Health Care and Gingivitis

According to the most recent statistics offered by the American Dental Association, about half of the American population does not have a dental plan. That's a whole bunch of unhealthy teeth and gums, not to mention potentially more serious health issues. One of the most serious problems related to oral health is gingivitis, and according to New York dentist, Dr. Robert Schwartz, Gingivitis is the most common periodontal disease, affecting 90% of the population. It is an infection of the gums caused by bacteria that form plaque.

According to Dr. Schwartz, in small amounts (when it is newly formed), plaque is invisible and relatively harmless. But when left to accumulate, it increases in volume and the proportion of harmful bacteria grows. These bacteria release toxins that result in inflammation of the gum tissue. Eventually, the plaque hardens and forms hard deposits called calculus or tartar. If not properly treated, gingivitis may progress to periodontitis, a periodontal disease in which there is loss of the bone that supports the teeth.

The Mayo Clinic reports that gingivitis is both preventable and treatable. Although factors such as medications and lowered immunity make you more susceptible to gingivitis, the most common cause is poor oral hygiene. Daily brushing and flossing and regular professional cleanings can significantly reduce your risk of developing this potentially serious condition. If you already have gingivitis, professional cleaning can reverse the damage. If not treated, gingivitis can progress to more-serious gum diseases, such as periodontitis, and eventually to the destruction of bone and to tooth loss. Because early-stage gum disease is seldom painful, you can have gingivitis without even knowing it. Often, though, you're likely to have warning signs such as:
--Swollen, soft, red gums.
--Gums that bleed easily, even if they're not sore. Many people first detect a change in their gums when they notice that the bristles of their toothbrush are pink — a sign that gums are bleeding with just slight pressure.
--A change in the color of your gums from a healthy pink to dusky red.

Gingivitis, also according to the Mayo Clinic, begins with plaque. This invisible, sticky film, composed primarily of bacteria, forms on your teeth when starches and sugars in food interact with bacteria normally found in your mouth. Brushing your teeth removes plaque, but it re-forms quickly, usually within 24 hours. Plaque that stays on your teeth longer than two or three days can harden under your gumline into tartar (calculus), a white substance that makes plaque more difficult to remove and that acts as a reservoir for bacteria. What's more, you usually can't get rid of tartar by brushing and flossing — you'll need a professional cleaning to remove it. The longer plaque and tartar remain on your teeth, the more they irritate the gingiva, the part of your gum around the base of your teeth. In time, your gums become swollen and bleed easily.

More information online from the Mayo Clinic goes on to say that although plaque is by far the most common cause of gingivitis, other factors can contribute to or aggravate the condition, including:
1.) Drugs. Hundreds of prescription and over-the-counter antidepressants and cold remedies contain ingredients that decrease your body's production of saliva. Because saliva has a cleansing effect on your teeth and helps inhibit bacterial growth, this means that plaque and tartar can build up more easily. Other drugs, especially anti-seizure medications, calcium channel blockers and drugs that suppress your immune system, sometimes can lead to an overgrowth of gum tissue (gingival hyperplasia), making plaque much tougher to remove.
2.) Viral and fungal infections. Although bacteria are responsible for most cases of gingivitis, viral and fungal infections also can affect your gums. Acute herpetic gingivostomatitis is an infection caused by the herpes virus that frequently leads to gum inflammation and to small, painful sores throughout your mouth. Oral thrush, which results when a fungus normally found in your mouth grows out of control, causes creamy white lesions on your tongue and inner cheeks. Sometimes these lesions spread to the roof of your mouth, your tonsils and your gums.
3.) Other diseases and conditions. Some health problems not directly associated with your mouth can still affect your gums. People with leukemia may develop gingivitis when leukemic cells invade their gum tissue. Oral lichen planus, a chronic inflammatory disease, and the rare, autoimmune skin diseases pemphigus and pemphigoid can cause gums to become so severely inflamed that they may peel away from the underlying tissue.
4.) Hormonal changes. During pregnancy, your gums are more susceptible to the damaging effects of plaque. The problem is compounded if you have morning sickness — nausea and vomiting may make it hard to brush your teeth regularly.
5.) Poor nutrition. A poor diet, especially one deficient in calcium, vitamin C and B vitamins, can contribute to periodontal disease. Calcium is important because it helps maintain the strength of your bones, including the bones that support your teeth. Vitamin C helps maintain the integrity of connective tissue. It's also a powerful antioxidant that counters the tissue-destroying effects of free radicals — substances produced when oxygen is metabolized by your body.

Gingivitis, according to eMedicineHealth.com, can be managed simply with good oral hygiene and regular dental appointments. Good mouth and teeth care, regular dental follow-up, and treatment of underlying illnesses are necessary for preventing gingivitis. Removing the source of the infection is primarily how simple gingivitis is treated. By brushing teeth regularly with a toothbrush and fluoride toothpaste approved by dentists, plaque build-up can be kept to a minimum. Flossing is another means of removing plaque in between teeth and other areas hard to reach. Regular check-ups with a dentist are also important. A dentist is able to remove plaque that is too dense to be removed by a toothbrush or dental floss. Severe gingivitis may require antibiotics and consultation with a physician. Antibiotics are medications used to help the body's immune system fight bacterial infection and have been shown to reduce plaque. By reducing plaque, bacteria can be kept to a level manageable by the human immune system. Taking antibiotics is not without risks and should only be done after consultation with a dentist or doctor.

According to eMedicineHealth, for simple gingivitis, work with your dentist. A concerted effort between good home dental hygiene and regular dental visits should be all that is required to treat and prevent gingivitis. If gingivitis continues despite the effort to prevent it, contact your doctor to investigate the possibility of an underlying illness. Gingivitis can usually be managed at home with good dental hygiene. If gingivitis turns into the most severe periodontal infection, acute necrotizing ulcerative gingivitis (ANUG), commonly referred to as trench mouth, treatment at a hospital may be required. ANUG not only affects the gums but may spread to adjacent tissues of the face, neck, and bone. Bleeding, loss of periodontal architecture, and pain all characterize ANUG. The breath takes on a fetid odor, the teeth become loose, and the lymph nodes of the neck are often swollen. People with ANUG often have fever and complain of a generalized weakness reflecting widespread infection. Like gingivitis, ANUG usually affects people with underlying immune system situations such as malnutrition, HIV, or cancer. Therapy involves getting rid of the oral bacteria with antibacterial mouthwashes, oral antibiotics, periodontal treatment, and treatment of the underlying illness.

Gingivitis can be easily treated with everyday common sense health care maintenance. Good oral health makes sense. Avoid the problems associated with this oral disease by taking care of your mouth, teeth, and gums. See a good dentist on a regular basis. Take care of your oral health--brush, floss, rinse. Your smile makes life much nicer.

Until next time. Let me know what you think.

Health Care and Second Hand Smoke

Smoking has long been considered to be cool. It was especially glamorized in the movies in the 1930's up until the last couple of decades. Unfortunately, the adage that smoking is cool is a lie that has been propagated by the tobacco industry for decades. The website AllAboutLifeChallenges.org states that the world has been deceived into believing the lie that smoking is socially acceptable and cool. Smoking is hazardous to the health of both the smoker and the bystanders. Passive smoking increases the risk of lung cancer and heart disease; this can hardly be socially acceptable. Another myth of smoking is that a smoker is sophisticated. However, a repulsive smell, yellow fingers and teeth is not a badge of sophistication. Dying of lung and heart disease or cancer won’t promote your popularity.

Consider the short-term effects of smoking:
--Smoking makes you smell bad, gives you bad breath, and stains your teeth.
--Smoking lowers hormone levels.
--Smoking causes cavities.
--Smoking lowers hormone levels.
--Colds last longer and smokers get sick more often.
--Most people would rather date a non-smoker.
--Smoking costs a lot of money.
--Smoking begins damaging your body the moment you start.

Second Hand smoke has been proven to be extremely dangerous also as a major health hazard according to the American Lung Association (ALA). Secondhand smoke, also know as environmental tobacco smoke, is a mixture of the smoke given off by the burning end of a cigarette, pipe or cigar and the smoke exhaled from the lungs of smokers. It is involuntarily inhaled by nonsmokers, lingers in the air hours after cigarettes have been extinguished and can cause or exacerbate a wide range of adverse health effects, including cancer, respiratory infections, and asthma.

The ALA also provides info on issues related to second hand smoke:
--Second hand smoke has been classified by the Environmental Protection Agency (EPA) as a known cause of cancer in humans (Group A carcinogen).
--Second hand smoke exposure causes disease and premature death in children and adults who do not smoke. Secondhand smoke contains hundreds of chemicals known to be toxic or carcinogenic, including formaldehyde, benzene, vinyl chloride, arsenic ammonia and hydrogen cyanide.
--Second hand smoke causes approximately 3,400 lung cancer deaths and 22,700-69,600 heart disease deaths in adult nonsmokers in the United States each year.
--Nonsmokers exposed to second hand smoke at work are at increased risk for adverse health effects. Levels of secondhand smoke in restaurants and bars were found to be 2 to 5 times higher than in residences with smokers and 2 to 6 times higher than in office workplaces.
--Since 1999, 70% of the U.S. workforce worked under a smoke-free policy, ranging from 84% in Utah to 49% in Nevada. Workplace productivity was increased and absenteeism was decreased among former smokers compared with current smokers.
--States are passing laws about second hand smoke. Eighteen states - Arizona, California, Colorado, Connecticut, Delaware, Hawaii, Illinois, Maine, Maryland, Massachusetts, Minnesota, New Jersey, New Mexico, New York, Ohio, Rhode Island, Washington and Vermont - as well as the District of Columbia prohibit smoking in almost all public places and workplaces, including restaurants and bars. Montana and Utah prohibit smoking in most public places and workplaces, including restaurants; bars will go smokefree in 2009. New Hampshire prohibits smoking in some public places, including all restaurants and bars. Four states - Florida, Idaho, Louisiana and Nevada - prohibit smoking in most public places and workplaces, including restaurants, but exempt stand-alone bars. Fifteen states partially or totally prevent (preempt) local communities from passing smokefree air ordinances stronger than the statewide law. Iowa, Nebraska and Oregon have passed legislation prohibiting smoking in almost all public places and workplaces, including restaurants and bars, but the laws have not taken effect yet.
--Second hand smoke is especially harmful to young children, and causes 430 sudden infant death syndrome (SIDS) deaths in the United States annually.
--Second hand smoke exposure may cause buildup of fluid in the middle ear, resulting in 790,000 physician office visits per year.
--Secondhand smoke can also aggravate symptoms in 400,000 to 1,000,000 children with asthma.
--In the United States, 21 million, or 35% of, children live in homes where residents or visitors smoke in the home on a regular basis. Approximately 50-75% of children in the United States have detectable levels of cotinine, the breakdown product of nicotine in the blood.
--Research indicates that private research conducted by cigarette company Philip Morris in the 1980s showed that secondhand smoke was highly toxic, yet the company suppressed the finding during the next two decades.
--The current Surgeon General’s Report concluded that scientific evidence indicates that there is no risk-free level of exposure to secondhand smoke. Short exposures to secondhand smoke can cause blood platelets to become stickier, damage the lining of blood vessels, decrease coronary flow velocity reserves, and reduce heart rate variability, potentially increasing the risk of heart attack.

The ALA is particularly adamant about how second hand smoke affects children:
1.) Children who breathe secondhand smoke are more likely to suffer from pneumonia, bronchitis, and other lung diseases.
2.) Children who breathe secondhand smoke have more ear infections.
3.) Children who breathe secondhand smoke are more likely to develop asthma.
4.) Children who have asthma and who breathe secondhand smoke have more asthma attacks.
5.) There are an estimated 150,000 to 300,000 cases every year of infections, such as bronchitis and pneumonia in infants and children under 18 months of age who breathe secondhand smoke. These result in between 7,500 and 15,000 hospitalizations!

Pediatrician Dr. Vincent Ianelli reports that understanding the effects of second hand smoke on our kids may help you give up smoking. Fortunately, most mothers understand the negative effects that smoking while they are pregnant can have on their unborn baby. These effects can include having a small or underweight baby, and having a baby with abnormal lung function. Mothers who smoke are also more likely to have a premature baby and according to the American Academy of Pediatrics, 'long-term cognitive and behavioral problems including lower intelligence and attention deficit disorder with or without hyperactivity.'

Although they may stop smoking during their pregnancy, many of these mothers do start smoking again after their baby is born according to Dr. Ianelli. This postnatal exposure to smoke by their children is also bad though. Being exposed to someone that smokes, even if they just smoke outside the home, is thought to increase a child's chance of having ear infections, allergies, asthma, wheezing, pneumonia and frequent upper respiratory tract infections. Smoke can also trigger asthma attacks in many children and they are often worse than in children who aren't exposed to someone that smokes. And infants who are exposed to a caregiver that smokes, or a mother that smoked while she was pregnant, are up to 4 times more likely to die of Sudden Infant Death Syndrome (SIDS). So improve your own and your child's health by getting some help quitting smoking.

The ALA also provides great tips on protecting you and your family from the effects of second hand smoke:
--Don't smoke in your home; and, ask other people not to smoke in your home, especially baby-sitters or others who may care for your children.
--Choose children's day care centers, schools, restaurants and other places you spend time in that are smoke-free.
--Ask smokers to go outside while they smoke.
--If someone must smoke inside, limit them to rooms where windows can be opened or fans can be used to send the smoke outside.
--Help people who are trying to quit smoking.
--Let family, friends and people you work with know that you do care if they smoke around you.
--In your car, do not smoke or allow others to smoke while the windows are rolled up.
--In restaurants and bars, ask to sit in the non-smoking area.
--Make sure your child's day-care, school and after-school programs are smoke-free.
--Ask your employer to make sure you do not have to breathe other people's smoke at work.

Smoking and second hand smoke are dangerous. Neither one of them certainly isn't cool. In addition to being a bad habit, your health and family will suffer long term results that will lead to very expensive medical issues both in the short term and later in life. If you smoke, STOP. If you know someone who does, try to help them quit. Smokers don't like to have their habit stepped on, but it is in their best interest and for the benefit of our national health.

Until next time. Let me know what you think.

Health Care and GERD

Heartburn is an expression of a condition known as gastroesophageal reflux disease (GERD), a phenomenon in which acid and pepsin rise from the stomach into the esophagus, much like water bubbling into a sink from a plugged drain according to the Harvard Health Publications Special Health Report as reported by Everyday Health. The burning sensation is usually felt in the chest just behind the breastbone and often extends from the root of the neck to the lower end of the rib cage. It can last for hours and may be accompanied by the very unpleasant, stinging sensation of highly acidic fluid rushing into the back of the throat. There may also be a sour taste in the mouth.

But, according to the Harvard Health report, the heart of heartburn is the burning behind the sternum. A variety of foods; certain emotions such as anxiety, anger, or fear; and even particular positions, like reclining or bending forward, can aggravate it. While heartburn is obviously a nuisance for many, others seem to live with it quite well. However, people spend countless hours and untold sums of money looking for a way to spell relief. Heartburn can mimic a heart attack but luckily is not life-threatening. About one-third of Americans have heartburn at least once a month, with 10% experiencing it nearly every day. One survey revealed that 65% of people with heartburn may have symptoms both during the day and at night, with 75% of the nighttime heartburn patients saying that the problem keeps them from sleeping, and 40% reporting that nighttime heartburn affects their job performance the following day. This epidemic leads people to spend nearly $2 billion a year on over-the-counter antacids alone. Clearly, it's a major problem.

EverydayHealth.com states that a doctor may be helpful when the symptoms are worrisome to the patient or if they interfere with sleep or daily life. Many people can manage heartburn without seeking medical care, through dietary changes and over-the-counter medications. If you do seek your physician’s advice, providing a detailed account of your symptoms will help him or her make the diagnosis. The doctor will review your medical history and ask detailed questions about the nature of the pain and its pattern of onset. For example, he or she may ask whether symptoms are worse after you eat a heavy meal or known dietary troublemakers such as high-fat foods or dairy products. Your doctor will want to know if bending over to tie your shoelaces or lying down aggravates the symptoms and whether the pain seems linked to anxiety or stress. A physician may ask whether regurgitated stomach contents leave a bitter or acidic taste in your mouth. A sudden outpouring of salty fluid in the mouth, called water brash, can result from salivary secretions stimulated by reflux.

Though simple reflux is uncomfortable according to EverydayHealth.com, it doesn't usually pose a danger to healthy individuals. From half to three-quarters of those with reflux disease have mild symptoms that generally clear up in response to simple measures. Over time, however, serious problems can develop when persistent GERD with frequent relapses goes untreated. These complications can include severe narrowing (stricture) of the esophagus, erosion of its lining, precancerous changes in its cells, and esophageal ulcers. One complication, known as reflux esophagitis, is inflammation that occurs when acid and pepsin, released from the stomach, erode areas of the mucosa, the surface layer of cells that line the esophagus. Besides the burning sensation of heartburn, patients with esophagitis may also complain of pain behind the breastbone spreading into the back or up to the neck, jaw, or even the ears. The pain can be so intense that you may have trouble swallowing and may even think you are having a heart attack. With esophagitis, food may feel as if it sticks in your throat before going down the gullet. Hot drinks are unpleasant to swallow, and you may have some nausea. You may also regurgitate some acid fluid into your throat, resulting in a cough. The inflammation of the esophagus can even lead to bleeding. Endoscopy is necessary to confirm the diagnosis of esophagitis and locate any associated ulcers or strictures.

AstraZeneca gives helpful tips for treatment of GERD. Medical treatment is not the only option for managing GERD symptoms. Changes in diet, nutrition, and routines can be used alone, or combined with a medical treatment, to gain relief from the pain associated with GERD. The following lifestyle changes have been shown to have a positive effect on symptoms associated with GERD in some patients:
--Losing weight
--Quitting smoking
--Wearing loose-fitting clothing
--Eating smaller meals
--Raising the head of the bed when sleeping
--Waiting at least 3 hours before lying down after eating
--Avoiding certain foods and drinks, including:
Chocolate
Peppermint
Alcoholic drinks
Caffeinated beverages
Citrus drinks
Tomato-based foods
High fat and/or fried foods

Make sure that if you experience this health situation that you visit your family doctor or an internist for a complete evaluation. They will be able to diagnose the problem and give helpful treatment advice including medications and other tests to verify the significance of the medical need. Don't postpone getting this health care issue resolved for your own comfort and peace of mind, and for immediate and long term improved health.

Until next time. Let me know what you think.

Health Care and Escalator/Elevator Safety

Safety is an extremely important health care issue, especially with children. Hidden dangers or hazards often taken a backseat to more highly publicized safety hazards, such as car accidents and drownings according to pediatrician Dr. Vincent Ianelli. Although the chance of your child getting hurt in an elevator, on an escalator, or playing on a soccer goal isn't very high, that doesn't make you or your child feel better if it happens to him. Learn about these hazards to help you protect your child and keep him safe. The Consumer Product Safety Commission (CPSC) reports that there were about 11,000 injuries on escalators in 2007, mostly from falls. In addition, there have been at least 77 reports of entrapment -- when hands, feet, or shoes (mostly clogs and slide sandals) get trapped in the escalator -- since 2006 according to About.com as reported by Dr. Ianelli.

Your kids can still ride the escalator, but be sure they do it safely. They should: tie their shoelaces before getting on the escalator--stand in the center of the escalator, face forward, hold the handrail, and step off at the end. Also, refrain from sitting or playing on the escalator -- it should not be treated as an amusement park ride. Perhaps most importantly, learn where the emergency shutoff button is so that you can turn off the escalator if someone gets entrapped while riding. Dr. Ianelli has many suggestions for safety.

Elevator Dangers:
Elevators can be dangerous too. Although most injuries and deaths involve the people who work on and maintain elevators, passengers can get hurt too. According to the Consumer Product Safety Commission (CPSC) National Electronic Injury Surveillance System, on average, about six people a year die in and around elevators. This includes about one child under the age of ten years old each year. Many others are injured. One study found that about 2,000 children each year were injured in and around elevators, with the most common injuries occurring when the elevator doors closed on a body part, such as a finger, hand, or arm. Of course, the most serious injuries, including those that were life threatening, involved falls into empty elevator shafts, including when the elevator doors opened and there was no elevator car to get in to. Deaths and serious injuries involving elevators also occurred when people get struck by the elevator between floors, fall when trying to get out of a stuck elevator, or when an elevator collapses.

To keep your kids safe when riding an elevator, be sure to:
--Watch young children, especially toddlers and preschoolers, as they get on and off an elevator
teach your kids that they shouldn't try to stop an elevator door from closing with their hands or arms.
--Teach older kids and teens to stay in the elevator car if it gets stuck and wait for assistance (push the alarm button or call for help using the elevator phone), instead of trying to get out on their own, even if the elevator door is open and they can see the next floor.
--Consider having your child carry a cell phone if he regularly rides in an elevator without supervision so that he can call for help if the elevator gets stuck and the alarm button or elevator phone is not working.

The Consumer Product Safety Commission has tips on staying safe on escalators. Here are some steps you can take to help prevent escalator injuries, especially injuries to young children:
--Be aware that loose shoe laces, drawstrings, scarves, and mittens can get trapped in moving escalators. In the past year, CPSC reached an agreement with a number of children's clothing manufacturers to remove drawstrings from the necks and hoods of children's garments. If your child's clothing still has drawstrings, remove them.
--Always hold children's hands on escalators and do not permit children to sit or play on the steps.
--Do not bring children onto escalators in strollers, walkers, or carts.
--Always face forward and hold the handrail.
--Avoid the edges of steps where entrapment can occur.
--Learn where the emergency shutoff buttons are in case you need to stop the escalator.

Also, the American Society of Mechanical Engineers/American National Standards Institute Escalator Committee set a voluntary standard for escalators. The standard requires:
--That the emergency shutoff buttons be at the top and bottom of each escalator. The button should be on the right side of the escalator when facing the stairs.
--That sidewalls be made of low-friction material so soft-soled shoes cannot get caught easily.
--That "skirt obstruction devices" (which sense the presence of a foreign object and automatically shut off the escalator) be at the top and bottom of the escalator.
--That side clearance at the edges of steps be no more than 3/16 inch
--That warning signs be placed on escalators reminding parents to hold children's hands and face forward.
--That each step have painted foot prints or brightly colored borders.

SafeKidsUSA says children are at risk from hidden hazards due to their curiosity, tendency to put things in their mouths, and their size. Lack of supervision increases the risk for some of these hazards. Some result from activity that comes naturally to children. Others result from products that just don’t mix with kids. When you are with children at any time, supervision becomes ever more critical when you're around escalators, elevators, or any other situation with multiple moving parts. Don't let children get injured, especially when you have the power to prevent them from getting hurt. Pay attention in areas where accidents are more prone to happen. Simple observation and prevention will go a long way to protect children from injuries due to accidents. Make sure that you are alert to possible accidents looking for a time and place to happen. Educate your kids about safety, and it will be a lesson well learned.

Until next time. Let me know what you think.

Health Care and Medical ID Fraud

Identity theft is big business. According to the Gartner Report and other sources, it has been estimated that about 10 million victims file cases for identity theft each year--an average of 20 people every 60 seconds. The overall cost of this has been almost $60 billion dollars in the last year. And it’s not just your bank account number, credit card number, or social security number that people wish to have for their intentions to commit crime. Even your address, names of your relatives, date of birth, phone numbers, and other such personal information can be useful to those who would steal your good name. Criminals can put together a picture of you and use this information in order to perpetrate identity theft and identity crime. This fake persona can then be used against you to steal your money, your tax returns, and even your livelihood--including medical ID theft or fraud. The report on Medicare Compliance just announced that over 9 million adults in the U.S. this year alone believe they or a family member have had personal medical information lost or stolen.

According to the World Privacy Forum, medical identity theft occurs when someone uses an individual’s name or other parts of the individual’s identity – such as insurance information or Social Security Number – without the victim’s knowledge or consent to obtain medical services or goods. Medical identity theft can also occur when someone uses the person’s identity to obtain money by falsifying claims for medical services and falsifying medical records to support those claims. The essence of the crime is the use of a medical identity by a criminal and the lack of knowledge by the victim. Some identity theft cases arise in medical settings, but they are not medical identity theft. For example, if a hospital worker steals patient credit card number or other financially-related identity information and goes on a shopping spree at a mall, that is not medical identity theft. It is more traditional financial identity theft. In this situation, the crime did not affect the medical identity of the individual, even though it involved the use of personal financial information.

US News & World Report indicates that the thief isn't always an individual desperately needing medical care. In some instances, the perpetrator can be a doctor hoping to pad his or her income by filing fraudulent claims. Even worse, law enforcement authorities say that more and more frauds are being perpetrated by organized crime rings who steal dozens, and sometimes thousands, of medical records, as well as the billing codes for doctors. The rings then set up fake medical clinics—offering free health screenings as a ruse to draw in patients—that submit bogus bills to insurers, collect payments for a few months, and then disappear before the insurers realize they've been had. But some privacy advocates fear that the rush toward digital health records could ironically create new nightmares for victims of medical ID theft. Rather than residing in a single doctor's paper files, fraudulent information could circulate in other medical databases across the country. Given that some medical ID thefts are "inside jobs," wherein rogue clerks sell patient data to fraudsters on the outside, privacy advocates believe that allowing data to flow more freely around a national network could make such thefts even easier.

Even worse, it can be difficult for patients to purge any fraud from their records according to US News & World Report. While the Fair Credit Reporting Act gives victims of financial identity theft the right to see and try to correct any mistakes in their credit records, critics say that victims of medical ID theft don't have the same recourse. Health privacy laws are limited and don't reflect the possibility of medical ID theft, and incorrect information could bounce around for many years. Victims of financial identity theft have a much clearer path to recovery than those whose medical identities are stolen. If someone swipes your wallet and goes on a spending spree, you can ask any of the three major credit bureaus for a free credit report, place a fraud alert on your account, and get inaccurate charges expunged. With medical identity theft, it's not that simple. In the first place, your records are most likely scattered among many different providers, and there's no medical records clearinghouse that keeps them. Under HIPAA, the federal law that addresses medical privacy, you're entitled to a copy of these documents, though you may have to pay for it. If there's an error, you can add a correction to the record, but you can't have information deleted. And if an impostor gets healthcare services in your name, you may really be stuck. Healthcare providers may actually refuse to let you see your own record because once it's intermingled with someone else's, that person's privacy must be protected.

Unfortunately, law enforcement authorities complain that many health-care facilities do too little to protect their patient data. However, in their defense, health-care executives say they've taken steps in recent years to deter identity thieves. Some hospitals, for instance, have begun reprogramming their computer systems to restrict staffers from accessing any patient data beyond what they need to do their jobs. And some have instituted procedures to ensure patients are who they claim to be as reported by US News and World Report.

For a medical identity theft victim, according to the World Privacy Forum, medical and health insurance records are essential to figuring out the facts in your case. The thief may have used your name when seeing a doctor, obtaining prescription drugs with your health ID number, filing claims with your insurance company, or doing other things that left a trail in your medical records. The actions of the thief may be intermingled with the records of your own treatment and payment activities. For example, your health insurer may have records showing bills submitted by your dentist, drug store, and obstetrician together with other bills that resulted from the thief’s activities. In some instances, the crook is not someone who sought medical care but a health care provider who submitted a wholly fraudulent bill in your name, your spouse’s name, or your child’s name.

The World Privacy Forum also reports that if you have reason to believe that you are a victim of identity theft, you need to find the facts. Obtaining a copy of your medical records from your health care providers, hospitals, pharmacies, laboratories, and health insurers is the main way to learn what happened. You may be tipped off to medical identity theft by receiving an explanation of benefits from your insurer for services that you never sought or received. You may receive a bill for services that you did not use. You may receive a dunning notice (a notice that a bill has not yet gone to a collection agency, but will if not paid soon) or phone call from a debt collector for a health care bill in your name that was never paid. If any of these things happen to you, you need to find the facts by obtaining basic records from providers and insurers; and ask questions, preserve your rights, and follow the trail of information.

Medical ID fraud is serious business. Those who are affected by it face a huge task to clear up personal and financial issues that result from someone's unscrupulous behavior. Keep your records safe, and follow up immediately on any unusual circumstances related to your own health.

Until next time. Let me know what you think.

Health Care and Consumerism

The Charlotte Business Journal has reported this month that participation in consumer-driven health plans is becoming an increasingly popular health insurance option. A survey released by employee-benefit advisory company United Benefit Advisors indicates that the total number of consumer-driven health plans has increased this year by 43% over 2007. They now account for nearly 13% of all plans offered by employers, and the plans cover about 4.4 million people. Consumer-driven health plans typically have lower premiums but higher deductibles and out-of-pocket costs for some medical procedures than other insurance plans. They typically include a health reimbursement account or health savings account to which employers contribute. The average employer contribution to a health savings account was $642 for a single employee and $1,053 for a family plan. AISHealth reports that according to a new study by George Mason University and the Urban Institute, total private health insurance expenditures are estimated in 2008 to be $829.9 billion.

For example, Aetna provides an overview of these plans for consumers. 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.

According to Aetna, consumer-directed health plans 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.

HealthAffairs.com shares insight on consumerism in health care for a second generation of consumer-driven health policies and products. The shortcomings of HMOs, capitation, IDSs, and the other components of managed competition have opened the way for alternative approaches to using market mechanisms for improving the health care system. Consumerism appeals to the widespread and legitimate desire for a more transparent, flexible, and personal system and provides a salutary counterbalance to the organizational hypertrophy and opaque administrative mechanisms of the managed care era. However, consumer-driven health care suffers from its own shortcomings. Blunt cost-sharing provisions, unadjusted for the patient’s income or health status, will penalize the poor and the sick while allowing their wealthier and healthier compatriots to retain higher balances in their HSAs. Nonselective network designs, the dismantling of utilization management, and a reversion to fee-for-service payment will encourage spending for high-cost services that fall above the insurance deductible. The emphasis on measurement, payment, and choice at the level of the individual practitioner rather than the provider organization will disvalue the information technology, managerial, and cultural infrastructure necessary to integrate care across comorbid conditions and codependent services.
After having tried every alternative, it is to be hoped that a market-oriented health care system will do the right thing and combine the best elements of the demand-side approach embodied in consumerism with the best elements of the supply-side approach embodied in managed competition. The combined approach could be termed managed consumerism.

A market-oriented approach must always put the consumer first before the provider as the locus of rights and responsibilities as indicated with critical research by Health Affairs. But the full potential of a consumer-driven system will be realized only when insurers create meaningfully distinct networks and providers create meaningfully distinct organizations among which informed and cost-conscious consumers can choose. Different consumer-centric benefit designs and provider-centric network designs will be appropriate for different health services, depending on whether utilization is strongly consumer preference–sensitive, provider supply–sensitive, both, or neither. Health plans are experimenting with various forms and levels of cost sharing and provider payment across services according to the sensitivity of demand and supply to financial considerations. Also, different forms of organization may offer the best combination of cost, quality, and convenience for different services depending on their clinical and technological characteristics. The health care landscape is blooming with minute clinics for low-acuity primary care, medical homes for chronic care management, centers of excellence for high-acuity surgical procedures, and focused factories for ambulatory surgery and oncology. Consumer choice needs to be combined with organizational management so that the pursuit of individual self-interest through market competition vicariously supports the social interest in an efficient, fair, and effective health care system.

Consumer Directed Health Care has been slow to take hold in the market place. Only in the past couple of years have employers and individuals seen how consumerism really helps to control costs and unnecessary treatment. As transparency and better methodologies become more available, the efficiency of consumerism in health care will demand that this model be more widely accepted every year. Taking control of your health is much more effective than government run health care. The market has changed in the past 5 years to make consumerism a very competitive option for health care. Explore options that save you money and keep you healthy, and learn to manage your health instead of reacting to it.

Until next time. Let me know what you think.

Health Care and Depression

Millions of Americans suffer from depression. According to a recent report by CBSNews.com, more than one in 20 Americans aged 12 and older are depressed, according to the latest statistics from the CDC. Of them, 80% report some level of functional impairment because of their illness, with 27% reporting that it is extremely difficult to work, get things done at home, or get along with others because of the symptoms of their depression. Rates of depression were higher in women and baby boomers aged 40-59 and non-Hispanic black people than other demographic groups, the study shows. And rates of depression were higher among poor people when compared to people with higher incomes. A treatment gap also exists. Only 29% of depressed individuals said that they contacted a mental health professional in the past year, and just 39% of people with severe depression contacted a mental health professional in the past year. The stigma that is still attached to depression may be partially to blame.

Depression.com has plenty to say about this disease. Some people say that depression feels like a black curtain of despair coming down over their lives. Many people feel like they have no energy and can't concentrate. Others feel irritable all the time for no apparent reason. The symptoms vary from person to person, but if you feel "down" for more than two weeks, and these feelings are interfering with your daily life, you may be clinically depressed. Most people who have gone through one episode of depression will, sooner or later, have another one. You may begin to feel some of the symptoms of depression several weeks before you develop a full-blown episode of depression. Learning to recognize these early triggers or symptoms and working with your doctor will help to keep the depression from worsening. Most people with depression never seek help, even though the majority will respond to treatment. Treating depression is especially important because it affects you, your family, and your work. Some people with depression try to harm themselves in the mistaken belief that how they are feeling will never change. The consensus is that Depression is a treatable illness.

Major depressive disorder, commonly referred to as "depression," can severely disrupt your life, affecting your appetite, sleep, work, and relationships according to Depression.com. The symptoms that help a doctor identify depression include:
--constant feelings of sadness, irritability, or tension.
--decreased interest or pleasure in usual activities or hobbies.
--loss of energy, feeling tired despite lack of activity.
--a change in appetite, with significant weight loss or weight gain.
--a change in sleeping patterns, such as difficulty sleeping, early morning awakening, or sleeping too much.
--restlessness or feeling slowed down.
--decreased ability to make decisions or concentrate.
--feelings of worthlessness, hopelessness, or guilt.
--thoughts of suicide or death.

If you are experiencing any or several of these symptoms, you should talk to your doctor about whether you are suffering from depression. Additionally, there are other types of depression that require specific treatment for the disorder:
1.) Dysthymia is another mood disorder. People who have it may feel mildly depressed on most days over a period of at least two years. They have many symptoms resembling major depression, but with less severity.

Information also provided by Depression.com indicates that symptoms of depression may surface with other mood disorders. They include seasonal major depression (also known as seasonal affective disorder), postpartum depression, and bipolar disorder:
2.) Seasonal Affective Disorder has symptoms that are seen with any major depressive episode. It is the recurrence of the symptoms during certain seasons that is the hallmark of this type of depression.
3.) Postpartum Depression is a type of depression that can occur in women who have recently given birth. It typically occurs in the first few months after delivery, but can happen within the first year after giving birth. The symptoms are those seen with any major depressive episode. Often, postpartum depression interferes with the mother's ability to bond with her newborn. It is very important to seek help if you are experiencing postpartum depression. Postpartum depression is different from the "Baby Blues", which tend to occur the first few days after delivery and resolve spontaneously.
4.) Bipolar disorder, another mood disorder, is different than major depressive disorder and has different treatments.

There are many causes for depression. Depression has no single cause; often, it results from a combination of things as reported by Depression.com, and you may have no idea why depression has struck you. Whatever its cause, depression is not just a state of mind. It is related to physical changes in the brain, and connected to an imbalance of a type of chemical that carries signals in your brain and nerves. These chemicals are called neurotransmitters. Some of the more common factors involved in depression are:
--Family history. Genetics play an important part in depression. It can run in families for generations.
--Trauma and stress. Things like financial problems, the breakup of a relationship, or the death of a loved one can bring on depression. You can become depressed after changes in your life, like starting a new job, graduating from school, or getting married.
--Pessimistic personality. People who have low self-esteem and a negative outlook are at higher risk of becoming depressed. These traits may actually be caused by low-level depression (called dysthymia).
--Physical conditions. Serious medical conditions like heart disease, cancer, and HIV can contribute to depression, partly because of the physical weakness and stress they bring on. Depression can make medical conditions worse, since it weakens the immune system and can make pain harder to bear. In some cases, depression can be caused by medications used to treat medical conditions.

The National Institute for Mental Health (NIMH) reports that Depression, even the most severe cases, is a highly treatable disorder. As with many illnesses, the earlier that treatment can begin, the more effective it is and the greater the likelihood that recurrence can be prevented. The first step to getting appropriate treatment is to visit a doctor. Certain medications, and some medical conditions such as viruses or a thyroid disorder, can cause the same symptoms as depression. A doctor can rule out these possibilities by conducting a physical examination, interview and lab tests. If the doctor can eliminate a medical condition as a cause, he or she should conduct a psychological evaluation or refer the patient to a mental health professional. The doctor or mental health professional will conduct a complete diagnostic evaluation. He or she should discuss any family history of depression, and get a complete history of symptoms, e.g., when they started, how long they have lasted, their severity, and whether they have occurred before and if so, how they were treated. He or she should also ask if the patient is using alcohol or drugs, and whether the patient is thinking about death or suicide. Once diagnosed, a person with depression can be treated with a number of methods. The most common treatments are medication and psychotherapy.

The NIMH offers suggestions to help a friend or relative:
--Offer emotional support, understanding, patience and encouragement.
--Engage your friend or relative in conversation, and listen carefully.
--Never disparage feelings your friend or relative expresses, but point out realities and offer hope.
--Never ignore comments about suicide, and report them to your friend's or relative's therapist or doctor.
--Invite your friend or relative out for walks, outings and other activities. Keep trying if he or she declines, but don't push him or her to take on too much too soon. Although diversions and company are needed, too many demands may increase feelings of failure.
--Remind your friend or relative that with time and treatment, the depression will lift.

There are many resources to help with depression. Consult your doctor about how to get treatment. Also, there are many sources including both public and private where you can get assistance or refer someone who is suffering from depression. Remember, the sooner treatment is available, the more readily you or a loved one can begin to recover.

Until next time. Let me know what you think.