Tuesday, September 29, 2009

Health Care and ALS

In the Golden Era of American baseball, Lou Gehrig teamed with Babe Ruth to form baseball's most devastating hitting tandem ever. The Iron Horse had 13 consecutive seasons with both 100 runs scored and 100 RBIs, averaging 139 runs and 148 RBIs; set an American League mark with 184 RBIs in 1931; hit a record 23 grand slams; and won the 1934 Triple Crown. His .361 batting average in seven World Series led the Yankees to six titles. A true gentleman and a tragic figure, Gehrig's consecutive games-played streak ended at 2,130 when he was felled by a disease that later carried his name, according to the Baseball Hall of Fame. Lou was the most valuable player the Yankees ever had because he was the prime source of their greatest asset -- an implicit confidence in themselves and every man on the club.

According to LouGehrig.com, ALS (Amyotrophic Lateral Sclerosis), also known as Lou Gehrig's Disease, is an incurable fatal neuromuscular disease characterized by progressive muscle weakness, resulting in paralysis. The disease attacks nerve cells in the brain and spinal cord. Motor neurons, which control the movement of voluntary muscles, deteriorate and eventually die. When the motor neurons die, the brain can no longer initiate and control muscle movement. Because muscles no longer receive the messages they need in order to function, they gradually weaken and deteriorate. The initial signs of ALS may vary. Symptoms include stiffness and increasing muscle weakness, especially involving the hands and feet. The disease eventually affects speech, swallowing and breathing. Because ALS only attacks motor neurons that control the body's voluntary muscles, patients' minds and senses are not impaired. Approximately 14 cases of ALS are diagnosed each day nationwide. Most of those who develop the disease are between 40 and 70 years of age. The average expected survival time for those suffering from ALS is three to five years. At any given time, approximately 30,000 people in the United States are living with the disease. The cause of ALS remains unclear, and no cure exists. While there is no drug to prevent or cure the disease, recent breakthroughs have resulted in Rilutek, a drug that modestly slows the progression of ALS.

According to the ALS Association, ALS has cut short the lives of other such notable and courageous individuals as Hall of Fame pitcher Jim "Catfish" Hunter, Senator Jacob Javits, actors Michael Zaslow and David Niven, creator of Sesame Street Jon Stone, television producer Scott Brazil, boxing champion Ezzard Charles, NBA Hall of Fame basketball player George Yardley, pro football player Glenn Montgomery, golfer Jeff Julian, golf caddie Bruce Edwards, British soccer player Jimmy Johnstone, musician Lead Belly (Huddie Ledbetter), photographer Eddie Adams, entertainer Dennis Day, jazz musician Charles Mingus, composer Dimitri Shostakovich, former vice president of the United States Henry A. Wallace and U.S. Army General Maxwell Taylor. ALS is a neurodegenerative disease that usually attacks both upper and lower motor neurons. A common first symptom is a painless weakness in a hand, foot, arm or leg, which occurs in more than half of all cases. The biological mechanisms that cause ALS are only partially understood. The only known cause of ALS is a mutation of a specific gene: the SOD1 gene. This mutation is believed to make a defective protein that is toxic to motor nerve cells. The SOD1 mutation, however, accounts for only 1 or 2 percent of ALS cases, or 20 percent of the familial (inherited) cases. Familial ALS represents between five to 10 percent of all cases. The rest arise spontaneously and mysteriously, making seemingly random attacks on previously healthy adults.

ALS can strike anyone, anytime, according to the ALS Association. Physicians have limited choices for treating ALS, and the options that do exist have come into use within the last 10 years. Studies suggest that patients' length of survival and quality of life are enhanced by night-time breathing assistance early in the course of the disease and by aggressive application of alternate feeding options to assure good nutrition once swallowing becomes difficult. At this time, riluzole is the only drug that has been approved by the FDA for treatment of ALS. In clinical trials, riluzole has shown a slight benefit in modestly increasing survival time. Stem cell and gene therapy are promising areas of research. In a variety of studies, ALS mouse models are being used to develop treatments that may someday lead to similar human clinical trials. Gene therapy is one field of research where The ALS Association is concentrating support for more study. More significant advances of research into ALS has occurred in the last decade than all of the time since Charcot identified the disease. Advances in technology and the genetic revolution are aiding researchers in unlocking the ALS mystery. As more scientists focus on this perplexing disease, the outlook for new understanding brightens each day.

According to the Mayo Clinic, researchers are studying several possible causes of ALS, including: 1.) Free radicals. The inherited form of ALS often involves a mutation in a gene responsible for producing a strong antioxidant enzyme that protects your cells from damage caused by free radicals — the byproducts of oxygen metabolism.
2.) Glutamate. People who have ALS typically have higher than normal levels of glutamate, a chemical messenger in the brain, in their spinal fluid. Too much glutamate is known to be toxic to some nerve cells.
3.) Autoimmune responses. Sometimes, a person's immune system begins attacking some of his or her body's own normal cells, and scientists have speculated that such antibodies may trigger the process that results in ALS.

As the disease progresses, according to the Mayo Clinic, people with ALS experience one or more of the following complications:
1.) Breathing problems--ALS eventually paralyzes the muscles needed to breathe. Some devices to assist your breathing are worn only at night and are similar to devices used by people who have sleep apnea. In the latter stages of ALS, some people choose to have a tracheostomy and use the full-time help of a respirator that inflates and deflates their lungs. The most common cause of death for people with ALS is respiratory failure, usually within three to five years after symptoms begin.
2.) Eating problems--When the muscles that control swallowing are affected, people with ALS can develop malnutrition and dehydration. They are also at higher risk of aspirating food, liquids or secretions into the lungs, which can cause pneumonia. A feeding tube can reduce these risks.
3.) Dementia--People with ALS are at higher risk of developing:
--Frontotemporal dementia
--Alzheimer's disease

If you're having some of the early signs and symptoms of a neuromuscular disease such as ALS, you might first consult your family doctor, who will listen to your description of symptoms and do an initial physical examination. Then your doctor will probably refer you to a neurologist for further evaluation, according to the Mayo Clinic. Once you're under the care of a neurologist, it may still take time to establish the diagnosis. If you've been referred to an academic medical center, your evaluation may involve a team of neurologists and other doctors specializing in different aspects of motor neuron disease. While a thorough workup usually means you're getting top-notch care, the process can be stressful and frustrating unless your medical team keeps you informed. These strategies may give you a greater sense of control. Keep a symptom diary. Before you see a neurologist, start using a calendar or notebook to jot down the time and circumstances each time you notice problems with walking, hand coordination, speech, swallowing or involuntary muscle movements. Your observations may reveal a pattern pointing to a specific diagnosis. Find one 'go-to' neurologist or neurology nurse specialist. If you see more than one doctor and visit more than one department, you need a coordinator who's familiar with your overall situation, willing to answer your questions and prepared to make your concerns known to the other people involved in your care. Your family doctor or the neurologist who orders your tests and subspecialty consultations may be the best candidate, but in some institutions, care coordination is the responsibility of a nurse, social worker, or case manager. Plus, your family doctor will carefully review your family's medical history and your signs and symptoms. Your neurologist and your family doctor may both check your neurological health by testing:
--Muscle strength
--Muscle tone
--Senses of touch and sight

Learning you have amyotrophic lateral sclerosis can be devastating. According to the Mayo Clinic, the following tips may help you and your family cope:
--Take time to grieve. The news that you have a fatal condition that will rob you of your mobility and independence is often nothing less than shocking. If you are newly diagnosed, you and your family will likely experience a period of mourning and grief.
--Be hopeful. Some people with amyotrophic lateral sclerosis live much longer than the three to five years typically associated with this condition. Some live 10 years or more. Keeping hope alive is vital for people with ALS.
--Think beyond the physical changes. ALS doesn't typically affect the intellect or spirit. Many people with amyotrophic lateral sclerosis lead rich, rewarding lives. Try to think of ALS as only one part of your life, not your entire identity.
--Join a support group. You may find comfort in sharing your concerns in a support group with others who have ALS. Your family members and friends helping with your care also may benefit from a support group of others who care for people with amyotrophic lateral sclerosis. Find support groups in your area by talking to your doctor or by contacting the ALS Association.
--Make decisions now about your future medical care. Planning for the future allows you to be in control of decisions about your life and your care. With the help of your doctor or hospice nurse, you can decide whether or not you want certain life-extending procedures. And you can determine where you want to spend your final days.

Talking about these issues isn't easy. But facing your anxieties about the future may help you better enjoy life today.

Until next time. Let me know what you think.

Monday, September 28, 2009

Health Care and Consumerism in the Marketplace

As U.S. health care costs continue to escalate, Consumer Directed Health Care (CDH) can be a positive force for change that allows patients to gain greater control over their healthcare decisions, allow employers to reduce their healthcare benefit expenditure, enable insurers to increase membership by making more affordable insurance available and provide opportunities for financial institutions to expand their presence in the healthcare industry, according to MBProject.org. CDH is expected to lower the overall cost of healthcare through market competition and fostering the expansion of solutions that can:
--Empower consumers by providing quality and pricing information, self-pay calculators, and expanded payment options;
--Lower employer fringe benefit/healthcare costs; and,
--Assist providers in receiving payments (debit cards, collection tools, etc.), and
expand the role of banks (health savings accounts, tools to expedite collection, such as payment cards and on-line payments).

The current heated debate in Congress may damage these concepts if the existing options on the plate are enacted in their current format. However, it is too soon to provide a death watch for any CDH options even if the federal government decides to enact a health care bill. CDH has the ability to reduce costs, and has proven in many cases to provide savings where it is applied. The entire health care industry is waiting for the final act in an ongoing struggle between socialized medicine, consumerism, patient rights, medical costs, freedom of choice in the market place, and the uninsured. Options are available now in the health care community that provide more transparency, and Americans are more empowered now than ever with the advent of medical information on reputable websites on the internet. More research is being conducted now in several medical fields helping to reduce the lack of knowledge by consumers and health care providers. Information technology has improved dramatically, although it still needs more ownership by the medical community to help reduce the cost of health care.

CDH members appear to be typically younger and more computer savvy than the general population, according to MBProject. These patients seek online billing and payment solutions, want to register (or pre-register) online and schedule services online. Many providers say they are in the process of planning to offer these on-line capabilities. Of the on-line access already available for patients most providers start with online bill payment. Making services available to patients online was said to reduce staff labor, making it available for other functions, such as eligibility checking and additional follow-up. In a nutshell, according to MBlog.com, healthcare providers need to recognize that the tools they need today are not the tools they have from yesterday…they have to realize that they’re at a severe disadvantage unless they re-tool for this new patient responsibility paradigm … today many providers are basically bringing knives to a gunfight.

Consumer Directed Healthcare (CDH) typically combines a high deductible health insurance plan (HDHP) with a personal saving/spending account, from which medical expenses can be paid directly, according to MBlog.com. Most common spending account plans are Health Savings Accounts and Health Reimbursement Arrangements. Although not to be considered the panacea for all Americans who need health care, the CDH arrangement does work for many employers and their workers. CDH is a growing portion of $2 trillion market:
--CDH plans grew by 43% in 2008. CDH plans are over 14.9M accounts in 2009.
--There is $5.3B value held in Health Savings Accounts which is expected to grow to $16B by 2010.
--Consumers spent over $250B on out of pocket healthcare expenses in 2008. $242B paid for by cash, check, credit, debit. The remaining $8B was paid by some form of Healthcare card
--According to the US Census Bureau consumers will pay over $1000 annually in out-of-pocket healthcare related expenses by 2012 up from $800 today.
--The proportion of patient payments is projected to rise over the next few years from 15% to 21%.

According to MBlog, there are key stakeholders in Consumer Directed Health Care:
1.) Consumers: Provides economic incentives to manage their own care. Ability to build a medical nest egg.
2.) Employers: Reduce benefit costs from lower premiums and FICA tax savings.
3.) Government: Proponents hope to drive down healthcare costs by stimulating market competition.
4.) Payers: Deliver high deductible health plans along with consumer tools such as quality and health information.
5.) Banks: Deliver Health Savings Accounts linked to a debit card. Offer online payment tools.
6.) Providers: Must manage rising patient payment portion resulting from higher co-pays and deductibles. Less predictability in collections as responsible party becomes blurred further.

The medical community and health care providers in general have been slow to accommodate CDH plans primarily due to factors related to cost, staffing, and other business issues. The health care industry has recognized the growth of consumerism but has been slow in certain areas to improve the ability for patients to benefit. According to MBlog, the many in the health care industry should strongly consider movement toward and adoption of the following recommendations:
--Assemble project team for examining current practices, evaluating options, making recommendations, and implementing new programs to adapt to CDHP growth trends and impact on their organization.
--Evaluate existing processes and tools in place today, and evaluate best practices to improve quality of care and transparency.
--Analyze method for managing commercial and governmental posting of EOB, ERA to speed posting process and potentially free up resources.
--Work with strategic banking partner to streamline revenue cycle activities as much as possible and to understand financial tools and options that are available.
--Determine suitability for new processes, tools, and/or possible upgrades to existing systems and capabilities.
--Prepare to implement new tools, software, staffing model, training programs, financial tools as needed.

According to Aetna.com, consumerism is not cost-shifting in disguise. Premiums in consumer-directed plans are more affordable than in most traditional plans, meaning more individuals can obtain coverage. Consumer-directed plan enrollees have demonstrated as much as a 23% increase in the use of preventive care, which both improves health and saves money. Also, consumerism gives individuals more control over their health care spending and informs them about the true cost of care, which makes them more cost conscious. Consumer-directed products have four critical attributes:
--They give individuals better access to information and more control over their own health care, allowing them to make informed decisions about treatment and provider options.
--They increase consumer involvement and raise awareness about the real cost of health care, which research has shown to reduce total health care spending.
--Featuring lower monthly premiums, these products make it more affordable for employers to offer coverage and for individuals to purchase it.
--Finally, consumer-directed products encourage healthy behavior.

Consumerism in health care is a good thing, no matter how much political naysayers may protest. Saving money is a very good thing, and giving Americans the power to make those choices helps reduce the cost and provide multiple options. The power of choice is a good thing, and the ability to hold medical providers accountable for the procedures and tests they wish to perform gives consumers more power to control their health care and their health care dollars. The medical community must recognize that consumers need help and quality care, and they need trustworthy information, and they need good advice. When the market place, consumers, and the health care industry work together to accomplish these goals, medicine and the healing process works.

Until next time. Let me know what you think.

Thursday, September 24, 2009

Health Care and Indigents

Health care for the indigent is a major problem in the United States. According to the National Institutes for Health, a very large pool of individuals under age 65 are at risk of being medically indigent. A myriad of health programs for some economically disadvantaged individuals do exist, but their level of funding has fluctuated over time--and many poor individuals must rely entirely on the generosity of a relatively small number of hospitals and other providers for their care. Economic pressures on these providers as well as structural changes in the health care sector can only adversely affect the amount of charity care that they offer. It is clear that a well-planned solution to indigent care in the United States, rather than a piecemeal approach, is needed.

According to UTSystem.org, although the provision of health care for this population is often characterized as indigent care, the population is extremely heterogeneous with only a portion of the population truly living in poverty. As well described in a recent series of six reports from the Institute of Medicine, the population includes a large proportion of working individuals who can support themselves quite satisfactorily but cannot afford the rapidly rising cost of health insurance. In this society in which health insurance is most commonly employer-based, those who work for organizations with few employees or who move from employer to employer often cannot maintain health insurance coverage. A significant portion of the population receives coverage through Medicaid or through the state Children's Health Insurance Program (SCHIP). These individuals often have limited access to care. Limited access is available to migratory farm workers, undocumented aliens, individuals between jobs and certain ethnic and racial groups.

Institute of Medicine studies have clearly documented the negative impact of the uninsured on the health of individuals and families; the negative economic consequences of inadequate healthcare for medically indigent patients on their communities; the extraordinary stresses imposed upon health providers, particularly hospitals who are providing increasing amounts of uncompensated care; and the overall cost to society of a system which focuses on providing emergency care rather than primary care for the medically indigent. A combination of demographic changes and continued rise in healthcare costs suggest that these challenges will progressively increase for the foreseeable future, according to UTSystem.org.

States have criteria in place to handle indigent health care. For example, Colorado has information on the official state website that provides instructions on qualifying for this type of health care, and it is not insurance. See more at about it at this website portal: http://www.colorado.gov/cs/Satellite/HCPF/HCPF/1214299805914 . The State of Georgia established an Indigent Health Trust Fund in 1990 to handle those who qualify as a resident in that state: http://dch.georgia.gov/00/channel_title/0,2094,31446711_31959660,00.html. And in Texas, individual counties are responsible for indigent care.

Providing care to the medically indigent is draining the financial resources of many hospitals, according to BNet.com. While a unified plan has yet to emerge from Congress, several proposals are being considered. These range from expanding Medicaid to requiring that employers provide a minimum level of healthcare benefits to employees. Meanwhile, states have begun to cope with the problem on their own. Special taxes, lotteries, supplements, and universal insurance plans are among the solutions being tested. Despite these efforts, the question of who will pay for those who cannot remains largely unanswered. Historically, hospitals shifted the cost of indigent care to private payers through increased charges. But a growing number of payers that use negotiated price contracts and preferred provider arrangements are refusing to recognize and pay for hospitals' costs of providing indigent care. Payment shortfalls, caused by inadequate third-party payments, challenge hospitals to find other sources to finance uncompensated services. Three major factors have added to this burden:
--Fewer payers are willing to share in the cost of providing indigent care.
--The cost of providing care has increased significantly.
--The volume of uninsured services has grown.

According to the Savannah Business Journal, state laws vary widely as to what is defined as a community benefit that a hospital provides. Some hospitals include bad debt, un-reimbursed cost of Medicare, charity care, cash and in-kind contributions, community health improvement services, health professionals education, medical research, economic development projects and housing programs. Also, many physicians will not accept patients who are on Medicaid in those years between 18 and 65, because they “lose money on those patients. They’re not welcome there. And they refer them over to the ER of the local hospital, which compounds the situation in the ER. With Medicaid, the reimbursement to physicians is very low. Some hospitals have had no choice but to pay physicians to care for patients that have presented themselves to the hospitals in order to fulfill their responsibility as a community hospital. Patients that are indigent or “self-pay" typically have little to no funds to pay for health care, where the odds of collecting any money for services is a relatively low percentage. And, according to the Sarasota County Beat, the profile of the typical indigent care recipient is someone who has a job, but does not have insurance.

According to NetSci.net, there are many approaches for developing and managing healthcare programs aimed at serving the indigent population. Common problems all of these programs face are:
--Not enough funding to cover the entire indigent population.
--Limited time and staff.
--Reporting requirements.
--Administrative challenges.

Counties pay medical claims for the poor at a reduced, or Medicaid rate, but health providers are not required to bill patients, indigent or otherwise, at the lower rate, according to the Rapid City Journal. And, it's logical that an uninsured person who receives health services should not receive a discounted billing rate. If Medicaid rates or less are paid for reimbursement, then hospitals are going to have to get that money from somewhere. If a person had a catastrophic illness and could have afforded health insurance, why should everyone else have to pay for that? On balance, there should be no problem helping those who are truly poor. Everybody's got access to health care. It's just a question of who pays for it. The indigent-care system could benefit from some transparency as it could give greater opportunity for public accountability. Rising costs for indigent care place unfair burdens on those taxpayers who pay their own health costs. Large health care bills create a conflict between individual privacy and the public's right to know. Taxpayers should be able to know precisely where their money is being spent.

In the Bible, Jesus is quoted as saying that "the poor you will have with you always." Until modern times in the U.S., families and charities took care of the indigent. In many parts of the world, this is still how it works. However, now Americans feel they are more sophisticated, and mandate that the government should take care of paying for indigent health care needs. Yet, these costs still are paid for by taxes collected from American taxpayers. So, in effect, those who receive the care have it paid for by those who pay the bill and don't receive the services. The pending legislation in Congress may offer a solution, but it will be an expensive one and have long lasting detrimental economic ramifications. Unfortunately, if you get sick, you need to see a doctor or go to an emergency room. There is no way around that. Even poor people need to get and stay healthy. The solutions are tough, but necessary. Government run health care? No. A better way to help the poor? Yes. Let's figure it out before the country goes bankrupt.

Until next time. Let me know what you think.

Friday, September 18, 2009

Health Care and Hearing Loss

According to the Mayo Clinic, gradual hearing loss that occurs as you age (presbycusis) is common. According to the National Institutes of Health, an estimated one-third of Americans between the ages of 65 and 75 and close to one-half of those older than 75 have some degree of hearing loss. Doctors believe that heredity and chronic exposure to loud noises are the main factors that contribute to hearing loss over time. Other factors, such as earwax blockage, can prevent your ears from conducting sounds as well as they should. You can't reverse hearing loss. However, you don't have to live in a world of quieter, less distinct sounds. You and your doctor or hearing specialist can take steps to improve what you hear.
According to the American Speech-Language-Hearing Association (ASHA), when describing hearing loss professionals generally look at three attributes: type of hearing loss, degree of hearing loss, and the configuration of the hearing loss. Hearing loss can be categorized by where or what part of the auditory system is damaged. There are three basic types of hearing loss: conductive hearing loss, sensorineural hearing loss and mixed hearing loss.
1.) Conductive hearing loss occurs when sound is not conducted efficiently through the outer ear canal to the eardrum and the tiny bones, or ossicles, of the middle ear. Conductive hearing loss usually involves a reduction in sound level, or the ability to hear faint sounds. This type of hearing loss can often be medically or surgically corrected. Examples of conditions that may cause a conductive hearing loss include:
--Conditions associated with middle ear pathology such as fluid in the middle ear from colds, allergies (serous otitis media), poor eustachian tube function, ear infection (otitis media), perforated eardrum, benign tumors.
--Impacted earwax (cerumen).
--Infection in the ear canal (external otitis).
--Presence of a foreign body.
--Absence or malformation of the outer ear, ear canal, or middle ear.
2.) Sensorineural hearing loss occurs when there is damage to the inner ear (cochlea) or to the nerve pathways from the inner ear (retrocochlear) to the brain. Sensorineural hearing loss cannot be medically or surgically corrected. It is a permanent loss. Sensorineural hearing loss not only involves a reduction in sound level, or ability to hear faint sounds, but also affects speech understanding, or ability to hear clearly. Sensorineural hearing loss can be caused by diseases, birth injury, drugs that are toxic to the auditory system, and genetic syndromes. Sensorineural hearing loss may also occur as a result of noise exposure, viruses, head trauma, aging, and tumors. Sometimes a conductive hearing loss occurs in combination with a sensorineural hearing loss. In other words, there may be damage in the outer or middle ear and in the inner ear (cochlea) or auditory nerve. When this occurs, the hearing loss is referred to as a mixed hearing loss.
3.) Unilateral hearing loss (UHL) means that hearing is normal in one ear but there is hearing loss in the other ear. The hearing loss can range from mild to very severe. Approximately one out of 1000 children is born with UHL. Unilateral hearing loss can occur in both adults and children. Nearly 3% of school-aged children have UHL.Children with UHL are at higher risk for having academic, speech/language and social/emotional difficulties than their normal hearing peers. Some children with UHL experience these difficulties but others do not. Many times we do not know the cause of hearing loss. Below are some possible causes of UHL:
--Hearing loss that runs in the family (genetic or hereditary).
--An outer, middle or inner ear abnormality.
--Specific syndromes.
--Specific illnesses or infections.
--Skull (temporal bone) fractures.
--Excessive or extreme noise exposure.
--Traumatic brain injury.
Degree of hearing loss refers to the severity of the loss, according to ASHA. The numbers are representative of the patient's thresholds, or the softest intensity at which sound is perceived. The configuration or shape of the hearing loss refers to the extent of hearing loss at each frequency and the overall picture of hearing that is created. For example, a hearing loss that only affects the high frequencies would be described as a high-frequency loss. Its configuration would show good hearing in the low frequencies and poor hearing in the high frequencies. On the other hand, if only the low frequencies are affected, the configuration would show poorer hearing for low tones and better hearing for high tones. Some hearing loss configurations are flat, indicating the same amount of hearing loss for low and high tones. Other descriptors associated with hearing loss are:
--Bilateral versus unilateral. Bilateral hearing loss means both ears are affected. Unilateral hearing loss means only one ear is affected.
--Symmetrical versus asymmetrical. Symmetrical hearing loss means that the degree and configuration of hearing loss are the same in each ear. An asymmetrical hearing loss is one in which the degree and/or configuration of the loss is different for each ear.
--Progressive versus sudden hearing loss. Progressive hearing loss is a hearing loss that becomes increasingly worse over time. A sudden hearing loss is one that has an acute or rapid onset and therefore occurs quickly, requiring immediate medical attention to determine its cause and treatment.
--Fluctuating versus stable hearing loss. Some hearing losses change—sometimes getting better, sometimes getting worse. Fluctuating hearing loss is typically a symptom of conductive hearing loss caused by ear infection and middle ear fluid, but also presents in other conditions such as Meniere's disease.
ASHA suggests ways to consider if you have hearing loss. For adults:
--You frequently complain that people mumble, speech is not clear, or you hear only parts of conversations when people are talking.
--You often ask people to repeat what they said.
--Your friends or relatives tell you that you don't seem to hear very well.
--You do not laugh at jokes because you miss too much of the story.
--You need to ask others about the details of a meeting that you just attended.
--Others say that you play the TV or radio too loudly.
--You cannot hear the doorbell or the telephone.
--You find that looking at people when they talk to you makes it somewhat easier to understand, especially when you're in a noisy place or where there are competing conversations.
For children:
--Your child is inconsistently responding to sound
--Language and speech development is delayed
--Speech is unclear.
--Sound is turned up on electronic equipment (radio, TV, cd player, etc.)
--Your child does not follow directions
--Your child often says "Huh?"
--Your child does not respond when called.
If you have concerns, seek the services of an audiologist certified by the American Speech-Language-Hearing Association.
According to eMedicineHealth.com, the likelihood that hearing will return depends on the cause of the hearing loss. Hearing will usually return to normal with removal of foreign bodies in the canal, removal of wax in the canal, and treatment of ear canal infections (otitis externa).
Hearing will usually return to normal after treatment of middle ear infection (otitis media).
Antibiotics are usually given for 7-14 days. Rarely, a second course of different antibiotics may be necessary if the infection does not respond to the first type of antibiotic. It may, however, take a longer period of time for the fluid in the middle ear to resolve completely and the hearing to return to normal. Injuries to the tympanic membrane will usually heal on their own. Once healed, hearing usually returns to normal. If the perforation is large (bigger than 50% of the membrane), surgery may be required to fix the eardrum. A skin graft is sometimes used to replace or fix the tympanic membrane. Hearing loss due to drugs may or may not return with withdrawal of the drug. No proven treatment restores the hearing other than removal of the drug. Some doctors may try giving drugs known as steroids to restore hearing. Hearing loss due to infections such as meningitis may not return. The doctor may try using steroids during the illness to decrease the amount of hearing loss. Hearing loss due to Ménière disease, acoustic neuroma, and age is usually permanent.
If you cannot determine the cause of your hearing loss, see a doctor, according to eMedicineHealth.com. Other symptoms that require a trip to the doctor include the following:
--You have associated symptoms such as ringing in the ears or vertigo.
--You have a fever or pain.
--You are taking any medications that affect hearing.
--Your hearing loss is sudden and prolonged.
Do not delay getting medical attention if your hearing loss is associated with any of the following:
--Recent or present foreign body in the ear
--Fluid or blood coming from the ear
--Recent pressure changes (diving)
--Fever not controlled with acetaminophen (Tylenol)
--Severe trauma to the head
Hearing loss is a serious health care matter. The severity can be temporary or permanent based on the type of loss, injury, or illness. See your primary care physician if the hearing loss is not caused by a traumatic medical situation. Always seek emergency medical care if the hearing loss is sudden and severe. Otherwise, take precautions to prevent hearing loss that are a common sense approach. Your hearing is precious. Don't take it for granted.
Until next time. Let me know what you think.

Tuesday, September 8, 2009

Health Care and Consumer Directed Options

America--land of the free and home of the brave. At least that is what our nation has been historically known for throughout the world. Come to America and realize your dream, including the right to work hard and be compensated fairly for your efforts. The Statue of Liberty, long a beacon welcoming immigrants to our shores, even states that anyone who is seeking freedom can come to America. The quote: “Give me your tired, your poor, Your huddled masses yearning to breathe free, The wretched refuse of your teeming shore. Send these, the homeless, tempest-tost to me, I lift my lamp beside the golden door!”, is emblazened on her as a stirring statement of the American ethos, as described by LegalLanguage.com.

Among the fundamental advantages that Americans have is the freedom to choose. Individuals and families can choose vocations, lifestyle, residency, and much more. As part of that freedom, the right to choose your own health care options makes perfect fiscal and common sense. And the market place has been moving toward consumer centric health care slowly but surely to take advantage of this type of buyer. Consumerism in health care is a trend that has become more and more popular in recent years. According to Aetna.com:
--Consumerism in health care is based on the idea that individuals should have greater control over decisions affecting their health care.
--A number of innovative products and plans are advancing the consumerism trend. Health Savings Accounts (HSAs) and Health Reimbursement Arrangements (HRAs) are savings vehicles generally paired with High-Deductible Health Plans (HDHPs).
--Consumer-directed health care is a common-sense approach for addressing two of the most vexing challenges in our health care system: controlling costs and improving access to affordable, high-quality care.

Consumer-directed health plans, according to Aetna, typically consist of three major components: a health fund or health savings account, a high-deductible plan that includes preventive care not charged against the deductible, and access to information and tools that help consumers make better health care decisions. Monthly premiums are lower in these plans and, once the deductible is met, consumer-directed plans pay benefits like traditional health plans. Individuals typically use funds from an HSA or HRA to cover all or a portion of the plan's deductible. HSAs are personal savings vehicles - similar to IRAs or 401(k) plans - that allow individuals and, in some cases, their employers to invest tax-free dollars in an account to pay for routine health care or to save for future health care expenses. Funds put into an HSA belong to the consumer, regardless of changes in employment or insurance status, and they can be carried over year to year. HRAs are entirely employer-funded accounts that employees can draw upon to pay qualified medical expenses and they too can be rolled over year to year.

According to Aetna, these new consumer-directed products have four critical attributes:
1.) They give individuals better access to information and more control over their own health care, allowing them to make informed decisions about treatment and provider options.
2.) They increase consumer involvement and raise awareness about the real cost of health care, which research has shown to reduce total health care spending.
3.) Featuring lower monthly premiums, these products make it more affordable for employers to offer coverage and for individuals to purchase it.
4.) Finally, consumer-directed products encourage healthy behavior. Enrollees do not pay out of pocket for routine physicals, child immunizations, obesity weight-loss programs, routine prenatal care, etc.

According to HealthAffairs.org, there is a struggle between Consumerism and Managed Competition. Consumerism and managed competition share the market paradigm that social resources, including medical care, should be allocated based on individual rather than collective decisions. Informed and price-conscious individual choices represent the values and preferences of the patient better than the choices of even the most benevolent third party. The performance of the delivery system is enhanced by consumer and provider incentives that align the pursuit of individual self-interest with the social interest in promoting a high-quality, cost-effective system of care. Collective-choice mechanisms such as regulatory agencies, professional associations, and corporate organizations find their utility in supporting, and their disutility in displacing, individual choices. The core of medical care, the clinical encounter between patient and physician, is beset by the uncertainties of illness and therapy, the social imperative to subsidize care for those unable to pay, and the proclivity of patients to demand more services if someone else is paying and for physicians to adjust their supply depending on how they are paid. Choice and competition in the clinical context therefore need to be embedded in a larger institutional framework, similar to that for insurance coverage, where benefit and network designs specify the consumer’s and the collectivity’s financial responsibilities and create incentives for balancing cost, quality, and other service characteristics.

As for genuine consumer-directed health care, according to Workforce.com, the rise of consumerism requires more effort, energy and involvement by all stakeholders to successfully launch and sustain. For plan sponsors, that means such commitments as adopting a documented multi-year health strategy; adding account-based or consumerist health plans as significant––if not the only––options over time; and making meaningful contributions to any health account so that most of the participants can reasonably expect to manage their health with the funds provided. It also demands a concerted effort to provide support, tools and information to help employees become more involved and informed health care consumers. And all of this needs to be wrapped in a compelling communication package with ongoing educational elements that continue long after implementation. But with consumer-driven health care done right, positive behavior changes, improved companywide health status and cost savings can often be seen over time. And even then, employers need to monitor the program, adjust elements as necessary and guard against unintended consequences such as care avoidance or a disproportionate impact on lower-paid or ill workers.

According to Deloitte.com, Consumerism is a fact of life and way of business in many sectors: companies consciously adapt how they package, deliver and price their products and services to match consumers’ needs and preferences. But the health care sector has been slow to adopt this approach. In fact, many employers, health plans and health care providers are faced with a business model that views individuals as traditional “patients” who are generally uninformed about their options and unable to distinguish between systems with varying levels of service, prices and quality. Employers, health plans and providers who fail to recognize and respond to this new reality may miss critical business opportunities generated by consumerism’s transformational force. To better align the system with their true level of need and prevent unnecessary care, individuals must become more accountable for their own health status, more engaged in the selection of the products and services they use, and more knowledgeable about the prices associated with their choices. This fundamental behavior shift must work in conjunction with system improvements designed to better deliver care and ensure alignment of financial incentives. A broader overview is available online at this site: http://www.deloitte.com/view/en_US/us/Insights/Browse-by-Content-Type/deloitte-review/article/46fba7d2770fb110VgnVCM100000ba42f00aRCRD.htm

Consumerism, according to Workforce.com, is fought not only in the trenches of innovative programs to create involved and informed consumers, but also on the battlefields of good benefit and health-plan management basics, vendor negotiations, network discounts and access, disease management programs, and health assessment and improvement efforts. But amid all the uncertainties and complexities that define the health care landscape in today’s increasingly global, fiscally fragile corporate universe, the advent of consumerism sounds a note of sense and sustainability. Its success calls for a commitment to consumer-driven health care––with no illusions.

As individuals assume greater responsibility for their health-related decisions, employers, health plans and providers not making the shift will find it increasingly difficult to attract and retain employees, enrollees and patients, according to Deloitte. Savvy, forward-thinking organizations already recognize the consumer variation and untapped opportunities that exist in the health care market. They are responding by seeking to offer new approaches to care and financing, modifying incentives, and building support systems to encourage both consumers and providers to shift their behaviors and attitudes in ways that will enable consumerism to gain momentum. Health plans, providers, employers, government agencies, associations and other players are making some progress in developing the products, information, online services and other tools that consumers need. The opportunity to fill this gap with new, innovative products and services is open to all. Companies tailoring their products and services to meet the needs of the new health care market will gain a tremendous advantage as the system continues its transformation toward a consumer-centric model.

Consumerism, not public option or government run health care, is one of the best models for Americans. The market place can support it, and both individuals and families can benefit from it. Americans enjoy and deserve liberty, not tyranny, when it comes to managing their health care. There is no need to mandate coverage with a single payer system overseen by bureaucratic fiat.

Until next time. Let me know what you think.

Wednesday, September 2, 2009

Health Care and Radiation

Ever have to get an X-ray or diagnostic procedure where radiation is used? Have you had radiation treatment for cancer or know someone who has? Do you work in radiology as a professional or have been exposed to radiation therapy? Have you been to the dentist and had bitewings taken of your teeth? What about MRIs, CT scans, and other tests? If you have, you may have concerns over the safety of radiation, even in small doses. Often, people express concern about the risks of the radiation exposure(s) from these exams. According to the Health Physics Society (HPS), people are encouraged to become well informed about the risks and benefits of all uses of radiation; and in the case of medical exposures, it is good to be an active participant in the process. This includes an understanding of the procedures involved and the possible risks associated with them.

According to the EPA, in general, the amount and duration of radiation exposure affects the severity or type of health effect. There are two broad categories of health effects: stochastic and non-stochastic:
1). Stochastic Health Effects:
Stochastic effects are associated with long-term, low-level (chronic) exposure to radiation. ("Stochastic" refers to the likelihood that something will happen.) Increased levels of exposure make these health effects more likely to occur, but do not influence the type or severity of the effect. Cancer is considered by most people the primary health effect from radiation exposure. Simply put, cancer is the uncontrolled growth of cells. Ordinarily, natural processes control the rate at which cells grow and replace themselves. They also control the body's processes for repairing or replacing damaged tissue. Damage occurring at the cellular or molecular level, can disrupt the control processes, permitting the uncontrolled growth of cells--cancer. This is why ionizing radiation's ability to break chemical bonds in atoms and molecules makes it such a potent carcinogen. Other stochastic effects also occur. Radiation can cause changes in DNA, the "blueprints" that ensure cell repair and replacement produces a perfect copy of the original cell. Changes in DNA are called mutations. Sometimes the body fails to repair these mutations or even creates mutations during repair. The mutations can be teratogenic or genetic. Teratogenic mutations are caused by exposure of the fetus in the uterus and affect only the individual who was exposed. Genetic mutations are passed on to offspring.

2.) Non-Stochastic Health Effects:
Non-stochastic effects appear in cases of exposure to high levels of radiation, and become more severe as the exposure increases. Short-term, high-level exposure is referred to as 'acute' exposure. Many non-cancerous health effects of radiation are non-stochastic. Unlike cancer, health effects from 'acute' exposure to radiation usually appear quickly. Acute health effects include burns and radiation sickness. Radiation sickness is also called 'radiation poisoning.' It can cause premature aging or even death. If the dose is fatal, death usually occurs within two months. The symptoms of radiation sickness include: nausea, weakness, hair loss, skin burns or diminished organ function. Medical patients receiving radiation treatments often experience acute effects, because they are receiving relatively high "bursts" of radiation during treatment.

According to the EPA, there is no firm basis for setting a "safe" level of exposure above background for stochastic effects. Many sources emit radiation that is well below natural background levels. This makes it extremely difficult to isolate its stochastic effects. In setting limits, the EPA makes the conservative (cautious) assumption that any increase in radiation exposure is accompanied by an increased risk of stochastic effects. Some scientists assert that low levels of radiation are beneficial to health (this idea is known as hormesis). However, there do appear to be threshold exposures for the various non-stochastic effects. Because children are growing more rapidly, there are more cells dividing and a greater opportunity for radiation to disrupt the process. EPA's radiation protection standards take into account the differences in the sensitivity due to age and gender. Fetuses are also highly sensitive to radiation. The resulting effects depend on which systems are developing at the time of exposure. Health physicists generally agree on limiting a person's exposure beyond background radiation to about 100 mrem per year from all sources. Exceptions are occupational, medical or accidental exposures. (Medical X-rays generally deliver less than 10 mrem). The EPA and other regulatory agencies generally limit exposures from specific source to the public to levels well under 100 mrem. This is far below the exposure levels that cause acute health effects.

According to Medical News Today, though, based upon an evaluation of the peer-reviewed literature that details the improvements brought about by such technologies, it is reasonable to conclude that millions of lives have been saved and millions more dramatically improved as a result of these imaging technologies. Technological advances and innovations in medicine have produced significant benefits for society noted by healthier, longer lives. Early disease diagnosis and some disease treatments involve imaging exams that expose us to radiation. With radiation, physicians have the capability to see inside the human body, see if any organ is not functioning properly, determine if a growth is cancer, treat disease, and look to see if our disease is gone after treatment. Timely detection and treatment of disease is critical to improving outcomes. As with any medical imaging procedure, individuals need to discuss with their physician the need for the procedure and the potential benefit of having it performed. Imaging procedures must be justified based on a need for information to improve the patient's health condition.

Health physicists generally agree on limiting a person's exposure beyond background radiation to about 100 mrem per year from all sources, according to the EPA. Exceptions are occupational, medical or accidental exposures. (Medical X-rays generally deliver less than 10 mrem). EPA and other regulatory agencies generally limit exposures from specific source to the public to levels well under 100 mrem. This is far below the exposure levels that cause acute health effects. Both the type of radiation to which the person is exposed and the pathway by which they are exposed influence health effects. Different types of radiation vary in their ability to damage different kinds of tissue. Radiation and radiation emitters (radionuclides) can expose the whole body (direct exposure) or expose tissues inside the body when inhaled or ingested.

Other than cancer, the most prominent long-term health effects are teratogenic and genetic mutations, according to the EPA. Teratogenic mutations result from the exposure of fetuses (unborn children) to radiation. They can include smaller head or brain size, poorly formed eyes, abnormally slow growth, and mental retardation. Studies indicate that fetuses are most sensitive between about eight to fifteen weeks after conception. They remain somewhat less sensitive between six and twenty-five weeks old. The relationship between dose and mental retardation is not known exactly. However, scientists estimate that if 1,000 fetuses that were between eight and fifteen weeks old were exposed to one rem, four fetuses would become mentally retarded. If the fetuses were between sixteen and twenty-five weeks old, it is estimated that one of them would be mentally retarded. Genetic effects are those that can be passed from parent to child. Health physicists estimate that about fifty severe hereditary effects will occur in a group of one million live-born children whose parents were both exposed to one rem. About one hundred twenty severe hereditary effects would occur in all descendants. In comparison, all other causes of genetic effects result in as many as 100,000 severe hereditary effects in one million live-born children. These genetic effects include those that occur spontaneously ("just happen") as well as those that have non-radioactive causes.

Radiation sickness, according to RightHealth.com, is illness and symptoms resulting from excessive exposure to radiation. Exposure may be accidental or intentional (as in radiation therapy). Radiation sickness results when humans (or other animals) are exposed to very large doses of ionizing radiation. Radiation exposure can occur as a single large exposure (acute), or a series of small exposures spread over time (chronic). Radiation sickness is generally associated with acute exposure and has a characteristic set of symptoms that appear in an orderly fashion. Chronic exposure is usually associated with delayed medical problems such as cancer and premature aging, which may happen over a long period of time. The severity of symptoms and illness (acute radiation sickness) depends on the type and amount of radiation, how long you were exposed, and which part of the body was exposed. Symptoms of radiation sickness may occur immediately after exposure, or over the next few days, weeks, or months. Children who receive radiation treatments or who are accidentally exposed to radiation will be treated based on their symptoms and their blood cell counts. Frequent blood studies are necessary and require a small puncture through the skin into a vein to obtain blood samples. Symptoms include the following:
--Bleeding from the nose, mouth, gums, and rectum
--Bloody stool
--Hair loss
--Inflammation of exposed areas (redness, tenderness, swelling, bleeding)
--Mouth ulcers
--Nausea and vomiting
--Open sores on the skin
--Skin burns (redness, blistering)
--Sloughing of skin
--Ulcers in the esophagus, stomach or intestines
--Vomiting blood
Your doctor will advise you how best to treat these symptoms. Medications may be prescribed to help reduce nausea, vomiting, and pain. Blood transfusions may be given for anemia . And, antibiotics are used to prevent or fight infections.

Here is how to prevent radiation sickness, according to RightHealth.com:
1.) Avoid unnecessary exposure to radiation.
2.)Persons working in radiation hazard areas should wear badges to measure their exposure levels.
3.) Protective shields should always be placed over the parts of the body not being treated or studied during x-ray imaging tests or radiation therapy.

Radiation has proven to be an effective way to find and cure diseases and to help with controlling the growth of certain diseases like cancer. However, it must be used in moderation and with protected methods by health care providers and technicians.

Until next time. Let me know what you think.

Tuesday, September 1, 2009

Health Care and Bi-Polar Disorder

Bipolar disorder, also known as manic-depressive illness, is a brain disorder that causes unusual shifts in mood, energy, activity levels, and the ability to carry out day-to-day tasks. Symptoms of bipolar disorder are severe, according to the National Institute of Mental Health (NIMH). They are different from the normal ups and downs that everyone goes through from time to time. Bipolar disorder symptoms can result in damaged relationships, poor job or school performance, and even suicide. But bipolar disorder can be treated, and people with this illness can lead full and productive lives. Bipolar disorder often develops in a person's late teens or early adult years.

Bipolar disorder affects approximately 5.7 million American adults, or about 2.6 percent of the U.S. population age 18 and older in a given year, according to the NIMH. The median age of onset for bipolar disorders is 25 years. At least half of all cases start before age 25. Some people have their first symptoms during childhood, while others may develop symptoms late in life. Bipolar disorder is not easy to spot when it starts. The symptoms may seem like separate problems, not recognized as parts of a larger problem. Some people suffer for years before they are properly diagnosed and treated. Like diabetes or heart disease, bipolar disorder is a long-term illness that must be carefully managed throughout a person's life.

According to MedicineNet.com, Bipolar disorder symptoms include depression and feelings of hopelessness during the depressive phase of the condition. Other depressive symptoms include thoughts of suicide, alterations in sleep patterns, and loss of interest in activities that once were a source of pleasure. What differentiates bipolar disorder from major depression is the occurrence of manic episodes, often described as emotional "highs," between the episodes of depression. Symptoms of manic states are varied and include restlessness, increased energy, euphoric mood, racing thoughts, poor judgment, intrusive or provocative behavior, difficulty concentrating, and a decreased need for sleep. People experiencing manic episodes often speak very rapidly, seem overly irritable, and may have unrealistic beliefs about their own power and capability. Much more info about this disorder can be found at http://www.medicinenet.com/bipolar_disorder/article.htm.

One side of the scale includes severe depression, moderate depression, and mild low mood, according to the NIMH. Moderate depression may cause less extreme symptoms, and mild low mood is called dysthymia when it is chronic or long-term. In the middle of the scale is normal or balanced mood. At the other end of the scale are hypomania and severe mania. Some people with bipolar disorder experience hypomania. During hypomanic episodes, a person may have increased energy and activity levels that are not as severe as typical mania, or he or she may have episodes that last less than a week and do not require emergency care. A person having a hypomanic episode may feel very good, be highly productive, and function well. This person may not feel that anything is wrong even as family and friends recognize the mood swings as possible bipolar disorder. Without proper treatment, however, people with hypomania may develop severe mania or depression. During a mixed state, symptoms often include agitation, trouble sleeping, major changes in appetite, and suicidal thinking. People in a mixed state may feel very sad or hopeless while feeling extremely energized. Sometimes, a person with severe episodes of mania or depression has psychotic symptoms too, such as hallucinations or delusions. The psychotic symptoms tend to reflect the person's extreme mood. For example, psychotic symptoms for a person having a manic episode may include believing he or she is famous, has a lot of money, or has special powers. In the same way, a person having a depressive episode may believe he or she is ruined and penniless, or has committed a crime. As a result, people with bipolar disorder who have psychotic symptoms are sometimes wrongly diagnosed as having schizophrenia, another severe mental illness that is linked with hallucinations and delusions. People with bipolar disorder may also have behavioral problems. They may abuse alcohol or substances, have relationship problems, or perform poorly in school or at work. At first, it's not easy to recognize these problems as signs of a major mental illness.

According to the American Foundation for Suicide Prevention (AFSP), early recognition and treatment of bipolar disorder may prevent years of needless suffering and death by suicide. And, 80 percent to 90 percent of people who have bipolar disorder can be treated effectively with medication and psychotherapy. The mood stabilizers lithium carbonate, carbamazepine and valproate, are the most commonly prescribed medications to treat bipolar disorder. Lithium carbonate has shown more effectiveness in preventing suicidal behaviors associated with bipolar disorder. The death rate for untreated bipolar patients is higher than that of most types of heart disease and many types of cancer. Studies of bipolar patients indicate that 25 percent to 50 percent of persons with this illness make at least one suicide attempt. Studies also indicate that most bipolar patients who die by suicide communicate their suicidal state to others, most often through direct and specific statements of suicidal intent. People suffering from bipolar disorder may die by suicide earlier in the course of this chronic illness than patients with other mental disorders. Recent hospital discharge is a very high-risk time. Hopelessness, a family history of suicide and previous attempts indicate bipolar patients at highest risk of suicide. Maintaining treatment for bipolar illness is critical. The suicide rate in the first year off lithium treatment is 20 times that during treatment. Early and accurate diagnosis of bipolar disorder and aggressive professional treatment are essential in preventing suicide.

According to Pendulum.org, the US Food and Drug Administration (FDA) has just approved the atypical antipsychotic Geodon (ziprasidone) for maintenance treatment of bipolar I disorder as an adjunct to lithium or Depakote (valporate) in adults. In 2004, the FDA approved Geodon for treatment of acute manic or mixed episodes in Bipolar 1 Disorder. The additional approval for maintenance treatment, gives doctors and patients another long-term use drug to help stabilize moods. Geodon was initially FDA approved, in 2001, to treat schizophrenia. Unlike other atypical antipsychotics, it appears that Geodon may not to be associated with weight gain. In a six-week, head-to-head study between Zyprexa (olanzapine) and Geodon, the Zyprexa patients' median weight gain over the six weeks was ten pounds, while Geodon patients gained less than one pound. In line with this finding, Zyprexa patients saw significant increases in cholesterol and other blood fats, while Geodon patients lipid profiles remained stable. These results suggest that not only is Geodon a healthier alternative, but patients may also be less inclined to stop taking it on their own due to weight gain.

Frontline recently aired a program, according to Pendulum.org, that explores the rapid increase in diagnoses of bipolar disorder in children during the past 7-8 years; the program is an update from earlier Frontline pieces which aired in 2001 and 2008. This program offers an overview of the current environment and attitude in the US vis-à-vis diagnosing young children with bipolar disorder and prescribing psychiatric medicines (many of which are "off label" for kids and adolescents). The video asserts that the rapid increase in diagnosis of bipolar disorder for kids is primarily a US phenomenon and conveys the heart wrenching uncertainty for families who wrestle with the counter-intuitive notion of giving young children psychiatric medicines. It also provides updates on kids who were first interviewed in 2001 and 2008 to see how they are progressing and how their bipolar diagnosis affects their lives. It's worthwhile to watch this program as it aptly raises critical issues for families and young kids faced with a bipolar disorder diagnosis.

According to Time Magazine online, some experts believe that kids are being tipped into bipolar disorder by family and school stress, recreational-drug use and perhaps even a collection of genes that express themselves more aggressively in each generation. Others argue that the actual number of sick kids hasn't changed at all; instead, we've just got better at diagnosing the illness. If that's the case, it's still significant, because it means that those children have gone for years without receiving treatment for their illness, or worse, have been medicated for the wrong illness. Regardless of the cause, plenty of kids are suffering needlessly. Yet scientists are making progress against the disease. Genetic researchers are combing through gene after gene on chromosomes that appear to be related to the condition and may offer targets for drug development. Pharmacologists are perfecting combinations of new drugs that are increasingly capable of leveling the manic peaks and lifting the disabling lows. Behavioral and cognitive psychologists are developing new therapies and family-based programs that get the derailed brain back on track and keep it there.

Bipolar disorder is a recognized health care issue. With the amount of resources devoted to those who suffer from the disease, treatment and medications are available, and research continues to improve understanding of the illness. Those who suffer from it should recognize the need to seek help, and those who have been diagnosed should continue to seek health care management of their medical, mental, and social situations. Intervention by those closest to the patient may likely be necessary to help with care. Stay in tune with updates about bipolar disorder through your medical provider or primary physician. For a huge amount of online data, go to the NIMH website and view material at http://www.nimh.nih.gov/health/publications/bipolar-disorder/complete-index.shtml.

Until next time. Let me know what you think.