest.

If your child is toilet trained, your child’s doctor or nurse may also instruct you to strain your child’s urine for several days and will explain how to do this. Straining the urine will enable you to collect any stone particles so that they can be analyzed in a laboratory. Your child’s doctor will use the information about the make-up of the stone to monitor your child and make recommendations (such as changes in diet) to prevent the kidney stones from recurring. A lot of additional material on this healthcare subject is located at this site: http://www.aboutkidshealth.ca/En/HealthAZ/TestsAndTreatments/Procedures/Pages/shock-wave-lithotripsy.aspx .

Kidney stones are very painful, and those that don’t pass easily are even worse. As one option for treatment, lithotripsy has its merits in spite of the associated risks. However, if your family has a history of kidney stones, you may possibly encounter this situation at some point. Educate yourself on how to deal with the medical options, the procedure, and its outcome.


Until next time.

Monday, May 16, 2016

Health Care and Dehydration

When your body doesn’t have enough fluid to maintain its equilibrium to sustain itself, you may be suffering from dehydration. According to osteopathic physician, Dr. Joseph Mercola, your body requires water to work well. In fact, up to 60 percent of your entire body is made of water, 83 percent of your lungs is water and 73 percent of your brain and heart are composed of water. Water is very important to your ability to function, think, breathe and live. More information is found at this website: http://articles.mercola.com/sites/articles/archive/2016/05/14/urine-dehydration.aspx#_edn1

Summertime means outdoor activities, prolonged exposure to the sun, and excessive sweating—all of which can lead to dehydration, according to Medicine in Motion. Although dehydration can happen any time of the year, the summer months are of particular concern because of the higher temperatures. When a person has lost more than two percent of their body weight during activity, they are considered to be dehydrated.

The best way to battle dehydration, of course, is to drink lots of water or sports drinks before, during and after any intense physical activity or prolonged exposure to hot temperatures. If ignored, dehydration can lead to other problems such as heat exhaustion, muscle cramps, fatigue or even heat stroke. More information is located at this site: http://www.newson6.com/story/31979569/austin-sports-medicine-practice-provides-warning-signs-and-life-saving-tips-for-dehydration .

Fluid concentration does not have to experience a major change before dehydration can occur. Dehydration is mostly caused by fever, serious sweating (after an intense workout, especially in summers), and diarrhea. Dehydration can occur in any age group, but it is most common in young children and older adults. The signs and symptoms of dehydration can be mild or severe. The good news is that your body will notify you if you are getting dehydrated. More details are available at this website: http://fatalsymptoms.com/10-symptoms-of-dehydration/?gclid=CL621JfU3swCFZCIaQod4NEBbg .

According to the Mayo Clinic, mild to moderate dehydration is likely to cause the following symptoms:
·         Dry, sticky mouth
·         Sleepiness or tiredness — children are likely to be less active than usual
·         Thirst
·         Decreased urine output
·         No wet diapers for three hours for infants
·         Few or no tears when crying
·         Dry skin
·         Headache
·         Constipation
·         Dizziness or lightheadedness

The Mayo Clinic also reports that severe dehydration, a medical emergency, can cause these symptoms:
·         Extreme thirst
·         Extreme fussiness or sleepiness in infants and children; irritability and confusion in adults
·         Very dry mouth, skin and mucous membranes
·         Little or no urination — any urine that is produced will be darker than normal
·         Sunken eyes
·         Shriveled and dry skin that lacks elasticity and doesn't "bounce back" when pinched into a fold
·         In infants, sunken fontanels — the soft spots on the top of a baby's head
·         Low blood pressure
·         Rapid heartbeat
·         Rapid breathing
·         No tears when crying
·         Fever
·         In the most serious cases, delirium or unconsciousness

Unfortunately, thirst isn't always a reliable gauge of the body's need for water, especially in children and older adults. A better indicator is the color of your urine: Clear or light-colored urine means you're well hydrated, whereas a dark yellow or amber color usually signals dehydration. More details about this health care issue are located at this site: http://www.mayoclinic.org/diseases-conditions/dehydration/basics/symptoms/con-20030056 .

According to the New York Times, there are some ways to help prevent dehydration:
·         Drink plenty of fluids every day, even when you are well. Drink more when the weather is hot or you are exercising.
·         If anyone in your family is ill, pay attention to how much they are able to drink. Pay close attention to children and older adults.
·         Anyone with a fever, vomiting, or diarrhea should drink plenty of fluids. DO NOT wait for signs of dehydration.
·         If you think you or someone in your family may become dehydrated, call your health care provider. Do this before the person becomes dehydrated.

For more severe dehydration or heat emergency, you may need to stay in a hospital and receive fluid through a vein (IV). Your health care provider will also treat the cause of the dehydration. Dehydration caused by a stomach virus should get better on its own after a few days. More information is available at this website: http://www.nytimes.com/health/guides/disease/dehydration/overview.html .

According to Everyday Health, when it comes to total water intake, which includes water gained from foods and other beverages like tea and milk, the  Institute of Medicine recommends that most women get about 2.7 liters of water a day (or about 12 cups), and most men get about 3.7 liters a day (or about 15 cups). Much more detailed information is available at this site: http://www.everydayhealth.com/news/unusual-signs-of-dehydration/ .

According to Merck Manuals, seniors are more susceptible to dehydration.  In older people, common causes of dehydration include the following:
·         Confusion
·         Disorders that make obtaining fluids difficult (usually because of restricted mobility)

Additionally, older people sense thirst more slowly and less intensely than younger people do, so even those who are otherwise well may not drink enough fluids. Seniors usually have a higher percentage of body fat. Because fat tissue contains less water than lean tissue, the total amount of water in the body tends to decrease with age. More detailed material is available at this website: http://www.merckmanuals.com/home/hormonal-and-metabolic-disorders/water-balance/dehydration .

Children are especially prone to dehydration. Be alert for the warning signs of dehydration in children, and notify the pediatrician immediately if any of them develop. More info is located at this site: https://www.healthychildren.org/English/health-issues/injuries-emergencies/Pages/dehydration.aspx .

Should you be concerned about dehydration during pregnancy? According to the American Pregnancy Association, the answer is YES. Dehydration is the result of your body losing water faster than you are taking it in. It is a serious issue for the health and wellness of anyone, but for pregnant women, it is especially important to stay well-hydrated.

Pregnant women need more water than the average person, since water plays an important role in the healthy development of your baby. Water helps to form the placenta, which is what a baby relies on to receive nutrients during pregnancy. Water is also used to form the amniotic sac later in pregnancy. Therefore, it is important to avoid dehydration during pregnancy. More information on this topic is located at this site: http://americanpregnancy.org/pregnancy-complications/dehydration-pregnancy/ .

Dehydration can be prevented if common sense safety precautions are observed. Don’t let yourself or someone you know lose too much fluid without replacing it right away. Dehydration can happen quickly and unexpectedly. It pays to know the symptoms and how to react when you suffer the symptoms.


Until next time.

Tuesday, April 26, 2016

Health Care and Endocrinology

You may have heard the word Endocrinology used in a sentence by a health care professional, like your family physician or someone that has had to visit an endocrinologist, but not really know what it is or what part of your body is the primary focus for this type of medical need. is a specialty of medicine; some would say a sub-specialty of internal medicine, which deals with the diagnosis and treatment of diseases related to hormones.

Endocrinology also focuses on the endocrine glands and tissues that secrete hormones, and it is a branch of biology and medicine dealing with the endocrine system, its diseases, and its specific secretions known as hormones. It is also concerned with the integration of developmental events proliferation, growth, and differentiation, and the psychological or behavioral activities of metabolism, growth and development, tissue function, sleep, digestion, respiration, excretion, mood, stress, lactation, movement, reproduction, and sensory perception caused by hormones.

From a clinical and research perspective, the Endocrine Society (100 years old this year) does a significant amount of scientific study about this particular field of medicine. The Society offers scientific statements to educate basic scientists, clinical scientists, and clinicians on the scientific basis of disease and its application to the practice of medicine with regard to both prevention and management.

Scientific statements provide an overview of basic and clinical science content on topics of emerging importance. Content is evidence-based to the extent possible but also identifies areas of basic or clinical knowledge that require additional research. Topics are selected on the basis of their emerging scientific impact on disease and broad clinical relevance to the general population. Much more detailed material is located at this website: http://www.endocrine.org/about-us .

According to the Society for Endocrinology, at its simplest, a hormone is a chemical messenger from one cell (or group of cells) to another. Hormones are released in the body and have an effect on other parts of the body. The effect is to communicate with other distant parts of the body. So for example, the adrenal glands may secrete adrenalin, which has an effect on several different organs. An endocrine gland is a gland which secretes hormones. Not all glands are classified as endocrine glands. For example, sweat glands or lymph glands are not endocrine glands).

Hormones are found in all organisms with more than one cell, and so they are found in plants and animals. They influence or control a wide range of physiological activities, such as growth, development, puberty, level of alertness, sugar regulation and appetite, bone growth and other bodily functions. You also find that problems with hormones and the way they work contribute to some of the major diseases of mankind; for example, diabetes, thyroid conditions, pituitary conditions, some sexual problems, some neurological problems, appetite and obesity, bone problems, cancer, and more. Additional info is found at this site: http://www.endocrinology.org/ .

The Journal of Endocrinology is a leading global journal, available through the Society of Endocrinology, that publishes original research articles, reviews and science guidelines. Its focus is on endocrine physiology and metabolism, including hormone secretion; hormone action; biological effects. The journal publishes basic and translational studies at the organ, tissue and whole organism level. You can find more information at this site: http://joe.endocrinology-journals.org/  

The American Association of Clinical Endocrinologists (AACE), founded in 1991, now has over 7,000 members who work together as a professional community of physicians specializing in endocrinology, diabetes, and metabolism committed to enhancing the ability of its members to provide the highest quality of patient care. Their website has significant information on the study of endocrinology and provides a detailed list of definitions for anyone seeking to know more about this type of medicine. More info can be found at this website: https://www.aace.com/about/mission .

On a more detailed basis, according to the American College of Physicians, endocrinologists are frequently involved with the diagnosis and management of these health care problems:
·         Hypothalamic disorders (abnormal sodium and water balance)
·         Pituitary diseases (tumors, over- or underproduction of pituitary hormones)
·         Parathyroid abnormalities (hypercalcemia, hypocalcemia)
·         Thyroid diseases (hyperthyroidism, hypothyroidism, goiter, nodules)
·         Adrenal cortex dysfunction (mineralcorticoid, glucocorticoid, sex hormone abnormalities)
·         Gonadal disease (hypogonadism and reproductive disorders)
·         Pancreatic endocrine disease (diabetes mellitus)
·         Bone metabolism (osteoporosis)
·         Lipid metabolism
·         Iatrogenic effect of glucocorticoids

Training in endocrinology includes two years of additional training following successful completion of a basic internal medicine residency training program. More details are found at this website: https://www.acponline.org/about-acp/about-internal-medicine/internal-medicine-subspecialties/endocrinology-diabetes-and-metabolism .

An additional materials resource is this site: http://www.nature.com/nrendo/index.html , where you can find detailed scholarly journals and research information about endocrinology. And, Healio online has some very good materials about this type of medicine: http://www.healio.com/endocrinology .

There are many good hospitals and health care organizations in the US that have special sections and staff allocated to the study of endocrinology. One of them is Children’s Hospital of Dallas, and you can find more details about their treatment options at this site: https://www.childrens.com/specialties-services/specialty-centers-and-programs/endocrinology .

Another great location for treatment, especially for adults who need specialty care, is located at the University of Chicago Department of Medicine. Their 3-fold mission: (1) to provide excellence in patient care; (2) to perform cutting-edge basic, clinical and translational research in endocrine diseases, diabetes, obesity and hypertension; and (3) to provide outstanding educational opportunities for medical students, house staff and fellows. More information is located at this site: http://medicine.uchicago.edu/endo/index.html .

Hormones are a huge part of what makes your body tick. Endocrinologists are medical specialists that can help determine what may be out of whack if you are experiencing symptoms or medical issues that need more detailed study and care. Talk with your doctor or a medical professional who can assist you in getting the quality of care you need for any problems dealing with hormonal imbalances. It’s worth your time.


Until next time. 

Friday, April 8, 2016

Health Care and Data Breaches

This blog post is my 500th article!!! 

One of the most critical issues in the healthcare field today, for medical providers and facilities and for consumers, is the breach of personal health care information. The theft of personal medical records is big money on the black market, and ID theft due to that crime is rampant.

According to Modern Healthcare magazine, 2016 is being deemed the “year of data security” in healthcare—if only because 2015 was a substantial wake-up call for the industry. Nearly 90 percent of healthcare providers have been hit by data breaches in the last two years, according to security research firm Ponemon Institute, with many large-scale and criminally driven attacks publicized in 2015. More details are located at this website: http://www.modernhealthcare.com/article/20160227/SPONSORED/160229900/2016-the-year-of-data-security

HIT Consultant reports that one in three Americans were victims of healthcare data breaches in 2015, attributed to a series of large-scale attacks that each affected more than 10 million individuals. These and other statistics are contained in Bitglass’ 2016 Healthcare Breach Report.

Among the most significant findings of the report was that in 2015, 98 percent of record leaks were due to large-scale breaches targeting the healthcare industry. These high-profile attacks were the largest source of healthcare data loss and indicate that cyber attackers are increasingly targeting medical data.

Such breaches include the widely publicized Premera Blue Cross hack involving 11 million customers, and the Anthem hack which resulted in 78.8 million leaked customer records. More info is located at this website: http://hitconsultant.net/2016/01/28/hackers-caused-98-of-healthcare-data-breaches/ .

According to Health IT Security, 80 percent of organizations handling sensitive information report concern for large-scale data breaches, based on a survey conducted by Advisen. This survey included organizations from several different industries, but the most highly represented industry was healthcare, comprising 22 percent of the respondent sample.

Despite the growing concern for large-scale data breaches, the study’s authors report that organizations may not be doing enough. While three quarters of respondents report having some sort of data breach response plan, these plans may not go through rigorous enough testing. You can find more material on this subject at this site: http://healthitsecurity.com/news/large-data-breaches-top-worry-for-health-pros-survey-shows .

Forbes Magazine reported that 2015 was the worst year yet for data breaches. The online mechanism for the Office of Civil Rights (OCR) under Health and Human Services publishes data breaches as reported to them and required by HIPAA. The numbers last year are just staggering:

·         According to OCR, there were 253 healthcare breaches that affected 500 individuals or more with a combined loss of over 112 million records.
·         The top 10 data breaches alone accounted for just over 111 million records that were lost, stolen or inappropriately disclosed.
·         The top six breaches affected at least 1 million individuals–and four of the six were Blue Cross Blue Shield organizations.

While HIPAA is the legislation (passed in 1996) designed to protect patients against loss, theft or disclosure of their sensitive medical information, the fines and penalties don’t appear to be having a discernible effect on either patient privacy or data security.

A recent data breach study estimates that breaches cost the healthcare industry about $5.6 billion annually. As healthcare moves toward connected care, the amount of data exchanged between organizations is only going to grow. So what does this mean? It means that in 2016, the healthcare industry is going to see a huge movement towards encryption in hospitals and other healthcare facilities in order to protect EHRs (electronic health records) and other vulnerable PHI (Personal Health Information). More detailed material is located at this website: http://www.forbes.com/sites/danmunro/2015/12/31/data-breaches-in-healthcare-total-over-112-million-records-in-2015/#3f9cb33b7fd5 .

Oddly enough, however, according to Health IT Security, the first few months into 2016 are showing a slightly different trend, with results from the Department of Health and Human Services (HHS) indicating that stolen devices and improper disposal are the top threats currently facing the industry. Patient names, addresses, phone numbers, Social Security numbers, dates of birth, health insurance numbers, other medical status and assessment information as well as some financial information have been exposed with these incidents.

The top five healthcare data breaches of this year so far do not involve hacking or an IT incident, according to the HHS Office for Civil Rights (OCR) data breach reporting tool. Instead, theft, loss, improper disposal, and unauthorized email access or disclosure have caused the largest incidents in 2016. More info is located at this website: http://healthitsecurity.com/news/top-5-healthcare-data-breaches-in-2016-not-from-hacking .

According to IT Business Edge, a big part of the problem is that security organizations are still focused on preventative security — looking for a silver bullet that will keep an attacker out of their networks in the first place. Despite a Gartner recommendation that organizations shift security efforts toward the detection of network intruders and the emergence of promising new behavioral analytic tools and security strategies, well under 1 percent of enterprises have the ability to find a post-intrusion network attacker. Cyber criminals continue to have the potential for unimpeded, long-term success. More info is located at this site: http://www.itbusinessedge.com/slideshows/2016-security-trends-whats-next-for-data-breaches-06.html .

Hospitals, health systems, payers and any organization with stewardship of healthcare data are prime targets for cyberattacks, according to Becker’s Hospital Review (BHR). And there are plenty of cautionary tales showing just how much damage hackers can do. While no healthcare organization will ever be completely invulnerable to such attacks, they can learn from others' mistakes.

Here are four lessons, according to BHR, healthcare providers can consider when thinking about data breach prevention and preparedness:
1.    Don't fall prey to known vulnerabilities.
2.    Utilize experience-based training.
3.    Consider a third party for security audits.
4.    Create a contingency plan.


Businesses, especially in the healthcare field, must always make every effort to protect patient information. That is their responsibility, and they can be held civilly responsible, and criminally responsible if there is a proven negligent act. As a consumer, you may receive a letter or an email informing you that your personal information may have gotten into the wrong hands as a result of a data breach.  Perhaps a media report alerted you to a security breach at a company where you do business.

Regardless of the type of data breach, medical information is more difficult to recover, manage, and restore, especially for consumers. According to Privacy Rights Clearinghouse, there are helpful tips on what to do if a breach has occurred. Much more detail is located at this website: https://www.privacyrights.org/how-to-deal-security-breach .

Always be diligent to monitor your healthcare information. Take steps to protect your personal data, and never provide your information to businesses that have no protection or privacy capabilities in place. Always ask who will see your information, and request a copy of their privacy policies. If you discover that a breach has occurred, take quick action to reduce the exposure and limit the damage that can be done. It’s your life. Keep it secret. Keep it safe.

Until next time. 

Friday, April 1, 2016

Health Care and FMLA

The Family and Medical Leave Act (FMLA) was passed as a federal law in 1993, requiring covered employers to provide employees job-protected and paid leave for qualified medical and family reasons. Qualified medical and family reasons include: personal or family illness, family military leave, pregnancy, adoption, or the foster care placement of a child. The FMLA was intended "to balance the demands of the workplace with the needs of families."

According to the US Department of Labor, the FMLA entitles eligible employees of covered employers to take unpaid, job-protected leave for specified family and medical reasons with continuation of group health insurance coverage under the same terms and conditions as if the employee had not taken leave. Eligible employees are entitled to the following benefits:

--Twelve workweeks of leave in a 12-month period for:
·         the birth of a child and to care for the newborn child within one year of birth;
·         the placement with the employee of a child for adoption or foster care and to care for the newly placed child within one year of placement;
·         to care for the employee’s spouse, child, or parent who has a serious health condition;
·         a serious health condition that makes the employee unable to perform the essential functions of his or her job;
·         any qualifying exigency arising out of the fact that the employee’s spouse, son, daughter, or parent is a covered military member on “covered active duty;” or

--Twenty-six workweeks of leave during a single 12-month period to care for a covered service member with a serious injury or illness if the eligible employee is the service member’s spouse, son, daughter, parent, or next of kin (military caregiver leave).  More information is available at this website: http://www.dol.gov/whd/fmla/ .

But there are some qualifiers for someone who is employed that wants to use this as a legal way to take time off from work for medical or family reasons. In order to be eligible for FMLA leave, an employee must have been at the business at least 12 months, and worked at least 1,250 hours over the past 12 months, and work at a location where the company employs 50 or more employees within 75 miles. The FMLA covers both public- and private-sector employees, but certain categories of employees are excluded, including elected officials and their personal staff members.

Generally, the FMLA requires an employee to give his or her employer 30 days' notice of intention to take FMLA leave, and the reason for the leave, according to FindLaw.com. There is no "magic language" that the employee must use in notifying the employer, nor does the employee need to mention the FMLA by name. Instead, the notice must give the employer enough information to know the employee is requesting time off, and why.

This allows the employer to determine if the request qualifies under the FMLA, and allows time to find a replacement for the employee. When the need for FMLA leave arises suddenly, like an unexpected medical emergency, employees may take FMLA leave without prior notice. However, employees must give the employer as much notice as is reasonable under the circumstances. More detailed material about this law is available at this site: http://employment.findlaw.com/family-medical-leave/family-and-medical-leave-act.html .

According to the National Partnership for Women and Families (NPWF), America's workers have used the FMLA at least 200 million times to take time off when they need it most, without having to worry about losing their jobs or their health insurance. However, About 40 percent of the workforce is not eligible for leave under the FMLA. More info is located at this website: http://www.nationalpartnership.org/issues/work-family/fmla.html .

The FMLA can be abused by employees in some cases, especially on intermittent leave. Employers have some options to monitor the requests. One of the biggest employer complaints about FMLA is the productivity problems caused by employees’ use—and abuse—of FMLA intermittent leave. The problem: employees with chronic health problems often take FMLA leave in short increments of an hour or less. According to Business Management Daily, here are four tips on certifying FMLA intermittent leave requests:

1. Ask about the specific condition. Medical certification must relate only to the serious health condition that is causing the leave. Employers can’t ask about the employee’s general health or other conditions.

2. Give 15 days to respond. After requesting certification, give employees at least 15 calendar days to submit the paperwork. If the employee’s medical certification is incomplete or insufficient, specify in writing what information is lacking and allow the employee seven days to cure the deficiency.

3. If the need for leave is doubted, investigate the certification. Under the updated FMLA regulations, an organization can contact the employee’s physician directly to clarify the medical certification. The contact person can be a health care provider, a human resources professional, a leave administrator (including third-party administrators) or a management official, but not the employee’s direct supervisor.

4. If the request is still not convincing, require (and pay for) a second opinion. Use an independent doctor selected by the employer, not a doctor who works for your organization. If the two opinions conflict, the employer can pay for a third and final, binding medical opinion

The law gives employers the right to demand certification from the employee’s doctor of his or her need for leave. More information on this topic is found at this website: http://www.businessmanagementdaily.com/glp/25988/FMLA-Intermittent-Leave.html .

According to FMLAOnline.com, the Family and Medical Leave Act is an on-going challenge for HR professionals. Because its rules are so complex, companies are vulnerable to FMLA abuse, exploitation, and miscomprehension. It takes only one confused or misinformed employee to cost a business tens of thousands of dollars in FMLA lawsuits. There are three different kinds of FMLA leave:

·         Continuous FMLA leave: An employee is absent for more than three consecutive business days and has been treated by a doctor.

·         Intermittent FMLA leave: An employee is taking time off in separate blocks due to a serious health condition that qualifies for FMLA. Intermittent leave can be in hourly, daily, or weekly increments. Intermittent FMLA is often taken when an employee needs ongoing treatment for their condition.

·         Reduced schedule FMLA leave: An employee needs to reduce the amount of hours they work per day or per week, often to care for a family member or to reduce stress.

All FMLA forms and information about an employee’s FMLA leave and condition must be kept confidential and separate from other employee files. It is an FMLA violation for an employer to share information about an employee’s FMLA leave with other employees. Additional material on FMLA policies is located at this site: http://fmlaonline.com/ .

According to HRHero.com, employers must keep accurate records pertaining to the leave and either physically or electronically post a notice of employees’ rights under the FMLA so that the information is accessible to both employees and job applicants. Furthermore, the FMLA requires employers to maintain the employee’s group health benefits while on leave on the same terms that it provided them when the employee was working.

Leave taken under the FMLA is job-protected, which means that employees must be given the same job or an equivalent job when they return. Employees or the Department of Labor can sue the employer for lost wages, benefits, reinstatement, attorneys’ fees, and liquidated damages for willful violations. Additional information is located at this site: http://topics.hrhero.com/family-and-medical-leave-act-fmla/ .

The FMLA is a definite benefit for qualified employees, and employers have certain protections under the law if there is suspected abuse or violation of FMLA. Going forward, both employees and employers must know the law and follow it to avoid any problems. Both family and medical leave is important in circumstances that mandate time away from work. The key is to understand how it works and how to manage it.


Until next time. 

Tuesday, March 29, 2016

Health Care and Your Gallbladder

The gallbladder is a 4-inch, pear-shaped organ. It’s positioned under your liver in the upper right section of your abdomen. The gallbladder stores bile, a combination of fluids, fat, and cholesterol. Bile helps break down fat from food in your intestine. The gallbladder delivers bile into the small intestine. This allows fat-soluble vitamins and nutrients to be more easily absorbed into the bloodstream. If you have problems with your gallbladder, you can feel very sick and not know exactly what’s going on until you get medical attention.

According to Every Day Health.com, the gallbladder releases bile, via the cystic duct, into the small intestine to help break down the foods you eat — particularly fatty foods. Typically the gallbladder doesn't cause too many problems or much concern, but if something slows or blocks the flow of bile from the gallbladder, a number of problems can result. Most gallbladder symptoms start with pain in the upper abdominal area, either in the upper right or middle. Below are common symptoms of gallbladder conditions:

·         Severe abdominal pain
·         Pain that may extend beneath the right shoulder blade or to the back
·         Pain that worsens after eating a meal, particularly fatty or greasy foods
·         Pain that feels dull, sharp, or like cramps
·         Pain that increases when you breathe in deeply
·         Chest pain (angina)
·         Heartburn, indigestion, and excessive gas
·         A feeling of fullness in the abdomen
·         Vomiting, nausea, fever
·         Shaking with chills
·         Tenderness in the abdomen, particularly the right upper quadrant
·         Jaundice (yellowing of the skin and eyes)
·         Stools of an unusual color (often lighter, like clay)

Some gallbladder problems, like simple gallstones that are not blocking the cystic duct, often cause no symptoms at all. They're most often discovered during an x-ray or CT scan that's performed to diagnose a different condition, or even during an abdominal surgery. More detailed info is located at this website: http://www.everydayhealth.com/gallbladder/symptoms/ .

Gallstones form when substances in bile harden. Rarely, you can also get cancer in your gallbladder, according to the National Institutes for Health (NIH). Many gallbladder problems get better with removal of the gallbladder. Fortunately, you can live without a gallbladder. Bile has other ways of reaching your small intestine. More details are found at this site: https://www.nlm.nih.gov/medlineplus/gallbladderdiseases.html .

According to HealthLine.com, any disease that affects your gallbladder is considered a gallbladder disease. Symptoms of a gallbladder problem may come and go. However, you’re more likely to develop a gallbladder problem if you’ve previously had one. While gallbladder problems are rarely deadly, they should still be treated. You can prevent gallbladder problems from worsening if you take action and see a doctor. More info is found at this website: http://www.healthline.com/health/gallbladder-problems-symptoms#3 .

Some problems associated with the gallbladder are gallstones, gallbladder attack and gallbladder disease. Gallbladder pain is usually caused by biliary colic, gallstones, cholecystitis, pancreatitis and cholangitis, according to LiveScience.com. Gallstones in particular are troublesome, and they are solidified particles of substances in the bile. They are made of a combination of bile salts, cholesterol and bilirubin. 

Gallstones can be as small as a grain of sand or as large as a golf ball. Gallstones can block the gallbladder ducts so that bile cannot reach the small intestine as effectively, which may prevent the gallbladder from doing its job and can lead to other gallbladder diseases. And, while most gallstones pass on their own, some require a minor procedure or even surgery.

According to the Mayo Clinic, factors that contribute to the risk of gallstones include obesity, high-fat or high-cholesterol diets, diabetes and taking medicines with estrogen. Women, people over 60, Native Americans and Mexican-Americans are also at a higher level of risk. Symptoms of a gallbladder attack may be similar to those of a heart attack and other conditions, so it is important to consult a doctor for a correct diagnosis. More info about the gallbladder is located at this site: http://www.livescience.com/42965-gallbladder.html .

Gallbladder problems are more common than you may think. Gallstones affect more than 25 million Americans with 1 million new cases diagnosed annually, according to the American Gastroenterological Association. And there are other things that go wrong with the gallbladder besides just gallstones, according to GallbladderAttack.com. People can go for years with digestive symptoms and never realize that they may be related to a gallbladder problem.

That's because they are so interwoven with other digestive symptoms such as indigestion, gas, bloating, constipation, diarrhea and nausea. Much more detailed material is located at this website, including some naturopathic options for treatment: http://www.gallbladderattack.com/gallbladdersymptoms.shtml .

Because gallstones are related to diet, particularly fat intake, the incidence of gallstones varies widely among nations and regions. For example, Hispanics and Northern Europeans have a higher risk for gallstones than do people of Asian and African descent. People of Asian descent who develop gallstones are most likely to have the brown pigment type, according to the University of Maryland Medical Center (UMMC).

Also, having a family member or close relative with gallstones may increase the risk. Up to one-third of cases of painful gallstones may be related to genetic factors. Studies indicate that the disease is complex and may result from the interaction between genetics and environment. Some studies suggest immune and inflammatory mediators may play key roles.

The UMMC reports as well that people with diabetes are at higher risk for gallstones and have a higher-than-average risk for acalculous gallbladder disease (without stones). Gallbladder disease may progress more rapidly in patients with diabetes, who tend to have worse infections. As well, being obese or overweight is a significant risk factor for gallstones. In such cases, the liver over-produces cholesterol, which is delivered into the bile and causes it to become supersaturated.

Men are also at increased risk for developing gallstones when their weight fluctuates. The risk increases proportionately with dramatic weight changes as well as with frequent weight cycling. For a significant in-depth study of gallbladder health issues, visit this website: http://umm.edu/health/medical/reports/articles/gallstones-and-gallbladder-disease .

If you have gallbladder disease, your gastroenterologist may recommend removing your gallbladder, according to the Florida Medical Clinic. You may need a referral from your family doctor if you don’t already have a specialist in this area of treatment. The surgical removal of the gallbladder is called a cholecystectomy. Gastroenterology is the study of the normal function and diseases of the esophagus, stomach, small intestine, colon and rectum, pancreas, gallbladder, bile ducts and liver. More details are found at this site: https://www.floridamedicalclinic.com/recognizing-the-symptoms-of-a-gallbladder-attack/ .

If you feel you may be experiencing symptoms of a gallbladder attack, get to your doctor or a medical facility as soon as possible to rule out other possible health issues. Get an action plan to deal with your pain and for any treatment that is recommended. The short and long term effects of getting a proper diagnosis and follow through is critical to reduce pain and suffering.

Until next time.